By Jessica Chavez
On Monday, June 27, the Supreme Court of the United States (SCOTUS) decided on the case of Whole Woman’s Health v. Hellerstedt, striking down restrictions that have significantly limited abortion access in Texas, especially for poor, rural, and otherwise medically underserved abortion seekers.
Over the past 20 years, legislators in states across the US have introduced a range of abortion restrictions based on claims that these measures protect women from harm. In 1992, the Court’s ruling in Planned Parenthood v. Casey first permitted such restrictions as long as they would not pose an “undue burden” to access, and in 2007, the ruling in Gonzales v. Carhart allowed restrictions that specifically aim to protect women’s health. Legal scholar Reva Siegel refers to this iteration of anti-abortion politics, one that claims to protect not only fetuses, but also abortion seekers, as the “woman-protective antiabortion argument” (Siegel, 2008). In a recent post in the Psychoanalytic Activist, Jane Hassinger described the targeted regulation of abortion provider (TRAP) laws and contextualized this trend in a broader “war on women” wherein abortion restrictions are framed as necessary to protect the common good, and meanwhile neoliberal policies re-entrench social inequalities resulting from racism, misogyny, classism, and other forms of oppression.
Last week’s Whole Woman’s Health ruling provides more clarity about what constitutes an “undue burden.” In short, the Court ruled that the Texas Legislature’s House Bill 2 (HB2), which required abortion providers to have admitting privileges at a local hospital and perform abortions in ambulatory surgical centers, indeed posed an unconstitutional barrier to abortion—without ensuring any benefit to health or safety. Thousands of Texas abortion seekers have faced longer wait times and other difficulties since the implementation of HB2 forced a number clinics to close, and this ruling will provide some relief in Texas and in states with similar restrictions.
Repealing HB2 and other TRAP laws, however, does not mean that abortion will be accessible to all. Since the passage of the Hyde Amendment in 1976, for example, abortion seekers who rely on federally funded programs for basic healthcare must pay for abortion services out of pocket. Additionally, as reproductive justice activists have long observed, a rights-based political agenda focused solely on abortion will not, on its own, completely address the reproductive needs of communities facing multiple forms of oppression and unique local struggles (e.g. racism, economic inequality). Reproductive justice activists have supported a broader range of political demands including, not just abortion access, but also changes that would allow community members to navigate parenting and other reproductive options in contexts free from coercion, sterilization abuse, poverty, police violence, environmental hazards, and other forms of injustice.
Citing evidence of abortion’s safety, the Court’s majority opinion in Whole Women’s Health states that “there was no significant health-related problem that the new law helped to cure” (p. 22). The invention of cures for problems that either do not actually exist or are due to more distal social factors is a phenomenon tied to the gendered processes of (bio)medicalization that treat the body as a controllable fetish object and deflect from broader contexts of inequality. Take, for example, the so-called ‘female Viagra,’ a biomedical intervention that, according to some feminist activists, medicalizes problems of women’s pleasure that have social roots in misogyny and repression. Additionally, Katie Gentile (2015) has applied psychoanalytic and queer theoretical lenses to consider ways in which the fetus as fetish, transplanted from its place in the adult body and floating into the post-9/11 public imaginary, has been used to manage the threat of a catastrophic future.
Woman-protective antiabortion politicians have also introduced measures that require abortion providers to warn patients about dubious claims that abortion causes psychological harm or PTSD-like symptoms. To support the view that abortion is inherently traumatic, researchers have misrepresented quantitative data on post-abortion mental health. Better-quality studies that use appropriate comparison groups and account for pre-abortion mental health, however, indicate that abortion does not lead to worse mental health outcomes. The women-protective antiabortion movement’s claims have thus created a point of intersection between discourses of mental health, trauma, and anti-abortion rhetoric, and psychological discourses have come to play a major role in the abortion debates. As is the case with psychologists’ support for post-9/11-era Department of Defense torture programs and for US eugenics programs starting in the early 1900s, psychological frameworks have again been used to reinforce uneven power relations and curtail freedom.
There are, however, an active and vocal set of psychological researchers doing important work to counter the claims of the women-protective antiabortion movement. In 2008, an American Psychological Association Task Force on Abortion and Mental Health published a report concluding that for adult women who experience unplanned pregnancy, “the relative risk of mental health problems is no greater if they have a single elective first-trimester abortion than if they deliver that pregnancy” (p. 4). Since this report’s publication, new methodological innovations have helped solidify this view. An Amicus Brief from Social Science Researchers offered in the Whole Woman’s Health v. Hellerstedt case included findings from psychological researchers (e.g. Antonia Biggs, Brenda Major, and Julia Steinberg) who offer additional evidence that abortion does not lead to worse mental health outcomes and that, in fact, being denied an abortion is detrimental to one’s mental health.
It is clear that abortion restrictions like those contained in HB2 are a cure in search of a problem, and although this recent SCOTUS ruling was a victory for abortion advocates, the struggle does not end here.
The role of psychoanalysis in this struggle, however, is not clearly defined. Except for among a small (but growing) and dedicated group of theorists and researchers, I cannot say that abortion is a word I frequently hear in psychoanalytic circles. I believe, however, that psychoanalytic activists are uniquely positioned to extend and support existing movements.
