Tales from an Insider

Tales from an Insider-Outsider on the Report of American Psychological Association's Task Force on Mental Health and Abortion

Rachel M. MacNair, Ph.D.

Director, Institute for Integrated Social Analysis, research arm of Consistent Life: An International Network for Peace and Life

We have known for a long time that the word "choice" in the abortion debate doesn't mean what it means in regular English, having become a euphemism for abortion rather than a matter of actually having options. Now we find that "science" means what the American Psychological Association (APA) says it means, rather than what those of us trained in a university might have been taught.

We start with the appointment of the Task Force. I'm an APA member, and on the Board of Division 48, peace psychology, though of course not on the APA Council which makes the decisions. Though I keep my ears attuned, the task force membership was appointed and explicitly not open to any more nominations by the time I first heard about it. Actually, there never had been any call for nominations. Membership had been decided by Division 35, psychology of women, and the Council apparently rubber-stamped the selection. I knew the fix was in at that point and subsequent events have confirmed this, but I gamely kept trying to talk about balance and science.

Having documented that three members of the task force were outspoken defenders of abortion and the remaining three had no public statements of positions, I immediately brought up the point of lack of the voice of skeptics wherever I could. Consistent Life sent out a letter to the entire Council last fall on this point, and received no response.

I volunteered to be a reviewer of the Report, which means someone that gives feedback from a scientific point of view. They decided I had the credentials to do so, along with Priscilla Coleman and David Fergusson of New Zealand. I don't know the rest of the 20 reviewers; David is self-described as an "atheist pro-choicer," but he shared his review with me and his opinion about the quality of the science therein was roughly the same as mine and Priscilla's.

I got the original November 2 report and to be polite I will say that I spent 30-40 hours giving them careful and relatively gentle line-by-line commentary. Once I got the March 6 revised version, I saw they had re-organized, based a more clearly worded conclusion on a whole different approach, and rather than including my alternative perspectives on several previous arguments for balance, they had simply left them out. But there was one major improvement: the short section on the abortion-as-trauma "conceptual framework" had dropped the grotesque caricature of pro-lifers and instead offered an explanation that left the reader no longer puzzled as to why anybody might think abortion was traumatic.

But I was startled to dig in and realize that the new rationale for the conclusion was based on only one study – using British women where there was a screening requirement we don't have in the U.S. The fact of many methodological flaws in that study isn't really the point, since in the real world all studies have some flaws. Far more important is that the study doesn't support the conclusion, since it did find more drug overdoses in women who had abortions compared to others. Also important is that it doesn't even address the conclusion, since it was only looking at extreme outcomes – drug overdoses rather than over-all substance abuse, for example. (See http://wiki.afterabortion.org/index.php?title=Gilchrist#Weaknesses for discussion of the one study).

We don't draw such a sweeping conclusion from only one study. As I said, they all have flaws. We put together a group of studies so that the flaws may balance out. One thing needs to be replicated before it's taken seriously. Setting aside the quality of the study itself, citing only one study in support of a politically-desired conclusion cannot be explained in any other way than a politically-motivated exercise. This is not a debatable point. This is Quantitative Research 101. Here is a quote from the official APA task force on the subject:

"Do not interpret a single study's results as having importance independent of the effects reported elsewhere in the relevant literature. The thinking presented in a single study may turn the movement of the literature, but the results in a single study are important primarily as one contribution to a mosaic of study effects." (Wilkison, L. & Task Force on Statistical Inference, APA Board of Scientific Affairs (1999). Statistical methods in psychology journals: Guidelines and expectations. American Psychologist, page 602.

So I immediately sent out a memo to the APA governance committees who were now reviewing the report, in case they missed it – it was buried on then page 66 (in the actual released report, it's on page 68; look for the conclusion and note the lone citation in parentheses). There was no response.

Consistent Life, upon noting a quarter of Council members had changed with the new year, sent out its letter again. This time it got a response, and sent another response; see http://wthrockmorton.com/2008/07/14/anti-violence-group-expresses-concerns-over-apa-abortion-task-force/. I am aware that many other people sent letters as well, making various points. I also sent a memo to all Council members on the idea that a better report would be one that pointed out where the consensus is and where the controversies still are, rather than taking one side in the controversy.

This takes me to the Council meeting of Wednesday, August 13, 2008. This was the first item on the agenda. Speaking for it were endorsers and people commenting that it was good science on the grounds that it was done by good scientists who had really worked hard on it.

I approached the microphone and started to speak as others had, but the president interrupted and said he didn't recognize me as a member of the Council; was I one? I said no, he said I would need permission to speak, I asked for it, and he gave it so long as I was short. I was told later that it is exceedingly rare that anyone outside of Council is allowed to speak at all.

That may help account for the fact that once I made points similar to the above, no one commented on them. To this moment, I don't have an answer to the basic point of how one study, whether an excellent study or not, could possibly be reasonably seen as supporting a bold and ideologically-desired conclusion. I'm an outsider who didn't even think to mention my credentials beyond the relevant point of being a reviewer.

One person did later comment on the letters Council members had received, with a smirk. No content was commented upon.

The vote to receive the report was near unanimous; I believe 6 abstentions. I asked the president-elect about this later, and he said that the vote was like a ribbon-cutting at a building; the building was already built, all the work had already gone in, so that point in time was too late. I pointed out that I had been making these points all along, and he acknowledged that I had been making valid points all along since he had seen me doing it. I told him APA had made a mistake since it was going to lose lobbying influence as people discounted the idea that it was actually promoting science, and he didn't deny it; he thanked me for trying.

More studies are coming out, of course. According to the logic of the report itself, if only one study can establish the conclusion, then in theory it should only take one study to knock it down, so long as the new study has the same strengths as the 13-year-old one. But that would be taking the assumption that APA was actually interested in keeping up with real science, an assumption for which at this point I have no evidence.

The Report dismisses many of the studies of post-abortion trauma on the grounds that women were already traumatized by the time they showed up to the abortion clinic. This is surely true, but doesn't it then follow that it's highly irresponsible to simply give them surgery and then send them home? If we have clear and undisputed information that a disproportionate amount of traumatized women (domestic abuse, substance abuse, etc.) are showing up at any medical location, how can it be reasonable medical care to not screen for this and provide opportunity for intervention? I pointed this out in my review, but they didn't see this point as worthy of inclusion.

Meanwhile, the report does say that they do know that there are groups that have higher negative aftermath: teenagers, women who are pressured, women who have more than one, those abortions that late-term. This is information we can put forth as at least being a consensus among all reviewers.