CEREBRAL PALSY - symptoms-treatment-medicines- signs, preventive care and cure

CEREBRAL PALSY

Cerebral palsy (CP) ranks as the most common cause of crippling of children in the United States. Almost one quarter of a million persons are afflicted. Too often people associate the abnormalities of movement and muscular control, which are the outstanding features of CP, with mental retardation and lifelong dependency on others. But the majority of CP victims is not mentally retarded and is capable, with special training, of becoming self-sufficient. Cerebral palsy is not an inherited disorder, or a contagious one, or a progressive one.

 Cerebral refers to the brain, and palsy to muscularweakness. So the name implies that it is a condition of muscular weakness or disability resulting from brain dam- age. The brain damage may occur before, during, or shortly after birth for many different reasons. (Brain damage in adulthood leading to disability is not considered CP.)

The nature and extent of disability will, of course, depend on the amount of brain damage. There are three ways in which the muscles may be affected: in the spastic variety of CP, muscles are stiff and tight, and weakness is profound; in the athetoid form, muscles contract without apparent reason, leading to uncontrolled grimaces and limb movements; in the ataxic form, talking and other movements are poorly coordinated. 

Along with these difficulties there may be hearing and sight impairment, speech disturbance, poor ability to learn, convulsions, emotional problems, and sometimes, unfortunately, mental retardation. Despite these handicaps, however, modern training methods offer more hope than ever before for even the most severe form of CPO Primary prevention of CP begins with good antenatal (prenatal) care.

German measles and other infections early in pregnancy may damage the brain of the developing child. Vaccination against German measles- before a girl reaches childbearing age or, in the case of an adult woman, when there is little likelihood of immediate pregnancy-is an important preventive measure. Other infections during pregnancy are often hard to detect, and the physician cannot al- ways predict whether or not they will harm the baby. 

The preventive approach is limited to recommending adequate protection against diseases for which vaccines are available and avoiding unnecessary exposure to others. Another known, and now preventable, cause of potential brain damage to children is Rh incompatibility.

Detecting this blood problem is now part of routine antenatalcare. The use of special techniques-such as intra- uterine blood transfusion for the fetus and delivery by cesarean section if necessary before severe damage occurs can prevent brain and other organ harm. A recent development promises to eliminate the hazard of Rh incompatibility. 

It is well known that the first child does not suffer harmful effects from Rh incompatibility; the succeeding children are at risk. This is because it takes time for the mother to become sensitized to the Rh factor.

A new medication, called Rhogram, when given to the mother within 48 hours after birth of the first child, prevents development of sensitization to the Rh factor and eliminates risk for succeeding children. To prevent sensitization from ever developing, the medication must be given after each subsequent pregnancy. 

Premature infants are more likely than others to be afflicted with CPo Among factors in the mother which predispose toward premature birth are cigarette smoking, infection of the kidney and bladder, and a history of having borne previous premature infants. 

Cancer prevention - ENDOCRINE GLAND SURGERY- symptoms signs - treatment

ENDOCRINE GLAND SURGERY FOR SECONDARY PREVENTION

 The growth of some cancers is influenced by certain of the endocrine glands. For example, in the spread of prostate cancer, hormones of the testicles play a role. It has been found that the painful metastases of prostate cancer to bone can be relieved for long periods by removal of the testicles. This is not as drastic as it sounds, since prostate cancer patients have reached an age when the eunuchizing effects of testicle removal will be minimal.

When breast cancer gets out of control and spreads to bones and other parts of the body, an endocrine gland operation may help to extend life for months and even years. The operation may be on the ovaries, adrenal glands, or pituitary gland in the brain. The age of the patient, the duration of the cancer, and the location of the metastases will be considered before the decision as to which operation to use is made. 

Tertiary Prevention Perhaps not too far distant is the day when organ transplantation be- comes fully practical. Then cancers that are destroying such vital organs as the liver and the pancreas may be removed entirely, and the missing organ will be replaced by a transplant from a cadaver. Cancer Phobia Cancer is such a dreaded disease that, understandably, many people have an irrational fear of it. 

The realistic fear that everyone has of this disease should be allayed by the sensible, scientific approach to prevention presented in this book. If strong fear of cancer persists, the phobia should be discussed with your doctor.

He can help you overcome it. If not, then he may wish you to have a talk with a psychotherapist.  

Breat cancer symptoms and signs treatment with mastectomy

There are often emotional upsets because of the psychological significance of the breast, and the patient may require counseling. There are many prosthetic devices-artificial breasts-to conceal deformity. If cancer has spread, much still can be done to prolong life and make the patient comfortable. Radiotherapy can be of value and is often used after surgery as an aid to affecting a cure. 

To avoid breast cancer possibilities, Angelina Jolie recently have undergone mastectomy and give hope for other breast cancer possible victims to remove the breast. a great job done by a celebrity in USA. The news spread like a fire and help worldwide women.  

Hormone treatment is sometimes helpful for those with metastases (cancer growths spread elsewhere) that are causing discomfort. In some cases, removal of the ovaries and/or the adrenal glands may be called for as a means of producing hormonal changes that may be helpful.

The decision on suitable treatment for the individual patient is often difficult, and the physician caring for the patient may require the advice of a specialist, usually a surgeon with extensive experience with this disease. 

Women who develop cancer in one breast will sometimes develop cancer in the other. Also, women with a strong family history of breast cancer are at higher risk. Therefore, they should have more frequent examinations by their physician along with mammography studies.

