CHAPTER THREE
DEALING WITH IT

It may strike many people that the obvious thing to do when faced with such stress from on-going traumatic experience is to cut out the traumatic activity, get a chance to calm down, and get some counseling. To keep going in the traumatic activity, however, requires defense mechanisms, and the world of violence has a long history of those kinds of defenses being used.

DISTANCING

The most common way to continue violence is by distancing yourself from the reality of what is happening, to isolate yourself from your horror.

One example of how this works comes from the war in Vietnam. At my college, peace activist William Sloan Coffin related a story told to him by an American veteran who had been captured. His plane was shot down, and he bailed out into a ditch. As he came out, he saw a man pointing a rifle at him, and slowly put up his arms. Though neither could speak the language of the other, the body language was clear enough, and they went marching through the jungle. At one point, the Viet Cong tripped and fell, and the gun was knocked out of his hands. The American picked up the gun, then picked up the man, handed him back his gun, and they went on as before.

At this point in the story, Coffin was startled, and asked if it were not his duty as a soldier to use the gun to shoot the man and make his escape. "Oh, it wasn't that simple," the veteran said. "I forgot to mention that there was a parade of children following. They would have run to the village to tell them, and they would have come after me and captured me, so there was no point in doing that."

It had never even occurred to him to shoot the children.

But when he was up in his airplane, bombing the villages, shooting and killing children was exactly what he was doing. From a distance, it was no problem. Close up, it was so horrifying that it wasn't even considered.

Coffin could see this right away, since he was very upset about the airplane bombing. He was using this story in speeches to show the power of distancing yourself from the horror in making it more possible to participate in the horror.

Another example comes from my college days, when we students were considering an experiment in how far people could be pushed into obeying authority. In a landmark experiment done by Stanley Milgram, an authority figure instructed the subject to give electric shocks to someone in a booth, under the pretense that this was an experiment in learning. Sound effects of human pain came from the booth in accordance with the length of the shocks. The purpose of the experiment was to see how far the authority figure could get before the subject would rebel and, as a matter of conscience, refuse to administer the shocks any more. Comparisons were then made over which people were more likely to submit to authority.

Upon looking at the numbers, the students found the high numbers who did submit, almost two thirds, discouraging. But they wanted to know more. They wanted to know about racial differences and other background differences. The experimenters had done a narrowly defined job, and it was noticeably lacking in what groups were covered. The students were hungry for more information about other groups and how they would react under the circumstances.

Then the students saw a film of the experiment.

Suddenly, the whole tone changed. No longer was there an idea that the experiment should be done on more groups. The students wondered how the experimenters dared do it at all. It was so cruel. The people who were giving the shocks were so clearly in anguish, and the pushing by the authority figure to keep giving the shocks was so clearly making them suffer, that it became obvious that the whole enterprise was unconscionable.

Such is the difference between numbers on a page and real life.

In order to keep any horror going, it helps tremendously to keep it at numbers and abstract principles on a page. The intrusion of reality must be defended against. If it can't be done literally, with distance provided by airplanes or words, then it still must be done in the mind.

Mark Twain used this point in his 1905 short story, "The War Prayer." Amid the excitement and banners flying and glorious parades of the community preparing for war, the prayer at church asked God to watch over the noble young soldiers and help them crush the foe. Then an aged and mysterious stranger appeared to address the congregation, and told them what they were actually praying for. "Help us to drown the thunder of guns with the shrieks of their wounded, writhing in pain; help us to lay waste their humble homes with a hurricane of fire; help us to wring the hearts of their unoffending widows with unavailing grief; help us to turn them out roofless with their little children to wander unfriended the wastes of their desolated land in rags and hunger and thirst, sport of the sun-flames of summer and the icy winds of winter, broken in spirit, worn with travail, imploring Thee for the refuge of the grave and denied it -- for our sakes who adore Thee, Lord, blast their hopes, blight their lives, protract their bitter pilgrimages, make heavy their steps, water their way with their tears, stain the white snow with the blood of their wounded feet! We ask it, in the spirit of love." Mark Twain ends this tale with the line showing the need for distancing to keep a war going, that it was believed this man was a lunatic since there was no sense in what he said.[1]

LANGUAGE

The very language commonly used to describe abortion shows a certain amount of distancing. To start with, abortion defenders tend to object to being called "pro-abortion," insisting instead on being called "pro-choice." Yet abortion is the "choice" that they're talking about.

