« 上一頁繼續 »
PSYCHIATRIC ANNALS/2:9 SEPTEMBER 1972
It has certain noxious stimulio that can be identifiable as etiological factors. • It has a primary symptom of misanthropy, which is a psychological tetrad of human antipathy, resistance to unforeseen change, pessimistic preoccupation with present technological difficulties and an inability to trust life 8.25 Such misanthropy enables the mental detachment necessary to dehumanize people by enumerating them as if they were nonpersons in much the same manner as the military analysts estimate nuclear war casualties.
• It is mediated by the central nervous system's ability to respond by external
social rejection as well as by internal biological anxiety. Population problems • Its pathogenesis involves environment and object relationships with people.
are as old as Population hysteria makes people forget that the world has had population recorded history problems as far back as history records; that population has always outrun the
technological means to provide for it; and that the eventual solutions of major problems have almost always been unforeseeable for any given generation. But as a psychosocial disease, it is new and appears to have afflicted many persons: scientists, physicians and parents. Its main symptom, misanthropy, is a cause of pregnancies being unwanted and probably has something to do with the willingness of physicians to perform abortions.
The second exfernal circumstances is less characteristically contemporary but more accessible to direct intervention. This is the father's rejection of his unborn child. Certainly no remedy will be found for the father who causes both the pregnancy and the unwantedness unless efforts are made to promote paternal behavior as a way of life for men in society.
Evidence is growing that failures in fathering play a critical role in psychosocial problems. For example, Bigner notes that the father's absence (relative or absolute) produces behavior problems and has deleterious effects on intellectual and personality development. Even when the father is present, paterr.al behav has qualitative importance. O'Neal et al. 19 demonstrate how a picture of a generalized antisocial behavior in the father was related to sociopathic personality in the child.
In general, data on fathering is somewhat more firm than data on unwanRetraining fathers tedness, and helping fathers by paternal training seems a constructive course.
appears crucial in Finding men for whom paternal training is warranted (for the benefit of themunwanted pregnancy
selves, their partners and their children) would appear relatively simple: find the unwanted pregnancies. Efforts to retrain a father appear at least on the surface to be crucial in solving the fundamental problems that underlie an unwanted pregnancy.
When both society and the father reject a pregnancy, it is little wonder that the potential mother finds it hard not to join in the general negativism, especially when her physician knows of no alternative to abortion.
ALTERNATIVES TO ABORTION
The physician rarely considers the alternatives to abortion when he acquiesces in the gross manipulation of himself that usually underlies such statements as, "If I don't have an abortion, I will kill myself." This sort of situation, in fact, is probably detrimental to the physician, besides being antitherapeutic for the patient, since to be consciously a party to a patient's manipulation represei the worst sort of doctor-patient interaction. What if someone asked for penicillin, a new car or a mammoplasty in the same way, and the physician went along PSYCHIATRIC ANNALS/2:9 SEPTEMBER 1972
with it? It is not surprising when this pauent later denies problems to the physician and perhaps refuses to return. In such cases, the manipulable physician has simply lost his patient's confidence.
MANIPULATIVE EXCLAMATIONS AND UNDERLYING PROBLEMS
To find alternatives to abortion, physicians must look past manipulative exclamations and depressive histrionics; more importantly, they must look beyond Misanthropy num! unwantedness to its causes. The fact that a pregnancy is unwanted is a symptom the physicians' of underlying problems that deserve attention. The average physician, however,
senses is ill equipped, both in training and time, to delve into the underlying causes of unwantedness. Misanthropy numbs the senses, making it difficult to say "no" to an abortion request or to communicate positive feelings about pregnancy and help the expectant woman understand why she does not want her child. Finally, the provision of suggestions for remedy and the enlistment of support from society21 become time-consuming chores for the busy physician.
Nevertheless, these broad therapeutic measures are feasible. Gordon and Gordon14 describe how emotional upset after pregnancy may be associated with and proportional to social stress. Helpful in such cases were brief psycho therapy, social assistance and advice with the enlistment of support from others, especially the child's father and an older woman experienced with infants.
