Abortion and Psychosis, some clarification on my part

Below is a direct copy past from an email exchange with a friend.

From: FRIENDTo: KELLY
Subject: RE: Grey Area Sticky Abortion Question
Date: Tue, 27 Aug 2013 20:28:41 +0800

Hey there Kelly,

Good on you for looking out for this girl, I’m sure she appreciates your support and listening ear right now.

 There were many questions that came to me while I was reading this scenario (see my red below). Ultimately, I think this girl needs professional help in two areas. One area is ethical advice, which really ought to go to someone more experienced and qualified. I think bioethics in the Archdiocese is Fr Joe Parkinson’s responsibility? Bronia at the RLO could also advise you on who could help. I’d recommend you get in touch with either of these asap.

 The other area of professional help this girl needs is counselling with regards to coming to terms with her pregnancy. I think she may be thinking that abortion is the least bad of the options she is facing. Pregnancy Assistance might be able to help. Bronia at the RLO might also be able to advise you what to do on this. This girl may also need counselling in general for just being in this complicated situation.

 How does this sit with you?

 I’ll keep this matter in my prayers.

 God bless,

FRIEND

  

I've a friend, whom I met in hospital, who is allergic to oestrogen. Which is unfortunate because she has XX Chromosomes, as I do. Her reaction to estrogen day to day is severe depressive episodes.
We met in hospital because she'd started taking oestrogen based contraception and it had triggered a suicidal psychosis. If her fiance hadn't unexpectedly come home two hours early to find her unusually calm, she would be dead. That was around 2x her normal day-to-day levels.

This friend is now worried that she's pregnant. Oestrogen levels by the end of pregnancy are, apparently, about 1000x that of day-to-day levels. She's extremely resourceful and, during her psychoses, can be very deceptive about how bad things actually are. At anything more that 2x her normal levels of oestrogen, she will find a way to kill herself. If she is pregnant then wont her oestrogen levels have already risen significantly? They go up relatively quick I thought.

The Church teaches, through the principle of double effect, that she can continue and increase treatment for her mental illness during pregnancy, even to the detriment of the child. Sounds like the principle of double effect, but before definitively concluding on this difficult situation I’d get another opinion from someone more experienced in ethics. Has this girl already seen an ethicist at the hospital? She could take some oestrogen-blocking therapy, even if it kills the child.

The child could, however, survive to or past around 20 weeks when both pain and viability-outside-the-womb become a possibility I’m not sure if you could block oestrogen AND get to 20 weeks pregnant – more likely to miscarry early in the pregnancy if the hormones are not at healthy levels? If the child is born, at whatever stage after that, there is a high likelihood of terrible suffering for them. It is unlikely that the child will survive long after birth, if at all. What does she mean by that? Is it a health issue or something else… 

She could, of course, not continue or receive more treatment. That decision would depend on her mental health doctors wouldn’t it? I don’t know a lot about her psychotic-suicidal reaction to oestrogen. What if she just went under 24hr surveillance? Her husband could take leave and care for her?

Meanwhile, even a week of high levels of estrogen - much more for if it's 40 weeks - and this friend is likely dead; almost certainly.

Her question to me: How is killing the embryo, foetus, child slowly, possible over 9 or 10 months, more ethical than a direct abortion? My intention in either case is to stop in estrogen and the result in either case is the thing dying?

I’m not sure how the child could die slowly over 9 or 10 months. If she blocks the oestrogen then I can’t see how she could bring the child to full term.

If the child was born, is this girl thinking of killing the child?

I appreciate her lose-lose situation, but we both know abortion leads to further suffering.

She needs counselling with regard to her difficult situation. Pregnancy Assistance?

My question to you: How should I answer?


EDIT to clarify: I use allergy somewhat allegorically.
She has BPD and has a psychotic-suicidal reaction to estrogen. 
My assumptions, the 'givens,' are based on my close knowledge of her and her condition.
Also, yes, she could continue with BPD therapy; the resulting death or injuries to the child are of the same likelihood.
And, she uses a utilitarian prism for her moral compass:
"Greatest good for the greatest number," while believing that "There is some suffering worse than death."

*   ***   ***   ***   *

From: KELLY
Sent: Tuesday, 27 August 2013 10:30 PM
To: FRIEND
Subject: RE: Grey Area Sticky Abortion Question

Thank you, FRIEND. You raise some great questions.