Simple mastectomy-removal of the breast tissue without removal of the lymph nodes as in radical mastectomy -is rarely employed for cancer. It sometimes may be used, however, for cystic mastitis after repeated biopsies of cysts over several years because the physician fears he may miss a possible hidden cancer.

 At present, there is intensive and, in the opinion of many experts, highly promising research into many aspects of cancer-causes, new detection methods, and new methods of treatment. Men rarely get breast cancer, but it is nevertheless a possibility.

Any breast lump in a man should be biopsied. See the section on cancer concerning the question of removal of breasts as a means of primary prevention of cancer. For some women, breast size is a matter of concern. Exercises can help tone muscles adjacent to breast tissue and may help to make the breast, appear larger.  

Allergies - Adverse reactions to medications

Adverse reactions to medications which are considered by some experts to be allergic are un- toward effects on blood platelets leading to hemorrhages into the skin, depression of blood cell production in bone marrow, and liver reactions.   The list includes it agents as aspirin, sulfa com- I'0unds, tetracycline and other antihrotlrs, insulin, antitoxins, local anestheues such as procaine, some of the Iranquilizers, mercury, and arsenic. 

In one case, a person seemingly allergic to a medicine may actually be acting to milk sugar used as a filler for the tablet or a dye used to color I pill. An important preventive measure for anyone with sensitivity to a medicine is to carry a card or bracelet indicating so, and also to announce the fact to every doctor or nurse who has occasion to take care of him. 

And when such a person is in a hospital, there should be a sign on or near his bed or in the room stating sensitivity to a given medicine. A person experiencing a severe allergic or other adverse reaction to a medicine should be promptly treated hy a doctor or go to an emergency loom in a hospital. It is not enough to rely on an antihistamine, which may be useful for a mild reaction.

Skin Allergy HIVES. A hive is a raised, blister- like area containing fluid, white in color but surrounded by a reddened area. It usually itches intensely. An acute attack of hives-also known as urticaria, giant hives, angioedema, angioneurotic edema, and nettle rash-may be caused by allergenic foods, medicines, or serums. 

There are also physical causes such as sunlight, heat, cold, and pressure on the skin. When hives are accompanied by edema or water-logging and swelling of throat and laryngeal tissues, there may be danger to life. Treatment is effective. In addition to the same medicines used for hay fever, the doctor may prescribe soothing creams, lotions, or baths for the itching skin.

Sometimes a strong laxative helps shorten an attack induced by food by hastening its elimination from the intestine. People subject to recurrent severe hives should be prepared to act to prevent an attack from progressing to the point of interfering with breathing. They should learn from their doctors how to handle an emergency and should carry the necessary materials with them at all times. There seems to be a strong emotional component in some cases of recurrent hives. Patient and doctor should discuss life-style and tensions and consider whether a session with a psychotherapist might be helpful. 

Mental Health and Infatuation and Marriage Age

INFATUATION There is a decided difference. A strong sexual desire is often mistaken for love. If it is not accompanied by other strong feelings, this is infatuation. In adolescence, infatuation is called "puppy love." Both in adolescence and later, infatuation is usually outgrown. While an adequate definition and love has troubled poets and philosophers from time immemorial, for the practical purposes of successful marriage you can ask yourself these questions: Do you feel a sense of oneness, each with the other?

That is, do you consider the other person a part of yourself? Do you feel you can trust the other person implicitly? Does he or she give you a sense of security? Are you deeply concerned about his or her welfare? Do you try in all ways to make the other person happy?

Have you found that, after being apart from the other person for a period of time; you still feel the same strong emotional attachment? Do you find that the longer you know each other the greater grows if desire to stay together and you do not grow bored as time goes by?

These questions, if answered glibly, will mean nothing. But if, after serious thought, you can say "yes" to all of them, you may safely say that you are in love. You will have noticed that they are concerned with true companionship. Physical attraction is not enough to guarantee a happy marriage. Sex is of basic importance in marriage. It is, one might say, the foundation upon which the house must be built; it is not the whole house.

MARRIAGE AGE There is, of course, no one best age for marriage. Ideally, perhaps, marriage should be entered into when maturity, both physical and mental, has been reached. Maturity varies from one person to another, although experts place the usual age in the 22 to 30 range. This has been found to be the age range during which most successful marriages are formed, with the husband generally from four to seven years older than the wife. There are exceptions, of course. In many happy marriages, the wife is older. The important consideration is that the couple be emotionally stable and mentally mature enough to handle the stresses and strains of marriage. Determination to make a marriage successful is a major weapon in doing so. There will need to be tolerance, understanding, and good humor.

 Neither partner can expect the other to give in on all points, to make all the sacrifices. Marriage is a mutual undertaking. When sacrifices have to be made, as they invariably must be, they should be made without resentment, with the larger view in mind-happiness for both partners. It has been said of a successful marriage that it represents the real success in life, and that it is better to fail in all else and succeed at home than to have success in all else and fail at home. Married love can be the most rewarding human experience. If we were to define it in its simplest terms, we would say it has three parts: sexual attraction; a deep feeling of companionship; and a desire for parenthood. The first two are essential; the third is valuable for emotional fulfillment and complete, enduring happiness.

Ask these questions to avoid Mental Illness

COURTSHIP

Thus marriage, important to society, very important to the individuals involved, with considerable impact on both emotional and physical health, is a complex relationship, one not yet, and possibly never likely to be, scientifically blocked out, with definitive pretests to guide young people before they enter into it. Not for one moment do we suggest here that a young couple contemplating marriage can depend upon any set of tests or rules to determine whether theirs will be a happy marriage. But certainly some exploration and stock-taking are in order before entering into such a significant contract.

