Talk:Abortion and mental health

From Wikipedia, the free encyclopedia

This is the talk page for discussing improvements to the Abortion and mental health article.
Article policies
Archives: Index, 1, 2, 3, 4, 5, 6, 7
This article is within the scope of WikiProject Abortion, which collaborates on articles related to abortion, abortion law, the abortion debate, and the history of abortion. For more information, visit the project page.
Start This article has been rated as Start-class on the quality scale.
This is not a forum for general discussion of abortion.
Any such messages will be deleted. Please limit discussion to the suggestions on how to improve the content of this article.
Discussions on this page may escalate into heated debate. Please try to keep a cool head when commenting here. See also: Wikipedia:Etiquette.
This talk page is automatically archived by MiszaBot I.
Any sections older than 30 days are automatically archived. An archive index is available here.
Archive
Archives (Index)
Archive 1 Archive 2 Archive 3
Archive 4 Archive 5 Archive 6
Archive 7
About archives

Contents

[edit] Too many studies

As some editors may have already noticed, I took my mind off this article for some time. It was sad to see that the article made little progress. The lead section seems to have slightly improved. However, as User: Andrew c has already noted, the article is becoming bloated with lists of studies once again. I suggest integrating the studies into "Neutral and positive psychological effects of abortion" or "Negative feelings experienced after abortion" depending on the finding of the study. Many of the studies look pretty similar; inconclusive regarding causation, some negative effects observed after abortion (such as Gissler's finding about elevated likelihood of suicide) etc мirаgeinred سَراب ٭ (talk) 20:08, 29 March 2008 (UTC)

No study will ever be conclusive regarding causal effects because most effects have multiple causes. The claim that studies are "inconclusive" simply means there is more to be studied. I do not consider the inclusion of relevant material to be "bloating." The inclusion of multiple studies and multiple conclusions from experts in the field is approrpriate and necessary to show the breadth of opinions and on going change in opinions in light of new research. Once we put the material in, it may be possible to condense it, but the solution is not deleting relevent material in its entirity--Strider12 (talk) 03:58, 1 April 2008 (UTC)
That's ridiculous. Wikipedia is not an indiscriminate list of studies. I didn't say they had to be deleted. I just said that they needed to be integrated to relevant sections. мirаgeinred سَراب ٭ (talk) 14:35, 6 April 2008 (UTC)

[edit] Fogel -Washington Post

Request for comments...

I previously added the following between material on Koop and the APA:

For a 1989 article regarding the Koop letter, Washington Post columnist Colman McCarthy interviewed 75-year-old Dr. Julius Fogel, a Washington based physician who is both a psychiatrist and an obstetrician who had performed over 20,000 abortions. Fogel told Coleman:

There is no question about the emotional grief and mourning following an abortion. It shows up in various forms. I've had patients who had abortion a year or two ago--women who did the best thing at the time for themselves--but it still bothers them. Many come in--some are just mute, some hostile. Some burst out crying... There is no question in my mind that we are disturbing a life process.[1]

McCarthy reported that Fogel had made similar statements in an 1971 interview at a time when he was doing "therapeutic abortions" before Roe v Wade[1][2]

At least excerpts from the Coleman article are available at Washington Post here. MastCell has deleted the material with objections found above. No one else has commented on it. Before discussing IF the Fogel quote belongs in the article, or whether the above is presented in sufficiently NPOV fashion, I'd request feedback from other editors on wheter they agree, or disagree with the following:

  1. Is the Washinton Post a reliable source?
  2. Is this source and quote relevent to an article on abortion and mental health?