In some cases, it's gotten so that the two words are synonyms. When bemoaning the closing of the last abortion clinic in Chattanooga, one clinic worker fretted that any woman who wished to exercise her "right to choose" would have to travel to another town. But that woman only needed to do so if she chose to get an abortion. Any other choice could still be done right in town. That is, assuming that she's pregnant, and choosing what to do about that fact.

The word "choice" implies that there are several things to choose from, or at least two options. Only one choice and no choice are really the same thing. Any abortion defender who keeps insisting that abortion is necessary and many women have no choice but to abort is not really being "pro-choice." That position would imply that more options ought to be offered to those women.

In any event, modern American thought is such that whenever you say you favor something, choice is implied. Someone who is pro-gun doesn't insist that everyone have a gun, but only that the option to own one remain free. Nor do you hear howls of outrage from them at being called pro-gun. If you mean that you favor something to be mandatory, you better say that outright. Otherwise, voluntary would be assumed. "Pro-choice" is really just a shorthand way of saying that you think something is tolerable. Running away from a term like "pro-abortion" is a form of distancing yourself from the act.

Language describing the act itself is also full of euphemisms. "Terminating a pregnancy" sounds more benign than abortion, as does "removing the products of conception."

ABORTION DISTANCING

The practice of any kind of medicine requires a certain amount of psychological distancing. The nurse that gives shots to children has long practice in turning a deaf ear to the cries of those children. None of us blame her for it. To the contrary, she's doing essential work. She has to become hardened to it to keep her sanity. That the lay person may be repelled by a graphic depiction of an abortion doesn't really mean anything, because a lay person is likely to be repelled by the average appendectomy as well. How many of us turn away when they're showing mere shots on television? A certain amount of distancing is essential to medical work.

The difference here is the fact that people who are already medical service providers still can have reactions to the sight of abortion. In their case, it's not just the graphic nature that comes with any surgery.

Dr. Hern and Nurse Corrigan reported on their own staff. "Reactions to viewing the fetus ranged from 'I haven't looked' to shock, dismay, amazement, disgust, fear, and sadness." Since there's not normally much shock and sadness at the sight of a disembodied appendix, and people with medical training don't generally make a point of avoiding looking at surgical products, this is a clear statement of deliberate distancing.

"We discerned that the following psychological defenses were used by staff members at various times to handle the traumatic impact of the destructive part of the operation: denial, sometimes through literal distance from viewing the procedure itself; projection, as evidenced by concern or anguish for other staff members assisting with or performing the procedure; and intellectualization. Popularly, the latter took the form of discussing the pros and cons of performing the D & E procedure and rationalizing its value."[2]

Former abortion staffperson Joy Davis describes it this way: "Each person that worked there had a different way of dealing with it. Dr. Tucker's assistant would look at the ultrasound the entire time she was in the room, but she would never look down in the pan. She would never look at the tissue being removed. She never wanted to see that. She would just never take her eyes off the screen. And then I had one that would never look at the screen . . . she would never look at the tissue and never look at the screen, she just didn't want to see anything."

Nurse Sallie Tisdale describes a very conscious, deliberate distancing. "Privately, even grudgingly, my colleagues might admit the power of abortion to provoke emotion. But they seem to prefer the broad view and disdain the telescope. Abortion is a matter of choice, privacy, control. Its uncertainty lies in specific cases: retarded women and girls too young to give consent for surgery, women who are ill or hostile or psychotic. Such common dilemmas are met with both compassion and impatience: they slow things down. We are too busy to chew over ethics. One person might discuss certain concerns, behind closed doors, or describe a particularly disturbing dream. But generally there is to be no ambivalence."[3]

The later the pregnancy and the larger the fetus, the harder it becomes to distance. Joy Davis gives another explanation, "When you did a suction procedure, it would come out in pieces, it would go in the jar, it would go in a stocking, it would go in a cup. You didn't actually see the baby. When you did a second and third trimester, if they come out in pieces, we were better. It didn't bother us as bad. If they come out intact, we had a dead baby there. So all of us would cry a lot, and all of us would hurt over that."

Dr. Don Sloan, in a book that vigorously asserts the need for abortion to be available, also shows awareness that this tactic is being used deliberately. "As the pregnancy advances, the idea of abortion becomes more and more repugnant to a lot of people, medical personnel included. Clinicians try to divorce themselves from the method." He goes into graphic detail and describes the need to check the body parts to make sure everything is out. "Want to do abortion? Pay the price. There is an old saying in medicine: If you want to work in the kitchen, you may have to break an egg. The stove gets hot. Prepare to get burned."[4]

COMPARTMENTALIZING

Another technique of distancing is to set the whole procedure up in compartments. A person can participate in one compartment, knowing that the other compartments are there, but ignoring them.