However much the heart races at the sight of the beloved, do not rush into marriage

 Give yourself and your potential future mate a chance to know each other. Face up to the fact that you should not marry anyone with the idea in the back of your mind of reforming him or her. Remember you are marrying an adult with fairly well fixed habits and tastes. If you marry for what your partner is, not for what he or she may become, it will save you a lot of disillusionment.

Use the time before marriage to discuss and try to reach basic understandings on all important matters

 Should the wife work? For how long? Are the husband's earnings adequate for both to live on? Who will manage the family income? How many children? How should they best be brought up? These are examples of questions that have to be faced at some time and may best be faced before marriage. Some additional questions may serve as a helpful guide;

You really enjoy spending most of your leisure time together?

Do you both enjoy the same friends?

Do you have compatible tastes in books, movies, art, sports, and other activities? Do your feelings and tastes about the kind of home you hope to have match reasonably well?

Do you agree on whether or not to have children and on their upbringing?

Does the prospective husband like to putter around the house, build and fix things, do gardening?

Does the prospective wife like to cook, sew?

Do you both have the same basic philosophy about life and your goals in life, the nonmaterial as well as material?

 Do you have the same religion or agree on attitudes toward religion?

Do you like or share each other's attitudes toward parents?

And are you in agreement on ways to deal with them?

Will you be likely, as best you can determine now after serious thought, to love each other when you are old?

Any couple who might answer "yes" to every question would be a rare one. You should not expect, nor desire, a mate who is a mere carbon copy of you. Disagreement on minor matters makes for stimulating conversation. Basic antagonisms, however, are another matter and intro- duce risk into marriage. Certain questions are more important than others. There should be a positive "yes" to the questions that are starred. About the seventh question: Religious disagreements have been found to playa small part in disturbing a marriage. These differences tend to be worked out satisfactorily during the courtship. After marriage, the problem is usually centered on the religious upbringing of children. The eighth question involves inlaws, who have been the cause of many marital upsets.

The courtship period is the ideal time to get to know them and make every attempt to like and be liked. The courtship period goes through several stages. Usually it has been preceded by "dating"-a time when the opposite sex is met at dances, school, clubs, and gatherings of various types. Dating should be constructive, a time for meeting different kinds of people and for enjoyment, but also for thoughtful exploration and understanding of members of the opposite sex. Courtship may be said to begin with "keeping company," when, after something "clicks" between two people, other dating falls off. "Going steady" usually follows; the attachment has become stronger. Private understanding is a succeeding phase for many couples. They have exchanged avowals of love.

Each has, if possible, been introduced to the other's family. Engagement is the final test before marriage. It should be the time for free, honest, and practical talk, for getting to know one another at deeper levels, for real understanding of each other's personality defects and for deciding about compatibility. For the average couple, one year has been suggested as a minimum engagement period. There is no ironclad rule; some couples need more time than others to get thoroughly acquainted or have had more time to do so prior to becoming engaged. But whirl- wind courtship should be avoided; too often it leads to divorce. 

Mental Health - Two types of Marriages affects the MEantal health

TWO TYPES OF MARRIAGES

As individuals, different people live by different standards. Couples do, too. And in understanding successful and unsuccessful marriage, it's important to understand that what connotes success to one couple may mean failure to another. For example, some couples take pride and obtain considerable gratification in participating in community cultural life. For them, this constitutes an extension of their good marriage. To other couples, with different tastes, that same involvement may seem to be a means of escape from an inadequate marriage. When a couple believes their marriage is happy, it may well be happy to them even if outsiders question the fact. But sociologists have recognized that if some objective criteria could be found, they might help to give married people fresh insights into their relationships.

After studying 437 men and women, Dr. John Cuber, professor of sociology at Ohio State University, has concluded that marriages can be divided into two basic types. One, called utilitarian, serves primarily as a means to such familiar ends as establishing a home, having children, furthering a career, or enjoyment of wealth and prestige. The other, called intrinsic, makes such considerations second in importance to the intimate relationship of the partners. All marriages do not fall neatly into one or the other category or remain constant. One category is not necessarily better than the other; each type of marriage reflects a different philosophy and serves different needs.

But the categories and their patterns provide a basis for psychologists to determine how well a marriage is functioning and may help people, as Dr. Cuber notes, to "discard the idea of a perfect marriage and be spared the frustration of measuring their lives by impossible standards." While a utilitarian couple may look upon marriage as a means to comfort and security, and while they may have only minor sexual feel- ings for one another, they do get along. And while the intrinsic couple find great pleasure in each other, enjoying differences as well as same- nesses, revealing their secret thoughts and feelings to each other without embarrassment, yielding to the limits of intimacy and fulfilling their sexual natures, this type of bond, ideal as it may seem, sometimes leaves no room for the outside world to enter. And when external pressures invade, as they invariably do, the marriage can be in jeopardy.

The utilitarian marriage, which thrives on outside interests, may have a greater chance for longevity. As a follow-up to the Cuber theory and in an effort to see what early signs might provide a preview of what will happen to couples, investigators at the National Institute of Mental Health worked with volunteer couples who had been married just three months and were of comparable age and social background. After extensive interviews and detailed questionnaires, the couples were given a color matching test to take together to determine how they handled conflict. Some couples virtually went into combat; others argued much like lawyers; some refused to argue and gave in almost immediately.

