Dr. Bennet I. Omalu published an article in the journal Neurosurgery in July 2005 that described the new brain disease he found in a dead former NFL player, Mike Webster. Webster, a former Steelers Hall of Famer, died at age 50 after years of increasing dementia-like behaviors. Dr. Omalu told GQ magazine in "This is Your Brain on Football" (October 2009) that he expected the NFL to respond to his research by taking action to protect its players. He believed that the NFL would welcome "scientific evidence that the kind of repeated blows to the head sustained in football could cause severe, debilitating brain damage. He thought they could use the research to try and fix the problem."
Instead of seeing this research as an important tool to protect and promote the health and longevity of its players, the NFL denied the findings, defended itself, and attacked Dr. Omalu. Four years later, despite the deaths of more players, despite more findings, more research, and more scientists who back up Dr. Omalu's claims, the NFL continues its Deny-Defend-Attack strategy.
"I was naïve," Dr. Omalu now says, to think the NFL would embrace his findings.
Now, consider the case of former Marines major Gamal Awad, an Iraq Veteran featured in a GQ article titled "The Few. The Proud. The Broken" (March 2010). Awad served 14 years in the Marine Corps, a career that included surviving the 9/11 terrorist attack on the Pentagon and a stint in Iraq, the details of which he refuses to discuss. Then, he was diagnosed with PTSD (Post-Traumatic Stress Disorder), and he attempted suicide.
How did the Marines respond to this soldier? They kicked him out with a less-than-honorable discharge. He no longer has access to the resources and health benefits of Veteran Affairs. "You have a mental illness? Get a straw and suck it up," is how Awad put it to GQ writer Kathy Dobie.
Deny the problems of mental injuries. Defend the military. Attack the veterans by cutting off their benefits. Deny-Defend-Attack.
Ten years ago, after I had an abortion, I was surprised that the only post-abortion emotional support services I could find were Christian-based, anti-abortion organizations using a "recovery" model, like a program for alcoholism or gambling. In this model, abortion is against God, and women need to find forgiveness for their bad choices.
When I decided to create a support service for all women post-abortion, one that encompasses a range of experiences, beliefs, and values, I imagined that pro-choice leaders would embrace the idea as critical to our shared goal of women's health and well-being. Certainly, I believed that they, more than most, would understand how important it would be for all women to have a private place to talk, free from judgment, and free from the vicious hostility that surrounds abortion in public.
I was wrong. I encountered that familiar pattern: Deny-Defend-Attack. Pro-choice leaders denied that women feel anything besides relief after abortion. They defended the right to abortion. They attacked anti-abortion foes for delivering "recovery" services. Deny-Defend-Attack.
As surprised as I was to encounter such resistance from people I expected to support Exhale's goal of women's wellbeing, it makes much more sense when I view it through the lens of stigma. This is what NFL players, suicidal veterans, and women who have had abortions have in common: Our mental health issues are not unknown. They are not mysterious. But they are locked in stigma.
Stigma -- the tool that keeps the people it most affects quiet instead of demanding action -- has another effect. It gives institutional -- or movement -- leaders the cover they need to ignore the problem and shirk their responsibility. Mental health stigma protects leaders from having to answer the hard questions: What if an NFL tackle causes a mighty giant to fall before his time? What if a Marine is not a robot, but a human with an emotional life? What if a woman who chooses abortion needs the chance to express her feelings afterward?
All is not lost. I write this post with hope and optimism for the future because I have been a witness to change, innovation and new thinking on mental health in the pro-choice movement. Yet, in this moment of heightened political gameplay around abortion, including new political tactics disguised as mental health promotion, we need something different from pro-choice leaders.
This is a leadership challenge, not a strategic one. We need leaders who are willing to lead -- leaders who are willing to challenge the stigmas that block support of mental health. We need leaders to change the culture within our institutions and our movements, and to share responsibility for promoting our mental health.
In fact, we already know what to do. For example, Dr. Julian Bailes, a neurosurgeon and a partner of Dr. Omalu, has suggested that the NFL "take the head out of the game" to reduce brain injuries. In short, let the lineman "start from a squatting position so there's no obligatory head contact." The Iraq and Afghanistan Veterans of America recommends declaring war on combat stress stigma by "launching a well-funded, researched and integrated nationwide campaign to promote the use of ... VA Services and...Suicide Prevention hotline." Our goals at Exhale are also straightforward: Every woman who has an abortion should get information and resources to promote her own well-being after abortion and, as we testified before the National Institutes of Health last year, new scientific research should be conducted to better understand, and therefore support, each woman's emotional and social experience of abortion.
