Media Flashback: “Post-Abortion Syndrome” Myths In Current State Litigation Were Debunked Years Ago

Media outlets are starting to report on the reintroduction of “post-abortion syndrome” (PAS) and similar junk science that claims a causal link between abortion and mental illness, which is being used in a coordinated attempt to defend restrictive state abortion laws in court. Witnesses claiming abortion leads to mental trauma are being organized by the discredited psychotherapist Vincent Rue, whose theories about PAS were debunked by reporters and experts years ago.

Meet Vincent Rue, The Discredited Psychotherapist Whose Bad Science Is Being Used To Defend New Abortion Restrictions In Wisconsin And Alabama

RH Reality Check: Vincent Rue “Has A Well-Deserved Reputation For Biased Testimony.” As explained by Jessica Mason Pieklo, senior legal analyst at RH Reality Check, the Seventh Circuit Court of Appeals has already expressed its suspicions regarding the “expert” witnesses Rue coached in Wisconsin, where a trial court is currently deciding the constitutionality of hospital admitting privileges imposed on abortion providers. The appeals court ultimately recommended that the lower court appoint an independent expert witness to testify alongside Rue's, because the appellate court was unconvinced that these two anti-choice physicians were qualified to testify on this “Targeted Regulation of Abortion Providers” -- or TRAP -- law: 

In December of 2013, when the U.S. Court of Appeals for the Seventh Circuit upheld a temporary injunction blocking a requirement that doctors performing abortions in [Wisconsin] have admitting privileges at nearby hospitals, the court did an usual thing: It urged the trial court to appoint its own expert to give testimony on the need and impact of the proposed regulations.


Normally in litigation, the parties hire expert witnesses to help explain their case to the court, and the federal rules of evidence spell out exactly how the court is to consider that testimony, and piles of case law further clarify when an expert is to be considered qualified and when they are not. Generally speaking, if some kind of scientific, technical, or other specialized knowledge will assist the court in understanding the evidence, and if a witness is qualified based on their knowledge, skill, experience, training, or education, then that witness can offer testimony -- so long as that testimony is based on enough facts or data, the result of the expert using reliable principles and methods, and the expert has applied those principles and methods reliably in the case at hand.

In the lawsuits challenging the constitutionality of admitting privileges requirements in Alabama and Wisconsin, this means experts testified on the purported health and safety rationale and the impact the requirements would have on the delivery of reproductive health care to patients in the state. But the case for admitting privileges depends on biased junk science to confuse otherwise settled issues of medical opinion, and that is exactly what state attorneys general offered in these trials.

As reported by The Isthmus, both of the expert witnesses relied on by attorneys for the State of Wisconsin were brought into the case by discredited psychotherapist Vincent Rue. Rue is best known for coining the phrase “post-abortion syndrome,” which purports to link abortion to various mental health issues like depression. Rue first invented the condition in the early 1980s, but the condition is not recognized by either the American Psychological Association or the American Psychiatric Association.

Rue is no stranger to serving as an expert in abortion restriction litigation and has a well-deserved reputation for biased testimony. Rue's testimony in what would become the landmark Planned Parenthood v. Casey case was rejected because his “admitted personal opposition to abortion, even in cases of rape and incest, suggests a possible personal bias.” [RH Reality Check, 6/11/14]

For more on Vincent Rue's sketchy science and his involvement in the anti-choice movement, see here and here.

