The Vanishing White Coat

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COMMENTARY

Based on what we know right now, the US Supreme Court is poised to overturn Roe v Wade, which allowed a patient and her doctor to make decisions about an abortion. According to the leaked initial draft abortion opinion, the states will decide,¹ which likely means that some states will not allow abortion. Other states may allow exceptions for rape and incest. To me, it feels like the Supreme Court burst into the examination room and sat between the patient and her doctor. This is an intrusion into the doctor-patient relationship.

The Supreme Court may not know women who have serious mental illness such as borderline personality disorder, rapid-cycling bipolar disorder, or treatment-refractory depression. However, these disorders are important to consider when deciding to bring a child into the world. This decision takes the doctor completely out of the picture and forces the woman with a disability, with a chronic mental illness, or in poverty to follow the law or else.

Particularly for women with serious mental illness, 9 months is a long time. Many must take medications, and these may have an adverse effect on the pregnancy. They also often experience morning sickness, which will have an impact on the level of psychiatric medication and may result in an increase in symptoms. For example, when my patients with bipolar disorder begin to sleep less, the concern is that this may be the beginning of a significant increase in symptoms.² It can be very difficult to sleep in pregnancy depending on how much the baby is moving, along with various other issues such as frequent urination and back pain.³ In addition, many chronically ill patients have symptoms even when they are appropriately treated on medications. Pregnancy can also be frightening; there are lots of sensations and discomforts that are not always easy to manage.⁴ All of this may result in patients needing to be hospitalized to keep them safe during this very challenging time.

With incredible support and resources, having a baby can be a very special experience. For example, I treated a young couple who both had serious mental illness. They married and were very excited about having a child. Both the husband’s and the wife’s parents came to the appointment, and the decision was made that the parents of the couple would lend incredible support. Both moms agreed to be available to go to all appointments and to handle calls if the couple was concerned. The moms also agreed to take turns staying with the couple after the baby was born, because babies do not sleep through the night. Despite this consistent support, there were a few emergency room visits and lots of doctor visits with medication adjustments. In the end, the couple moved in with one of the parents when the baby arrived.

Not all women have this level of support, however—especially now that 1 million individuals have died of COVID-19 in the United States.⁵ Some young women have lost partners, parents, siblings, aunts, uncles, and grandparents—the support system of other individuals in their family who could have helped them with a new baby. Without a support system to help, having a new baby can be a very trying experience, particularly for women with serious mental illness.

Fifty years ago, Roe v Wade decided that a woman and her doctor had the right to make this decision about an abortion—a clinical decision that would take into account the patient’s entire medical and mental health history. Now, 50 years later, the Supreme Court is set to overturn Roe v Wade,¹ removing the doctor completely from the equation and putting the states in charge of an important medical decision. Not only does this undermine the doctor-patient relationship, but will also have a particularly negative impact on patients with serious mental illness.

Dr Johnson is a practicing psychiatrist in Atlanta, Georgia.

The opinions expressed are those of the author and do not necessarily reflect the opinions of Psychiatric Times™.

References

1. Gerstein J, Ward A. Supreme Court has voted to overturn abortion rights, draft opinion shows. POLITICO. May 2, 2022. Accessed May 5, 2022. https://www.politico.com/news/2022/05/02/supreme-court-abortion-draft-opinion-00029473

2. Jones I, Chandra PS, Dazzan P, Howard LM. Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period. Lancet. 2014;384(9956):1789-1799.

3. Spinelli MG. Maternal infanticide associated with mental illness: prevention and the promise of saved lives. Am J Psychiatry. 2004;161(9):1548-1557.

4. Miller LJ, Finnerty M. Sexuality, pregnancy, and childrearing among women with schizophrenia-spectrum disorders. Psychiatr Serv. 1996;47(5):502-506.

5. Chuck E, Siemaszko C. Covid’s toll in the U.S. reaches a once unfathomable number: 1 million deaths. NBC News. May 4, 2022. Accessed May 5, 2022. https://www.nbcnews.com/news/us-news/covids-toll-us-reaches-1-million-deaths-unfathomable-number-rcna22105