Impact of divorce on teenagers

The Impact of Divorce on Teenagers Jack C. Westman, MD Divorce is common in the contemporary way of life and deserves objective study. It may have redeeming features, but from the point of view of children, divorce is a stressful experience because of the disruption of the home and its financial, emotional, and social costs. The adverse impact, however, can be minimized by realistic and sensitive attention to its effects on children. Although divorce alters the living arrangements of affected families, it does not end family relationships. For this reason, marriage and divorce counseling should deal with the perspectives of both adults and children. Most teenagers and their parents adjust to divorce and later regard it as having been a constructive action; but one-third do not. In those instances the turbulence of the post-divorce phase plays a crucial role in influencing pathological reactions in affected teenagers. The phy- sician is in a strategic position to act as diagnostician, a clarifier of values, an educator in the facts of family life and divorce, a counselor in working through feelings about and attitudes toward divorce, and a source of support for teenagers. WM%l General Reactions to Divorce I~It~R~E IS A FAMILY AFFAIR. One of three Families that experience divorce represent a va- youngsters grow up today either anticipating, expe- riety of patterns. In Wallerstein and Kelly’s study,’ riencing, or reacting to parental divnrce.’1 one-half suffered from loneliness and isolation, with Contrary to the popular view, divorce is not a final closing of an unfruitful marriage and the beginning family members going their own ways; but one-quar- of a new life. Divorce is a realignment of material ter had a rich history of dose-knit relationships. The and interpersonal relationships that does not erase decision to divorce was regarded as based upon ra- the past nor create an unrelated future. Parents re- tional factors in about one-third of the cases. In other main mother and father of a child. Consequently, instances divorce could be seen as related to exter- working through the divorce, its causes, and sequel- làe are life-long matters for affected children and nally generated or personal psychological stress. Some were impulsive and undertaken without rejection or their parents. serious consideration of consequences. Other divorce From the Department of Psychiatry, University of Wisconsin decisions were made within the context of psycho- Medical School, Madison, Wisconsin. therapy or with the encouragement of friends or professional. Correspondence to: Jack C. Westman, RrL~9., Department of Psychiatry, University of Wisconsin Medical School, 600 Highland Wallerstein and Kelly2 found that two-thirds of the Avenue, Madison, WI 53792. . men and one-half of the women were satisfied with Presented at the annual meeting of the American Academy of the divorce action five years later; on the other hand, Pediatrics, New York, New York, October 25, 1982. Received for one-third of the men and one-fifth of the women publication November 1982; revised March 1983, and accepted April 1983. were strongly dissatisfied. This substantiates an ear- 692

lier finding that one-third of divorces involving chil- physician can determine whether or not psychiatric dren were marked by turbulent post-divorce rela- consultation is indicated. Second, the physician can help the teenager clarify values that underlie judg- tionships between the parents.~3 ments about adult behavior and family life. Third, the physician can educate the teenager and parents From the point of view of the children, Brun4 regarding the facts of divorce. Fourth, direct coun- seling can be carried out to improve communication found, on clinical examination, that one-fourth who and understanding between family members. Last, the physician’s sustained interest in a teenager’s life had experienced divorce were adversely affected provides a stabilizing extra-family influence. emotionally, one-fourth were improved, and one-half were apparently unaffected clinically by the divorces Diagnosis of Pathological Reactions to Divorce of their parents. The reactions of adolescents to parental divorce depend upon age, stage of development, sex, per- In Wallerstein and Kelly’s study,~ 28 per cent of sonality strength, quality of the early environment, the children strongly approved, 42 per cent were amount of stress previously experienced, sibling group, and the ability of their parents to meet their neutral, and 30 per cent strongly disapproved of the needs during the divorcing process. In clinical pop- divorce five years later. Significantly, however, 56 ulations of emotionally disturbed teenagers who had per cent of the children saw no improvement in their experienced parental divorce, the majority charac- family lives, 22 per cent saw modest improvement, and 22 per cent thought their personal lives were terized communication between their parents as ei- much better. ther very stormy or virtually nonexistant. 1,6 Three types of pathological adolescent reactions Most adolescents experience divorce as extraor- dinarily painful. The sequence of emotional reactions to parental divorce have been described.~ In the first usually is grief accompanied by guilt; later, it tends group were adolescents for which the separation and to be shame and resentment. Within a year following divorce process served to exacerbate preexisting separation, however, the majority are able to take up problems which had not received adequate attention their individual agendas satisfactorily. Those who and treatment. Many of these adolescents displayed adapt the most readily are the ones who can maintain school failure, emotional instability, withdrawal or some distance from the parental crisis and still have severe depression. They required psychiatric con- sultation in order to devise a treatment plan. empathy with at least one parent.5 A second group was composed of those adolescents Divorce can be a rational, problem-solving action who displayed premature attempts to enter adult- that benefits not only the adults but also the children. hood in the form of antisocial behavior and running away. Many spoke of being eager to attain the age When teenagers can understand the rationale for the of 18 and &dquo;to split.&dquo; The girls turned to sexual acting out, substance abuse, and impulsive behavior. The divorce and see resulting improvements in one or boys became school dropouts, liars, thieves and sub- both parents, their personal experience can be one stance abusers. These cases required social, educa- of relief. The removal of irrationality and strife from tional and psychiatric interventions. a teenager’s life can free the teenager to proceed with the process of personal development. As one A third group revealed a pattern of temporary teenagers said, &dquo;After what I have seen in my parents, regression in the form of depression, anxiety, or an- ger. These adolescents had previous relatively stable I think I know more about how to choose my mate,&dquo; family lives, good adaptive capacities, and appropri- ate developmental progress. In these families there The expanded social experience available to some had been little, if any, discussion of parental sepa- teenagers by exposure to two separate parental lives ration prior to the event itself. The resultant shock after divorce can be broadening. When remarriage of family disruption caused a temporary regression occurs, new family units are created, providing added contacts with blended families. Although step-par- ents and siblings can pose new problems, they also can provide opportunities for personal growth. The Role of The Physician i The physician can play several key roles in helping teenagers and their parents negotiate the vexing is- sues surrounding divorce. First, as a diagnostician the 693

