Curran, Richard F.

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The Linacre QuarterlyVolume 33 | Number 4 Article 14November 1966The Quiet MurderRichard F. CurranFollow this and additional works at: http://epublications.marquette.edu/lnqRecommended CitationCurran, Richard F. (1966) "The Quiet Murder," The Linacre Quarterly: Vol. 33 : No. 4 , Article 14.Available at: http://epublications.marquette.edu/lnq/vol33/iss4/14The Quiet Murder RICHARD F. CURRAN, M.D. There is no cry of protest sent from the victim. It is done where no eye can witness. There is no grave with marker to identify orincriminate. This quiet murder isabortion. But it is not completelyquiet. Someone hears a noise. Ishould like to discuss the someoneand the noise. The problem of abortion is of special concern to doctors. For, al­though the legal and moral argu­ments grow daily in complexity and volume we, as physicians, are still left to face, in our service to the patient, our own personal argument.As Catholic physicians our medicalconvictions are shaped by our moralones on this subject. We are, there­fore, quite often reproached for alack of objectivity on such a timelytopic as abortion. It is my hope in this article topresent some considerations basedon clinical experience. I believethese observations to be objective.No attempt will be made to enterthe legal or moral arena. These arethe thoughts of a Catholic whois a psychiatrist, not a "Catholicpsychiatrist." It is the workings of the human mind that we shall examine. It is the mind of one who is involved in a death. Such a mind is opened to a psychiatrist for examination and treatment when a pain becomes intolerable. Let us consider the process of the pain, a mental pain as it develops before, during and 344 after the fact of murder. What is the motive? T 2re is no simple answer. To uncle cand the possibilities we might le psychological soil into seed of pregnancy is sowall soil it can nourish or : latter possibility is at firs· epugnantand contradictory to ou. rnditionalviews of motherhood. 1 t it is es­sential to understand tr there are forces at work in the mind of every expec which tend on the c complete the biologic;pregnancy and on thr � at the �1ich the As with ect. This :1conscious 1t mother hand to process of ,ther hand to expel and be rid c . he unseen life within a life. Th.1c ,leasures of expectancy with the s, . .time magicof life-building and Ji! .;iving maybe nudged by the ap· ,hension ofcarriage and delivery ith the in­evitable discomfort ar pain. Psychological attitu. s affect and are affected by biolo� . al attitudes toward the pregnanc7 The early experience with nausr·:1, vomiting, anorexia and other g&:, ro-intestinal upsets are strong rem: .1ders of the altered physiology Df the host organism. Hormonal adjustment s  trigger temporary changes in other systems such as the cardio-vascular, respiratory and genito-urinary sys­tems. These processes may precede or proceed from powerful mental forces that are set in motion and tend to use the rejecting and reten­tive forces of the body as a language of ambivalence. Never is pregnancy accepted, biologically or psycholog1-L1NACRE QUARTERLY cally, with complete passivity. The psychiatrist becomes more aware of the interaction of the psyche and soma from the pregnant woman than from any other patient. Let us return to the psychologicalproblems. The normal instincts toward motherhood represent the positive wish to participate in theprocess of life and to offer oneself to this natural aim completely. Yet, as already noted, there may exist strong unconscious counter-wishes which spring less from the dread of biological demands than from deep seated attitudes toward impregna­tion and child-bearing. These atti­tudes · are often the remnants of childhood wishes and fantasies. But,pregnancy is not a fantasy. It is areal event and demands a real and substantial strength of ego. Other­wise, neurotic and even psychotic ental defenses i:ire employed. Fore these attitudes represent theergence of 1.mresolved hostility d aggression toward figures ine's own life. interesting research has done concerning such attitudes. group of investigators studied enty-five women with histories habitual abortion (more than miscarriages) .1 These women e found to have no related or­ic deficit such as hormonal im-ance or structural deformities. e results of the study indicated ificant differences in the emo­al makeup of this group and ntrol group of so-called normal en with several successful preg-cies. They found that the worn­of the group under study were ly compliant and dependent, MBER, 1966 usually to a m0fw- or mother fig­ure. This compliance served topresent a socially ac,·eptable facade.Behind the facaci<' was a goodlyamount of hostility <tlld resentment.The tensions and frustrations whichresulted from their constant effortsto please would only periodicallyerupt. But for fear of losing what­ever dependent gratification wasavailable these emotions were usu­ally stifled. It was felt that a psycho-physiologic expulsive act wasthe result when these women wereconfronted with strong ambivalentfeelings toward the pregnancy. TheRorschach responses were repletewith ideas of competition, fightingand depreciation of human figures.There were an unusuaf number ofresponses concerned with weapons,fires, claws, blood, explosion, in­complete figures and violation ofliving tissue. The investigators con­cluded that there was certainly a significant relationship between theemotional structure of the studiedgroup and their repeated unex­plained miscarriages. From