The Claim That Abortion Causes Mental Illness Is Influential On GOP-Controlled State Legislatures But Has Long Been Exposed As Illegitimate

Slate's Emily Bazelon: “Pro-life” Activists Hoped To Reframe The Anti-Choice Position To One That Argued Abortion Should Be Illegal “For Women's Sake.” There is no scientific evidence causally linking abortions with subsequent mental trauma. But as legal expert Emily Bazelon pointed out in 2007, this debunked and often anecdotal “research” is part of a concerted right-wing effort to convince those who are undecided on abortion policies to shift to an anti-choice stance, a strategic move away from a focus on the fetus to a focus on the “health” of the mother instead:

[In 1973,] the Supreme Court decided Roe v. Wade, and since then the American abortion wars have pitted the rights of “unborn babies” against those of living women. ... [But] a growing number of abortion-recovery activists want to dismantle that framework and replace it with this: Abortion doesn't help women. It hurts them. With that conviction, these activists hope to accomplish what the anti-abortion movement has failed to do for more than three decades: persuade the “mushy middle” of the American electorate -- the perhaps 40 to 50 percent who are uncomfortable with abortion but unwilling to ban it -- to see that, for women's sake, abortion should not be legal. Spread across the country are anti-abortion groups that offer post-abortion counseling. The Catholic Church runs abortion-recovery ministries in at least 165 dioceses in the United States.


For anti-abortion activists, this strategy offers distinct advantages. It challenges the connection between access to abortion and women's rights -- if women are suffering because of their abortions, then how could making the procedure readily available leave women better off? It replaces mute pictures of dead fetuses with the voices of women who narrate their stories in raw detail and who claim they can move legislators to tears. And it trades condemnation for pity and forgiveness. “Pro-lifers who say, 'I don't understand how anyone could have an abortion,' are blind to how hurtful this statement can be,” Reardon writes on his Web site. “A more humble pro-life attitude would be to say, 'Who am I to throw stones at others?' ”

This way of thinking was first articulated in the early 1980s. Vincent Rue, a family therapist and ally of [one of the originators of the theory, David Reardon], testified before Congress in 1981 about a variant of post-traumatic stress disorder that he claimed was afflicting women -- “post-abortion syndrome.” Six years later, Ronald Reagan asked his surgeon general, C. Everett Koop, to issue a report on the health effects of abortion. Koop was against abortion, but he refused to issue the report and called the psychological harm caused by abortion “minuscule from a public-health perspective.”


Soon after Koop's refusal in 1987 to report on the health effects of abortion, the American Psychological Association appointed a panel to review the relevant medical literature. It dismissed research like Reardon's, instead concluding that “well-designed studies” showed 76 percent of women reporting feelings of relief after abortion and 17 percent reporting guilt. “The weight of the evidence,” the panel wrote in a 1990 article in Science, indicates that a first-trimester abortion of an unwanted pregnancy “does not pose a psychological hazard for most women.” Two years later, Nada Stotland, a psychiatry professor at Rush Medical College in Chicago and now vice-president of the American Psychiatric Association, was even more emphatic. “There is no evidence of an abortion-trauma syndrome,” she concluded in an article for The Journal of the American Medical Association.

Academic experts continue to stress that the psychological risks posed by abortion are no greater than the risks of carrying an unwanted pregnancy to term. [New York Times, 1/21/07]

Mother Jones: Language Of South Dakota's 2005 Abortion Law Was “Lifted Directly” From Another Discredited Anti-Choice Activist Pushing A False Connection Between Mental Health And Abortion. Rue isn't the only discredited figure in the national effort to criminalize abortions through Republican legislatures who has tried to causally link abortion with guilt, regret, and depression. As detailed by Mother Jones in 2011, Harold Cassidy, an anti-choice lawyer, was instrumental in helping pass one of the most prohibitive abortion laws in the country, which was “not backed by mainstream scientific findings”:

For almost two decades, Harold Cassidy has quietly advanced the pro-life cause by giving legal shape to the stories of women who terminated their pregnancies and came to regret it. He has sued abortion providers for, among other things, not warning these women that they would experience the profound grief he's convinced afflicts many who have ended a pregnancy. And while these ideas have become part of the vanguard of pro-life thinking -- protect the woman, not just the unborn -- few have heard of the man who helped bring them to prominence.