Luhra Tivis reports that Dr. George Tiller of Kansas, who specializes in the late-term abortions, had a similar technique. "One of the ways he runs the clinic is, he's got nursing staff that are nurse's aides and LPNs who work in the exam rooms, where they do the sonograms, and they take blood for the blood work, and then he's got the nurse practitioner, who goes down in the basement with him. And then he's got an RN that stays at the motel overnight with them. He's got people compartmentalized. And then there's the office staff, who never have anything to do with the medical side. I was the only one on the office staff who regularly handled the medical records and typed them up. So he has people compartmentalized, so they don't all have the facts of what's going on. They just see their own little section. That way, he keeps them from getting too upset about what's going on."

Carol Everett reports something similar. "I put (my daughter) Kelly on the telephone in the afternoon. She was thoroughly trained in how to sell an abortion. I paid her well to bring in the clients and our numbers began to rise right away. However, there was one line Kelly would not cross, even for me: she wouldn't go to the back where the killing was done."[5]

Going back to sources from abortion defenders, there is some awareness that putting things in compartments has an effect. One doctor is quoted in the book In Necessity and Sorrow as saying, "I think the nurses have a harder job than we do. They are the ones who see the fetus. I don't see a fetus -- maybe once a week, one -- so that there's a separation of the final product and what I do."[6]

Putting the tasks into different divisions is needed and used, but putting the responsibility into different compartments is also quite necessary as a defense. Nurse Sallie Tisdale explains, "I couldn't be here if I tried to judge each case on its merits; after all, we do over a hundred abortions a week. . . For me, the limit is allowing my clients to carry their own burden, shoulder the responsibility themselves. I shoulder the burden of trying not to judge them."

There are many people involved in the whole process -- counselors, nurses, doctors, social workers, clients, clients' families and partners. The responsibility can always be found to go somewhere else.

IS IT BURNOUT INSTEAD?

A lot of these symptoms could come simply from another well-known type of stress -- burnout. This is, in fact, the term often used by abortion defenders who have noticed the psychological strain that abortion staff are under. It has the strong advantage of associating no moral problem with its cause. It can be a common problem among social workers and childcare-givers, for example.

Repetitious and monotonous work will cause burnout. Long hours and especially hours devoted to other people's problems will cause it.

This would make it logical to believe that burnout is a problem in the abortion field, and there's probably little doubt about this among knowledgeable people on all sides of the issue. Is it the explanation for those things that we have suggested result from stress after trauma?

For the most part, symptoms don't have labels on them to let us know their origin. Besides, the human mind is complicated, and there's no reason why there can't be many origins at the same time. But burnout can't explain the dreams. Dreams are a common symptom of post-traumatic stress, but not a common symptom of exhaustion in helping professions. Dreams have content, and come a lot closer to indicating their origin.

In any event, burnout is a much easier problem to solve, and it certainly can be solved while leaving any service organization intact. The common steps:

1) Reducing the staff-client ratio. That is, give each staff member fewer clients. Don't overload. As one book on this subject, Career Burnout: Causes and Cures, says, "Unfortunately, in most human service organizations, there is a tendency to assign large numbers of clients to each staff member, as a result of cost/benefit calculations or insufficient staffing. We urge organizations to include the cost of burnout in these calculations."[7]

2) Making "Times Out" Available. Give people a chance to withdraw from stressful situations. This is not merely short breaks for lunch or coffee, but time for staff to choose some less stressful work like paperwork, or cleaning while other staff take over the stressful responsibilities. Rotate the work so that people have a chance to get away from work that deals with people's problems. Staff can then still be serving the organization while replenishing themselves. Vacations would also be quite helpful.

3) Limiting hours of stressful work. That is, not limiting the hours of work itself, but limiting the hours of direct contact with clients. People should be aware of the limit to the number of hours anyone can work and still be productive. The negative effect of prolonged contact is increased by the severity of the client's problems.

Additionally, the book suggests increasing organizational flexibility so that the group is taking advantage of individual talents rather than making the individual fit the group, training people on watching out for their stress levels, and improving work conditions would help. The organization should provide employees with some sense of completion, rewards, appreciation, and meaning.

The counselors especially are likely to be victims of burnout. If they are in a compartment away from the actual procedure, then burnout may be more likely than post-traumatic stress. Rotating their work and giving them vacations should be easy enough to do. In some cases, counselors are paid so poorly that there is high turnover in that job. In those places where low qualifications are demanded anyway, a shortage of counselors is not a daunting obstacle that the abortion business faces.

