CHALLENGES OF FAMILIES WITH SPECIAL CHILDREN.

Irrespective of culture, race or geographical location; children are not just bye products of the marital relationship but a crucial basis for societal modulation of the family unit. This explains the basis for   different cultures having varied but potent reactions to infertility where children cannot be produced and having children with peculiar challenges. Beyond the medical explanations for infertility or special children; there are very potent sociocultural and religious issues that are capable of militating against beneficial approach to the effective management options of these problems. Special children in this context are those with peculiar needs that require much more support than other children for them to function optimally. This condition  may have been precipitated  by the mishandling  of the pregnancy where certain drugs are  taken that  damage  the growing  brain  of fetus,   failure to take precautions against possibility of jaundice in  certain circumstances  or  mismanagement of the delivery process  such as  prolonged labor, premature draining of the waters  that can result in fetal distress and mechanical trauma  to the fragile brain of the new born baby through unprofessional  handling of the delivery process. We have   many untrained traditional birth attendants and religious maternity centers that are not professionally supervised which may lead to an increased incidence in the population of children with special needs.  There may be other causes traceable to some genetic factors, some inherited metabolic disorders or advanced maternal age. These children may be born with cognitive defects associated with seizures   that could manifest in many ways. As the child grows there may be deficits in the achievement of developmental milestones with associated poor performance in the school short of that expected for their chronological age.  The overall presentation could be mild, moderate or severe depending on the severity on the overall global functioning of the child. These children may also have problems with posture and sensations   that will require orthopedic and physiotherapeutic interventions. These children often require a multidisciplinarian   approach in their management with the ultimate goal of assisting them   maximize the available intellectual resources for their ultimate good.  There are some of them that can perform brilliantly well in certain aspects of life when appropriate educational techniques identify such dimensions and assist in developing them.  Drugs are often indicated in a number of them which should be professionally administered so that the side effects of some of these drugs do not outweigh the beneficial effects especially for children with behavioral challenges that require medications. 

However, our society through the sick role has explanations and prescribed interventions for these special children which make it difficult for the parents of these children to get the best out of them. Within this context, children with special needs are viewed as products of   spiritual attacks and that their parents may be serving some form of punishment from God for a wrongdoing which can explain the hostile attitude of some  neighbors to these children and the society at large. In some instances these children are viewed as spiritual agents of misfortune and some individuals in the society use them as agents of social crime.   As a result of the stigma, some of them are locked up away from the glare of the public without any intelligently coordinated intervention since they are seen as financial and emotional devourers.  Africans through our primitive culture have very wrong attitudes to these children that make them vulnerable to all forms of abuse. The parents by extension are also maligned especially the mothers who may be seen   as the custodian of evil forces that manifest through   abnormal children in their own reckoning. Several unwholesome religious and cultural interventions include   beatings, starving and burning of certain parts of their bodies in the process of exorcism apart from injuries a number of them sustain through uncontrolled seizure attacks.  When these children exhibit some behavioral problems as a result of poor judgment or antisocial behavior, such a child is often treated with grave physical abuse tending towards ostracism while the parents are made to feel guilty for having brought such a child into the world. Some individuals actually rape such children, use them to commit crimes and take advantage of their deficits rather than support them to maximize their available intellectual resources.  This unfavorable position in the society has affected government and relevant health agencies that should have been supportive in giving these children the best. The care of such children consumes not only enormous   financial resources but a lot of emotional resources especially on the part of the parents. Policies that can support, protect and encourage professional care of these children should be encouraged. Corporate institutions can rise to this challenge by setting up a highly equipped educational and vocational centers for these children in a multidisciplinary setting as social network of their children should be encouraged.