Another example of nonsurgical therapy is Babikian and Goldman's3 description of efforts to develop ego and superego that can be offered to pregnant teen-agers by prenatal and postnatal instruction, child care discussions and vocational counseling. Such efforts certainly need be confined to teen-agers
v even limited to mothers-to-be for the involvement of the father may have al-reaching beneficial effects in terms of marital and paternal attitudes.
PREGNANCY AS STRESS
In addition, when the salutary effects of the newborn on the mother 16 are considered, then such group therapy efforts and social assistance would appear to offer more permanent therapeutic efficacy than would a quick abortion with the woman sent back whence she came with little more than contraceptive advice.
Finally, it is helpful to recognize that pregnancy is normally a stressful situation anyway. Bibring and her colleaguess feel that pregnancy is a normative crisis similar to puberty. They describe the normal transitory crisis features of pregnancy which were resolved by the salutary effects of presenting a "positive attitude ... towards the patient's pregnancy." Pregnancy, they think, can be a maturing and growth experience whether the woman is married or unmarried, whether the child is wanted or unwanted and whether society is approving or disapproving. Most important is their finding that women will often respond to the positive attitudes of others towards a pregnancy with positive attitudes of their own.
Emotions, which science as a method is capable of bypassing, have over
elmed scientists everywhere in their attitudes towards abortion. It is highly questionable that a medical procedure should be accepted without being subjected to the rigors of the scientific method. After looking at the scientific data or abortion, on the lack of therapeutic value and legitimate indications,
PSYCHIATRIC ANNALS/2:9 SEPTEMBER 1972
on unwantedness in pregnancy, on the real underlying problems such as population hysteria and nonpaternal attitudes of fathers and on pregnancy being a normal developmental crisis, it should be obvious that the alternative to abortion is the practice of scientifically sound medicine applied to the whole patient. In order to practice medicine ethically (which means on a scientific basis), the physician will have to learn to say no to an abortion request and to offer psychosocial help to both the mother and father to be.
in the prediction and treatment of emotional disorders of pregnancy. Amer J Obstet Gynecol. 77 (1959). . 1074.
1. American Medical Association Opinion and Reports of the Judi Council Including the Principles of Medical Ethics and Rules of the Judicial Council (E G Shelley. Chairman of the Judicial Council). Chicago: The American Medical Association, 1969. 9.10.13
15. Helper, MM, Cohen, R. L; Beiterman, E. T.; Eaton, L. F Lite-events and acceptance of pregnancy. J. Psychosom. Res. 12 (1968). 183
2 Ausubel. D. P.: Balthazar, E E.; Rosenthal, ki Blackman, L. S. Schpoont, S. H; Welkowitz. J. Per. ceived parent attitudes as determinants of children's ego structure. Child Development 25 (1954). 173.
16. Klaus, M. H.; Jerauld, R.; Kreger, N.C.; McAlpine, W: Stetta, M.; Kenneil, J. H. Maternal attachment: importance of the first post-partum days. N. Eng. J. Med. 286 (1972). 460
3. Babikian, H. M. and Goldman, A. A study in teenage pregnancy Amer J. Psychiat 128 (1971), 755 760
17. MacCarthy, D. and Booth, E. M. Parental rejection and stunting of growth. J. Psychosom. Res. 14 (1970). 259.
4 Bartemeier, L. H. Discussion of therapeutic abortion and psychiatry by Z A. Aarons. Amer. J. Psychiat. 124 (1967). 753
18. Meyerowitz, S.; Satloft, A.; Romano, J. Induced abortion for psychiatric indication. Amer, J. Psychiat. 127 (1971). 1153
5 Bibring, G. L; Dwyer, T. F.; Huntington, D. S. Valenstein, A F. A study of the psychological pro cesses in pregnancy and of the earliest mother child relationship. I. Some propositions and comments. Psychoanal. Stud Child 16 (1961), 9.
