An illustration of avoiding comes from the ObGyn News. "Besides its use in ascertaining fetal age, sonography can be very helpful during actual abortion procedures, both as a teaching tool and as a means of enhancing safety. But sonography in connection with induced abortion may have psychological hazards. Seeing a blown-up, moving image of the embryo she is carrying can be distressing to a woman who is about to undergo an abortion, Dr. Dorfman noted." She recommends turning the screen away from the patient. As for staff, they need to find other ways to avoid the problem. "Staff members also may be affected by sonographic images and may need opportunities for venting their feelings and reconfirming their priorities, Dr. Dorfman said."[1]

The American Medical News article gives another example. "This may sound like repression: However, it does work for me,' said a counselor from Kansas. 'When I find myself identifying with the fetus, and I think the larger it gets, that's normal . . . then I think it's OK to consciously decide and remind ourselves to identify with the woman. The external criteria of viability really isn't what it's about. It's an unwanted pregnancy and that's the bottom line.'"[2]

Nurse Sallie Tisdale comments on this attitude. "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]

Struggles on this point will generally not be public, but exceptions arise. The American Medical News article has several instances. A Seattle nurse talked about watching her first late-term abortion, done by dilation and evacuation method.

"I was watching the doctor struggle with the cannula, trying to pull it out," she said. "I didn't understand what the resistance was all about. And I was very alarmed and all of the sudden the doctor pulled the cannula out and there, as I was at the woman's side, I looked down at the cannula and there was a foot sticking out. I will never forget the feeling I had in my chest as the doctor pulled that cannula out. And it almost took the breath out of me. Because the reality of this was very hard for me." The nurse said it took weeks for her to process the issue. "This sounds terribly cavalier, I suppose, but within about a month, like everything else we do after a while, it just becomes pretty routine and it has never bothered me since then."[4]

This theme comes up in the reflection of those who are no longer in the abortion business as well. When Bernard Nathanson was explaining why he changed his mind, the most important part was that, "I opened myself up to the data. When one is caught up in revolutionary fervor, one simply does not want to hear the other side and filters out evidence without realizing it."[5]

This doesn't just have to do with the unpleasantness of the work. If so, all this would just be a distancing strategy to avoid that kind of stress. Since one of the ideas of the abortion business is that it is to serve women and give them choices, the question would naturally arise as to what they did when a pregnant woman chose to do something else. Some clinics just send them away, and others send them to agencies set up to help women through troublesome pregnancies. This offering of options is done by the people most frequently called "anti-choice." Various local groups who set up local volunteer centers, and national groups like Birthright, Care Net, and Catholic organizations are also made up of abortion opponents.

Joy Davis's clinic did this. She was asked about this in a tape-recorded interview. She said, "We sent them to the prolifers, we knew they were going to take care of them." The next question was if it ever bothered any of them to think that they weren't the ones actually helping these women. "No. We helped them -- we sent them to where they could get help." The interviewer clarified the question by asking if it ever occurred to them that they weren't helping women, but it was the prolifers that were? "When I was active in the abortion clinics, I don't know that any of us had any feelings about anything. We didn't really have a lot of feelings about the women, about the moral issues."

Kate Michelman, head of the National Abortion and Reproductive Rights Action League, made a statement to the Philadelphia Inquirer. "We think abortion is a bad thing. No woman wants to have an abortion." After publication in that paper, Michelman denied that she said it, but it was on tape. NARAL issued a denial saying, "Michelman has never said -- and would never say -- that 'abortion is a bad thing.'" Later she told the Washington Post that she would, "never, never, never, never, never mean to say such a thing."

It's interesting that a denial was seen as necessary. Michelman's original statement would probably be agreed to by most people that designate themselves pro-choice. People in general prefer not to need any kind of medical procedure. No one would conclude that the procedure should accordingly be unavailable. That explanation would satisfy most reasonable people, but instead the response was an emphatic denial that a tape-recorded statement was even made.


If one of the elements that is contradictory can be made unimportant, then that can take care of any tension that might otherwise arise.