There were also some who listened carefully to each other's point of view and eventually agreed to disagree. The latter couples maintained their faith in themselves and their relationship, and it is these couples who develop intrinsic marriages. Those who seemed to concede too quickly may find themselves in a utilitarian marriage or even in a devitalized marriage in which the partners start out with high hopes and settle into a life of apathy and disappointment. Becoming familiar with marriage patterns may enable couples to understand the real nature of their relationship and may help them move toward the relationship they want.

Mental health- A LOOK AT LATE MARRIAGE DISSOLUTIONS

A LOOK AT LATE MARRIAGE DISSOLUTIONS

The number of long-standing marriages terminating in divorce has been growing. In Georgia, for example, Dr. Alfred A. Messer of Emory University found that, in 1953, 9 percent of divorces involved couples whose marriages had lasted 20 years or more; by 1966, the rate had gone up to 11 percent. A sampling of divorces in Fulton County, Georgia, in 1967 showed 14 percent to have taken place after 20 years of marriage. Nationwide data for 1963 revealed that 24 percent of divorcing couples had been married more than 15 years, indicating that the problem is not localized. As the result of his investigations, Dr. Messer advances several reasons for these "20-year fractures." For one thing, divorces are now more socially acceptable, and more people can afford them.

Also, more women now are able to work and are no longer financially dependent on their husbands. Divorce laws, too, in many states are more lenient than in the past. But one major reason, Dr. Messer believes, is that partners do not get to know each other well enough before marriage to be sure they can form a new identity as a pair. Also, child orientation is overemphasized in many families; the children become the nucleus around which all activities revolve, leaving little time or emotion for a husband-wife relationship.

Most couples attempt to make up in marriage for traits they think are lacking in their own personalities, says Dr. Messer. Unlike attract and likes repel. The man who is shy and silent is often happier with a vivacious wife. The frail woman likes to have a strong and vigorous husband. In a child-oriented family, the parents may begin to look more and more to their children for this type of gratification. The woman may cook and dress more for her children than for her husband, and the man may prefer to be with his children rather than with his wife. When the children leave, there is a void, and the husband and wife may feel that their needs are not satisfied by each other.

In every family, there should be a balance between adult-oriented and child-oriented needs, says Dr. Messer. In our "century of the child," the pendulum seems to have swung a bit far toward the child side. There is need for more "adult time," more second-honeymoon activities for the husband and wife to balance their role as parents.

Mental health

As one investigator has pointed out, the trend toward "equality" be- tween the sexes in marriage, without any clear division of labor and authority-as there was when the wife was expected to be exclusively a homemaker and the husband a breadwinner-creates "great potential for conflict and disillusionment." Under any circumstances, "boys and girls are bound to differ in some areas of role expectation." How they are able to modify these expectations when the honeymoon aura is over, and human weaknesses are revealed, is vital to the marriage. In describing how the health of a marriage can deteriorate when there is insufficient, or no, adjustment, Dr. Richard H. Klemer, of the Department of Psychiatry at the University of Washington, Seattle, says: "Al- though it may not be intentional or even conscious, one partner or the other begins to have something less than complete acceptance for his mate. If it begins with the wife, the husband soon senses this change of attitude and begins to protect himself, again perhaps only half-consciously. In turn, the wife protects herself against the husband's slightly changed attitude.

Then she protects herself further, and so forth. This goes on till the partners arrive at a state of complete hostility-or worse, apathy-in their efforts to protect their own ego against their mate's disillusionment." It is this that Dr. Klemer calls the "modern marriage disease." It can be prevented and checked when husband and wife realize that some expectations have to be modified and proceed to modify them as soon as possible. There is no marriage that does not require adjustment. Obviously, a mature person who acts on the basis of reason, not just emotion, will have much less trouble adjusting to marriage than a person who may be physically adult but is still a child emotionally.

Marriage can be an exacting business. It was once thought that personality development virtually stopped at the age of five; now it is recognized that personality development can continue all through life. If it does continue, a marriage is likely to be a happy one. After devoting many years to marriage studies at Harvard Medical School's Laboratory of Community Psychiatry, Dr. RhonaRapoport finds that getting married is exacting because it involves a II critical transition from one social role to another." It calls for changes in behavior and social relationships between the individuals and entails "personality change of a more or less enduring nature. II Dr. Rapoport goes on to note: "Major social-role relationships are inherently disrupting. As an individual's social role changes, his image of himself is affected, the way in which others expect him to behave changes.

And his legitimate expectations for the behavior of others alter. As all this goes on, the individual may grow and develop under the impact of the stimuli or he may find them so burdensome and distressing that his functioning is impaired, in extreme cases involving symptoms of emotional disturbance:" Everything does not have to be mutually satisfactory in a happy marriage. Studies reveal that in most marriages that are happy, several phases of marital life are not what the partners would have liked. If adaptability and the maturity that makes it possible are essential, so is motivation. With strong motivation, the desire to make a marriage work, adaptability may be furthered. The Harvard and other studies suggest that what happens in the engagement period before marriage often indicates how a marriage will go. Couples best able to adjust to each other during the engagement period have least trouble moving happily from the freedom of single life to the demands as well as opportunities of marriage and family life. This is a good reason for a fairly long, relaxed period of courtship. 

What research says about Mental Illnesses?

INSIGHTS FROM SOME RECENT STUDIES With researchers today investigating every facet of the husband-wife relationship-many of the studies are sponsored by the National Institute of Mental Health because of recognition that marital conflict is a major health problem-new insights are constantly being turned up. It should be emphasized that they are insights, not definitive conclusions. It is difficult to reach definitive conclusions in areas as complex as marriage. But the insights are worth noting.