19. O'Neal, P.; Robins. L. N.; King. L. Ji Schaeter, J. Parental deviance and genesis of sociopathic personality. Amer. J. Psychiat 118 (1962), 1114
6 Bigner, J. J. Fathering research and practice implications. Family Coordinator 19 (1970), 357.
20. Osotsky, J. D. and Osotsky, H. J. The psychol-
7. David, H. P. Family Planning and Abortion in the
21. Peck, A. Therapeutic abortion: patients, doctors,
8 Ehrlich, P. R. and Holdren, J. P. The negative animal. Saturday Review (June 5, 1971), 58-59.
22. Pohlman, E. Unwanted conception: research on undesirable consequences. Eugenics Quarterly 14 (1967), 143
9. Ehrlich R The Population Bomb. Chicago: Ballantine Press, 1968
23. Simon, NM and Senturia, A. G. Psychiatric sequelae of abortion. Arch. Gen. Psychial. 15 (1986). 378
10. Ferreira, A. J. The pregnant woman's emotional attitude and its reflection in the newbom. Amer. J. Orthopsychiat. 30 (1960), 563
24. Sloane, R. B. The unwanted pregnancy. N Eng. J. Med. 280 (1969). 1206.
11. Fleck, S. Some psychiatric aspects of abortion. J Nerv, Ment. Dis. 151 (1970). 42.
25. Spiger, M. J. Anti-population sabbatical. N. Eng J. Med. 284 (1971), 284
12. Ford, C. V.; Castelnuovo-Tedesco, P.; Long. K. D. Abortion: Is it a therapeutic procedure in psychiatry? JAMA 218 (1971), 1173-1178
26. Stallworthy, J. A., Moolgaoker, A. S.; Walsh, J. J. Legal abortion: a critical assessment of its risks. Lancet II (1971), 1245-1249
13. Forssman, H. and Thuwe, I. One hundred and twenty children born after application for therapeutic abortion refused: their mental, social adjustment, and educational level up to the age of 21. Acta Psychiat Scand. 42 (1966), 71
27. Wallace, H. M. and Gold, E, M. Relationship of family planning to pediatrics and child health. Clin Pediat. 9 (1970). 699.
28. Zemlick, MJ and Watson, R. I. Maternal attitudes of acceptance and rejection during and after pregnancy. Amer. J. Orthopsychiat. 23 (1953). 570
14. Gordon, RE and Gordon, K. K. Social factors
THE DECLARATION OF RIGHTS AND RESPONSIBILITIES DEFINING THE PERSONNESS OF CHILDREN I
14 to 18.
5 to 14.
To free assembly.
Of peaceful nondestructiveness in assembly.
quisition and preservation of belongings.
of privacy in what offends or upsets others. To due process (i.e., humane, gentle treatment if of rendering due proess to all others.
accused of doing something wrong plus the
opportunity to tell one's own side of the issue).
Of learning without animosity.
Of listening considerately.
Of using the scientific method in a pro-life direction.
Of keeping peace and order.
Of not killing.
Birth to 5.
1 By Samuel A. Nigro, M.D., Copyright © The Mankind First Co., 1974, from the book entitled "The Death of America.'
Senator Bayh. Thank you, Doctor. .
Our final witness this afternoon is Dr. James W. Prescott, health scientist, Administrator, and developmental neuropsychologist, National Institute of Child Health and Human Development, at the National Institute of Health.
STATEMENT OF JAMES W. PRESCOTT, PH. D., HEALTH SCIENTIST
ADMINISTRATOR AND DEVELOPMENTAL NEUROPSYCHOLOGIST, NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT, NATIONAL INSTITUTES OF HEALTH
Dr. PRESCOTT. Thank you, Mr. Chairman. Let me state my appreciation for your giving me this opportunity to testify before your subcommittee and to share with you some of the data that I have that I believe is related to the issue of abortion.