An example would be the view that current numbers of population are too high, or that the current numbers of "undesirable" people are too high. There are those who are obsessed with the idea of overpopulation. Some believe in eugenics, the philosophy that certain people are burdens on society and accordingly their births should be prevented.

Many of those who believe overpopulation is the cause of most of the problems the human race now faces, also believe draconian measures may be called for. A little covering up is also justified. Limiting births becomes far more important than concerns like the safety of women, and the prevention of births is a goal worthy of the occasional dead woman. If people are less likely to be convinced to have abortions because they fear unsafe consequences, then they need to be convinced that they are safe. That doesn't make it necessary that they actually are safe, only that people think that they are. Choice, consciousness-raising, safety and respect for women all become irrelevant, which means that their conflict with a position in favor of pushing abortion would not bring on the tension of contradictions.


The fact that some people may wish to screen out unpleasant facts or ideas that challenge their previous beliefs is hardly surprising. Very few would find this a mystery. The reason that cognitive dissonance has been widely accepted as an explanation for what would otherwise be bewildering is that it explains the irrational behavior of dogmatically insisting on something that's been proven wrong, and taking actions to reinforce the belief by getting other people to share it. This behavior can easily be counter-productive, but is done with zeal anyway. This makes sense when jettisoning any particular belief would be too painful because too much has been invested in the rightness of it.

The dynamics of slavery is an example of how this works in a social movement. When slavery started to be criticized by a handful of people, and then by larger numbers, the slaveholders could have responded by saying that was their problem and leaving it alone. But instead, they insisted on the passage of the Fugitive Slave Act of 1850, which aggressively expanded the frontiers of the slave system. It meant that Northerners now had the spectacle of manacled blacks being led back into bondage, making slavery harder to ignore. That was more effective than mere words from the abolitionists.

The slaveholders insisted on expanding the system westward into the new territories. Their biggest triumph, and their biggest downfall, was the decision of Dred Scott v. Sandford, in which a slaveholding majority of the Supreme Court gave slaveholders everything they wanted. This outraged many people.

A lot of people who would have been happy to just leave the whole thing alone were pushed into action. The slave system was expanded. The distinction between slave states and free states was unclear when the Court insisted that the law could not treat blacks as people and that slaves, being property, could be brought up to the Northern states. Indifference wasn't possible anymore. The dynamics of the slaveholders' drive had generated an opposition.

John Noonan looked at this point at length. "Why did the slaveholders act as if driven by the Furies to their own destruction? . . . Why did they take such risks, why did they persist beyond prudent calculation? The answer must be that in a moral question of this kind, turning on basic concepts of humanity, you cannot be content that your critics are feeble and ineffective, you cannot be content with their practical tolerance of your activities. You want, in a sense you need, actual acceptance, open approval. If you cannot convert your critics by argument, at least by law you can make them recognize that your course is the course of the country."[6]

Abraham Lincoln recognized this in his famous speech at Cooper Institute in 1860. He was asked what would convince the slaveholders that his party had no designs on their property or the Constitution. He replied, "This, and this only: Cease to call slavery wrong, and join them in calling it right. And this must be done thoroughly -- done in acts as well as words. Silence will not be tolerated -- we must place ourselves avowedly with them."[7]

The sweeping nature of Roe v. Wade has been likened to the Dred Scott case before. A gradual approach of opening up abortion was working, and may have continued to work. Roe brought a backlash which is still going strong over two and a half decades later.

Some of the proposals that have shown that mere tolerance was not enough, but active cooperation was demanded, include an attack on "conscience clauses" that say doctors are not obligated to perform abortions. Harriet Pilpel, an attorney with Planned Parenthood, has said that doctors with religious scruples against abortion are practicing "sectarian medicine" and could be sued for malpractice.[8]

Another example is an insistence that taxpayer funding of abortion is not optional. While insisting that the state was to take no sides on the issue of whether the unborn have any value, taxes are still to be used for those who think them disposable.

