Talk:Abortion and mental health

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Request for Clarification of Objections to moving 1989 APA review to history section

On several occasions my attempts to move the discussion of the 1989 APA review from the "Current scientific evidence" to the "History of Abortion and Mental Health in the Law and Politics" section, under the information about Koop. It seems self evident that the 2008 report by the APA is the more current and that the 1989 report is historical, and was in fact largely driven by the APA's desire to respond to the Koop investigation.

Can those who object to this edit please articulate here the reasons for their reverts of this proposed move of historical content to the history section? -- Saranoon (talk) 15:03, 27 August 2018 (UTC)

I don't think anyone necessarily opposes moving the 1989 APA report to the history section. (I think your edits to that effect were reverted because they were conflated with a variety of other changes which moved the article in a non-neutral direction). I see you went ahead and moved the 1989 APA report to the history section, which looks reasonable to me. MastCell ^Talk 19:26, 29 August 2018 (UTC)

Weight and MEDRS Concerns

Regarding MastCell's revert of my edit regarding the history of the abortion mental health claiming WEIGHT and MEDRS concerns.

1. What is the MEDRS concern? The sources cited are invited commentaries in a peer reviewed medical journal regarding the change in RCP position and an article from the Times of London, a very prominent UK newspaper, that specifically puts the RCP change into historical context (history being the topic of this section). Exactly on what basis are you alleging that these are not reliable sources?

2. Regarding WEIGHT, on exactly what basis are you arguing that the weight that the Times (and other articles) give to this matter should be excluded?

3. Regarding WEIGHT, it is my understanding that even if some editors believe that there is a majority view, at least as expressed by a few medical organizations, that minority views should also be presented in an article. In this case, literally a half dozen literature reviews, including several published following the APA and NCCMH are being banned from the article. I would think that if medical journal editors and peer reviewers are in agreement that these literature reviews add to the literature and should be published, they should be represented in this article...rather than placed on an official censure list.Saranoon (talk) 19:34, 9 October 2018 (UTC)

To quote from policy regarding Due Weight:

Neutrality requires that each article or other page in the mainspace fairly represent all significant viewpoints that have been published by reliable sources, in proportion to the prominence of each viewpoint in the published, reliable sources.[3] Giving due weight and avoiding giving undue weight means that articles should not give minority views or aspects as much of or as detailed a description as more widely held views or widely supported aspects." (emphasis added)

Is anyone really contesting that the peer reviewed reviews by Fergusson and Coleman and Bellini are not "significant viewpoints" or that they have not been published in peer reviewed journals that are normally considered reliable? Moreovere, since even the APA review admits "it is clear that some women do experience sadness, grief, and feelings of loss following termination of a pregnancy, and some experience clinically significant disorders, including depression and anxiety" it is also clear that the "minority" views of Fergusson, Coleman and Bellini are not completely contradicted by the APA but rather contested only in regard to the magnitude of the problem. Per policy, then, due weight requires that these other views and sources should be included "in proportion" to the number of literature reviews on the topic.

I can find nothing in WP Policy that supports the purging of the viewpoints of individual researchers/reviewers that are published in peer reviewed medical journals simply because their conclusions contest the findings of prior literature reviews published by professional organizations. -- Saranoon (talk) 17:35, 10 October 2018 (UTC)

I don't have much to add, because we've been over this before. For one thing, you keep pushing to add a specific news piece by the Times of London. Not only does WP:MEDRS suggest avoiding such pieces, but the source in question is clearly an outlier even among popular-press coverage. Generally, the best way to write these articles is to first identify the best available sources, and then follow where they lead. It's obvious that you haven't taken this approach; if you had, you'd be citing the dozens of other popular-press pieces which more accurately characterized the RCP findings. You seem to be proceeding by identifying a small subset of sources that advance a specific small-minority viewpoint, and then editorially amplifying and privileging those sources. That's the source of my due-weight concern.

More generally, I don't see convincing evidence in the cited sources to support the idea that the RCP recognized "a growing body of literature showing a link between abortion and mental health problems". There is no such body of literature, so the underlying assumption is false; if anything, consensus and the evidence base have moved gradually toward a firmer rejection of a causal link. And so on. MastCell ^Talk 19:22, 10 October 2018 (UTC)

Thanks MastCell, since you offered no arguments or disagreement regarding the fact that the sources I cited are reliable (peer reviewed reviews) and that they represent "significant viewpoints" that should be covered in the current per WP:Due, I'll work them in over the next few weeks.

