A conversation with psychiatrist Mark Xuereb

The abortion debate is still raging, also because it is mentioned in the election manifesto of one of the Parties. During a recent conversation with Dr Mark Xuereb – a psychiatrist specialised in crisis management teams – I asked him about his perspective on the abortion issue. He reminded me that he spoke from 15 years of experience as a psychiatrist, having qualifications in emergency medicine and family medicine, and as the clinical lead of the crisis teams.

He told me that he still had to find one woman who has either had an abortion or thought about one – and her significant others – who hasn’t been psychologically affected in one way or another. This does not mean that they are more necessarily prone to suffer from a mental or a psychological disorder, but it does leave a wound: “There isn’t a day when I don’t think about this baby, there isn’t one day that I don’t think ‘if only’, there isn’t one day when I don’t feel angry at my mother/my father/my boyfriend, who dragged me into doing this abroad” is what the psychiatrist often hears when he and his team has to manage this not infrequent crisis.

Even if there isn’t any overt regret, there is a big risk that this experience is introjected – in a very Freudian sense – and displaced to the unconscious. People may become irritable, get headaches or develop somatic symptoms.

Some are pushed to suicide because of guilt, he claimed, not necessarily religious guilt but the guilt of having harmed somebody, of not having any control, of not having thought clearly at that moment, of “having been coerced or forced by mummy/daddy to save our reputation”. Because, you know, it is considered a very bad thing to have a teenage pregnancy, and “my daughter could lose her career, opportunities, she would remain single, etc, etc”, he said.

On the other hand, continued Dr Xuereb, people who are counselled say: “Thank God I saved the baby!” Again, this is not about guilt trips, and neither is it about judging. It is about reaching out to people in non-dismissive ways. These people are in crisis and go through a lot. They need tonnes of love and support and even forgiveness at times.

At this point I interrupted him, asking him if he accepts that abortion is a right that belongs to women.

It’s about the innate humanity we all have, was his immediate reply. We all have rights, including the unborn child.

Dr Xuereb explained that it is important to empower people, that is to enable people to make “informed decisions”. This is what our Malta Medical Council and similar world establishments insist on. The Royal College of Psychiatrists, the Royal College of Emergency Medicine and even the Malta College of Family Doctors, for instance, have training modules about the ethics of helping people make informed decisions. “Informed” means giving all possible pros and cons, and consequences by trained and up-to-date professionals.

One of the consequences of aborting, he underlined, is in fact a risk of psychological illhealth – in its broadest: depression, anxiety, post-traumatic stress, somatisation, and loss of function in extreme cases. Rarely, women may develop paralysed arms and legs. When you dig deep in their psychoanalytic history you will find that they would have amputated themselves – a symbolic gesture representing aborting the foetus.

The latter are called ‘conversion or medically unexplained symptoms’. Conversion is a psychoanalytic term that refers to when an anxiety-provoking issue, or ‘psychic pain’ you face, is introjected, moved from the conscious to the unconscious, and then it is displaced, manifested through physical symptoms, nervousness, amnesia (loss of memory), fainting, etc.

This is the mind’s way – through the body – of dealing with the experience. Everybody is affected by abortion, no matter what people say. It has nothing to do with whether you are weak or strong: there is always an impact.

Some women or loved ones may also develop psychological issues due to concomitant factors (e.g. psychosocial deprivation, pre-existing mental illness or poverty).

A crisis can be life-long guilt, which again can trigger suicide. And, yes, we have seen in Malta, through Crisis Resolution Malta (that has been around for nine years now), about 13 cases of women who have contemplated or tried to commit suicide because they had had an abortion.

“This guilt is the anguish of having done this to a vulnerable, defenceless person. Obviously we do not want to point fingers, but – going back to the informed decision – an informed decision means that the counselling professional has to know the good and the bad about every procedure, and then you allow the person or couple to make an informed decision.”

Abortion brings in its wake a significant risk factor for mental ill-health, for a crisis.

I had to interject, saying that there are women who claim that it did nothing to them.

“Those women who make such claims, who dismiss it as ‘just the removal of a piece of meat’ could – but I don’t want to generalise – have morals that are of a different standard to those prevalent in society,” was his answer. “They may act on impulse or out of helplessness, or because they don’t have the financial or social means to care for the baby.” He explained that their conscience could be very different to that of society. “There might also be personality issues such as dissocial traits.”

I then asked him about what should be done when finding oneself in such a situation. His eyes lit up. “There are so many couples”, he said, “who cry and beg for children and spend thousands and thousands of euros on IVF. And consider the anguish – you have to pump up this woman with steroids, she may become hairy, plump... we see the anguish in couples every day going through the IVF cycles. Imagine waiting for the moment to see if the embryo is growing or not or seeing your peers having kids and you can’t.

“So, my appeal is: don’t abort! Give your child for adoption! Like this it would be a win-win situation!” Out of something which was apparently a crisis, you create an opportunity. “You make the best out of the situation. I understand that it is easier said than done. But with support, with help, one can overcome the crisis.”

There are anecdotal crisis arguments, he said, such as rape and developmental difficulties in the foetus. These may be valid arguments in terms of the suffering women and their loved ones go through. But again, such scenarios are an opportunity to grow, to learn, to give children out to couples who are desperate to have a child. “I feel passionate about it because the crisis teams and I see this very often. We want babies to live and have a loving family. In essence, do we waste a life and promote psychological ill-health or do we support life and help infertile couples give the child the love and care they deserve?

“By not aborting, you are actually saving a life, empowering yourself and taking the opportunity to manage a crisis successfully.

“However, I must once again stress that we have to help and reach out to these people in crisis in a non-judgmental way. There is help out there. Get it. You will be surprised at what an exhilarating experience saving a life is and how psychologically beneficial it is to everyone when you offer the baby to couples who are yearning to be parents.”

If you are in crisis, get help on the free 24/7 Crisis Line +356 9933 9966, on Facebook (Crisis Resolution Malta), or on crisismalta@gmail.com. There is always hope.