Thus, research studies at Harvard, the University of Michigan, and other major institutions suggest that when husband and wife are equally mature and motivated, they can get along as well-even though they do not have similar backgrounds, attitudes, interests, and personalities as couples who do have such similarities. And, conversely, when a couple is unable to adjust and to grow with the marriage, it does not matter how great the initial similarities were. Unrealistic marriage expectations, many studies show, are the chief source of marital unhappiness. Among couples asked to rate themselves on a happiness scale, those who scored themselves happiest turned out to be playing roles in marriage which they had expected to play and which their spouses expected them to play.

Those who expected their spouses to act like a favorite TV or movie star, or like Dad or Mom, were in trouble. This is not surprising, of course, but some studies also reveal that some young people, even among those who plan seriously for marriage, have expectations that seem reasonable but aren't really realistic for them. Thus, many young people tell researchers that when they marry, the wife will not work; she will go to college; it is more important for her to be an interesting and entertaining companion than a good housekeeper or cook. But the fact is that many wives must work, are unable to go to college, or fail when they do go. And study after study shows that most men, whatever they may say to the contrary, much prefer having a wife who is neat and efficient around the house than one who is brilliant and a witty conversationalist but leaves dust on the furniture or dirty dishes in the sink.

Treatment for Mental Illnesses,

NUMBER OF FRIENDS

 Generally, men and women who have had many friends of each sex before marriage are likely to be the types who will make satisfactory mates.

MEMBERSHIP IN ORGANIZATIONS

 It may be a good sign if an individual is a member of a social, labor, or other club or organization, indicating that he accepts, and is accepted by, a large group of people.

EMOTIONAL ADJUSTMENT

 Obviously, people who are emotionally well- adjusted have the best chance for happiness in life and for making the many adjustments required in marriage. Some authorities list the following characteristics which should be considered before marriage and advise that at least two of the good characteristics should be present: GOOD BAD Optimistic personality Pessimistic personality Dominating personality Cooperativeness Consideration and sympathy Inconsiderate and unsympathetic Some degree of emotional dependence Too self-sufficient emotionally; too much narcissism or self-love Dependent personality; too strong an attachment to parents

NEUROTIC MARRIAGES

What do most people seek when they marry? Happiness, of course, but other things, too

 Some marry for security; some for love; some for prestige or social gain; some because it is time to marry, to be grown-up, or to have children and family. There are other conscious, and socially acceptable, reasons. But if, without realizing it, people marry for buried neurotic reasons, a marriage is not likely to be successful. For example, some men marry women not really as wives but as mothers; and some women seek fathers in their spouses rather than husbands. Some people seek mates who will serve as father and mother, the omnipotent decision-making parents of early childhood.

Some unhappiness is to be expected in every marriage, but when the unhappiness is constant and pervading, outweighing the pleasure and satisfaction that should be expected of marriage, the marriage is neurotic. It is sometimes possible for a neurotic marriage to seem to go along fairly well but it is so precariously balanced that any new factor may tip the scales. That is especially likely when a child is born, for then the neurotic partner may find the situation intolerable, regarding the child as a competitor. It is helpful to understand that the neurotic factors an adult brings into marriage are likely to have had origins in childhood. Thus, the son of a domineering father who made all the decisions may have a desire to avoid adult responsibility and may well seek a wife who will make the family decisions. If he finds such a wife, his marriage may be far from blissful but not an outright obvious failure. But if the wife, like he, is a decision avoider, there can be chaos as each waits for the other to move. Many factors in childhood may-though they certainly do not necessarily always-lead to difficulties in marriage.

They include sibling (brother or sister) rivalry, favoritism, too demanding or too indulgent parents, parental discord and divorce, uncertain parental discipline, over- protectiveness. It is helpful to understand the influence of such factors both in terms of choosing a marriage partner and, later, if there should be difficulty. Such understanding may in itself help a little to ease the problem, and it may permit proper help to be sought to save the marriage. 

Personalities and character structures affect Mental strength

Personalities and character structures are of prime importance in this most important contract of adult humans. It is upon these factors that the success or failure of the marriage depends. When difficulty arises in a marriage, when there is discontent, frustration or discord, physical and psychic symptoms may follow. Preventive medicine has become increasingly aware that many health problems are precipitated by marital problems. While there is no such thing as a blueprint for a happy marriage, it is wise, before entering marriage, to be aware of the factors that are most likely to lead to successful marriage and those that may foredoom a marriage. Out of scientific studies which have investigated many thousands of marriages to determine reasons for success and failure, experts in the field have arrived at some guidelines.

CULTURAL BACKGROUND

 Generally, people feel more at home with others who have had similar childhoods and have similar customs, manners, and tastes. Certainly, marriages between people of different races, religions, and economic and social classes can be successful. But it is only realistic to recognize that such marriages must overcome extra problems, not necessarily insoluble but real enough-problems caused not only by social disapproval but by the number of adjustments that must be made. For example, a rural Southern boy and a city-bred Northern girl may find it quite difficult to arrive at a way of living that makes them both happy and comfortable.

EDUCATIONAL LEVEL

 Not only the actual learning experiences but the experiences of being with others and the opening up of interests which Healthy Adjustment in Marring!! / 37 schooling provides can be of importance in marital adjustments. It is usually helpful to a marriage when both partners have roughly the same amount of education.

ECONOMIC AND JOB STATUS

 More important than the size of a man's income is the job he has, not alone the salary he gets from it but the satisfaction; the challenge it offers him; the fulfillment he gets from working at it; the possibilities it holds for the future, either in itself or in other opportunities to which it may lead. Generally, today, the more educational preparation he has had for his work, the more rewarding- not only in immediate financial return but in other ways-it is likely to be, and the better candidate he is for marriage. 

