Wade overturned: Processing the decision
On June 24, the Supreme Court, in a five to four vote, overturned the 1973 Roe v. Wade ruling giving women the right to have an abortion. Supreme Court Justice Samuel Alito, who wrote the opinion, determined that abortion is a matter for individual states to decide. The decision prompted protests both in support of the ruling and against. Psychologists in New England are examining the issue and evaluating its immediate and potential effects on patients.
Nicole Issa, Psy.D, director, PVD Psychological Associates in Providence, Rhode Island, has seen first-hand how this decision has negatively impacted her patients, and not just cisgender female clients.
“The decision to overturn Roe v. Wade has triggered intense fear among individuals of all minority groups, BIPOC individuals and also members of the LGBTQIA community who all fear the rolling back of basic human rights’ protections,” she said. “I also work with women struggling with infertility and this decision has led to some uncertainty regarding the future of reproductive medicine. It leads to concern about what more will be changed unexpectedly. “
Issa emphasized that it is essential that psychologists make space to talk about this issue in sessions and not to make assumptions since clients’ concerns may differ from what the therapist may expect or may be farther reaching that the therapist would realize.
“Each individual is impacted differently by events that are scary and signal extreme change and cope differently,” she said.
Issa said she and other psychologists are working to process and practice radical acceptance around the decision. “Radical acceptance is not the same as agreeing with something or resigning oneself to it, but rather, it is about acknowledging reality as it is without energy focusing on fighting reality. This is a skill from dialectical behavior therapy and other third wave CBT.”
According to Issa, everyone – clients and practitioners alike – can benefit from making space to personally process the decision, seeking more information, and finding ways to feel empowered.
“Feeling empowered counteracts the feelings of helplessness that are inherent in these types of major changes,” she said. “Find ways to educate oneself, find ways to get involved with a community and develop a voice.”
The New Hampshire (NH) legislature recently acted to ban abortion services after 24 weeks and is seeking to restrict funding for reproductive healthcare services, according to Brittany St. Jean, Psy.D, president-elect of the New Hampshire Psychological Association (NHPA) and a board of psychology liaison. St. Jean is also clinical manager for White Birch Educational & Psychological Services in Bedford, New Hampshire.
The Supreme Court ruling prompted NHPA to release a statement on July 8 in response. In part, the statement said, “NHPA recognizes the rights of every individual to determine what medical procedures are appropriate for themselves and to consult privately with medical professionals before making such determinations. Abortion is a medical procedure and the decision to have an abortion falls to the pregnant person, not to state or federal legislatures. The Supreme Court of this nation has drawn a distinction around childbearing people in this country and stated clearly that they are to be viewed as worthy of fewer protections. NPHA summarily rejects this assertion.”
Although St. Jean cannot speak for all New Hampshire psychologists who identify as a woman, she indicated that many are trying to figure out how to protect and advocate for human rights, while also practicing self-care as they navigate these times.
St. Jean predicted that psychologists will hear more stories of trauma and ethical dilemmas that both female and male practitioners will face.
“We are responsible for educating ourselves and better understanding our patients’ concerns and needs, while following our ethical principles and codes. Because NH is a member of PSYPACT, clients seeking our services may come from other states where the laws are different than New Hampshire’s,” she said. “Bodily autonomy of a woman as a basic human right has now legally become an ethical interpretation in conflict with some states. We must collaborate and compile resources as we all comprehend the relevance of this recent change in the laws.”
Psychologists must also continue advocating for patients who are too afraid to speak up for their civil rights in the current climate, St. Jean said.
Additionally, practitioners need to process how the scope of this decision impacts practitioners individually and professionally. “For me the APA leadership, and the NHPA have been resources that provide empowerment and connectedness for psychologists navigating their professional and personal emotions and experiences,” she noted. “Engaging in events such as an APA town hall ZOOM meeting or using the resources provided by associations like the NHPA have helped handle this topic in practice with patients.”
Beth Taylor, MS, owner Green Mountain Psychology PLLC in Brandon, Vermont, reported that she does not foresee challenges for women seeking an abortion in her state, although she does detect a growing sense of doom in her clients, particularly among the youth.
The rollback of Roe v. Wade is increasing stress, anxiety, and tension in this population, which cannot vote yet and has no control over the circumstances, she said.
Taylor added that those who are LGBTQ+, trans-persons, impoverished women and women of color are concerned about the decision, fearing a rollback of other hard-won rights. She wondered how much the decision had to do with misogyny.
While not all women will choose to have an abortion, they lament the right to make the choice, Taylor said. “Women’s rights are the issue. And women who have had an abortion may not speak out. They don’t want backlash.”
Elizabeth Rathbun, LPC, PsyD, assistant clinical professor in the department of psychiatry, Yale School of Medicine indicated that a majority of her clients booked appointments immediately after the ruling to process the decision.
“They felt powerless, that autonomy had been taken away. They felt anger, confusion and asked what’s next?” Rathbun said.
Furthermore, recent times have been rife with chaos because of COVID and the political climate. Women have been devastated, even if they have not been directly affected.
Rathbun, who also has a private practice in New Haven, Conn., noted, “Even some male and transgender clients feel it’s a humanity issue. [Males] feel the decision is reflective of a political system taking more control.”
Research tells us that inaccessibility to abortion is a threat to mental health, especially for the poor, racial minorities, and other under-served communities, Rathbun said. “I have seen research that when a woman is not allowed an abortion, she is more likely to feel more anxiety, less life satisfaction, low self-esteem when forced to have a baby,” she said. “There is also more interpersonal violence. For those with limited socioeconomic resources, this contributes to existing issues. Down the line, problems arise. We have enough crises already.”
Denying the right to abortion can also affect generational cycles of abuse and poverty, according to St. Jean. “More women will be impacted by abuse, and more children will be born into violent households. This will also perpetuate addiction, suicide, and additional mental health concerns.”
St. Jean noted that legislative and social trends are deeply concerning. Many patients are experiencing increased levels of distress in different forms over concern that this SCOTUS decision opens the door to curtailing other rights, such as same-sex marriage and obtaining contraception legally, she added.
“This is alarming, knowing that denial of these rights can negatively impact mental health.”
She pointed out that there is a significant ethical concern not only about bodily autonomy for people with reproductive capacity but for all, including groups who have fought for equal rights for LGBTQ+ people and those who may face dire consequences, such as BIPOC and those with low socioeconomic status.
According to Rathbun, society is moving backwards. “Bodily autonomy is taken away while technology is moving forward. This feels confusing and threatening.”