I'm going to wait a couple days for comments. If there is consensus that it is a relible source and pertinent, then I'll move on and request comments and discussion of why or why it shouldn't be included.Strider12 (talk) 00:14, 2 April 2008 (UTC)

I can't see why it's not in the article. --WikiCats (talk) 10:47, 2 April 2008 (UTC)
Yes, WaPo is a reliable source, and yes the source and quote are relevant to the article. As you indicate, that does not resolve whether the Fogel quote belongs in the article, or whether it would be presented in an NPOV fashion.Ferrylodge (talk) 14:34, 2 April 2008 (UTC)
Who is Julius Fogel? Why does his opinion matter? Is his opinion notable (with regards to NPOV and weight issues)? Is a 1989 column from the Style section on the top of the list of reliable sources? From the manner in which you present the information, it seems as if some random doctor is presenting some anecdotal evidence in a non-medical forum. Anyway, to answer your questions: #1 is a yes and #2 depends on the answers to my questions. I'm not sure we should go about this article as reporting every opinion as quoted in the media. I don't believe your proposed text is acceptable, but depending on the answers to my questions, I could see the citation fitting into the article somehow. -Andrew c [talk] 23:14, 2 April 2008 (UTC)
As well could I ask "Who is Nada Stotland and why does her opinion matter?"
Fogel is a psychiatrist AND obstetrician AND abortion provider. He's an expert in the field and was interviewed by Coleman precisely because of his expertise. He's pro-choice expert who says abortion is "not as harmless and casual an event as many in the proabortion crowd insist." This dissent from political rhetoric is notable.
Fogel's opinion is deserves equal consideration to that of Stotland whose much quoted (and often misrepresented views) are in a 1992 JAMA commentary. Fogel's contemporary statement from 1989 (on the heels of Koop's letter) adds balance regarding the range of perspectives even among pro-choice experts. Some editors have been hanging their hat on Stotland's view as defining THE majority view and WEIGHT of opinion. Fogel demonstrates that not even all pro-choice experts agree with Stotland's assessment. He also demonstrates that the claims of some editors that "only pro-lifers" believe abortion can have mental health consequences is not supported by the facts. Many otehr pro-choice experts, including Fergusson, DePuy, Wilmoth, Gissler, Lask, and many others reported in verifiable, reliable sources I have introduced in the past side more with Fogel than Stotland...but as in this case, material from these dissenting pro-choice experts have been frequently deleted in the past because they don't support Stotland's "majority" view. --Strider12 (talk) 14:43, 4 April 2008 (UTC)
According to what we state in the article, Nada Stotland is the "current vice president of the American Psychiatric Association", not just someone who went to medical school and got a job. Also, the commentary section of JAMA and the Style section of the Washington Post are also not on the same level either. I thereby argue that on the basis of these two considerations, that the weight does NOT "deserve equal consideration". I'm not sure where you are getting the idea that Fogel is pro-choice. Do we have any verifiable sources that state "Julius Fogel self-identifies as pro-choice" or even anything that comes close to that? If the reason we are to include Fogel is based solely on the notion that he is notable dissent among pro-choice, then that line of reasoning is fallacious until we establish he IS pro-choice. If we leave politics out of it, Fogels view may still be notable, but I'm not following the arguments in the last post.-Andrew c [talk] 16:00, 4 April 2008 (UTC)
Nada Stotland was not VP of APA back in 1992, nor does being VP doesn't endow one with greater knowledge or expertise in their field, so it is really an irrelevent point. By contrast, there are very few experts like Fogel who are psychiatrists who are also obstetricians who do abortions. Most physicians who do abortions (20,000 in Fogel's case) do not object to being characterized as pro-choice. I don't call him pro-choice in the article, just in discussion on talk page. For the sake of argument, let's assume he is a conflicted pro-life abortionist. He is still an OB, a psychiatrist, and an abortionist who has worked with many women who regret their abortions in his practice and has been notably interviewed on that subject in response to Koop's letter in a syndicated Washington Post column that happened to be placed in the STYLES section (if that last part is true), which makes it notable. Just because MastCell resists all edits that conflict with Stotland's views does not justify excluding Fogel's views.--Strider12 (talk) 04:29, 6 April 2008 (UTC)