There was an initially successful attack on "informed consent" or "right-to-know" legislation, giving a woman information that might be pertinent in her decision-making on abortion. In the Thornburgh decision of 1987, Justice Blackmun said that the information was not "always relevant to a woman's decision, and may serve only to confuse her, and heighten her anxiety."[9] Legally protecting people from getting information that might not be relevant is unprecedented. This established a constitutional right to ignorance for women. This case was explicitly overturned in the Casey decision of 1992.

In the case of Hope v. Perales in New York state, plaintiffs wanted the Court to add abortion to the Prenatal Care Assistance Program, or else eliminate the program. The contention was that it discriminates and takes away the constitutional rights of the women in the program if they don't have abortion. New York already funded abortions for the poor. In 1992, New York covered about 50,000 abortions at taxpayer cost of $20.5 million. This suit was not a way of getting funding that wasn't there otherwise. Arguing that a program that supplies prenatal care shouldn't even exist if it doesn't include abortion insists on everyone's active participation in abortion. The case ultimately lost.

The case of Roe v. Wade itself is an example. The justices found that the abortion laws of all fifty states were unconstitutional. Normally, the laws of a few states on some subject may be unconstitutional, but not all of them. In addition, the premise upon which they were so declared had never been offered by any judges before. All the states were scolded for the unconstitutionality of their laws without any warning that such a scolding was coming.


The basic idea of saying that, no matter what the contradictions, it's someone else's fault, would have to come naturally. Since greater responsibility is one of the factors in increasing the discomfort of cognitive dissonance, the mental exercise of disclaiming responsibility would be an elementary strategy.

Just as Posttraumatic Stress Disorder may make people want to put the responsibility in a different compartment of their minds, the stress of cognitive dissonance would make people want to insist that those who are supposed to benefit are the ones who take the responsibility for it if something goes wrong.

Charlotte Taft, Dallas abortion clinic director, made this offhand remark in a telephone conversation.: "For many women nowadays, they're angry that they had a choice. It's too bizarre, but it's like, if you weren't here, I wouldn't have had to make this choice. And so, instead of feeling gratitude toward the physician and a sense of [being helped] a lot of times that woman [is] in her own pain or anger, and the doctor may not get a lot of that [gratitude] these days. The woman herself may be anti-abortion.

"We're working real hard at this clinic to assist women in moving from a place of experiencing themselves as victim of their decision, or of their boyfriend, to moving to a place where they see this differently . . . Victims are too annoying, you know. They don't invite your participation."

The pro-life philosophy finds no riddle in the idea that women would be angry at the presence of the clinic giving them a "choice." That clinic gives them all kinds of pressures that actually take away choices. Because that clinic is there, other people withdraw necessary support that the woman is entitled to. The father may refuse to pay child support, the employer may balk at maternity leave. Because the clinic is there, other people make remarks and even threats about that pregnancy that wouldn't make any sense if it weren't there. There is even the strength of a medical model that says that when you feel sick, as with morning sickness, you go to the doctor and get it taken care of. The way our society is set up, the temptation is formidable. Yes, people do resent having temptations put in their way, temptations to actions that they know can come back to haunt them.

This is not to argue that the women are not responsible for choosing to have abortions. But the people who pressure them into it, and the clinics that do sales on it, are also accountable. When "choice" is used as a way of saying the responsibility belongs solely to the client and not to the seller, then its meaning is different. It becomes a mental ploy.


In extreme cases, the proselytizing on behalf of abortion can take on the form of outright religious terms. This is not common, but it illustrates the point to know that it happens and has been published. The New Age Journal carried an article entitled "Moon Times: A Meditation for Spiritual Healing from Abortion". It says, "I approach this abortion as a sacred act of compassion and letting go. Many mothers before me, in grief and with wisdom, have made holy this sacrifice."[10]

The same article says, "It was in the moon lodge that I was finally given, at the age of thirty-eight, the kind of initiation into feminine mysteries that centuries ago were given to all young females, and I discovered there a new way of making sacred the sacrifice of abortion. . . . For those sisters who have chosen the 'sacrament' of abortion, we will make sacred the sacrifice. For those who are suffering from unhealed abortions, we will witness and comfort and confirm. . . perhaps we'll ritualize the RU-486 pill with prayers to Artemis or the Divine Mother, she who gives and takes life."[11]

The author of this article mentions that she is greatly influenced by Ginette Paris, author of the books The Sacrament of Abortion and Pagan Meditations. Paris's basic contention is that the goddess Artemis provides a role model for women seeking abortion. Artemis is well-known for demanding human sacrifice.