The nurses and doctors are another matter. Rotating their work and giving good vacations is more of a problem, because there's more of a shortage. Reducing the number of clients per person hardly works either. You'd have to have more doctors in order to have enough to actually give attention to each client individually.

But herein lies the big difference with most abortion clinics -- the assembly-line way of doing abortions means that the doctor has remarkably little contact with the patient in the first place. Usually, that doctor only meets the patient on the table with the abortion about to be done. Whether the patient's problem is small or great makes no difference to the doctor, and very little to the nurse. Any sense of overload comes from volumes of business, and perhaps from complications, but not from knowledge of individual problems.

It's certainly comforting to abortion defenders to think that burnout is the only problem, because burnout would be a much easier problem to solve than any post-trauma stress. All that's needed is to get more people involved in the field in order to spread the workload and see that no one gets overloaded.

IS IT FANTASY?

An alternative explanation has been suggested in the scholarly literature to account for the prevalence of the dreams.

Dr. Kibel explains. "One learns about the process of conception and reproduction during preschool years. Whether it is properly explained by parents or haphazardly accumulated in a piece-meal fashion, the child inevitably mixes fact with fantasy. Unable to conceptualize the whole process in sophisticated terms, the child thinks in concrete terms. He visualized an 'egg' in 'the stomach' and believes that a formed baby develops at the outset, growing for nine months into a full size infant."

Dr. Kibel believes this is the way to account for the dreams. "As one grows one's intellectual concept of reproduction matures. But the primitive fantasies remain in the unconscious. This is universal. Therefore, even those who become intellectually committed to abortion have to contend with their own unconscious view of a fetus as a real baby. The emotional trauma observed in these nurses was a result of the psychic conflict between their intellectual commitment, on the one hand and their unconscious views, on the other. Inwardly, they experience themselves as participating in an act of murder."[8]

Is seeing the fetus as a baby just a figment of the imagination? A symbol? An oversimplification? If so, it should be easy enough to deal with.

The best way to counter a fantasy is to show the reality. With the wonders of modern technology, we are now able to show photographs of embryos and fetuses. We're able to do sonograms to show the movement and actuality of them at the very time it's occurring, although in shadowy form. A strong dose of reality should put a fantasy to rest.

Curiously, this technique seems to be counter-productive. Former abortion doctor Joseph Randall, for example, said, "I think the greatest thing that got to us was the ultrasound. At that time, the ultrasound, or the sound wave picture which was moving, called 'real-time ultrasound,' showed the baby on TV. The baby really came alive on TV and was moving. And that picture, that picture of the baby on ultrasound bothered me more than anything else. . . . We lost two nurses. They couldn't take looking at it."[9]

I say with confidence that proposing to show the reality in order to counter this over-simplified fantasy is a practice that abortion staff will object to strenuously. They make a point of screening the information away from clients. A different remedy must be searched for, if the source of the dreams is only childish symbolism.

THE NEED

The most common response to all this is that, no matter how emotionally trying it may be on the practitioners, it is necessary for women to have access to abortion. Therefore, there must be people willing to do them. Women can't safely self-abort. If assistance is required, there must be people to give the assistance. If those people suffer strain because of it, then we need to find interventions that will help them to keep at it.

We need support groups, chances to talk it out, and expressions of appreciation. We need to ease the pain of it, but we need them to tough it out in order to keep abortions available. The scholarly articles that look directly at the emotional response of abortion staff address this directly, and take this approach. As one of them put it, "With the persistent need for abortion services, and thus for willing and confident providers, a deeper understanding of the everyday experience of legal, medicalized abortion work is clearly needed."[10] We need to understand what's going on in the minds of abortion staff in order to know best how to keep them doing the job. Ambivalence needs to be resolved for the noble purpose of helping women.

If the evidence were clear-cut that women were being helped, then that technique should work. Soldiers and others throughout history have been talked into all kinds of trying circumstances on the assurance that many other people benefited from their sacrifice.

Do medical staff in emergency rooms have the same symptoms? They would be dealing with constant trauma, and this is a real concern for all types of emergency workers. But at least they have confidence that people not only benefit from their work, but would suffer greatly without it.

With certainty that a heroic deed is being done, that a necessary service for women is being given, a person can put up with all kinds of things. With a conviction that all the problems are encountered only in a valiant effort to alleviate women's sufferings, verbalizing feelings and a chance to look at the situation and get the priorities straight would help keep emotions under control. That makes the confidence in abortion practice benefiting women a matter of great consequence.

There are problems with this, however. These will be detailed in following chapters.

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