But, according to Dr. Bailes, "Instead of answering anything we bring to them, the NFL is ducking and shooting arrows at us. Criticizing us. Saying our work is a bunch of bunk. They have only attacked us."
NFL players, suicidal veterans, and women who have had abortions are all dealing with the impact of mental health stigma. Across the spectrum of our unique mental health issues, we all face similar reactions from the very people who we believe should care the most, the people who should feel a shared sense of responsibility for our mental health.
As Lieutenant Colonel Colby Vokey, Marine Corps' chief defense lawyer, said in GQ, the military should "feel some responsibility for what happens to [veterans] in the long run." So, too, should pro-choice movement leaders who -- despite their advocacy for abortion rights, increased government funding of abortion services, and training of abortion providers -- still do not have a public platform in support of a woman's well-being after an abortion. Condemning the efforts of anti-abortion recovery groups is not a platform for mental health.
It's time to let go of the Deny-Defend-Attack strategy. It's time for leaders to step outside the status quo and embrace change. Luckily, they will not have to look that far for direction or advice. And they will certainly not be alone. The very people they need are already leading the way.
Because while the conventional Deny-Defend-Attack voices were expressing outrage that Minnesota Governor Pawlenty declared April as "Abortion Recovery Month" and that pro-life feminist Michaelene Fredenburg plastered the New York City subway system with ads depicting abortion's negative emotional impact, the voices of the future were busy thinking -- and working -- outside the box. These leaders were already challenging stigma and changing the movement so that it becomes a source of support and respect, not denial and attack.
A small university research team has answered the call for more science and is initiating new investigations into the social and emotional aspects of abortion. A volunteer network provides nonjudgmental emotional support to women before, during, and after abortion. A movement-building initiative is organizing and advocating for policies and services that put the well-being of every woman -- the whole woman -- front and center.
How do you know that a movement is ready to change? How can you tell that the culture is shifting, and that leaders are approaching similar problems, but making different decisions and advancing new solutions?
You know when you sit where I do. After 10 years of advocacy for a woman's well-being after abortion, I know the culture is shifting when I witness that not everyone jumps on the Deny-Defend-Attack bandwagon immediately. I see it when people pause and take time to consider a different approach. I know when they reach out and ask for a change and then embrace it, however small, however seemingly innocuous, and they see, like I see, the possibility for the long-lasting fundamental changes that can result. I see that for many advocates it is no longer scary to ask the question: What if a woman who chooses abortion needs the chance to express her feelings afterward?
I see that this question is nearly accepted, that it has been deemed valid and worthy, and that actions will soon follow. Yet, I still dream of a public statement, a public platform, from a pro-choice leader that affirms and validates emotional experiences of abortion with an actionable agenda to promote every woman's well-being.
This week, that dream feels closer than ever.
On April 13, I received an email from a pro-choice researcher with a link to Governor Pawlenty declaration and a request: "Oh, Aspen, can you make this into something good?" When I responded and Exhale declared April as "Abortion Well-being Month," (our challenge against stigma, our stand for well-being, and our role modeling of an alternative strategy to Deny-Defend-Attack), a pro-choice communications strategist wrote: "I love the positive vision you are offering about how we think about abortion and abortion care. Not only is it a more appropriate response than Gov. Pawlenty, but it challenges pro-choice advocates as well. Too often we let our opponents define this issue as somehow harmful. We can and should discuss the impact of abortion in realistic, honest, and affirming ways." Then, two days later, an editor at the pro-choice blog RH Reality Check picked up the call and declared April as "Abortion Well-being Month" too. Then, a woman on Facebook made this her status: "It's Abortion well-being month. I'm Pro-Voice and I will listen to your abortion story with support and respect. Everyone has a different story to tell and everyone's story deserves to be heard. This includes men." Another woman tweeted: "Announce: 'April is Abortion Well-being Month."
This is how institutions, movements, and cultures change.
The folks at IAVA feel confident that their legislative agenda to reduce combat-stress stigma will soon pass. They have found leaders -- First Lady Michelle Obama and a four-star decorated general -- ready to challenge mental health stigma in the military. These leaders know that asking for help is a sign of strength and resilience, not weakness.
I hope the pro-choice movement leaders are the ones to show the NFL how mental health stigma is challenged, and not the other way around.