BEREAVEMENT AND MENTAL WELL-BEING

The central theme in bereavement is LOSS; but not loss in a general sense.   It is the specific, personal loss of a loved one through death.  It is a final exit of a loved person from the physical space where all forms of previous interpersonal contacts become absolutely impossible again.  This picture attempts to capture in graphic terms the impact of this loss on the human mind and the consequent activation of the coping mechanisms.  The involuntary emotional and behavioral reactions to this loss are often described as grief while the traditional, voluntary ,social expressions  to this loss is mourning which may overshadow  all the other aspects of bereavement  especially in Africa. 

It is normal for human beings to express this involuntary grief reaction by an initial phase of shock, protest and disbelief followed by preoccupation with the thoughts of the deceased which is often characterized by searching for other intrusive thoughts about the dead.  As a process of resolution, there is a stage of reluctantly accepting the reality of the loss which is then followed by outright rejection of attitudes of guilt or self-pity with respect to the deceased. 

Where adverse bereavement- related symptoms persist for more than 6months or when there is the absence of expected grief symptoms or the avoidance of painful symptoms within the first 2 weeks; a situation of abnormal grief reaction ensues that require psychiatric consultation. The human cognitive template has valuable recordings of memorable interactions with the loved one that cannot be switched off as can be done to a television. To view the human mind at that mechanical level is to have a poor understanding of how the human mind functions. The grief reaction state may come out in close resemblance to depressive illness except that guilt and suicidal ideations are not free floating if they ever exist as they will always be in the context of the deceased. There are usually no associated feelings of worthlessness, hallucinatory experiences or prolonged functional impairment.  The grief reaction may initially appear mild until the one year anniversary when manifestations may become more intense.  To mask this; some may take to alcohol and substance abuse. 

 Frank stress reactions to the loss especially when the death is sudden, unexpected or violent may present with re-experiencing and flashbacks of the circumstances of the death of the deceased. Folks with previous history of psychiatric illnesses may be more prone to committing suicide following bereavement.  There is a demonstrable higher rate of hospital admission and increased medical consultation among those bereaved especially if they are parents, children or spouses in relation to the deceased.  The women may present more with frank psychiatric disorders while the men would develop more medical complications as a consequence of bereavement if they do not remarry.  Some of the subtle but potent factors that can facilitate complications of bereavement are social and emotional isolation, absolute loss of social role, unemployment, financial hardship and loss of supportive social networks. Some bereaved individuals may have low self esteem, ambivalent or dependent relationship with the deceased or previously unstable personality profiles.  The women  especially become more vulnerable and destabilized following bereavement just as men show less acceptance of their loss and turn to other romantic relationships sooner.

  Mourning as a conscious, voluntary socio-cultural facility could have a creative and profound positive impact on the grief reaction by ameliorating factors that can get it complicated. 

In Africa where a widow is viewed more as   property of the deceased husband and by extension of the extended family; prospect of remarriage is usually marred by family gossips and persecution as obsolete cultural practices whereby a sibling of the late husband may be  expected to take over the widow of his late brother without her consent. Properties acquired jointly are oftentimes seized by the extended family if she does not comply with the family directives. Some mourning practices can take several months which may foster social isolation, loss of self esteem and disconnection from supportive social networks and means of livelihood. Both religious and cultural practices should ensure that those who harbor guilt feelings following the death of their loved ones are reassured so that they can have enhanced mental capacity to bear the loss rather than wallow in self pity. Memories of our loved ones can be devoid of pain when we immortalize them with projects that can serve the good of the community especially the vulnerable ones. As a consequence of suicide bomb attacks, air disasters, increasing road traffic accidents and reduced life expectancy generally; there is definitely an increasing population of widows, widowers, orphans that would require a robust social welfare program from our government at all levels because their bereavement would  have taken a negative toll on their socioeconomic standing.