this and similar studies one gains respect for the strange body compliance, as mental processes. proceed to exert powerful directive forces. With this knowledge it be­comes more understandable from whence the idea to abort emerges. The feelings behind a self-induced or assisted abortion are less mysteri­ous. And one becomes more skepti­cal of the rationale for abortion. For behind every legitimate reason is the unreasonable potential for murde{. For many the unconscious becomes conscious. The outer garment of logic, utility and practicability hides 345 an ugly impube. And no one isabove such an impulse.A chilling picture now comes tomind. It is a picture I have cometo recognize when treating somepatients with histories of abortion.The patient describes the predica­ment of an illegitimate or unwantedpregnancy, but with emphasis onthe advice and help offered by thepatient's mother. Usually there isundisguised bitterness as the patientdetails the coaxing, suggestion anddirection given by her mother to­wards ending the existence of theunwanted child. The patient ulti­mately reveals a deep resentmentfor such motherly advice. There areopen and veiled references to moth­er's destructive potential. These emerge partly from the need to shift blame and partly as an unwillingexpression of their own deep dis­appointment in an idealized person.They are sad and hurt.The potential for murder is uni­versal as we have seen it developat the unconscious level. And theonset of pregnancy presents thepsyche of some women with a pos­sible victim. The. unique privilegeof motherhood can create an im­mense burden to the disturbed or confused mind. Let us follow thethought to the deed.Let us not limit our thoughts tothe so-called illegal abortion. Forwe must keep in mind that whetherthe termination of pregnancy be atthe hands of a surgical team withhospital approval or by self-admin­istered tools and potions, or byclumsy, unsterile professional abor­tionists, the· psychological .burden of 346 guilt rests with the womar. '\nd it is no wonder that one _ 1rs of extreme fear, ambivalence a. doubtas the hour approaches.Eagerness to end the pi �nancyis dampened by fears both ealistic and unrealistic. Realistica[ thingscan and often do go wro' ;. Thecomplications of hemorrhaf sepsis, mutilation and death give 1.fficientreason for apprehension � d fear. The irrational fears usual spring from the growing doubts, t ilt feel­ings and anticipation of pur ;hment. Added to this is another f tr, usu­ally vague and transient, � ared bymost pregnant women, [ d even their husbands. It has to lo with the strange feeling that : give alife means to lose one. )r some women this idea is so grip :ng thatthey await labor and deli· ·ry withabsolute terror. This· F )cess ofthinking is less strange f. we try to appreciate the unique re .tionshipof the prospective mother 1d fetus.There is a certain biolog al unity in the sense of a sharing )f tissue,blood, nutrients and m tabolites.There is a strong emotic 1al bondwhich begins with the idf of preg· nancy and develops accorcLng to the mother's self image and takes onshape and color according to the individual's identification with thefetus and to the resoluti:,n of herambivalence about the pregnancy.If there are those who fear sick­ness or death as a result of their decision to end a life within them, then there are others who seek such"punishment." For some women burdened by the emotional pressureof their conflict and overcome by t�gravity of their decision proce LINACRE QUARTERLYwith an unnatural deliberation to seek out the most dangerous ways to abort. This presents us with the grisly drama of murder and suicide.Once the deed is accomplishedthe mind is taxed anew. Ambiva­lence gave way to action. For some,there is nagging guilt of a misdeedthat cannot be undone. Others be­come painfully aware of the fearfulhostility ,in themselves; a hos.tiHtythat can be acted upon. Still othersexperience a mounting hatred anddistrust directed toward any and allwho advised or assisted in themisdeed. It is disheartening to consider thedamage to the emotional make-upof a young girl, who has not at­tained a reasonable · maturity of ego. The concept of self in termsof ideal values and 'images is dealta mortal blow. The event is re­called again ·and again. Soon it 'becomes necessary to drown out the . noise that is heard, as she is forced to review her act of murder. Pow­erful repressive forces stir as the ego tries to preserve a mental equi­librium. What cannot be pushedhack into the vaults of the uncon­scious must be defended against.Thus, the emergence of neurotic or psychotic reaction patterns.The milder reactions may takethe form of conversion reactions phobias or obsessive - compulsiv�mechanisms. These patterns are usu­ally not brand new, but representa re-emergence of old traits. Thusthe compulsive type will often be­c_<>me more rigid in habits of clean­liness, punctuality or parsimony.Those women given to the expres-NovEMBER, 1966sion of emotior>d conflict via the body language will develop psycho­P?Ysiologic disorders. The phobicdisturbances are perhaps the easiestto understand when one grasps the symbolism behind the feared situa­tion. I have treated patients withirrational fears of crov ..