Regarding the Times, article, it's common for newspapers such as the New York Times (similar in stature to the Times of London), is an ideal source regarding the history of the issues their reporters cover. As you'll see, a number of newspaper articles are already cited in this article, Bazelon for example, and several regarding the history of the issue in regard to Koops letter, which like the RCP position statement, was very short. Furthermore, in citing the Times article, I'm not relying on the reporter to interpret the RCP's guidelines (Fergusson and Casey are better positioned in that regard, since they are experts who were invited to submit their insights in a peer reviewed journal) but rather as a good reliable source putting the RCP modification in historical context, which is the subject of this subsection. Regarding the "growing body of research," that is evident not only in the Fergusson study mentioned in the Times, but in the Casey and Fergusson commentaries, and in the subsequent APA and NCCMH and Coleman reviews which examined scores of studies, which summarized as the "growing body of research," and also by the fact that in 2006, the U.K.'s House of Commons Science and Technology Committee specifically requested the RCP to update its position in light of the research the committee reviewed, including Fergusson's first longitudinal prospective study. Feel free to change the wording if you like.--Saranoon (talk) 20:12, 10 October 2018 (UTC)

---

References

References

Important paper on this topic missing

Recent, important source:

• Horvath, S; Schreiber, CA (14 September 2017). "Unintended Pregnancy, Induced Abortion, and Mental Health". Current psychiatry reports. 19 (11): 77. doi:10.1007/s11920-017-0832-4. PMID 28905259.

This review says, as do other high quality reviews, that studies of the correlation between mental health and abortion have always been observational and therefore confounded (if there is a correlation, which causes which, or are both caused by something else?) (our article already mentions this)

The review describes the Turnaway study, which "prospectively enrolled 956 women seeking abortion in the USA and followed their mental health outcomes for 5 years. The control group was comprised of women denied abortions based on gestational age limits, thereby circumventing the major methodological flaw that had plagued earlier studies on the topic." and puts its results in the context of prior findings. Jytdog (talk) 19:35, 10 October 2018 (UTC)

• • Horvath's paper is not a literature review of the topic, it is only a review of the set of studies based on the single dataset of the Turnaway Study. That data set as been strongly criticized for its super low participation rate, with over 70% of women invited to participate refusing and half of those who did participate dropping out. It is therefore not generalizable to the population of women having abortions. ---Saranoon (talk) 17:11, 26 October 2018 (UTC)
    • User:Saranoon It is a review and is perfectly fine per WP:MEDRS. Yes the paper focuses on turnaway but it also reviews the older literature. Please strike your objection or explain it based on the spirit and letter of MEDRS. I am uninterested in your assertions about criticism; if you have sources for that I would be interested to see them. Thanks. Jytdog (talk) 17:23, 26 October 2018 (UTC)

Horvath's paper devotes only two paragraphs in the section "Early Research," with only a handful of citations. The rest of the paper is entirely devoted to the Turnaway studies. Clearly, it is not a review of the entire subject of abortion and mental health; it is a review of the Turnaway studies alone. It is not even a critical review, as evident by the authors's failure to discuss the high non-participation and dropout rates. Mostly, it is just an argument for ignoring all other research on abortion and mental health in favor of the Turnaway approach--using only women who were turned away from late term abortions as the comparison group.

Regarding criticisms of the Turnaway study, a few minutes of googling lead to this article by Coleman and another by Reardon in a peer reviewed journal and a summary of the latter. There are others, of course, but these are examples FYI.

I do not in principle oppose inclusion of material about the Turnaway studies if and when this article is opened up to a broader overview the published research. But as it stands, major reviews like those of Fergusson, and Coleman and Bellini have been blocked in violation of the principles for due weight and MEDRS, so it is clearly inappropriate to add further imbalance to this article by giving such extensive coverage to a single data set.--Saranoon (talk) 18:49, 26 October 2018 (UTC)

Thanks. yes, reviewing other literature is a small part, but there.

mercatornet is not a MEDRS ref. Its an interesting for Christian/Catholic ethics, but is not relevant here.

The Reardon piece (PMID 30275603) is classified by the Linacre Q as a "research article"; it is not a MEDRS ref.

afterabortion.org is not a MEDRS ref either.

None of these are useful - please read WP:MEDREV and please do not introduce further refs that are not OK to use.