HEALTHY ADJUSTMENT IN MARRIAGE

 HEALTHY ADJUSTMENT IN MARRIAGE

MARRIAGE HAS been described as the "incredible entanglement of two people." If incredible, such entanglement has proved to be the most suitable and durable means by which most men and women achieve emotional gratification. A merger involving two personalities, each with his and her own individuality and distinctive familial background and standards, is not and never has been uncomplicated. You may hear it said that the American family is heading for collapse. But such ominous predictions have long been made. Early in the century, some writers seemed to think that horse and buggy reins had been the ties that had bound the family together and "the citizen, shaken loose from his safe domestic base by much streetcar straphanging, takes to socialism and drinking.

The matron, without the steadying discipline of having to get home in time to feed the horse, gads and grows extravagant." If marriage and the family today face changes and problems, they have always done so. Every generation has its problems of progress. The Victorian era-patriarchal, well ordered, and romanticized ever since-- lasted only half a century and constitutes a small part of our heritage. Perhaps, as sociologists point out, if there is an American norm, it is the frontier tradition of breaking away from the Establishment at an early age, and young families today resemble the pioneers who fought the wilderness. They fight a new kind of wilderness, not geographic, but psychological and moral. They are almost constantly on the move, with jobs taking them from one city to another, one region to another. They "do it themselves"; household help virtually does not exist any longer nor the handyman for hire nor the quickly available, reasonably priced serviceman.

 With disruption of many once-fixed values, with the moving about that does not allow the continuity that can be a stabilizing influence for children, young parents must and do compensate, working harder at understanding their children than any parents before. Perhaps in reaction to having been brought up on standards of material success, young couples today often consider material success of relatively small importance as contrasted with working for something of greater social significance. They try to be of service; young fathers carry petitions; young mothers attend lectures on social problems; they teach their children to think in terms of service to humanity. And if the American family, as Phyllis McGinley has put it, "seems threatened-by the impact of violence and war, by frequent divorce, changing sexual attitudes and a general atmosphere of wariness toward established religion-it is also protected by this fresh concern for the rights of human beings." Still, marriage is a highly personal situation, exposing the partners to the most private and intimate of contacts. 

Fatal MEntal illness

Sickness and operations

 We live longer and so are more subject to chronic illnesses. Often, these illnesses can be well controlled. But the very fact that an illness exists, even when controllable, can lead to feelings of despair or depression. Be sure you talk openly of your feelings about an illness to your doctor. And be open, too, with your spouse and friends. If you need an operation, you have every right to discuss with the doctor just what is involved, what will be done, how long a period of recuperation will be necessary, what the fee will be for operation, and what other expenses will be involved. And remember that almost everyone has some gloomy days after a major surgical procedure, but there come the happy days when the body overcomes the stresses of surgery and anesthesia.

Fatal illness

 Some people think that awareness of a fatal illness must lead to emotional depression. This is not necessarily so. Most people take the fact well. There may be forlorn moments as the situation is first accepted as reality. Most depressions come from misunderstandings, such as that cancer will inevitably produce unbearable pain or will so destroy the body that other humans will shrink from contact. If a diagnosis of cancer causes great anxiety or frank depression, a long talk with your doctor, or with a psychiatrist your doctor can arrange for you to see, can be most helpful. We have seen people who have had a good, rich emotional life grow to even greater appreciation of life as they faced their last days during a known fatal illness. 

MEntal Illness causes and treatemnt

 Marriage can help assure a healthy mental and emotional life if there is true love, acceptance of each other's good and weak points by the mates, and a happy, fulfilling sexual life. Marriage should continue to grow as a creative experience and not settle into "dullsville." Because marriage is so important in preventing emotional problems, at the first sign of significant marital trouble there should be a talk with a marriage counselor. Sometimes a single session will work wonders. (See page 327 for further discussion of marriage.)

Pregnancy and the arrival of children

 Pregnancy can set off emotional problems. We have a section on pregnancy. The coming of the first child and then of later children expectably changes the quality of marriage. It should deepen ties. But each partner needs to realize that the other, deep down, wants and needs reassurance that a child hasn't usurped all love. If pregnancies and the coming of children go well, what then can threaten the emotional stability of adults? Here are several situations that cause tension and sometimes serious emotional disturbances: Loss of job or business reverses.

We have known people who have lost fortunes and made them again. Nothing disturbs their inner conviction that they will succeed in their work. On the other hand, we have seen emotional disturbances develop at the threat of a change of job or a small temporary reverse in a man's business venture. Such disturbances call for a talk with your doctor or other counselor.

Menopause

 This is a dramatic, emotion-charged event for some women. See our special discussion about its emotional component.

Sex in the later years

More and more, medical science recognizes the need of older people, and their ability, to continue sexual activity into very old age. Even many individuals with heart disease and other ailments can enjoy sexual activity. Sex deprivation, especially in an older man, may cause depression. Here again, a talk with a sympathetic physician will prove helpful.

Security

 We live in a competitive society which really has little mercy for the person who doesn't provide for himself and his family. Social security benefits are inadequate. It is reassuring-and a good preventive of mental tension-to work out early in life a program of disability, retirement, and life insurance which will provide for the family. This doesn't mean that you have to become so worried that you become "insurance poor." There are low-cost, term insurance policies which young people can afford. And almost everyone belongs to at least one organization that offers inexpensive group insurance.