I just noticed, this same basic topic was covered around March 22, and Mastcell similarly said to me that equating Stotland to Fogel was not appropriate in terms of NPOV weight. In the future, please do not start new topics on subjects that have recently been discussed on this talk page. It's better to keep the older topics alive, and the conversation in one place. -Andrew c [talk] 18:09, 4 April 2008 (UTC)
MastCell was the only one who commented then, after reverting my edit. We discussed, I found her arguments unconvincing and to be in conflict of policy regarding inclusion of many verifiable viewpoints. Reinserted. She deleted again. I started a new discussion for input from more editors.--Strider12 (talk) 04:35, 6 April 2008 (UTC)
It has been covered before. Brief summary of misleading claims:
  1. Stotland's views are just from a 1992 commentary. No; a better, more recent, and more scientific source would actually be the review article she wrote in the Journal of Psychiatric Practice in 2003 (PMID 15985924).
Agreed. Then cut Stotland's 1992 commentary as I'm sure she finds the "no evidence" claim somewhat embarrassing now that she is complaining, in the NOW interview, that there is now a "stack" of evidence that Coleman and Reardon have produced.--Strider12 (talk) 04:29, 6 April 2008 (UTC)
  1. Stotland and Fogel are equivalently noteworthy here. No; Stotland has published on the psychiatric aspects of women's reproductive health since 1982 and is President-Elect of the American Psychiatric Association ([1]). Fogel has published zero papers on anything relating to this topic, if PubMed is to be believed - the source is an anecdotal quote he gave for the Style section of the Post in 1989 which is available at present only on pro-life websites.
The argument for inclusion seems to be that Fogel is notable because he reinforces a point Strider12 would like to make. That is not a convincing argument. I'm not categorically against using this newspaper piece as a source, but the proposed text, as well as the claim that Fogel "equals" or "balances" Stotland, are deeply flawed. MastCell Talk 18:45, 4 April 2008 (UTC)
The argument of inclusion is that the WEIGHT of this article does not reflect all opinions, including those of like Fogel, who is uniquely experienced and is quoted in a reliable publication. The argument for inclusion is that Fogel presents a viewpoint sorely lacking in this article, namely that psychiatrists who actually work with women who have had abortions know they DO have significant psychological problems associated with their abortions. Something Stotland did not do until 1998 (see case study she published in Abortion: Social Context, Psychodynamic Implications" Am J Psychiatry, 1998 155(7):964-967...(but MastCell doesn't like that source either and has repeatedly deleted it because in it Stotland no longer insists there is no evidence of negative reactions to abortion but instead discusses how significant unresolved issues with abortion can come forward unexpectedly) The argument for inclusion is that WEIGHT should be shown by inclusion of facts and opinions from many experts.
And by the way, Stotland has published ZERO statistically validated studies on abortion, and zero comprehensive reviews of the literature. She is a board member of a pro-choice activist group for physicians[2] and her publications on abortion fall into the category of opinion pieces, reflections, commentary, and advocacy. If you are going to do a publication count for Fogel and Stotland, we should also do one for Stotland and Reardon[3] regarding their studies related to abortion and mental health. Who has more peer reviewed studies in that comparison, MastCell? Odd that Reardon is being excluded from this article, isn't it? And if you are going to accuse me of being "misleading" it would be helpful if you be more specific in documenting this charge. Are you claiming I have misrepresented Fogel's opinions?--Strider12 (talk) 04:29, 6 April 2008 (UTC)
Re: your first paragraph: Fogel represents the anecdotal account of one psychiatrist quoted in the popular press. You're attempting to generalize his claims to speak for "psychiatrists who actually work with women who have abortions", which is invalid. The rest of your post (misrepresenting Stotland's "epiphany", "whose PubMed listing is bigger", etc etc) has been dealt with ad nauseum and I refer you to the preceding 6 months of dialog. As to misleading, my experience has been that you consistently spin, appropriate, or selectively quote sources to advance your POV, so based on past experience I prefer to verify the sources you cite where possible. MastCell Talk 17:38, 7 April 2008 (UTC)

