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Mental Health Matters Journal for Psychiatrists & GP's

MHM September 207x300

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Literacy is a luxury that many of us take for granted.  We depend on written communication for information, guidance, and access to heath care information That is why SADAG created SPEAKING BOOKS and revolutionized the way information is delivered to low literacy communities. It's exactly what it sounds like.a book that talks to the reader in his or her local  language, delivering critical information in an interactive, and educational way.

The customizable 16-page book, accompanied by local celebrity audio recordings, ensures that vital health and social messages can be seen, heard, read and understood..

We started with books on Teen Suicide prevention , HIV, AIDS and Depression, Understanding Mental Health and have developed over 30 titles, such as TB, Malaria, Polio, Vaccines for over 30 countries.

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There are numerous causes and consequences of marital conflict, most of which often cannot be clearly defined as being one or the other. This conflict, more often than not in today's society, leads to divorce, with two out of every three marriages in South Africa ending in divorce.

Marital conflict and divorce can create serious instability in the family and insecurity in a child. Consequences of divorce are split families, poorer parent-child relationships and in some cases economic deprivation. This immense disruption in the home life can create a situation that serves as a dysfunctional learning experience in all aspects of a child's life, but especially in the area of interpersonal functioning.

In the past studies focused mainly on the immediate effects of marital conflict and divorce on children's adjustment and behaviour, but long-term studies have also recently revealed a lot of information on the residual effects that last long into adulthood.

Poorer parent-child relationships due to divorce and interparental conflict can cause these children have less secure attachments with parents and that as a result of this develop "internal working models" that contain negative expectations about relationships. The happier they perceive their parents' marriage to be, the more secure they are.

Also associated with divorce is the exposure of children to dysfunctional learning experiences. Children model the aggressive tactics they see their parents using, while others model avoidant strategies of conflict resolution and learn to turn their anger inward.

Divorce has also been associated with economic deprivation, which causes a disrupted home life which, in turn, is associated with subsequent diminished academic achievement, low occupational attainment and poverty.

But the main problem associated with divorce is its "intergenerational transmission" or passing down through the generations. Research has shown that children of divorce are more likely to divorce themselves.

Studies have come to the conclusion that parental divorce is indeed associated with interpersonal and intimacy problems in adulthood. Young adults of both sexes from broken homes experience difficulty in establishing intimate interpersonal relationships. Children of divorce who experienced high levels of pre- and postdivorce conflict have been shown to have decreased beliefs in the benevolence of people and the impersonal world and in the dependability of their future spouses, decreased trust in their mothers and fathers and between their parents, and less optimism about their future dating relationships and marriage.

Links between divorce and lower levels of self-esteem have also been found. Research links lower levels of self-esteem to higher levels of marital conflict, to unhappy versus happy homes, and to rejecting versus accepting homes. This drop in self-esteem has been related to a decline in the quality of the parent-child relationships. According to Kline, the parent-child relationship is particularly vulnerable during the period of divorce and in times of marital conflict, as the parents' energies are exhausted by their preoccupation with their own emotional responses and numerous social and environmental changes. This parental self-absorption results in a diminished capacity to parent, and parents may also burden their children with requests for emotional support and other assistance. This diminished parenting style is characterized by less consistent discipline and affection, and tends to be a more rejecting style of parenting, which has been linked repeatedly to emotional and behavioural problems in children.

The subsequent implications of a lowered self-esteem and a negative self-concept are linked to later interpersonal difficulties in a number of ways. A low self-esteem implies a lowered self-efficacy, and this combined with negative expectations of marriage, and a predisposition to divorce, could mean that any difficulties encountered in the intimate relationship are not dealt with effectively.

The immediate problems often found soon after and during marital conflict and divorce, tend to be more pronounced in boys, while girls tend to exhibit problems later in life. So whereas girls tend to internalize the problems, boys tend to externalize them. Aggression, conduct disorders, and delinquency are among the problems most frequently associated with parental discord. A consequence for parents as well as for some children of divorce, is a "withdrawing" and depression.

Depression is a highly disabling disorder, in fact so much so that the World Health Organization has predicted that by the year 2020, it will be the disease that causes the most worldwide disability. Depression consists of a persistent sad or 'empty' mood, feelings of guilt, helplessness and worthlessness, restlessness and irritability, fatigue, and sleep and weight disturbances. As well as being a commonly diagnosed disorder itself, there is a high incidence of it occurring in conjunction with other illnesses and mental disorders.

This depression, anxiety and pent-up anger can lead to substance abuse, in parents as well as children. A substance-abusing parent can then exacerbate the emotional and behavioural problems of the child.

If you feel you or any of your loved ones may be suffering from depression, there is help available. The Depression and Anxiety Support Group offers more information about depression, telephone counselling by trained counsellors, and referrals to appropriate mental health professionals and to various support groups throughout South Africa. They can be contacted, Monday to Friday, between 8am and 7pm, and on Saturdays, between 8am and 5pm, on (011) 783-1474/6. According to the American National Mental Health Association, treatment by medication, psychotherapy, or a combination of both is successful in more than 80% of people with depression.

The deterioration of parent-child relationships is a consequence of marital conflict and divorce. The fact that these relationships play an important role in the healthy development of children implies that disturbances in this parental bonding will have an impact on the development of mental disorders later in life.

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