Asymmetrical Information

An acquaintance with manic depression got accidentally pregnant and was faced with the choice of going off lithium (which evidently is harmful to the fetus) or facing her manic depression unmedicated.

I am not sure if that falls under your definition of mental health since there was a physical/chemical component to her situation, but it's the first thought that sprang to mind. That and Andrea Yates.

BerthaMinerva nailed it. The issue of what to do about pharm therapy during pregnancy is a big issue for people. The archived entries at dooce.com are very good on this.

Presumably any woman who doesn't want to be pregnant will be made unhappy by it

Precisely the problem with attempting to nail down a medical definition for this sort of exemption. As I recall, following Roe it was the language of "the woman's health" that got defined down in subsequent case law (Doe vs. Bolton, was it?) to mean "any time and reason," since every preganancy technically poses some sort of health risk to the mother. One might question whether that was really the original intent of the language, but regardless, that's what it later became.

There are a _lot_ of things that can go wrong, starting with ectopic pregnancies and going down the list.

I have been a volunteer with the National Alliance on Mental Illness for several years now because my finacee's mother is schizophenic and bipolar. Her symptoms began to appear when she was first pregnant with my finacee's older brother, her 1st child. The hormonal changes that occur during pregnancy can set off genetic predispositions. It is fairly common for women to 1st exhibit signs of mental illness while pregnant. I don't mean to suggest that women's "irrational" behavior while pregnant is to be considered mental illness, but that serious, long lasting symptoms may arise.

See:
http://www.nimh.nih.gov/healthinformation/depwomen.cfm

Levels of serotonin, dopamine, and other neurotransmitters are affected by pregnancy. A healthy woman will be able to adjust, but someone who has trouble keeping their chemistry in balance can be pushed into depression or anxiety by the hormonal changes. This can happen even if the pregnancy is planned and wanted, so certainly an unwanted pregnancy will be even worse.

Women can get so disoriented when pregnant and giving birth that they abandon their child and wander off. We don't really know why, just that some people react that way. There is a just so theory that lack of support, nurturing, socializing prior to birth makes a parent cut their losses with a baby that wouldn't have had sufficient resources back in the days when food was scarce. We don't know if there is an evolutionary reason or if it is just exaptive. I think Hrdy wrote a book on that.

Is this a new article? I don't remember what was on the cover of the last issue, but the one before that had the IRA dude.

Well, the UK’s Abortion Act has something very similar in it.
Usually, in practice, taken to mean "unhappy".

Yep, in the UK the mental health argument had the effect of allowing abortion on demand. I don't know whether that's good or bad, but it does mean that the abortion reformers lied.

Back in the pre-Roe days, in areas that had a mental health exemption, all that was needed to get an abortion was to go to the right doctor and say: "If I have to carry this pregnancy to term, I'll kill myself." and you got on the schedule for the procedure. I don't expect that it would be different today if Roe was cut back.

In Canada there is no fussing over such niceties. Abortion is completely unrestricted up to the point where the umbilical cord is cut. Before that no reason is needed since "a woman's right to choose" is the sole moral principle that has any weight whatsoever. There is no such thing as an illegal abortion, and all abortions are fully funded by the taxpayer.

Meanwhile in Quebec population growth has reversed itself dramatically and the "pur laine" Quebecois are headed for ethnic extinction.

Rosemary's baby
Also Damien

And what about the _father's_ mental health, dammit?

Women who have had severe post-partum depression and/or post-partum psychosis may presume they will likely have episodes following future pregnancies - and there's some evidence, as I understand it, that episodes may become more severe.

I know of at least one woman who has elected to refrain from future reproduction due to the severity of her depression with her first child. She is an excellent mother and has a great family life, but it was several years of therapy and re-balancing to get to something we'd think of as "normal" and she won't risk going back there...

I don't know what her views are on choice, I don't know if she would go so far as to abort if she became pregnant despite taking precautions, but I would think she might consider it.

As you know, poll results can vary based on how the question is asked.

I'll bet 65-70 percent would agree to the following contradictory statements: "Do you think an unborn baby's life should be protected in the womb? and "Should a woman have the right to decide whether to take a pregnancy to term?"

What exactly is meant by mental health?

I suspect people would hang up on pollsters if they qualified every question and provided full information on every case, possibility, condition, etc.

