Is Psychiatric Consultation in Abortion Obsolete?

Abstract

The 1973 United States Supreme Court decision removing all impediments to abortion requested by adult women in the first trimester eliminated the necessity for psychiatrists to “approve” such abortions on psychiatric grounds. At the same time, the development of new thinking about post-abortion emotional problems occurred. It was shown that despite the formerly widely held view that abortion was usually followed by psychiatric illness, such complications are in fact rare. Therefore, the two principle reasons for routine psychiatric consultations in abortion cases are no longer viable. Nevertheless, there are important indications for psychiatric involvement in pre- and post-abortion counseling and consultation which cannot be overlooked. These can be summarized as cases in which: 1) the woman exhibits marked ambivalence, or in which motivation for continuing or terminating the pregnancy is suspect; 2) unhealthy, self-destructive or inappropriate use of sexuality results in pregnancy, with the use of abortion as birth-control; 3) the woman is incompetent to decide on continuation or termination of pregnancy; 4) a serious physical illness may have compromised the ability of the woman to cope emotionally with the issue of pregnancy or abortion; 5) there is a history of prior psychiatric illness, especially postpartum illness or suicidal behavior; or 6) the primary role of the psychiatrist is in liaison or education of the physician or staff. Six illustrative cases are briefly presented and discussed.