WHAT WOMEN LIBERATION DOES TO THE MENTAL HEALTH OF MEN

Recent years have witnessed significant awareness on the issues of gender and human rights in standard setting and to some extent application of those standards through international and domestic legislation and jurisprudence, and in institutional programming and development. Some international and regional human rights bodies now go beyond just including women in a list of vulnerable groups, and have begun to incorporate women’s experiences and perspectives into recommendations for structural changes needed to bring about file enjoyment of human rights by women and girls. Despite this progress, many challenges remain. Domestic violence appears to be on the increase as tensions rise in the global economic crisis. Gender based discrimination persists in the work-place,  housing, education, disaster relief, political life, inheritance ,health care, access to food, and countless  other areas.

Access to justice continues to be hindered by a range of obstacles, including restrictions in some countries on freedom of movement, discounting of evidence given by women and lack of training of prosecutors. Religion, tradition and culture continue to be used as   shield for violating women’s rights, despite, strong and persistent statements adopted by states in United Nations’ fora that they are not a valid justification for such violations. This brief presentation of problems usually from the academic, civil rights groups and most reports from our international developmental agencies may illustrate some of the problems but the paradigm adopted in tackling these culture-sensitive issues may be flawed. Gender refers to the socially – constructed differences between men and women as distinct from sex which refers to their biological differences. In all societies, men and women play different roles, have different needs and face different constraints. Gender roles differ from the biological roles of men and women although they may overlap. These roles demarcate responsibilities between men and women in social and economic activities, access to resources and decision making authority. These roles can and do shift with social, economic and technological change.

In essence, the very substrate that gives definition to gender is the culture. Gender is the cultural value ascribed to the biological differences ascribed to men and women. This paradigm is very crucial in understanding gender issues and proffering solutions to them. The world over, people generally think that they perceive reality and approach problem solving in a way that is objective, accurate and culture-free. The survey of the history of development theory shows that western economists propose interventions from their sociocultural, historical and economic realities in their countries to interpret evidence.  This mismatch between their analysis and the reality make for some bad policy especially in a good number of our developmental programs because intervention should have a cultural paradigm to be effective.Pre-colonial Africa was a patriarchal society with rigidly defined authoritarian roles for men and supportive roles for women.  However with the advent of colonialism and globalization of values; gender roles are changing with strong implications for our mental health. Our women for instance are no longer passive merely supportive partners in the marital relationship but strong contributors. This has had a profound implication for marital relationships with attendant challenges on the mental health of the husbands especially as their traditional autocratic roles are being challenged because women are gainfully employed hence more financially independent with robust social capital. Older men in retirement are lonelier as their wives move from one continent to the other to nurse their grandchildren.

Harmonious leadership roles are disrupted as the men become incapable of coordinating the family life because women are getting more empowered and less adapting. The children suffer from this gender warfare as they grow up in an atmosphere of discordant authority voices.

Contemporary advocacy from the western world overemphasize the discrimination against women without considering a subtle but profound incapacitation of manhood in the developing countries. A good number of our men suffer from depressive illness masked by alcoholism, abuse of psychoactive drugs, erectile dysfunction just as they develop high blood pressure mostly before 40 years. The challenge to sustain leadership by being financially buoyant to survive the emotional combat may be responsible.

There is increased marital conflict characterized by gender violence especially when men get frustrated by the challenge posed by their combative modern wives. Some of the men carry their reservations about women into the work place and entrench the campaign of gender discrimination as they seek to disempower women by blocking their promotion, refusing to encourage their education once married or outright sexual abuse of women subordinates. The ultimate resolution of this gender warfare cannot take place unless our cultural values are interrogated so that our gender conventions and declarations can be creatively domesticated. Reckless challenge of the existing cultural values from a purely western paradigm can only worsen the existing gender discrimination with attendant mental health challenges.

ERECTILE DYSFUNCTION, CULTURE AND MANHOOD.