[edit] Supreme Court - Abortion "fraught with emotional consequence"

While not a medical body, the opinion of the Supreme Court is surely significant and in it's review of evidence surrounding the recent partial birth abortion case the majority of the supreme court described abortion as "fraught with emotional consequence" [4]-- a point picked up by the press[5]. The Supreme Court has also stated and reiterated that the “medical, emotional, and psychological consequences of an abortion are serious and can be lasting . . .” (Matheson, 450 U.S. 397, at 411, 413; Danforth, 428 U.S. at 67; Casey, 505 U.S. at 833.) As the views (finding of fact?) of the Supreme Court are significant, they should be worked into the article someplace. Perhaps in one of the introductory sections.--Strider12 (talk) 16:24, 7 April 2008 (UTC)

Contextomy ahoy. The full sentence reads: "In a decision so fraught with emotional consequence, some doctors may prefer not to disclose precise details of the abortion procedure to be used." It also deals specifically with intact dilation and extraction, aka partial-birth abortion, which many believe to be significantly more fraught with emotional consequences than the 98+% of abortions that are performed by other means because of the viability of the fetus and the technical aspects of the procedure.

The quote is from a 5-4 majority opinion endorsed by Roberts, Alito, Scalia, Thomas, and Kennedy, Republican appointees all, while Ginsburg, Souter, Breyer, and Stevens (mostly Democratic and one Republican appointees) dissented - this is probably notable. I don't think that scavenging this partial-birth abortion decision for a sentence fragment dealing with emotional consequences is going to make the article better. Where the Supreme Court has expressed a clear opinion on the psychological aspects of abortion, it may be notable as to the political aspects of this question. Could you provide a link to the other decisions you quoted, so I can verify the context for myself? MastCell Talk 17:29, 7 April 2008 (UTC)

Not scavenging the primary source. Picking up on news reports, primarily in Christian press but also secular, regarding Kennedy's remarks on abortion and mental health, including a statement regarding depression and self esteem, which I did not bother pointing out. I don't have links handy to the other decisions, but they are easy to find on the web.--Strider12 (talk) 18:54, 8 April 2008 (UTC)
I recommend the following. which addresses both the majority and minority opinion, be added in a section regarding the importance of the issue to the political controversy.
The controversy over abortion and mental health is fueled by the potential effects this issue may have on the political and judicial debate over abortion.[6] In it's most recent ruling on abortion, Gonzales v Carhart the majority opinion indicated that abortion was "fraught with emotional consequences" which may include "[s]evere depression and loss of self-esteem." [3] The minority opinion, however, while acknowledging that "for most women, abortion is a painfully difficult decision" concludes that there is "no reliable evidence" for the view that "[w]omen who have abortions come to regret their choices, and consequently suffer from '[s]evere depression and loss of esteem.'”[4]
The issue of Gonzales v. Carhart is probably a bit too complex to sum up in that manner. Let's leave aside for a moment the fact that the case focused on intact dilation and extraction ("partial-birth abortion"), a controversial procedure which accounts for 0.17% of all abortions in the US and is quite different from the other 99.83%. You portray the decision as 5 majority justices "indicating" that abortion results in depression and low self-esteem, while the 4 minority Justices "acknowledged" that abortion was a painfully difficult decision. (BTW, Kennedy's full quote was: "While we find no reliable data to measure the phenomenon, it seems unexceptionable to conclude some women come to regret their choice to abort the infant life they once created and sustained. Severe depression and loss of esteem can follow." The "no reliable data" part is often omitted in pro-life transciptions.)

The context was a bit more detailed. Justice Kennedy's opinion (that abortion could lead to depression and low self-esteem) was based on an amicus brief filed by the Justice Foundation, a pro-life group which provided anecdotal evidence from its "post-abortion counseling". The 4 dissenting Justices were quite harsh about Kennedy using the case to give so much credence to this sort of data from an obviously partisan and non-scientific source; Justice Ginsburg wrote: "The court invokes an anti-abortion shibboleth for which it concededly has no reliable evidence." Source: New York Times. If you want to talk about the political elements of the debate in the article, which I think is a reasonable suggestion, then let's dig a bit deeper than selecting quotes from a single Supreme Court opinion. Let's use secondary sources. MastCell Talk 21:42, 10 April 2008 (UTC)