First, as psychoanalytic clinicians, our aim is to help patients make sense of psychic pain related to past wounds to find agency and a sense of internal freedom. Abortion is a common and invaluable means by which people regain control over their lives and bodies and find self-determination. According to the most recently available data, nearly half of all pregnancies in the US are unintended, and 30% of women will have an abortion by age 45. Indeed, many of our patients benefit directly or indirectly from the work of abortion providers. Physician Lisa Harris (2008) has applied the notion of “dirty work,” or work that plays a crucial yet disavowed role in society, to consider the role of abortion providers. As we help patients delve into difficult states of mind and body to make narratives out of fragmented, painful, and at times unbearable pasts, I argue that we also do some form of “dirty work.” The work we do makes suicide, substance abuse, childhood sexual abuse, and taboo expressions of sexuality, for example, day-to-day topics of discussion that go largely unacknowledged in the mainstream. In this way, our work, like the work of abortion providers, delves into areas of life that are commonly experienced yet widely disavowed in order to help people regain a sense of self-determination, and through initiatives like the Providers Share Workshop, this commonality can provide a basis for solidarity and mutual support.
Clinical psychoanalysts can also help advocate for including discussions about abortion in clinical training. My own forthcoming research exploring psychologists’ approaches to thinking about abortion and mental health reveals how the perceived lack of training on abortion and reproductive issues in general in clinical programs leaves clinicians with few spaces to make sense of their own feelings, biases, and experiences related to reproduction and abortion. A feminist psychoanalytic view can help clinicians consider the relational nature of stigma and decisional conflict and explore these experiences in the context of the relationship between patient and therapist. Psychoanalysis can also provide a framework for considering how the therapist’s own reproductive history, values, assumptions, and beliefs permeate the intersubjective space in which patients work through their own abortions and/or unwanted pregnancies.
At the political level, a psychoanalytic lens can contribute a critical approach to the gendered rhetoric of abortion politics. Indeed, efforts to block abortion access often rely on misogynist attitudes about women’s claims to self-determination and sexual pleasure, so it makes sense that abortion access is commonly framed as a women’s problem. As a queer-identified abortion advocate who has not always felt like the category of “woman” has fit perfectly with my gender identity, however, some mainstream pro-choice campaigns seem to exist in what affect theorist Lauren Berlant (2008) refers to as an intimate public of “women’s culture,” a matrix that creates emotional attachments to the fantasy of oneness while masking lived realities of difference. Although I am a second-generation Planned Parenthood beneficiary and thus will fight for their survival, recent Planned Parenthood campaigns that drenched protestors’ shirts, signs, and Facebook profile pictures in the color pink seem to reduce urgent threats to justice for everyone, regardless of gender identity, to a “women’s issue” and demand an affective attachment to cisnormative femininity. Could I #StandwithPP, I wondered, if I was cringing at these pink posters? Indeed, not all people with the body bits necessary to become pregnant identify as women, and people who can become pregnant are not the only ones who benefit from abortion, so work is needed to disentangle discourses that address the misogyny of antiabortion rhetoric from those that reinforce the idea that pregnancy and abortion are inherently feminine experiences. The psychoanalysis of gender has offered a potent challenge to the “natural” status of the gender binary while also providing a framework to understand the social function of enforcing that binary, and as a system of thought that embraces dialectic and ambiguity, psychoanalysis is uniquely equipped to help us work through intersections between the politics of gender and abortion.
Finally, one of the oldest insights of psychoanalysis, the view that sexual repression leads to individual and collective ill-health, can help reorient the abortion debate to honor entitlement to sexual desire and conceptualize antiabortion rhetoric as sexual repression. Discourses that frame abortion as a health issue are important because they underscore abortion’s essential (and often lifesaving) role in helping people maintain their physical and mental health. These discourses, however, can have the unintended effect of depoliticizing pro-choice movements and deflecting from the equally valid view that abortion is a means to sexual freedom, which is also a basic human right. As psychoanalytic activists, we can use our disciplinary knowledge about the violence of sexual repression to demand a kind of liberation that makes room for the erotic dimensions of human experience.
Below there are some suggestions of what people can do to concretely help:
- Support your local abortion fund. Go to https://fundabortionnow.org/explore to find out how.
- Listen, read, and learn from reproductive justice movements:
- Donate to an organization supporting reproductive rights or reproductive justice:
Berlant, L. (2008). The female complaint: The unfinished business of sentimentality in American culture. Durham: Duke University Press.
Gentile, K. (Ed.). (2015). The Business of Being Made: The Temporalities of Reproductive Technologies, in Psychoanalysis and Culture. New York: Routledge.
Harris, L. (2008). Second Trimester Abortion Provision: Breaking the Silence and Changing the Discourse. Reproductive Health Matters, 16(31), 74-81. Retrieved from http://www.jstor.org/stable/25475404
Siegel, R. (2008). The Right’s Reasons: Constitutional Conflict and the Spread of Woman-Protective Antiabortion Argument. Duke Law Journal, 57(6), 1641-1692. Retrieved from http://www.jstor.org/stable/40040629