Sigmund Freud remains one of the most creative, dramatic and significant contributor to the field of modern psychiatry especially through his famous theory of psychoanalysis in explaining varied forms of abnormal behavior. Of particular relevance to this discourse is the dual – drive theory in relationship to human sexuality. He described sexual drive as the ultimate premise of biological motivation for human behavior just as instincts serve similar purpose for animals. Under the dominance of the sexual drive and guided by the primary process thinking; the libido exerts an ongoing pressure towards gratification operating in accordance with the pleasure principle.  The aggressive or ‘death’ drive which is profoundly self-destructive is responsible for the development of depression and suicide and runs counter the pleasure principle of the libido. A basic inference from this theory is that the sexual drive is the energy of life and when it is frustrated could result in unconscious self- destructive psychological strategies that may end up in depression and suicide. This explains the central role that mental health experts play in sexual dysfunction. Men and women have always been curious about sexual life; its inherent mysteries, drives, intentions, oddities and common sexual problems. Treatment rituals, folk remedies, advice, and sex manuals have been discovered among the writings of the ancient Greek physicians, Islamic and Talmudic scholars, and Chinese and Hindu practitioners. Even today the public’s insatiable curiosity about sexual life, especially how to enhance,improve,restore,or cure problems, is the focus of every monthly women’s magazine, television and radio programmes,books and videos.

Biographers have observed that most of our great leaders and inventors have been peculiarly endowed with enormous libidinal energy creatively harnessed and plugged into their particular creative outlets rather than wasteful dissipation in consonance with the concept of sexual transmutation. For the love of a woman; a man can perform essentially animated by the energy of the libido. 

I think it is in agreement with Freud’s theory of libido that guided our culture to define manhood among other qualities in the context of sexual agility.  The African society is essentially patriarchal and sexual agility is considered a resource for man to take full control of his emotional and psychological territory just as the women are expected to derive security in the enjoyment of this facility. However changes in the dynamics of the modern marriage with the attendant psychological challenges may explain an apparent increase in incidence of sexual dysfunction among men especially erectile dysfunction and their patronage of local culturally compliant remedies. The women because of the cultural and religious inhibitions may never admit to their sexual dysfunction.

From basic psychology; the sexual response cycle can be divided into 4 phases of functioning: desire, arousal, orgasm and satisfaction. Sexual dysfunction in clinical practice follows this theoretical model including the sexual pain disorders. Erectile dysfunction is a disorder of sexual arousal characterized by persistent or recurrent inability to attain or to maintain erection until completion of the sexual activity. The dysfunction may occur as full erection occurs in the early stages of love -making but declines when intercourse is attempted; or erection does occur, but only when intercourse is not being considered; or partial erection, insufficient for intercourse occurs but not full erection. And for women; there is the persistent inability to attain or sustain adequate lubrication-swelling response of sexual excitement Significant enough to cause distress and interpersonal difficulty. Couples or individuals who discover that they do not have optimum sexual satisfaction should  seek medical advice since some medical conditions like diabetes, hypertension,  some  surgical conditions and some medications like the  antihypertensive.  Depressive illness presenting  with reduced libido,   antipsychotics and some drugs of abuse may be cause erectile dysfunction.

  

However, strong cognitive and emotional factors may be responsible for the majority of cases.  Until recently; clinicians used to consider performance anxiety to be responsible for the development and maintenance of life long and acquired erectile dysfunction. However, recent findings are showing that the cognitive processes interacting with anxiety are responsible for sexual dysfunction.

The challenge for the mental health expert is to elicit deep seated psychological and relational barriers usually fed by faulty cultural and religious paradigms and defective communication patterns. The African man’s definition of manhood as sexual conquest of his partner readily makes him vulnerable to sexual dysfunction especially when his partner demands to be treated with respect rather than conquered. The quality of the couple’s non- sexual relationship is examined such as conflicts emanating from work, finances, partner’s health, and difficulties with parents and children. Partners could provide useful information that the client is concealing like bereavement, indebtedness, not getting promotion or a son’s drug problem.  The goal of therapy is to assist couples to accept changes in their lives such as menopause, disability, and other life stresses.