I've been in contact with both RLO and PA.
I'm hoping to hear back from both tomorrow.

Alas, this woman is suspicious of anyone clearly on either 'side' of the 'abortion fence,' so to speak.
This means that the likelihood of her speaking to someone other than me or Fr Giles (whom she met while we were in hospital) is quite low.

Now, to your questions:

If she is pregnant then wont her oestrogen levels have already risen significantly? They go up relatively quick I thought.Yes. That's why she's worried that she's pregnant. It's been about a week and she's noticed a huge increase in her depression and the first symptoms of psychosis.

Sounds like the principle of double effect, but before definitively concluding on this difficult situation I’d get another opinion from someone more experienced in ethics. Has this girl already seen an ethicist at the hospital?This is part of my reason for contacting RLO.

Although we probably could have asked to have seen an ethicist in hospital, it's not really high on a mental-health patients list-of-professionals-to-see.

  I’m not sure if you could block oestrogen AND get to 20 weeks pregnant – more likely to miscarry early in the pregnancy if the hormones are not at healthy levels?Probably can't.

But she also has the option of continuing her current medication without taking the oestrogen blocker-thing which would severely harm the child.

What does she mean by that? Is it a health issue or something else… Health of the child in regard to the effects of the medication/s she'd be taking during pregnancy.

 That decision would depend on her mental health doctors wouldn’t it? I don’t know a lot about her psychotic-suicidal reaction to oestrogen. What if she just went under 24hr surveillance? Her husband could take leave and care for her?  Well, kind of. Under the Mental Health Act, you have the right to refuse treatment.

The only type of supervision that might work is being in a Locked Ward for the duration of the oestrogen spike.

She'd probably have to be literally tied down: it's the curse of being a high functioning mental health patient that, once you've decided that you need to die, nothing but physically preventing you from acting will stop you. 

 I’m not sure how the child could die slowly over 9 or 10 months. If she blocks the oestrogen then I can’t see how she could bring the child to full term.If the child was born, is this girl thinking of killing the child?I appreciate her lose-lose situation, but we both know abortion leads to further suffering. She needs counselling with regard to her difficult situation. Pregnancy Assistance?

 As above, probably not. 9 months in the womb, maybe a month outside.She has not intention of killing a live-born child.It does, but so does several months of phychosis. 

I will continue trying to chase (up or down) any help I can get for her.

 Thank you, again, for your help and - more especially - for your prayers.

 You remain in my prayers, too.

 -Kelly

Abortion and Psychosis, A question

I've a friend, whom I met in hospital, who is allergic to oestrogen. Which is unfortunate because she has XX Chromosomes, as I do. Her reaction to estrogen day to day is severe depressive episodes.
We met in hospital because she'd started taking oestrogen based contraception and it had triggered a suicidal psychosis. If her fiance hadn't unexpectedly come home two hours early to find her unusually calm, she would be dead. That was around 2x her normal day-to-day levels.

This friend is now worried that she's pregnant. Oestrogen levels by the end of pregnancy are, apparently, about 1000x that of day-to-day levels. She's extremely resourceful and, during her psychoses, can be very deceptive about how bad things actually are. At anything more that 2x her normal levels of oestrogen, she will find a way to kill herself.

The Church teaches, through the principle of double effect, that she can continue and increase treatment for her mental illness during pregnancy, even to the detriment of the child. She could take some oestrogen-blocking therapy, even if it kills the child.
The child could, however, survive to or past around 20 weeks when both pain and viability-outside-the-womb become a possibility. If the child is born, at whatever stage after that, there is a high likelihood of terrible suffering for them. It is unlikely that the child will survive long after birth, if at all.

She could, of course, not continue or receive more treatment.

Meanwhile, even a week of high levels of estrogen - much more for if it's 40 weeks - and this friend is likely dead; almost certainly.

Her question to me: How is killing the embryo, foetus, child slowly, possible over 9 or 10 months, more ethical than a direct abortion? My intention in either case is to stop in estrogen and the result in either case is the thing dying?

My question to you: How should I answer?



EDIT to clarify:
 I use allergy somewhat allegorically.
She has BPD and has a psychotic-suicidal reaction to estrogen. 
My assumptions, the 'givens,' are based on my close knowledge of her and her condition.
Also, yes, she could continue with BPD therapy; the resulting death or injuries to the child are of the same likelihood.
And, she uses a utilitarian prism for her moral compass:
"Greatest good for the greatest number," while believing that "There is some suffering worse than death."