As a matter of introduction, my name is Dr. James W. Prescott, a developmental neuropsychologist and health scientist administrator with the National Institute of Child Health and Human Development. I am a past president of the Maryland Psychological Association and served as a member of the Maryland House of Delegates Judiciary Committee's Subcommittee on Abortion Reform, 1967–68. I am currently a member of the Day Care Licensing Advisory and Study Committee, Department of Health and Mental Hygiene, State of Maryland. Additionally, I am a member of the American Ethical Union and the American Humanist Association where I am currently a member of the board of directors. I am testifying as an independent professional and as a private citizen. This statement does not necessarily reflect the viewpoints
of the National Institutes of Health or the Department of Health, Education, and Welfare.
I have prepared a longer, more detailed report, “Abortion or the Unwanted Child: Issues in Child Abuse and Neglect,” of which this statement is a summary. With the chairman's permission, I would like to have this made a part of the record. And a shorter article “Before Ethics and Morality," which deals with the same issues from a somewhat different perspective.
Senator BAYH. We would be glad to include that in the record. [The report and article referred to follow:]
ABORTION OR THE UNWANTED CHILD: ISSUES IN CHILD ABUSE AND NEGLECT
(By James W. Prescott, Ph.D., National Institute of Child Health and Human
Development My name is Dr. James W. Prescott, a developmental neuropsychologist and health scientist administrator with the National Institute of Child Health and Human Development. I am a past president of the Maryland Psychological Association and served as a member of the Maryland House of Delegates Judiciary Committee's Subcommittee on Abortion Reform (1967–68). I am currently a member of the Day Care Licensing Advisory and Study Committee, Department of Health and Mental Hygiene, State of Maryland. Additionally, I am a member of the American Ethical Union and the American Humanist Association where I am currently a member of the Board of Directors. I am submitting this material as an independent professional and as a private citizen. This statement does not necessarily reflect the viewpoints of the National Institutes of Health or the Department of Health, Education and Welfare.
It is recognized that the issue of abortion is characterized by constitutional, religious, philosophical, medical, psychological and social controversy. It is the intent of this testimony to address itelf to the social and psychological implication of abortion for the individual and society. From a social-psychological perspective abortion can be viewed as an issue of the unwanted child. Women who seek to terminate a pregnancy and are denied an opportunity to do so by society are forced to give birth to a child they do not want. Consequently, it is important to know what the consequences of being "unwanted” are for the development of the unwanted child" and for society in general. This becomes particularly crucial when a society considers establishing laws to prohibit abortion and to provide criminal sanctions for its violation.
The integrity and excellence of development of each individual and the achievement of a stable, compassionate and humane social order should be the objectives of any society. It is within these objectives of society that abortion will be examined and questions raised and answered as to whether abortions serves or does not serve these objectives of society.
My testimony will review studies that examine:
(a) the consequences of being an unwanted child as reflected by abortion requests being denied and by acts of filiacide and neonatacide;
(b) the relationship of high infant mortality and child mortality rates to the abortion issue and their relationship to a variety of measures reflecting social unrest and disorder;
(c) cross-cultural studies of societies which permit and do not permit abortion and how these social customs relate to other, social behaviors of these societies;
(a) an assessment of the abortion and anti-abortion personality and its implications for social legislation in this country;
(e) an evaluaton of the expected consequences of repressive abortion legislation for the future of this country.
A. CONSEQUENCES OF ABORTION DENIED
1. The Scandinavian Study
One of the most important studies in evaluating the consequences of being an unwanted child upon the development of the child was conducted by Forssman and Thuwe (1966) from the Department of Psychiatry, Goteborg University, Sweden. Therapeutic abortion was first officially legalized in Sweden in 1939 and liberalized in 1946 to include mental health criteria. These Swedish investigators examined the development of children from birth to age 21 who were born to mothers during the years 1939–1941 who had applied for abortion but were denied. The sample included 120 children who were compared to a control group of children whose mothers had not applied for abortion. There were 66 boys and 54 girls in the abortion-denied group, 32 (27 percent) of the unwanted children were born out of wedlock whereas only 9 (8 percent) of the control children were born out of wedlock.
57-676 0.76 - 27