Your objections are not valid under the policies and guidelines. Please self-revert your removal of this content. Please be aware that there are discretionary sanctions on this topic, and policy-violating editing and talk page discussion are likely to result in sanctions being enforced. Thanks. Jytdog (talk) 20:22, 26 October 2018 (UTC)

DSM

@Kailani: "Post-abortion syndrome (PAS) is not included in the Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR or in the ICD-10 list of psychiatric conditions, nor is the term commonly used outside of the anti-abortion community. " - This statement had four citations. I only have access to two, which don't contain it, but did you check the other two before removing it? –Roscelese (talk ⋅ contribs) 00:18, 25 October 2018 (UTC)

I didn't see any citations on that statement. Kailani (talk)

In that case, I will be restoring it, because there are citations there that you evidently did not check. –Roscelese (talk ⋅ contribs) 16:46, 27 October 2018 (UTC)

@Kailani: The statement has four citations. Are you or are you not saying that you checked the Stotland sources and they do not support the text? –Roscelese (talk ⋅ contribs) 23:26, 27 October 2018 (UTC)

I told you that I didnt see any citations on it. There were zero citations. Look for yourself. [1]. Kailani (talk) 03:16, 31 October 2018 (UTC)

Recent edits

Jytdog recently reverted a large number of edits by Saranoon. I don't propose to discuss those. However, there was one section leftover that appears new compared to a few weeks ago, which reads as follows:

"The idea that abortion was linked to negative psychological effects was widely reflected in the psychiatric literature pre-dating the legalization of abortion in the United Kingdom and the United States."

The Grisez book was by a philosopher and does not, on the face of it, seem like a good source to support the claim being made that the psychiatric literature (so some interpretation of WP:MEDRS may apply) reflected these views. Nor is any mention made of alternate views at the time: e.g. Osofsky & Osofsky (American Journal of Orthopsychiatry. 42(1):48–60, 1972, doi:10.1111/j.1939-0025.1972.tb02470.x) comes to quite a different view.

There is then another section that reads:

"This modified opinion was influenced by a growing body of literature showing a link between abortion and mental health problems, including a 30 year longitudinal study of about 500 women born in Christchurch New Zealand and a Cornwall inquest into the abortion related suicide of a well known British artist, Emma Beck."

Again, is this accurate and does it meet MEDRS?

References

-- Bondegezou (talk) 17:42, 21 November 2018 (UTC)

When looking at previous edits, I saw that another editor had cited the Grisez book previously, though his/her edit was reverted. I thought it was perhaps misplaced but a valid reference and contribution to the article. So, I inserted it in the fashion you described above. I believe it does qualify since it is a true academic review of the literature at that time. (Rather than deleting contributions of editors, I try to look for ways to include them.)

Regarding the second section, as you noted, the statement regarding the impact of the Fergusson study on the request for an update of the RCP statement is accurate and cites two peer reviewed articles and a newspaper article from the UK discussing the change in the context of UK law and politics...and since this section is regarding the history of this issue in law and politics, source policy regarding history and politics is applicable, not MEDRS.

Finally, you reverted the opening sentence in which I cite systematic reviews that meet the MEDRS standard...including several which are more relevant than the APA and NCCMH reviews because they are most recent. As you may know, MEDRS recommends reliance on more recent reviews. While you may feel that this "a list of systematic reviews doesn't add much," I disagree for two reasons. First, the list will help readers find the systematic reviews that are available to advance their own research. This will be helpful for college and high school students, for example. Second, this opening sentence and list is a precursor for further development of this section since these other reviews should be included in the discussion per the requirements of MEDRS to give due weight to the entirety of the literature reviews, not just a selected couple. Fergusson's review, for example, needs to be discussed, and it is in line with other reviews also cited. Since you do not disagree that this list is inaccurate, but simply have the opinion that it not "add much" according to some arbitrary standard of your own, I would ask you to revert your own reversion. As indicated above, I believe it is good policy to look for way to include editors contributions and sources. Move it around, or reword if it you think that will improve i . . . that is what collaborative editing is all about. But simply deleting it because you question how much it "adds" to the article is counterproductive.--Saranoon (talk) 18:25, 21 November 2018 (UTC)

If the Grisez book was previously removed, then I support that past decision and believe we should stick to it. It looked like a polemic to me and not to be a valid review of the psychiatric literature, unlike Osofsky & Osofsky. If we want something more historical, I suggest Osofsky & Osofsky or something similar -- something from the psychiatric literature -- is a better source.