ARISTO SYNDROME AND CHALLENGE TO WOMANHOOD

If you live in Nigeria, this topic will not be strange as the aristo coinage comes   from the word ‘’aristocracy’’ which in this peculiar context connotes a group of individuals considered to be superior to others .It describes the relationship between the young, vulnerable young ladies and the economically advantaged men. This social phenomenon is very common in Nigeria although with some religious and cultural rationalizations in certain quarters but not without enormous medical and psychosocial consequences that impact negatively on the mental capital development of the victims.

Nigeria is a developing nation but the oil wealth has made us acquire social class designations   that are not articulated on   productivity but crass opportunism.   The character of this primitive upper class is not only opportunistic but comes with a reckless orientation to violate their victims with impunity.  The middle class that is a natural custodian of egalitarian values barely exists in its true character since the Nigerian society is enmeshed in a chaotic, continuously evolving class segregation and struggles premised on opportunism without a pedigree of creative productivity.  The aristo cohort in context comprises of those men who occupy some position and   have enough economic means to secure the attention of a younger, vulnerable lady for reckless self-gratification.

Borrowing   strongly  from  the pre-colonial rulership  cultural  software of the elite class; the modern elite class take pleasure in the violation  of these  vulnerable , economically deprived girls . It is also important to note that these girls are from homes where their parents have been rendered poor through the misrule of this aristo clan directly or indirectly.  A good number of them have parents that cannot pay their school fees, secure accommodation and cannot feed them.  These impacts negatively on family cohesion as a number of these ladies have grown up without a father figure in the home. They have had to survive the murky waters of the real life out there without requisite support from home through destructive maladaptive coping mechanisms. As a consequence of their damaged self-esteem; they learn to parade their bodies in a modified form of prostitution for economic gain. This explains their exhibitionistic mode of dressing and manipulative tendencies.  The aristo men also are aware of their economic deprivation which serves as the premise of bargain such that some of them can have sex with 2 or more at the same time as a demonstration of superiority and opulence. 

This practice is very common in our political outings, higher institutions as we saw lately in sex for grades scandal, our corporate environments and even in religious organizations. Every girl needs a father or a father- figure as a maturation template   especially through the teenage years which could explain the healthy attraction of the oedipal complex. This relationship facilitates the creative channeling and focusing of the chaotic emotional experiences of adolescence in a way that confers healthy self-esteem and identity. The Aristo syndrome in context is an unconscious quest by these vulnerable ladies for a father figure to mentor them into womanhood apart from the economic gain.   A quick check of the ladies in this cohort suffer from poor self-esteem, victims of rape, child-labor and chronic economic deprivation occasioned by an absentee father. It is a vicious cycle of oppression, deprivation and violation. Their parents are oppressed with resultant economic deprivation that renders their children to be vulnerable to be violated by their oppressors. The aristo syndrome should be a social facility for engaging these valuable girls in creative mentorship so that they can become balanced and well-adjusted adults.  Any relationship between an older, more advantaged man and a younger, vulnerable girl should have this goal and could be articulated as a development initiative. When they are recklessly violated; they end up as single mothers, unemployable school drop outs, victims of HIV-AIDS and damaged womb resulting in infertility, serial divorcee, multiple drug abusers and could end up as criminals .A good number of them invariably come down with mental illness of different types. A few years back, I was at the inauguration of a non-governmental development initiative specifically dedicated for equipping girls to make informed choices. Precious Jewels; as a development initiative is intended by the initiator to mentor these vulnerable girls to become successful in their career pursuits, responsible mothers and accomplished wives.  This coincided with the initiator’s   40th birthday who is   already at the peak of her career with a great marriage and mother  of two lovely children. She is from a   basic family in Nigeria and has risen steadily through the ranks in a balanced way. This is the opportunity that the aristo syndrome presents rather than the reckless violation of the potential womanhood in these vulnerable girls.