Paris reasons that abortion frees women to be equal to men. Without abortion, only men have the power to kill. With abortion, women have equal powers of destruction. "Men have the right to kill and destroy, and when the massacre is called a war they are paid to do it and honored for their actions. War is sanctified, even blessed by our religious leaders. But let a woman decide to abort a fetus. . . and people are shocked. What's really shocking is that a woman has the power to make a moral judgment that involves a choice of life or death. That power has been reserved for men . . . the ancient Goddess Artemis invites us to imagine a new allocation of life and death powers between men and women, an allocation that allows men to appreciate the cost of a life and women to make decisions based on their mother-knowledge."[12]

In short, instead of achieving equality by having men rise to a higher plane of peacefulness, she advocates women lowering themselves. Instead of making war less sacred, she proposes expanding the sacredness of violence. She rightly decries a double standard, but chooses to eliminate it by embracing the violent standard of men rather than proposing a nonviolent standard for everyone.

She makes statements such as, "I believe it is time to sacrifice to Artemis the fetus to which we are not prepared to give the best."[13] She makes it clear that she is not speaking metaphorically.


Another defense mechanism to having ideas that don't fit together is simply to not be bothered by the problem. While most people find a tension in the disharmony of their thinking, apparently not everyone does. We said before that "importance" was one of the factors that can make the discomfort of cognitive dissonance greater. Rather than making an attempt at reconciling conflicting ideas, some choose to deal with the problem by reducing the importance of the conflict itself.

Machiavellianism is a kind of personality which, for purposes of study, can be defined by scores on what's called the "Mach Scales." This is a series of statements which come from the Machiavellian philosophy. They are drawn from The Prince and The Discourses, works written by the 16th century Italian Niccolo Machiavelli. The Mach scales make a difference between High and Low Machiavellian people based on how much they endorse his rules of conduct. In effect, the scales distinguish between those with relative standards, such as never tell anyone the real reason for your actions unless it is useful to do so, and people with absolute standards, like those who believe honesty is the best policy in all cases.

The Machiavellian philosophy is pragmatic. It advocates behavior inconsistent with private belief when that behavior works. Telling people what they want to hear would be one example.

It could be expected that those with high scores on the Mach scales may, in general. be better able to tolerate dissonance caused by a discrepancy between behavior and attitudes. As Philip Zimbardo, who did some tentative work on verifying this, said, "A characteristic that seems to underlie all these behaviors is the maintenance of emotional distance. High Machs do not get emotionally involved in others' behavior, or even in their own behavior. This emotional detachment or coolness leaves them free to concentrate on the cognitive, rational implications of the situation. . . Perhaps consistency has value for such subjects only to the extent that it has implications for manipulation (exploitation of others) and not for any . . . function it may normally serve for other people. . . . Another way of looking at dissonance in High Machs is to consider the possibility that they do not experience dissonance because of the dominant tactic in Machiavellian strategy that involves "conning" and deceiving others . . . Such an approach involves the controlled use of discrepancy and inconsistency in the service of their own gratification."[14]

The clinic directors who agreed to limit their ads to half a page in the Birmingham Yellow Pages, yet double-crossed the others and put in full-page ads, would be an example of this. They wouldn't be able to reason that they didn't lie, and they were lying to other people like themselves. They simply knew that they wanted to make more money, and they took actions in accord with that principle. All other principles were not taken into account, and therefore the conflict may have brought on little tension.


A smoker in the 1960s who first heard of the cancer effects from the surgeon general could deal with it by ignoring it, demanding more evidence, or coming out in favor of smoker's rights. It could also be dealt with by quitting smoking. This would resolve the conflict and relieve the stress caused by it. However, it could also be dealt with by a smoker making a conscious decision that smoking was important enough to be worth the risk.