The article should summarise what systematic reviews and guidelines say. Your list of various systematic reviews merely said that they criticised each other, but didn't offer any summary of what they say. That is not a balanced summary of the literature. It gives a false impression that there isn't a broad consensus. Bondegezou (talk) 11:06, 22 November 2018 (UTC)

Necessity for including MEDRS Reviews in order to provide Due Weight

Previously, Bondegezou deleted citations to peer reviewed reviews of the literature alleging that the mere citation of these sources did not substantially contribute to the article. He is correct in noting that these articles should be given greater weight in light of policy regarding due weight and a preference for more recent reviews WP:PSMED: "Look for reviews published in the last five years or so, preferably in the last two or three years. The range of reviews you examine should be wide enough to catch at least one full review cycle, containing newer reviews written and published in the light of older ones and of more-recent primary studies."---Saranoon (talk) 18:04, 26 November 2018 (UTC)

I don't think this comment adequately explains your continued hedging about the fact that the current scientific evidence does not support the claim that abortion causes mental health problems. –Roscelese (talk ⋅ contribs) 18:16, 26 November 2018 (UTC)

Then you aren't reading the content and the reviews carefully enough. The most recent review, by Fergusson, concludes that there actually is a small, measurable effect of abortion on mental health of women who abort compared to women who carry unwanted pregnancies to term based on 14 studies, including a 20+ year longitudinal study. Please read the [Fergusson review] and MEDRS policy. If you would like to help summarize the Fergusson review in a way you feel makes it most accessible to readers, please do.--Saranoon (talk) 18:24, 26 November 2018 (UTC)

I agree with Roscelese. You are cherry-picking the 5-year thing while violating the underlying principles behind WP:MEDRS. (I feel qualified to say that, since I played a major role in writing that guideline). The guideline is designed to ensure we provide readers with clear, accurate, and unbiased medical information. Your activity here—your sole activity on Wikipedia, as far as I can tell—has been to try to obscure a clear statement of scientific consensus on this article by any means necessary. It is disruptive and tendentious, and I am formally asking you to stop. MastCell ^Talk 20:17, 26 November 2018 (UTC)

It appears that you are attacking me rather than discussing the content of the article. No one can dispute that the reviews I have cited are (a) peer reviewed medical journal reviews, (b) meet all the requirements for being considered reliable secondary sources per MEDRS, and (c) that the MEDRS policy requires giving due weight to all such reviews in some reasonable proportion to the number of reviews and recency of the reviews providing a perspective on the topic.

A number of editors of this article appear to argue that Wiki-editors know more than peer reviewers and that "we" have a right to ignore MEDRS and delete content that cites any peer reviewed review articles that criticize or question the conclusions of seven to ten year old review articles that are preferred by the same wiki-editors. That is hardly in keeping with the "spirit of MEDRS" which clearly requires balance of viewpoints from reviews that been accepted for publication in peer reviewed journals. There is no basis in WP:MEDRS for constantly deleting all mention of reviews that post-date, critique, or improve on prior reviews.

It is especially notable that while no one has identified inaccuracies in any of the material I have submitted, nor can dispute that the material is based on reliable secondary reviews published in peer reviewed journals, the response to my edits has been complete reversion rather than seeking ways to include the material in a clearer or more proportionate manner. If, for example, one believe the paragraph I added regarding Fergusson's review of the unwanted deliveries vs abortion in light of the APA, NCCMH and Coleman reviews could be shortened or made more clear or accurate, the proper thing to do is to edit the material . . . not just delete it. Does anyone here understand the idea behind "collaborative editing?" The goal is to find ways to include pertinent material...not to simply make up excuses for deleting it.

Please either (a) clearly describe why the material I contribute it inaccurate so I can edit it to make it more accurate, or (b) edit it to make it more accurate yourself, or (c) restore the material and work in a collaborative fashion to improve this article rather than block improvements of this article.--Saranoon (talk) 22:53, 26 November 2018 (UTC)

One of the reasons that WP:MEDRS exists is to prevent exactly what you're trying to do. As an analogy, it would be possible to create a Wikipedia article, using only peer-reviewed publications, which would make it sound like HIV doesn't exist and is not the cause of AIDS. You're trying to do something similar: you are cherry-picking peer-reviewed papers and arranging them in such a way as to convey an inaccurate and misleading impression of the state of knowledge on this topic. What WP:MEDRS says (among other things) is that it's not enough simply to cite a collection of peer-reviewed papers; the sources must be used in a way that accurately conveys the overall state of knowledge in the field. It absolutely violates WP:MEDRS—and violates our basic responsibility to be honest with the reader—to present a collection of cherry-picked papers in order to rebut or undermine the global scientific consensus on a topic. You are doing exactly that. At this point, the policy issue has been explained to you many times, by several different people. That you persist in adding the same material, along with repetitive walls of text, is a behavioral issue; it falls under tendentious editing, and soup-spitting. MastCell ^Talk 00:44, 27 November 2018 (UTC)

1. That you decline to identify any inaccuracies in my edits must be interpreted as an admission of my accuracy.

2. That you decline my request to edit my changes in a way that, in your opinion, puts the cited material into proper context, must be interpreted as a refusal to engage in collaborative editing.