The secondary sources are all calling out the same phrases, which is I where I started from. I'm hardly suggesting that the Justices are actually experts in the science, only that the issue is peculating in the Court and is a bone of contention and concern as shown in this good MSM article on it.[7] I add links to the primary source, even though the quotes are also in the secondary source, because I consider it a courtesy to readers to give links to primary sources.
Also, you are right, it was about partial birth, but many believe Kennedy was using the occassion to signal to anti-abortion forces that he was open to legislation that focused on protecting women's health, including their mental health. The context also indicates that Kennedy's use of the phrase "no reliable data" should probably be interpreted differently than Ginsberg's use of the same phrase. Kennedy, like Koop, is likely to be saying that since there are no studies that are above criticism he's not going to give the press or Ginsberg fodder by citing any of them. Instead he cites the testimonies of women as examples of general, undeniable truth that SOME women are deeply troubled by their abortions. That is sufficient, in his view, for the Court recognize a potential problem. The law must often recognize the exceptions. Therefore, abortion law does not hinge on how many women may suffer, but it may and arguably should take note of the importance of even a few suffering. Ginsberg, obviously, focuses her dissent regarding this idea on the view that post-abortion emotional problems are probably exaggerated. But even Ginsburg's dissent falls short of denying that problems ever occur and actually tries to be sensitive in acknowledging that women do have negative feelings.
But we aren't here to analyze any of that. All I was suggesting is that such citations to the court, as in the article I cited, demonstrates the growing interest in this issue has been in part sparked by this Supreme Court tiff and by the prospect that it may influence future decisions.--Strider12 (talk) 19:42, 11 April 2008 (UTC)

[edit] Reorg

Many (most?) of us think that this article is badly organized and should be structured but most of the discussion is about tweaks to the current (bad) article. I'd like to have more discussion about the replacement article. So I hope that this post will help lead our discussion. There are subsections for different aspects of the reorg; each has as list of possible components and then a discussion section. I don't know how this will work but let's give it a try. Sbowers3 (talk) 01:07, 8 April 2008 (UTC)

[edit] Sources

consensus
  • Koop
  • APA
  • Royal College of Psychiatrists
others
  • Stotland
  • Wilmoth
  • Gissler
  • Adler
  • Major
  • Schmeige-Russo
  • Coleman
  • Fergusson
  • Reardon
  • Fogel
  • Bazelon (NYT)
  • NOW (PBS)

[edit] Discussion

I have taken the liberty of starting with a few sources in the consensus list because I think everyone will agree that these sources will be included. In the "others" list I have included all those in the current article, as well as all those I have read someone suggest. As for moving between "others" and "consensus" let's discuss here and try to reach consensus before actually moving them. Sbowers3 (talk) 01:07, 8 April 2008 (UTC)

