- Sara Zafarullah Sheikh (GN12119)
According to World Health Organization, an individual with good mental health is able to cope with the stress of everyday life, knows his or her own abilities and work productively in every aspect to contribute to the community. On the other hand marriage is defined as a union of husband and wife in a universal and legitimate relationship recognized by law and social institution (Watkins, 2013). Both of them have a big influence over each other and are affected by each other (Ostwald, 2009)
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In my view marriage contributes to a healthier society, building up a separate unit called family, which is at the same time part of the society as a whole. This serves society by its children, by labor of its members and through other aspects. It provides keeping of traditions and continues generations promoting cultural aspect of society. Therefore, it is regarded as pillar to the society. Goesling & Avellar (2010) states marriage to contribute to an individual’s emotional and social benefits in all aspects thus contributing its part in physical health as well. Regardless of the fact, marriage is considered to be not meant for psychiatric patients considering them not capable of taking responsibilities, dangerous for the spouse and lacking of their self-identity, adding it to their social stigma (Gray, 2011). While negotiating with my patient, I recognized the seriousness of this issue and decided to reflect upon it so as to emphasize the importance of marriage in society and its mental health benefits.
On my clinical rotation to Karachi Psychiatric Hospital, I was assigned to interview an old lady; 42 years old diagnosed with Schizophrenic paranoid with symptoms of aggressiveness, hallucinations, somatic delusions, irritability and self-talk. Upon interaction she appeared responsive and cooperative. According to the patient, she was accompanied to the hospital by her mother. On taking the family history, patient verbalized of having four sisters and one brother. She further verbalized that all her siblings are married. According to the client only she was not allowed by her mother to get married regardless of her wish of getting married like her other sisters. Upon close observation she seemed to be attracted towards opposite sex. She even took some names that she verbalized of getting married with but eventually also said, “they will not marry me.” No indicators for sexual abuse were found which clearly reflected her need and wish of getting into a secure relationship that provides her with support and identity, which was now a requirement of her age as well. She verbalized her engagement in the substance abuse due to this reason.
Glancing at the cultural context, parents hold the complete authority for choosing partners for their children in eastern culture whereas, in western culture children have the right to choose their mate and made decisions for their future life.
Nock proposed the theory of domesticating role of marriage to explain the phenomenon that married people are found to consume healthful and delighted lives than unmarried compeer (2005). As the institution oblige responsibility on both of the spouses and implies assurance to both of them creating a huge room for positive change. Men tend to change, as before marriage they live less healthy lives and are much more involved in dangerous behaviors including substance abuse drinking and car racing. They work regularly, have a tendency to involve more in religious practices and become future oriented. Women are generally viewed to be responsible since childhood and less involved in anti-social behaviors. According to Loveless & Tolman (2007) women think about themselves complete after marriage. Women enjoy commitments and duties after marriage, they love being busy with children, spouse and household chores. If this sensorium of completeness is not achieved they get indulged in anti-social behaviors example, substance abuse and are prone towards mental illness. Wood (2007), inferred that unmarried women show more depressive symptoms than the ones married. My patient also wanted to live like a married women enjoying all commitment a marital life embraces. As she could not achieve the outright goal she started using substance abuse to diminish the emotion of unsatisfaction.
Marriage contributes to mental health by providing subsequent support and emotional intimacy, creating sense of self-identity and self-worth, building a satisfied connection between two partners, making the innate human need to fulfill (Wood, 2007). According to Howell (2009), report on marriage and mental health, product of many random sample studies revealed that marriage makes individuals less prone to have psychological illness. Marriage ensures engagement of partners in less risk taking activities and also it influences the quality and size of gains. A study revealed that intermediate rates of mental disorders were found in widowed, highest in divorced and separated while married people had the lowest rates among them. Study of 80,000 suicides in U.S, also indicated that suicide is committed less by married women compared to unmarried ones. They define themselves less depressive and emotionally healthier than unmarried ones. Relating it to my clinical scenario the patient also required emotional stability, self-worthiness, a partner to whom she can share her emotions, and her own family. Neither had she wanted the illness nor loneliness. Therefore, she started saying that she is suffering from tuberculosis associated with somatic delusions denying the fact that she had any mental health problem.
In society specifically Pakistani society, mental illness is considered as social stigma leaving it to be neglected. Interventions should be applied on individual, group and national level. At individual level clients should be allowed to ventilate their feelings providing them with support. In association with the health care professionals at group level these patients should be involved in different rehabilitation therapies to work with their creativities and find out strengths in them using therapeutic way of communication, which would help them enhance their self-esteem and build sense of self worthiness. Embroiling my patient in the occupational therapy I asked her to bore seeds for new plant to build a hope and see new sunrises in her life. Family support plays an essential role for these people to view their lives in positive face. At community level institutions should be formed to gather these people helping each other to fill unfilled gaps of their lives. At state level policies should be formulated for unmarried suffering from mental illness.
To conclude it is important to realize the potential need of every person for a companion, the intimate love one needs in life. According to Carl Rogers, this is human’s basic nature of an intrinsic need of warmth and acceptance from the mate. Each and every one has a right to have partner, and declaring a person not mentally fit and therefore, not allowing the person to get married makes the person more prone to mental illness.
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Wood,R.G., Goesling,B., & Avellar,S. (2007).The Effects of Marriage on Heath: A Synthesis of Recent Research Evidence(9). Department of Human and Health Services.
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