3. My understanding, which is reflected in many of your own arguments on this page, is that MEDRS objects to use of primary sources, even peer reviewed primary source, and favors instead literature reviews that are published in peer reviewed medical journals. It is exactly such literature reviews that I have cited. That is not cherry picking. That is a sincere effort to include reviews which show the evolving nature of this area of research. In my view, it is clear that editors who insist on citing only a few of the many literature reviews, especially older ones, and object to even a citation to newer reviews which have found fault in prior reviews who are cherry picking...and this is in clear violation of the requirement to give due weight to conflicting reviews.

4. Give me an example of a peer reviewed literature review that has concluded that HIV doesn't exist. Or are you just making things up to justify blocking content that clearly does cite peer reviewed literature reviews?

5. Please give a detailed explanation, preferably from a peer reviewed source, why Fergusson (2013) gives a "misleading impression of the state of knowledge on this topic." If you actually read the paper, it is clear that Fergusson, who is pro-choice, is critical of all prior reviews and is presenting evidence to the effect that the mental health effects of abortion are not as great as abortion critics like to say but as cannot be as easily dismissed as the APA and NCCMH reviews suggested when one really does look at the studies that compare delivering an unwanted pregnancy to abortion. Seriously. Stop ignoring this obligation. Fergusson post-dates these earlier reviews. His review was subject to peer review and published in a highly respected journal and therefore "endorsed" as at least a reasonable interpretation of the literature and as a contribution to the knowledge and debate over this issue. Silencing this source by an asserting, as you appear to be doing, that "the Fergusson team should be ignored in favor of the older reviews by the APA or NCCMH" is simply not reasonable, and is clearly not suggested or supported in letter or spirit by WP:MEDRS. (I realize MastCell is asserting that he is the governing authority on MEDRS given his contributions to that page, but even a governing authority should be able to identify what the problems are with citing Fergusson or other reviews. Moreover, it is my understanding that WP does not actually give such governing authority to individual editors.)

6. You claim that you and others have explained policy to me, but policy is actually explained at WP:MEDRS. The only thing you and others have have explained is that WP:MEDRS is not applied to the abortion and mental health article because a select group of editors policing this article have decided to exclude any reliable, peer reviewed literature reviews, or even citations to these reviews, whenever they conflict with your presentation of the 2008 APA and 2011 NCCMH reviews. It appears that the "consensus" of the policing editors is that the literature must be "frozen" in time, and only those reviews selected, and as interpreted (often incompletely) by your group of policing editors should be allowed despite WP:MEDRS guidelines and preferences for inclusion of alternative views and more recent reviews.

7. I'm a bit confused by your constant accusations of "tendentious editing." Does this mean that editors who actually reading MEDRS and assume that other editors will read and respect those guidelines when introducing reliable secondary sources (medical literature reviews) published in peer reviewed medical journals must be persistent when seeking to overcome the policing of articles by those who seek to promote a POV? If so, yes, I am being persistent precisely because WP:MEDRS makes it clear that the material I am inserting is appropriate, relevant, reliable and should be given due weight.

8. Please read WP:PRESERVE. We could make headway if editors would seek to fix and improve upon my edits rather than simply delete them, wholesale. The content I have provided is accurate and well sourced. If editors believe that other sections should be expanded to give more weight to other views, do that! But deleting well sourced and accurate content simply that is not included anywhere else in the article, is disruptive and anti-collaborative. --Saranoon (talk) 01:20, 27 November 2018 (UTC)

Tendentious editing is a manner of editing which is partisan, biased or skewed taken as a whole. It does not conform to the neutral point of view, and fails to do so at a level more general than an isolated comment that was badly thought out. On Wikipedia, the term also carries the connotation of repetitive attempts to insert or delete content or behavior that tends to frustrate proper editorial processes and discussions.

This is exactly what you are doing. Please try listening to what your fellow editors are trying to tell you. Walls of text with enumerated demands do not inspire collaboration. You are cherry picking policy, and attempting to place wildly unreliable sources (Coleman) into this article. You should not be surprised that such attempts will be resisted. — ArtifexMayhem (talk) 05:16, 27 November 2018 (UTC)