In 2005, with Cassidy's guidance, South Dakota passed one of the nation's most restrictive counseling laws. Its language -- lifted directly from Cassidy's legal writings -- compels providers to tell women they are taking the life of a “whole, separate, unique, living human being.” The law, which Planned Parenthood is challenging in federal court, has inspired imitators in Missouri and North Dakota, with looser interpretations introduced in Indiana and Kansas.

These bills are not backed by mainstream scientific findings. In a 2008 review, the American Psychological Association found “no evidence sufficient to support the claim that an observed association between abortion history and mental health was caused by the abortion.” More recently, a team at Johns Hopkins University reviewed the relevant literature and concluded that the highest quality studies suggest “few, if any, differences between women who had abortions and their respective comparison groups,” while “studies with the most flawed methodology” found negative effects.


The ultimate goal of all anti-abortion efforts is a sympathetic hearing from the Supreme Court, and in 2007 that body gave Cassidy's arguments an unexpected and unprecedented boost. In the majority opinon in Gonzales v. Carhart, which addressed Congress' so-called partial-birth abortion ban, Justice Anthony Kennedy wrote that banning the late-term procedure could be justified by the state's “profound respect for the life within the woman.” Kennedy acknowledged that there is “no reliable data” on whether abortion affects women's mental health, but he nonetheless found it “unexceptionable” to conclude that some women who have abortions will suffer “severe depression” and other ills--and that they would suffer further if they underwent a “partial-birth” abortion and only later learned about the procedure's gruesome details. In support of his position, Kennedy cited not a scientific study but rather a brief submitted by Cassidy's allies on behalf of Sandra Cano and 180 other women. (Among other things, their brief argued that the partial-birth ban needn't contain an exception for the woman's health.)

In a blistering dissent, Justice Ruth Bader Ginsburg chastised the court for invoking “an antiabortion shibboleth for which it concededly has no reliable evidence...This way of thinking reflects ancient notions about women's place in the family and under the Constitution--ideas that have long since been discredited.” [Mother Jones, 2/2011]

The Influence This Pseudoscience Can Have On The Entire Country Was Exemplified In The Supreme Court's Decision In Gonzales v. Carhart

The New York Times' Linda Greenhouse: The Court's Decision In Carhart Is Based On A “Contested Premise” That Abortion Is “Bad For Women.” Although other courts have rejected Rue's questionable hypotheses, the Supreme Court appeared to embrace the idea of “post-abortion syndrome” in a 2007 case, Gonzales v. Carhart, which upheld the federal Partial-Birth Abortion Ban Act. As reported by former Supreme Court correspondent and current Yale law professor Linda Greenhouse, the Court endorsed a retrograde view of women and abortion rights that had little, if any, support in settled science:

That abortion is bad for fetuses is a statement of the obvious. That it is bad for women, too, is a contested premise that nonetheless got five votes at the Supreme Court on Wednesday.

It was a development that stunned abortion rights advocates and that represents a major departure from how the court has framed the abortion issue for the past 34 years. The question on the day after the justices voted 5 to 4 to uphold the federal Partial-Birth Abortion Ban Act is where the court goes from here.

Regulating abortion for the sake of a woman's health has been part of the court's consideration since Roe v. Wade in 1973; Justice Harry A. Blackmun wrote for the court then that “the state does have an important and legitimate interest in preserving and protecting the health of the pregnant woman.”


But never until Wednesday had the court held that an abortion procedure could be prohibited because the procedure itself, not the pregnancy, threatened a woman's health -- mental health, in this case, and moral health as well. In his majority opinion, Justice Anthony M. Kennedy suggested that a pregnant woman who chooses abortion falls away from true womanhood.

“Respect for human life finds an ultimate expression in the bond of love the mother has for her child,” he said.

Justice Kennedy conceded that “we find no reliable data” on whether abortion in general, or the procedure prohibited by the Partial-Birth Abortion Ban Act, causes women emotional harm. But he said it was nonetheless “self-evident” and “unexceptional to conclude” that “some women” who choose to terminate their pregnancies suffer “regret,” “severe depression,” “loss of esteem” and other ills.