Coping with Suicide: The Scottish Play

In my first post in this series, I said that I wanted to get back to normal as son as possible. This particular hour, these past few days, I am not sure what ‘normal’ is. My normal is doing lots of things so as to avoid discovering, as Henri Nouwen would say, my loneliness.

This past two months has been so slow. It’s been 52 days since Christmas and 73 since dad died. It feels like it was only this week that we had his funeral. It feels like only a few months ago that I saw him, alive and in Canberra.

I miss my dad. It seems like an odd thing for someone who avoided seeing their father to say, I guess; but I really do miss him. I’ve missed him for the past few years. There’s a voice in my head that says I should have made more of an effort to see him, but that voice isn’t reasonable. There is no way that I could have.

I had put in so much work to be able to get to the point where I felt like I could call him, to talk to him, to relate to him as both of us were able and as I needed. It was only the end of November when I had, with the help of my counselor, got to the point where I thought I might be ready to call him again. I’d intended to do so around Christmas time.

But I couldn’t. I can’t.
He’s dead and I can’t.

Normal, in 2012, was trying to figure out how I could best relate to my dad. That’s not really something I can get back to. The same was true in 2011. Trying to figure this out was difficult and often resulted in poor academic and social performances on my part. I cannot yet begin to relate, even to myself, the process that I went through, mentally and spiritually, to come to the point where I felt that I might be able to relate to my dad in a way that befitted both our natural relationship (that of father-daughter) and the history of our relationship, together with our personalities, various addictions and crosses.

I have supped full with horrors.

Yet, having had my fill, I had begun to digest them. Just as I was preparing for the battle of repairing my relationship with him, I received the terrible news, almost word for word:

Your dad, Kelly, is dead.

He should have died here after. There would have been time for such a word.
I could have at least made an attempt, have tried to heal some of those wounds which I had caused him; I could have shown him the wounds he caused me as the beauty that they now display. They are, in a sense, very much like the Grand Canyon (I borrow here, Nouwen’s image.) They are a great schism, a tear in the surface of my self, my identity. Yet, they have become a source of knowledge about myself. I wish I could have shown this to dad while he was alive.

Glenn Morrison, a past lecturer of mine recently reminded me that there is no limit to the pain a person can feel. There is no limit to any person’s woundedness. There is always, however, also an infinite possibility of healing. Often, there are multiple wounds, multiple levels of woundedness; yet, these always hold within themselves the possibility of limitless levels of healings. But they take time.

All my yesterdays may have lighted fools on the way to dusty death. They have very often lit that way for me. However, they do not have to. Seen in the right light, as it were, the path leads away from dusty death; all my yesterdays can be, should be, are filled with hope. “[A]t the very least, hope is moving from despair to something more positive,” Fr Tony Kelly writes in Eschatology and Hope. “Hope in all its registers implies a trustful and confident movement toward the future.” Despair is not too strong of a word. It is often over used to mean ‘great sadness,’ however, it is more than this. It is defined by the lack of hope; dusty death is the image of despair. If death and dust is all that is left for us, then despair is the most reasonable attitude. However, one would not wish to hasten the inevitable.

Glenn challenged me to change my thinking on suicide. “Suicide is actually an act of hope,” he said, “it’s as if they’re looking forward to something beyond this life.” If anyone other than Glenn had said this, I would have rejected it straight away. However, Glenn’s appreciation of the face of the Other (to use his own terms) makes me think there might be truth in what he is saying. I don’t know. I would like to believe that it is so, but I really, really can’t say.

Tomorrow
I will get up and do things like an average person

And Tomorrow
I will spend more time in prayer

And Tomorrow
I will live in the hope my God gives me through His Son.

Thus creeps in this petty pace from day to day to the last syllable of recorded time:
Time continues to move slowly for me, but I must make the best use of it. I must continue to live in His grace, His Love. In this way, though I am a poor player with but an hour upon the stage, I dare not strut because I rely on Him for everything; I need not fret, for I live in the hope of Him providing everything.

Life is often full of sound and fury, it is so important to  take a break from both. It means switching off, as it were, the voices in my head, the anger, the mistrust, the misgivings; it means becoming comfortable with my loneliness. It means sitting and binding my wounds one at a time. Because life does not signify nothing.

“In Him was Life.” “In hoc signo vinces”