[edit] Strider12's Reorg & Rework Suggestions
There is consensus, as all sources agree, that "some" women have "significant" post-abortion emotional reactions. The problem is that the definitions of "some" and "significant" vary and lead you very quicly away from any broadly supported consensus. (There is also, however, a consensus in all sources that certain groups of women are more likely to have negative reactions, such as those with pre-existing depression, those who are pushed into an unwanted abortion, conservative morals, etc., but that is often viewed as secondary to the "big" issue of prevelance of the problems) That's why I think Wilmoth's statement is the most conservative and unimpeachable consensus statement. Some women have problems, and all sides agree that there is disagreement on how to define A,B,C & D.
Move beyond Wilmoth, and I become doubtful that you can find any meaningful consensus statement regarding the majority opinion in a field where no polls of the experts has been published. In part this is because this area is so very fluid, controversial, and impactful on politics and medical practice. Even if, for example, Fergusson's study convinced the RCP that there is a significant problem, they would naturally tone down their consensus statement to minimize the political and practical effects of a significant shift in their scientific opinion. Consensus, afterall, is a political process, not a scientific process. Consensus statements don't reveal truth, just what people can agree on...and often what people think others want or need to hear.
I'm more concerned about facts. All the viewpoints that can be represented are looking at the same facts. I favor just putting forward all the evidence in a NPOV fashion so people can draw their own conclusions. To give context, certainly viewpoints and consensus statements reflecting on the evidence are necessary. Whose viewpoints should be included? As a starting place, there are some easily identified experts, most of whom you've listed, who have published multiple times or have published key studies (like Fergussons) whose viewpoints should clearly be iuncluded. As MastCell has noted, the APA is expected to issue a new summary opinion just as the RCP has, but a new opinion will not change the available facts on which it will be based.
What I want to see discussed, and agreed upon, is that the policy on WP:WEIGHT is not about empirical facts, it is about maintaining a balance of viewpoints. It says nothing about selecting facts or studies in such a manner that they proportionately fit what are claimed to be the majority or minority opinions. (And how do you know if a minority opinion is 10% or 49%?) I think we can reach a consensus on including a variety of experts opinions which are representative of the ways different parties view the same set of facts. My main argument is that empirical findings (statistically validated results) of peer reviewed studies are FACTS, not opinions, and should therefore not be included or excluded based on arguments of WEIGHT, which applies only to opinions.
Whether the statistically validated facts from peer reviewed studies are presented individually, or in paragraph form (like in Coleman's summary listing multiple studies), is not that important to me. But I do believe it is important that AT LEAST the citations to all relevent peer reviewed studies brought forward by editors should be retained in the article. This not only shows respect for the contribution of the editor bringing forth the reliable source, it also creates an expanded bibliography so that readers (and future editors) have the ability to dig down to as the reliable secondary sources as they may be interested in.
That said, while some studies certainly deserve detailed discussion, I have no problem with a condensed list like Coleman's. I've even tried inserting such (a single sentence with multiple citations regarding each symptom identified, for example), but they have generally been deleted.
The problem in the past has been that some editors object to including even the citations to symptoms and studies demonstrating a link between abortion and depression, for example, because such a listing undermines the "tone" of the article which they felt should be centered on Stotland's 1992 conclusion that there "is no evidence" of a problem. Afterall, if Stotland represents the majority view, and it is true, than all the studies presenting evidence of a problem must be false and untrustworthy. That has been the central bone of contention in this article for many months. How much evidence FOR a link between abortion and mental health problems should be allowed since Stotland 1992 and APA 1990 say there is no problem (and Koop refused to draw any conclusions)? --Strider12 (talk) 19:42, 8 April 2008 (UTC)

[edit] Structure

chronological

intro, PAS section, chronological studies, summary

POV sections

intro, PAS, neutral studies, negative studies, summary

other orderings

[edit] Discussion

After the intro, I think we should continue to have an explanation of PAS - I don't know whether editors think the current section is neutral or not - then the scientific studies arranged either chronological or by POV (neutral or negative), then possibly a summary, but a summary might be hard to write without violating SYNTH or repeating the intro.

I originally favored the chronological ordering because I thought it lent itself to prose, but have changed my mind. I'm afraid that it would like a disorganized list and I can't think of any natural way to divide the studies except by name of author. Arranging it by POV looks a little more organized and that seems to be the only natural division of the studies. Sbowers3 (talk) 01:07, 8 April 2008 (UTC)

I was just over to abortion-breast cancer hypothesis. It may provide some model for this article. It gives a pretty extensive review of studies.--Strider12 (talk) 04:00, 9 April 2008 (UTC)

[edit] Coleman Bio

IronAngelAlice creatd a bio for Priscilla Coleman. As the section on Coleman's review in this article had an overly long biographical information about Coleman (with an emphasis on implications that she has a pro-life bias and can't be trusted because she's published with Reardon which seemed a bit out of place in and disproportionate to other experts), I removed these biographical paragraphs and added the link to Priscilla Coleman where readers can discover these allegations in the context of a biography. I'm sure IAA would appreciate help with that biography. I left a few notes on the talk page but did not venture into editing the article in light of the long history of edit warring with IAA aka 131.216.41.16 over misapplied citations and unsupported inferences in regard to the Reardon bio.Strider12 (talk) 19:04, 8 April 2008 (UTC)

[edit] Reorg'd

I have reorganized the article without changing any of the wording. Many of us have said that it was badly organized but nobody did anything about or even talked about it much so I went ahead and did it. The main change is to have separate sections for inconclusive, neutral, and negative instead of a studies section. I think it now reads as being organized.

My longer goal is to expand the prose in the Psychological effects section while trimming each of the subsections of expert studies. I think there is some agreement that a good article should be more prose and less "listy".

It's a start and I hope people will try it out for a while before reverting. Sbowers3 (talk) 01:29, 1 May 2008 (UTC)