Consequently, he said, the government has a legitimate interest in banning a particularly problematic abortion procedure to prevent women from casually or ill-advisedly making “so grave a choice.”

If “a necessary effect of the regulation and the knowledge it conveys will be to encourage some women to carry the infant to full term,” Justice Kennedy continued, that outcome will advance “the state's interest in respect for life.”


On his blog, Balkinization, Prof. Jack M. Balkin of Yale Law School defined the message behind what he called the “new paternalism”: “Either a woman is crazy when she undergoes an abortion, or she will become crazy later on.”

Despite the activity in the states, the anti-abortion movement's new focus remained largely under the radar until it emerged full-blown in Justice Kennedy's opinion. As evidence that “some women come to regret their choice to abort the infant life they once created and sustained,” Justice Kennedy cited a brief filed in the case by the Justice Foundation, an anti-abortion group that runs a Web site and telephone help line for women “hurting from abortion.” The brief contained affidavits from 180 such women, describing feelings of shame, guilt and depression. [New York Times, 4/20/07]

Yale Law Professor Reva Siegel: Theories Like Rue's Reify The Sexist, Paternalistic, And Archaic Belief That “Women Are By Nature Mothers.” In 2008, Professor Siegel also questioned the Court's decision in Carhart, in addition to the new concern for women's health expressed by the anti-choice movement,  arguing that the purported link between mental illness and abortion advanced a “woman-protective rationale for restricting abortion” with no real empirical support. Siegel rejected the claim that depression and guilt are “synonymous” with abortions and also warned that view is deeply rooted in likely unconstitutional gender stereotyping about women's family roles:

The concept of “post-abortion syndrome” on which so much of the South Dakota Task Force Report is based was first proposed in the early 1980s by Vincent Rue, who has since become an international authority in the antiabortion movement whose work is cited nine times in the Report. In 1981, Rue -- then a professor of family relations who directed the Sir Thomas More Clinics of Southern California -- testified before the Senate about abortion's social effects. His testimony, which described abortion as “antifamily,” elaborated that charge in a bill of particulars culminating in the claims that “abortion emasculates males,” “abortion reescalates the battle between the sexes,” and “abortion is a psychological Trojan Horse for women” -- a claim Rue advanced by attacking the pervasive clinical view within psychology that the procedure had “only temporary, nonpathological, and limited adverse emotional sequelae.” In Rue's view, “guilt and abortion have virtually become synonymous. It is superfluous to ask whether patients experience guilt; it is axiomatic that they will.”


But how exactly is this claim persuasive? It persuades -- if it persuades -- by fusing some relatively new forms of talk about public health and women's rights with some very old forms of talk about women's roles: Abortion must harm women because women are by nature mothers. Choosing against motherhood and subverting the physiology of pregnancy will make women ill -- and in all events cannot represent what women really want, because any real woman wants what is best for her child. Women who seek abortions must have been confused, misled, or coerced into the decision to abort a pregnancy -- because the choice to abort a pregnancy cannot reflect a normal woman's true desires or interests. Using law to restrict abortion protects women from such pressures and confusions -- and frees women to be true women.


[H]ow exactly is it that criminalizing abortion would free women and protect their health? To make this claim persuasive, the movement infuses feminist and public health frames with familiar stereotypes about women's capacity and women's roles on which the claim's persuasive power depends. These gender-conventional convictions--that women are too weak or confused to be held responsible for their choices, and need law's protection to free them to be mothers--help make reasonable abortion restrictions that are wildly over- and underinclusive and are unresponsive to the real dilemmas women face.

The antiabortion movement is not proposing to identify particular groups of women who have emotional difficulties or particular groups of women for whom ending a pregnancy is a second-best option and offer these women the various long-term resources they need to make different choices. Women who are mentally ill need more than abortion restrictions, while healthy women do not need to be treated as if they were mentally ill. [Duke Law School, 2008]