As people grow up and grow older, and, perhaps, grow old, they develop a sense of who they are. That sense of themselves is not an abstraction. They see themselves as they are in their families and come to understand what sort of child they are, and, later on, what sort of husband or wife they are, and, then, what kind of parent they are. They may not see themselves entirely accurately, but they recognize themselves, as the people around them recognize them, as a certain sort of person, inclined to do one thing rather than another, and likely to respond one way rather than another. Over time, each individual fits into that self-image a picture of how he or she behaves as a friend, or as a worker, even as a member of a community. If that self-understanding changes over time, it is only in a subtle way. We see ourselves, we remember ourselves, as one particular, although perhaps complicated, kind of person, “This is me,” each of us says. “This is who I am.”

“This is what I believe in,” each of us can say, if we bothered to stop and think about such things. We all have an idea about what the right thing to do is, and we have confidence in ourselves to do pretty much the right thing. We see ourselves behaving the same way most of the time. The right way. Almost all of us, even criminals, think we live up to a certain code. That ethical view is formed in part by the people around us as we grow up, by our religion, and by a host of little actions by other people whom we know. We know what is right and what is wrong. We can count on ourselves to behave in the right way. And then something happens.

As a psychiatrist, I come to know people pretty well. They tend—after a while, at least—to speak to me openly about what they feel, what they want, and what they have done. And what has been done to them. Some of what they say has the character of a confession. They expect me not to judge them; and I do not. There is something about a person coming to me for help than inclines me to be sympathetic and see things from their point of view.

Sometimes the things people tell me they have done are in my opinion bad things.  They are things I would not do, I think. Some of these things I have never imagined doing—a betrayal of a friend or lover, an act of larceny, and worse. But when I talk to these patients at length and come truly to know them, an odd thing begins to happen. I begin to see myself in some sort of similar situation, behaving similarly.  In the end there have been few things patients have told me that I could not imagine myself doing under just the right, or just the wrong, circumstances--except for committing a physical act that would directly  hurt someone. I cannot imagine myself doing such a thing. But, even then, I think I may be wrong. I think my imagination may be failing me. The history of the world suggests that ordinary people, not any different than me, can do cruel things to each other. All the very worst things we read about in the newspapers or history books have been done mostly by ordinary people. I suppose there are limits to the things anyone can imagine. Still, I am pretty sure that in the end I am capable of doing things I think, or have thought of, as being wrong. Until something happens…

I wish I could describe certain things so graphically that other people, too, could imagine themselves in those terrible circumstances, having to step away from who they are and behave in ways that they would not have anticipated, and would not have condoned.

The fact is, people behave in ways that are not consistent with their beliefs. But I want, right off, to distinguish most of these people from some who are charlatans, who never believed in the first place what they espouse, but who take the moral high ground because they know that is what their audience wants to hear. These include politicians who set out cynically to exploit their offices for personal gain and religious leaders who use their authority to take advantage of their congregants sexually, all the while inveighing against sexual misbehavior. Examples of hypocrisy of this sort are reported regularly in the press. But there are others, perhaps even in these groups, who do intend to behave themselves properly and are subverted from their purpose by events. By unexpected feelings and circumstances. The Lord’s prayer says, “Lead me not into temptation.” Those who have always followed their moral compass include some who have simply been lucky enough to have escaped temptation.

Over the years I have seen righteous people, people who thought they were righteous and seemed so to others, who violated their moral precepts in ways they would not have anticipated:

--A man who stole from his child’s inheritance. “Things happened, and I had no choice.”

--A lawyer who responded to unexpected expenses by withdrawing money from a fiduciary account, money that belonged to someone else, and then borrowed more and more until there was too much to repay. In the end he turned himself in to the district attorney.

--A man who had previously been faithful to his wife despite working in an industry in which infidelity was common was seduced finally by a young woman who pursued him so aggressively she locked the two of them together in a room. I would not have expected a clumsy stratagem like that to work, but it did. They entered into a long affair, which ended his marriage.

-- A man who found himself part of a mob and participated in a crime. This act was completely out of character. He regretted it the rest of his life.

--A married woman who was seduced by a twelve year old! She had not been unfaithful to her husband previously, and was never unfaithful again.

Some of the rules people govern themselves by hardly rise to the level of a moral code, but are binding nevertheless. Some of these rules are idiosyncratic.  I knew a straight-laced woman who condemned other women who forgave their husbands’ infidelity. She was contemptuous of them. She could not imagine being weak in such a way. But then, something happened. Her husband confessed to her a very brief affair. Suddenly, matters were not so clear in her mind. She did not want her children to have to deal with a divorce. She did not want to separate from her friends and lose touch with her in-laws, whom she loved. She put off speaking to a lawyer and put it off again and again. But she was still angry at her husband; and she was angry at herself for not being able to stick up for herself the way she thought she would, and should.

And then, of course, there is the matter of abortion.

In this country many people polled disapprove of abortion. Most of them have not had to deal with the issue since it has not come up in their lives or, as far as they know, in the lives of members of their family. Of course, a family member knowing of their disapproval might not be inclined to share with them a decision to have an abortion.