I think abortion will be an issue for the next several centuries. Why? The pro-choice side has never been able to convince enough people that abortion just gets rid of a useless blob of tissue. No doubt improvements in ultrasound technology should continue to trouble people's consciences.

There is a potential, very correctable heart defect that is associated with the use of lithium to respond to the more recent concern. Not that that is nothing. My father was an Obstetrician. I have been in general psychiatric practice for 25 years. I have never heard of, or read of, a case where terminating a pregnancy was looked at as a potential mentally therapeutic option. It is even unusual to see somone's treated psychiatric illness get worse during pregnancy. This is not to gainsay the history of onset of illness, subsequent difficulty that makes pregnancy avoided. I have come closer to thinking that someone's uterus was taken out for hysteria. The personal issue for people is more on the order of, 'You have panic disorder which responds to Klonopin. With the evidence available, I can't prove that there is less than a 1 in 20,000 chance of a birth defect if you get pregnant.' People will chose not to take Klonopin, for example, in that instance.

Does postpartum depression ever manifest following abortion? I don't know the physiology behind it.

BerthaMinerva, a friend of a friend was in a similar situation...she's ADHD, OCD, bipolar and then some, and requires quite an extensive cocktail of medications to be able to function. When she got pregnant, she chose to quit all those medications rather than risk it with the baby and was essentially unable to function throughout her pregnancy. And she *wanted* the child and had been trying to get pregnant....

Any woman with a severe pre-existing psychiatric condition (psychosis, schizophrenia, bipolar disorder, or clinical depression) could experience decompensation and worsening of symptoms during pregnancy due to the hormonal changes and stress (which would be worse if the pregnancy was unplanned and unwanted). I would consider these conditions to be as dangerous to a woman as medical conditions that are worsened by pregnancy. Also, a woman with a severe psychiatric disorder usually cannot be a good parent, and even if she got through the pregnancy and put the infant up for adoption, the psychological stress of all that might be detrimental to her mental health. I would feel rather bad if I counseled against abortion and the woman killed herself or became so psychotic that she had to be committed to a psychiatric hospital.

The issue of post-partum depression or psychosis is less clear-cut. If a woman experienced such a problem after a previous delivery, then interventions (drug treatments, stress reduction measures, better support at home, etc.) could prevent or reduce the severity of depression or psychosis. I would not recommend abortion for the sole reason of previous post-partum depression.

Tom. T., A late term abortion might put you in the same physiologic situation as being post partum. Colagirl, given criteria for diagnoses and the ways they are often made, bipolar was likely the underlying illness. Carbamazepine, cf. Equetro now, is used for sezures and bipolar disorder and the malformation risk appears to be the same with or without carbamazepine. For a long time we treated bipolar disorder in pregnancy with Mellaril; in general there are no malformation issues with antipsychotics, which are also used for bipolar disorder. Obstetricians are tempted to use the John Edward's rule of OB. If something goes wrong it is the OB's fault; the best defense is probably to appear to 'do nothing.'

My understanding is that in New Zealand, abortions are banned except for the health (including mental health) of the mother. The result: pretty much any woman can get an abortion any time, because you can always claim that not having an abortion will harm your mental health. As the father of two children, I find it hard to disagree with that sentiment.

Wouldn't it be simpler and cheaper and more humane to simply sterilize these women before the opportunity for a pregnancy to worsen their conditions arises?

Many women often suffer from feelings of depression caused by the guilt after having an abortion.

So should an abortion be denied to a particular woman if it could/will worsen her mental health?

My wife was diagnosed with Bi-Polar Disorder after our thrid child was born. The doctors were emphatic in their conclusion that the pregnancies exacerbated the problem (this in conjunction with what turned out to be petite mal seizures, also undiagnosed).

So yes, I suppose the argument can be made. Now I'll go ead all the previous comments :)

Insanity is heredity.

You get it from your children.

D----:

Many women often suffer from feelings of depression caused by the guilt after having an abortion.

Oh, doG, not "post-abortion syndrome" again...despite the fact that a great many women do not regret having had one.

Oh, doG, not "post-abortion syndrome" again...

What the dickens is this all about?

It does occur among some post-abortive women. And it was a perfectly valid counterargument in the context, namely, helping to illustrate that "mental health" is too nebulous a concept to be plied consistently in the absence of strict definitions.

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