The method of quitting the abortion business is available to some. Staff members who never had a real commitment to abortion, or only a mild one, and who have been there a short time, can easily quit. They also have more leeway to decide that they've changed their minds on the acceptability of abortion by virtue of having gotten more information on it than they had before. The doctor who only moonlights there can do the same, or can simply decide that he or she has other things to do. Short-term staff have little control over the situation, and therefore little responsibility. They can escape guilty feelings more readily, or can at least seek relief from the strain of cognitive dissonance more easily.

But the doctor and staff members who've been in it awhile have greater psychological difficulty in using these techniques. Since they have made their decision after having seen all the choices, this option is less open to them.

The other technique of adjusting to the conflict is to live with both contradictory things recognized at the same time, like the smoker who decides to take the risk. In the abortion context, this is normally called "ambivalence." Those in the belligerent mode of dealing with cognitive dissonance normally deny any ambivalence, but expressions of inner conflicts are not uncommon, as shown in "Abortion Providers Share Inner Conflicts," in the American Medical News.

"'Ambivalence is not a dirty word,' says Terry Beresford, who trains abortion counselors for Planned Parenthood and other groups. 'We're not ambivalent about women's right to choose abortion. And we are not ambivalent about the need for safe, legal abortion. But abortion is not a simple-minded decision. It is a complex one. Everybody has mixed feelings.'"[15]

In a survey of abortion providers done by Project Choice, almost 38 percent responded yes when asked if any aspect of the abortion procedure ever caused them moral concern. This was a surprise to the researchers, who expected that such an admission would be rare, at least in the form of a clear-cut answer on a form sent in to strangers.

Books that take this approach include The Ambivalence of Abortion and In Necessity and Sorrow: Life and Death in an Abortion Hospital. The latter book was a series of interviews written by a Ph.D. in psychology, Magda Denes, shortly after her own abortion. She describes herself as "a pro-abortionist with a bad secular conscience."

For example, Dr. Charles Bender, age 37, (a pseudonym), said at one point in his interview, "I have no conscious conflict over killing a fetus." Then, at the end, he says, "I don't feel that any girl goes into Maxwell Plum's just because she wants to have sexual relations. She's going in there because she's seeking a relationship. We are not that liberated. The relationship is being sought, I feel, sadly, through a sexual contact. I think this has to reduce one's self-image, one's self-respect. It takes, I feel, a significant and meaningful aspect of one's life out of context. I think we're certainly living in a time of decreased human respect, of decreased human relationships, and of decreased sensitivity to killing off things." Dr. Denes herself points out the contradiction between these two statements, and her impression that he is unaware of it.[16]

Dr. Don Sloan started doing abortions when they were illegal and has been doing them ever since. He clearly grapples with this in his book.

That leaves the antichoice feminists -- the "feminists for life," as if other feminists weren't. They make some interesting points, though. Their position is that choice and abortion are in reality sexist, because they absolve men of responsibility for the products of their philandering. As long as society remains permissive, boys will be boys. The only way to get them to grow up is to remove the 'easy out,' and make them responsible for the pregnancies they help to create. Then and only then will there be equality. Antichoice feminism has a pretty impressive list of founding mothers speaking for it. Activist Elizabeth Cady Stanton said in 1878 that abortion treats women like chattel or property. In 1869 the suffragist Susan B. Anthony urged prevention and not "execution." The woman, she said, was guilty if she committed the deed, but "thrice guilty is he who drives the woman into the crime." And in 1875 Victoria Woodhull, the first woman to run for president . . . said, 'every woman knows that if she were free, she would never . . . think of murdering [a child] before its birth.' Woodhull, a true feminist, knew even as she argued against abortion that women were not free. But it's a chicken-and-egg argument. Without freedom of choice, how can women be free?"[17]