Still, a lot of women have abortions. Those women who do not disapprove of abortion on principle do not usually experience problems in the aftermath of the procedure. The physical dangers from a medical abortion are much less than those associated with giving birth. The psychological consequences are rare, and none have ever come to my attention. The procedure itself is uncomfortable, and the whole business of having an unwanted pregnancy is upsetting; but abortion is only a part of that.

Over the years, I have occasionally seen women who regretted having an abortion. I remember two women in particular who were childless previously and remained so the rest of their lives. Both women had been pressured into having an abortion against their wishes.

Women who disapprove of terminating a pregnancy for any or all of the usual ethical reasons sometimes find themselves pregnant. They consider all the usual options: giving birth and keeping the child or giving it up for adoption. Or, against their principles, having an abortion. Many choose to have the abortion. “I really have no choice,” they explain to me. Someone else might tell them that they certainly do have a choice, either of the ones mentioned above; but they think they do not.  These women may have felt impelled by social or financial considerations, or any of a number of psychological reasons, but that is the way they feel. The emotional consequences of an abortion are likely to be more severe for them than for women who do not have moral objections to the procedure. People feel guilty usually when they go against their principles. Sometimes I see such a woman in my office. I try to do or say whatever I can to relieve her guilt and distress. “People have principles,” I explain, “but sometimes things happen…”

A particularly distressing situation developed with one couple. The man, whom I will call Tony, had a relative, a cousin, as I remember, who had Down’s Syndrome. He loved this man, Simon. Simon had a genial nature despite being mentally retarded. He had learned with a lot of help to function well enough to work at an undemanding job. He was friendly and a pleasure to be around. Knowing Simon, Tony had developed a very strong attitude against aborting a fetus with the genetic markers of Down’s. His own life would have been diminished without Simon, if Simon had never been born.

Tony was 38 years old when I knew him. He was married, and he and his wife, Amy, were looking forward to their first child. And, right off, the first month they tried to conceive, they were successful. But Tony had been told at some point that there was a very small chance that the chromosomal defect that Simon carried might affect other members of the family. I did not understand why that should be true, but Tony began to worry about this possibility. Finally, in order to put his mind at ease, Amy underwent the appropriate tests to rule out that condition. Perhaps the result had nothing to do with the fact that Tony had a cousin with Down’s. Perhaps it was a coincidence; but the tests came back positive.

Tony and Amy began to research the consequences of Down’s syndrome. I don’t remember what weighed most heavily in their minds when they decided to end the pregnancy. Certainly, the fact that their child would be retarded, perhaps severely retarded, was their principal concern. But, also, individuals with Down’s syndrome are prone to a great many diseases and, finally, to dying prematurely, although premature death was more the rule then, than now.

I looked up Down’s syndrome recently to remind myself of the various vulnerabilities someone with the disorder is subject to: heart problems, including septal defects, hearing and vision problems, all sorts of gastro-intestinal problems, hypothyroidism, emotional problems including depression, obsessive-compulsive disorder, and autism, certain cancers, including leukemia, and, particularly troubling, early-onset dementia. None of these occur invariably, except the retardation, but any of them are possible.

Tony and Amy were probably thinking of all these possible disabilities. All of them argued in favor of an abortion. After all, the next baby waiting in line to be conceived would very likely not have any genetic defect. And that child could not be born unless Amy aborted the child she was carrying. It seems about 92% of couples confronting the fact of being pregnant with a Down’s child choose to end the pregnancy. Which means, I guess, that 8% choose to carry the pregnancy to term.

The decision was not up to Tony alone. Amy had an opinion; and she strongly favored abortion. And so, in the end, Tony violated his fundamental beliefs and went along with Amy’s decision.

He paid an emotional price. I do not think he overcame his guilt feelings, his denial of Simon--because that is what it felt like to him—until his son, his normal son, was born two years later.

Tony, and a number of other people who started off disapproving of abortion, became less adamant after choosing to undergo the procedure themselves. But not everyone.

Cecilia disapproved of abortion every bit as strongly as Tony had. She picketed a local clinic where she thought, in error as it turned out, that abortions were being performed. And then something happened. She got pregnant. She was a sophisticated young woman who was so nervous about the prospect of getting pregnant that she used two forms of contraception. But she got pregnant, anyway. Without a lot of soul-searching, it seemed to me, she opted for an abortion.

“I have no choice,” she told me. “The new job is contingent on my relocating and travelling. I can’t take care of a baby.”

She found a place where she could have an abortion without anyone finding out. And a month later she was back in front of the clinic picketing!

I suppose this has to be regarded as hypocrisy; but she did not think of herself as a hypocrite, and, the truth is, I did not think of her that way either. Standing up for the life of the “unborn child” was fundamental to who she was. The fact that she herself could not live up to her standards did not make those standards wrong. Those views defined her. She was not flexible enough to see herself, and the rest of the world, from a slightly different perspective.

Cecilia did not suffer pangs of remorse, as far as I could tell. It was as if she decided she had to do something, she did it; and now she could go back to being herself.

Cecilia avoided blaming herself through a trick of the mind. But others do not. Some people, having suffered through a previously unimaginable circumstance change a little in what they believe. I would argue in that direction. I would like people to become less rigid, more tolerant and forgiving of themselves. And more tolerant and forgiving of others who have different ethical standards. (c) Fredric Neuman 2012  Follow Dr. Neuman's blog at

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