·ds, of soli­tude, of foods, bugs, kni\·es. Othersavoid visiting certain places or per­forming certain acts. Some willshun the doctor who performed theabortion and Jor those women who performed the act themselves one is likely to hear, for example, of the panic that descends when the ce·n­tral plumbing breaks down and thepathway to disposal of the "deadone" backs up.A fear of instruments and weap­ons is not uncommon. If one re­members that a phobia represents adisplaced fear against a forbiddenimpulse, this phenomenon makesmore sense. Knives are scrupulouslyplaced out of reach, not because ofthe searching 'hands of toddlers, butbecause of the doubtful control ofthe murderess.Further pregnancies may be quite upsetting. The normal fears, doubts,and feelings of ambivalence becomeweighted with the memory of weak­ness and betrayal. The wish to retain and the wish to expel meetand wrestle anew. But now thecontest seems less even, for theformer contestant, "expulsion" haswon the first fall.The significance of other eventsmay be overdetermined. Accidents,illnesses and reversals of one sort or another may be seen as punishment.Then inescapably the menopausal347years arrive. T1�e child bearing years are past. h,r most women it is a difficult time. Hormonal and other physiologic systems undergo major alteration. These changes exact from the emotional make-up of each woman equal measures of adjustment and alteration. The process of reproductive involution stirs anew the serious deliberations about a woman's role, responsibility and purpose in life. The anxieties of youthful menarche are revisited, but the mystery and challenge of fertility is not the problem. Instead there is apprehension and reluctance over the changes leading to infer­tility. For the woman who has tam­pered with these natural functions and aborted, there is so often an extra burden. For there arises from the realm of repressed conflicts the haunting reminder of the dreadful �ct. When the miracle and priv­ilege of procreation is denied by involution, she is forced to retrace old unsettled feelings. One sees 348 unusual amounts of guilt, SE ment and despondency. These are but a few obs, gathered from the histories women whose guilt is not re nor accepted in our court: nor by quite a large numbe pie outside the· courts. Ct· is not placed upon them b Yet it is felt. For in the mir is always held. The verdict and the sentence harsh. r, sentenced to hear a noise and tormenting . It is an � the quiet murder. 3.base-ations ' those gnized _,f law, Jf pea­.ability thers. a trial guilty cy are Jnstant o from Dr, Curran practices general ps :iiatry in the Danvers-Salem, Mass. area \ gradu­ate of Tufts Medical School, I-: interned at Salem Hospital where he i ;resently on the staff. His psychiatric re,, ency was at Boston VA Hospital with er. 1 psychi­atry training at Mass. General, :rving on that staff also as well as Hun \1emorial Hospital in Danvers. He visits . Danvers State Hospital as a member ol he Mass. General teaching unit; he is a J on the staff of the Rosary Clinic a:. , azareth. Dr. Curran is also a psychiatrit ·onsultant at North Shore Catholic Chari .'s. LINACRE QUARTERLY Regulation of Ovulation Time In Normal Women With Clomiphene Citrate· and Perfecting the Practice of the Rhythm Method· J. G. BouTSELIS, M.D., N. VoRYS, M.D. AND J.C. ULLERY, M.D. According to Marshall, the basic fundamentals of the rhythm method have been known to physicians for the past 35 years; however, this form of family planning has failed to obtain the confidence of a sig­nificant segment of the Catholic population. Even highly motivated and properly instructed patients fre­quently fail to accomplish their ob­jective because of an unsuspected premature or late ovulation in an otherwise fairly predic:table ovula­tory pattern. These rhythm failures would imply th.at the responsible body processes which regulate the time of ovulation are not perfect and possess intrinsic peculiarities which prohibit repeated perfect tim­ing of ovulation. Hypothalamic dis­turbance is but one example of how the pituitary-ovarian axis might dis­turb ovulation timing. During the past decade, many steroid compounds have been made available for use in the area of family planning and their efficacy has been virtually 100 per cent. Their mode of action is attributed lo a three-fold mechanism, namely: 0) Inhibition of ovulation, (2) roduction of a hostile cervicalucus, and (3) interfering withplantation of a fertilized egg bytering the endometrial environ­t.1·2·5·10,12 It is not within theMBER, 1966scope of this presentation to discuss the morality of their use. The purpose of this report is to discuss our experience with clo­miphene citrate and  its ability to regulate the time of ovulation. Clomiphene is a n e w  orally. administered non-steroid compound which is an analogue of the weak estrogen TACE. Clomiphene was made available in 1960 for infertile anovulatory patients. When admin­istered to these patients, ovulation occurred and is characterized by all scientific criteria of ovulation, in­cluding pregnancy. In a summa­rized report by Johnson et al/ it was noted that 1809 out of 2616 anovu­latory patients ovulated following the administration: of clomiphene citrate and approximately 40 per cent became pregnant during the first three clomiphene treated cycles. The mechanism of action of clomi­phene is by the direct stimulation of the ovary11 or by the stimulation of the hypothalamico pituitary axis.3 In a careful review of the litera­ture, there are no published reports concerning the use of clomiphene citrate in normal women for . the regulation of ovulation time. The purpose of this study was to see if clomiphene citrate would regulate the time of ovulation and make the 349 

The Quiet Murder

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The Quiet Murder

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