Many abortion defenders ignore the early and modern anti-abortion feminists. Sloan strengthens his case by not screening it out altogether. Yet in the same chapter, he cites cases where a woman doesn't use birth control or continues having one child after another because that's what her male partner wants. As he puts it, "It's never simple. But when it comes to a choice between the man and the pregnancy, many women yield. They do what the man wants."[18] He further comments, "It can't be pure coincidence that the three surgical procedures most frequently performed on the female patient are hysterectomy, abortion and cesarean section -- all of them assaults on the uterus, the maternal end organ. Somehow, it seems that the manipulation, removal and 'cleaning' procedures that the womb is subject to arise from an attitude that it's expendable -- what one feminist friend of mine calls the 'We Don't Have It You Don't Need It" school of medicine.' . . . Abortion is, by almost any standards, a violent act. All surgery violates the integrity of the body; purely elective surgery seems particularly gratuitous. On the positive side, it gives women the means to decide their own fates and control their own reproductive lives. But it also puts more of the weight on women's shoulders, allowing men and society in general to literally scrape and vacuum away their responsibilities."[19]

Articles in periodicals show this pattern of ambivalence as well. The American Medical News broaches this topic. "Oddly enough, many of the issues that disturb abortion foes also seem to trouble providers. Ultimately, however, they have different moral balance sheets. For providers, the bottom line is the woman's life and the particular circumstances that drive her to choose abortion. For opponents, the bottom line is what actually happens during an abortion: a human life is taken."

The problem is that all the information in the last chapter shows that the bottom line of women's welfare doesn't balance the balance sheet. It actually provides further dissonant information.

The recognition of ambivalence could, therefore, be a partial step toward reaching that reality. When deliberately ignoring and aggressively beating down the opposition are no longer available tools, a more persuasive case is made, because those methods are not really highly persuasive. Yet the reason they're used in the first place is because the need felt for them is so strong.

Naomi Wolf suggests a need to face clearly that a death occurs during an abortion, saying that pro-choice rhetoric would be more honest and therefore more effective. "Clinging to a rhetoric about abortion in which there is no life and no death, we entangle our beliefs in a series of self-delusions, fibs and evasions. And we risk becoming precisely what our critics charge us with being: callous, selfish, and casually destructive." She applies this idea to helping abortion staff. "Pro-choicers, too, scapegoat the doctors and clinic workers. By resisting a moral framework in which to view abortion we who are pro-abortion-rights leave the doctors in the frontlines, with blood on their hands, the blood of the repeat abortions -- at least 43 percent of the total; the suburban summer country-club rite-of-passage abortions; the 'I don't know what came over me, it was such good Chardonnay' abortions; as well as the blood of the desperate and the unpreventable and accidental and the medically necessary and the violently conceived abortions. This is blood that the doctors and clinic workers often see clearly, and that they heroically rinse and cause to flow and rinse again. And they take all our sins, the pro-choice as well as the pro-life among us, upon themselves.

"And we who are pro-choice compound their isolation by declaring that that blood is not there."[20]

By no longer screening out or denying, and by no longer using belligerency as a defense mechanism, the case for "choice" is strengthened yet weakened at the same time. It's strengthened by helping to adjust to the conflicting information without resort to unhealthy ways of avoiding reality. It's weakened because those methods are no longer available to help avoid the reality.

This method of trying to adjust to the tension leaves people miserable, to the point of almost being frantic. Sallie Tisdale ends her article saying that, "Abortion . . . requires a willingness to live with conflict, fearlessness, and grief. As I close the freezer door, I imagine a world where this won't be necessary, and then return to the world where it is."[21]

Dr. Sloan echoes the sentiment. "I don't think there's anyone doing abortions who hasn't wished at some point that the situations creating the demand for them wouldn't just go away. That includes me. There have been plenty of times when I've wanted to say, 'Enough! This is more human tragedy than I want to deal with.' But that would require a different world."[22]

How long does it take to get from a strong desire for abortion to be unnecessary to a position that abortion is, in fact, unacceptable?

Adjusting is not resolving. The tension remains.

If cognitive dissonance were the only tension, that would be bad enough. But if the perception that a heroic deed is being done in the service of women is necessary to the resolution of Posttraumatic Stress Disorder, then that ambivalence will rob the abortion worker of what is needed most. Instead of having misery that's swept under the rug, the misery is out in the open.

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