Retirement

 What happens at retirement will probably reflect the sum total of your personality growth during your lifetime. Some people enjoy retirement; others abhor it. Talk at length to your doctor about your emotional as well as physical needs in the retirement period. A change of location may be beneficial emotionally for some people, not for others. If you need part-time work to keep you cheerful, remember that you usually get this more readily in your home location where you are known.

Treatment for Mental stress and Illness

Beginning of school

 This is a big event in the emotional life of a child, especially for one who has not gone to nursery school. Extra love, sup- port, and praise should be given him as he makes this big adjustment. The parents should become part of the school life through visits, parent- teacher activities, etc. Some experts on child rearing believe that personality is relatively fixed by the time a child starts school. We disagree, even though we believe strongly that the early years are highly important. We believe that personality is constantly developing and changing as life proceeds, and that only death marks the end of personality and emotional change for a human being. From the beginning of school until puberty there is a quieter period in the emotional life, the so-called latency period, when the child undergoes fewer upheavals and is usually highly receptive to education at school and at home.

This is the calm before the storm. Then come puberty, adolescence, and the teen-age years. Until adolescence, there will be no doubt of a child's dependence on the parents. Now, however, the situation becomes ambivalent. The child lives at home but begins to feel the powerful biological and social drives that will transform him into an adult.

During these stormy years, personality will be molded by the outcome of explorations and reactions to Dating and petting experiences For the girl, menstruation (treated elsewhere in this book); for the boy, growth of sex organs and the occurrence of wet dreams Masturbation Homosexual feelings, activities, and fantasies Sex drives toward the opposite sex Acceptance or rejection by classmates of both sexes Athletics and other school activities Scholastic achievement Some degree of rebelliousness with parents, teachers, police Experimentation with drugs, cigarettes, alcohol Part-time jobs and summer activities Handling of money, budgeting, use of own or family car Surely, we haven't listed all the possible critical factors of the lively teen years.

We can only hope that these and other problems will be dis- cussed by parents and children, because their resolution in a positive, healthy way will do much to prevent mental illness. We suggest that parents and children read the wise book by HaimGinott, Between Parent and Teenager. When parents and teen-agers cannot achieve open discussion and communication, they should find a mature, sympathetic person who can provide guidance (and referee misunderstandings and quarrels).

A teacher, clergyman, doctor, relative, or school counselor may be just such a person. A visit to a psychiatrist may be needed in some cases when personality problems become severe-for example, when a child wants to drop out of school, begins to use drugs regularly, exhibits cravings for alcohol. Nineteen is the last teen year but hardly the end of emotional strains and growth. There follows the period when major decisions must be made about career and marriage. Surely, almost every expert on personality would agree that a rewarding job in which the individual is happy is great insurance for mental health. This, of course, is a good argument for obtaining the right education to open up a wider choice of career possibilities. A secure, happy marriage can be a bulwark against emotional problems.

We deal with marriage later. Let us stress that marriage is so important that the decision to enter into it should be based on mature judgment, not entirely on romance. Remember that more and more marriage counselors are helping people before marriage with advice about possible suitability and compatibility and by giving them realistic previews of problems to be faced. 

Treatment for mental Illness

Toilet training

 The handling of toilet training can be an important determinant of personality. During World War II, Navy doctors were so impressed by the relaxed behavior of Okinawan civilians under bombardment that they studied the personality backgrounds of these people. The significant factor seemed to be that the Okinawan child was per- mitted to set his own pace for toilet training. Children vary in the development of brain areas and nerve pathways involved in the complex reflexes required for urination and bladder control. Our advice is to consult your child's doctor; he knows at what pace the child is developing and can make a good estimate of the date when toilet training should be started.

Talking

 There is big variation in the time when children begin to talk. Don't worry because a neighbor's or relative's child may talk at a very early age, earlier than your own child. But if you are getting nervous about your child's timetable, discuss this with your doctor.

“Abnormal" curiosity

 A child is curious about everything. That includes genitals, feces, urine as well as more acceptable objects in the unfolding world around him. Let him explore. Don't shame him. If he gets too messy, distract him gently.

Social experiences

 Introduce your child to other children gradually. Do it at play places, at home, in playgrounds. This is especially important for an only child.

Nursery school

 One of us wrote some years ago that if he had to make a choice because of limited tuition funds between nursery school and college for a child, he would choose nursery school. He was thinking of a really good nursery school with trained, sympathetic teachers who supplement the efforts of parents in the important years between age 3 and 6.

Identification with parents

 Many psychiatrists believe that in the 3- to 6-year age period, a struggle goes on in the inner, unconscious minds of children and that it has important bearings on later emotional health. At this time, the boy struggles unconsciously to supplant his father in his mother's affections, and gradually to identify with the father; the girl undergoes a similar reverse situation. This "oedipal conflict" may help determine how a boy or girl will feel later in life about the male or female role. During this important period, parents should not make favorites of children, should be careful not to appear to be seductive, should exclude the child from the marital bed, and should exercise care that the child has no opportunity to view their sexual activities.

It is best neither to take baths together nor to share the bathroom with children at this age.

Vacations

Separation from home during vacations can be a positive or negative influence depending upon the child's readiness for the experience. Overnight camp is a big dislocation for a young child and should be undertaken with caution. And remember that a vacation with grand- parents may seem natural to you but a child may view them as strangers.

Movies and TV

Parents should guard against making babysitters out of TV programs or movies. No one really knows how much influence these media are having on the emotional development of our children. But it surely seems sensible for parents to select programs carefully for the very young child.

Birth of a new baby

 A child may fear displacement when a new baby arrives. It is a challenge to parents to make the child feel even more loved and to give him a sense of participation in the care of the new arrival. Parents should consider nursery school or other activities for the child long before the baby is born to challenge his place.

cuddling and affection treatment for

Teething sometimes may be traumatic. Extra cuddling and affection at this time can be helpful. In some cases, the doctor may need to determine whether dental intervention may be required. The baby with frequent and severe colic has a hard time, as do the parents. Many pediatricians would be glad to prescribe paregoric or other suitable medicine for relief of the colicky pain but are afraid that the parents may feel that they are "doping" the baby. If your baby is colicky, have a good talk with your doctor about providing relief. Weaning is an important event for the baby. Weaning should be gradual and, if possible, at a time when the parents, particularly the mother, can spend extra time with the child. If in doubt about the technique, go over the details with the baby's doctor.

The baby should be introduced cautiously to water, whether it is for bathing, hairwashing, or actual swimming. Children vary enormously in their fears about the feel and look of water. Child begins to explore his room and his curiosity while protecting him from danger. Wise parents, building a secure emotional life for the child, will avoid the constant repetition of "No, no." They will try as much as possible to hide dangerous articles, provide reasonably safe play areas, safeguard beds, shield electrical out- lets, put gates on stairways, etc.

To satisfy a child's natural curiosity and desires, a play space should be provided with a "messy area" where there will be opportunity to experiment with wet clay, sand, and paper. A friendly puppy or kitten may prove a great asset at this stage of life. Eating habits worry too many parents needlessly. If you stay relaxed, you will find that the child will settle down to an adequate diet. If not, rather than become a nagging parent; discuss diet with your doctor.

PREVENTIVE PSYCHIATRY

PREVENTIVE PSYCHIATRY

FAMILY DOCTORS and pediatricians are often asked by prospective parents and actual parents: "How can we guarantee that our children will grow up free of emotional illness?" This is a logical question in an age when we can guarantee protection against polio and many other serious or unpleasant diseases. Unfortunately, we don't have vaccines to prevent development of abnormal personalities, neuroses, and psychoses. Some doctors even take a completely negative attitude; they feel that there is not enough knowledge to give any valid advice on prevention of mental disorder. However, most physicians, psychologists, and child educators believe that there are useful guidelines.

 We believe that a child has a better chance to develop the type of normal personality we have outlined previously if certain guidelines are followed. And we go along with the thinking of those psychiatrists who believe that if there are any hereditary or familial tendencies to emotional breakdowns, the individual with a sturdy personality can fight them off or, if afflicted, will have a better chance of recovery. We believe that of overriding importance are the basic attitudes of mother and father. When parents love and relaxed, there is usually a good future for a child.

Even babies sense love, poise, and acceptance in their parents, especially the mother. The mother's voice and touch are appreciated by the baby at an early age. If they are loving, warm, positive, the baby has a good start. When a mother is loving, eager to have her child grow into a happy, resourceful human being, and has realistic hopes for him, the child's upbringing and future are likely to be soundly based. Even though mistakes almost certainly will be made, they will be offset by a strong "bank balance" of loving, normal, good care. Because the first year of life, even the earliest days and weeks, are important, planning during pregnancy is important. It is often helpful for new parents to take a course in baby care. If a rooming-in arrangement -one in which the baby can be close to the mother (and shared by the father)-can be arranged in your particular hospital, we think it a good idea.

Sometimes, a little extra pressure on the obstetrician may make this possible. We think breast feeding brings mother and child into a close, warm emotional relationship. However, if it is not feasible, the mother should cuddle the child closely so that bottle feeding has much the same overall physical feel for the baby as breast nursing. If circumcision is desired, it should be arranged in the hospital before taking the baby home. Later in life, this minor operation may have major emotional importance. Prolonged separation from parents, especially from the mother, in the first year of life (and later, too) can be the basis for later psychological problems. Separations should be avoided if at all possible.

When unavoidable because of illness, divorce or death, a parent substitute should be introduced as soon as possible. The substitute should have the qualities of a good mother or father. Introduction of the baby to the new person should be made gradually because even a grandparent may rank as a total stranger to a child. After breast or bottle feeding has been settled upon, there should be a decision about demand versus scheduled feeding. We favor letting the baby's hunger set the schedule rather than having the clock prevail. However, that does not mean that the mother must be a slave to every first whimper from a baby. Infants are capable of tolerating some minor frustrations. 

Qualified professional approach

Only a qualified professional, after personal contact with and evaluation of an individual, can validly suggest the type of treatment that would be most suitable. But the point is this: Unresolved emotional problems are the basis for much mental anguish and for much physical torment. That fact is very clear today. And society's attitudes have changed, too; there is no longer any shame (there never should have been) in having an emotional problem and in seeking help for it. Help is increasingly available, and effective, and quite often relatively inexpensive. Few people, if any, would not be willing to spend the time and money to be cured of tuberculosis or to have an operation to remove a cancerous growth.

 Surely, it is worthwhile to invest the same amount of time and money to overcome a crippling emotional illness; It is important to emphasize that such an illness-even when the person suffering from it feels that he can take it-can have serious effects on others, especially spouse and children. Also, it is hardly wise to put off getting help in order to save money, since delay usually in- creases the amount of treatment needed. It is true, of course, that some people just do not have the money for psychiatric treatment.

Yet there are clinics at large hospitals and medical schools, and mental hygiene clinics operated by various social agencies, which often can provide therapy you might not otherwise be able to afford. Your family physician usually can provide information about such clinics.