in the adolescent’s coping abilities. In these instances of receiving rather than giving, and anxiety is han- the primary care physician can make substantial con- dled by escape. Discussing these concerns with a phy- sician can be helpful in placing them in realistic per- tributions. spective. Value Clarification Physician as Educator The empathic ear of a physician can have a pow- erful effect in clarifying values for teenagers. Non- The physician can be an educator by presenting judgmental discussions with an adult in an authori- both parents and teenagers with the facts regarding tative position can relieve a teenager’s embarrass- divorce as a way of life. It is particularly important to ment, mistrust, anger, and sense of being different help family members relinquish misconceptions and from others. realistically face the multifaceted aspects of the stages In order to appreciate an adolescent’s viewpoint of divorce. the physician should have an awareness of contem- Because teenagers have established themselves as porary social issues and anxieties. Adolescents tend relatively independent persons, the impact of divorce to react to the world at large and judge adults from upon them has less effect upon basic personality de- the heights of idealism and the depths of despair. An velopment and more consequences in personal issues overriding concern for young people at the time is related to self-identity and practical considerations.’ the question of the survival of the earth as we now know it, with the increasing threat of both a nuclear Unlike younger children, teenagers have achieved holocaust and the gradual pollution of the environ- ment. Although teenagers have more immediate per- sufficient cognitive ability to be able to reflect upon sonal concerns, this backdrop of uncertainty cannot be ignored as a factor in fostering mistrust of adults the circumstances of divorce. Their first concern, and a hedonistic or helpless attitude &dquo;because there however, is the personal meaning of the divorce to will be no future.&dquo; them. Only later do they come to an appreciation of their parents’ motives and needs. The demise of the hero in our culture also has In spite of its prevalence, teenagers are likely to contributed to a general sense of helplessness for teenagers. They do not see adults effectively solving experience divorce as embarrassing since they tend problems at broad levels of society. For teenagers living in troubled families there is an additional lack to wish that their own families would fulfill the cul- of personalized modeling of adult mastery. Further- more, movies appeal to prurient interests, and the tural ideal. Divorce signifies failure in that regard. media emphasize the world’s problems. A distorted romantic view of family life prevails, so that disillu- Just as a teenager takes pride in parental achieve- sionment readily occurs when marriage does not of- fer the fantasied fulfillment of personal needs but ments through the process of identification, parental instead demands committed giving. disappointments and failures also tend to be expe- In contrast with past prejudice against it, divorce has come to be regarded as an acceptable measure rienced personally. for solving problems by leaving or avoiding distaste- Although teenagers usually recognize that they are ful situations. This attitude also is reflected in ado- not the direct cause of the divorce, they may feel that les~e~at attitudes toward school attendance in which they are not important enough to influence the par- one simply avoids boring and difficult situations. The ents to preserve the family unit: &dquo;I’m not good use of ehe~nieal substances further expresses this cul- enough for Dad to want to stay with me.&dquo; Divorce tural trend to escape or modify uncomfortable emo- means the departure of one of the parents, except tional states. in carefully tailored joint custody arrangements, so Thus, teenagers today must contend with a social climate in which the survival of the earth is in jeop- that departure is from the children as well as a spouse. ardy, marriage is portrayed romantically as a means Because their parents’ divorce involved either an initial lack or later loss of the ability of the parents to sustain an intimate, loving relationship, teenagers are confronted with questions about their own abil- ities to love. Some have not personally experienced tenderness between their parents. Most are con- . cerned about divorce as a family pattern. Thus, a frequently encountered question is, &dquo;Is divorce he- reditary ?&dquo;i 694

Although no teenager should bear the responsi- ager should play a critical role in determining the bility for decision making, it is important for a teen- ager to play a role in the parental divorcing process. nature of visitation, and this should be flexible and The sudden announcement of the parents’ divorce can be experienced as a devastating betrayal. The responsive to the teenager’s needs: enough contact, but not impractically and rigidly prescribed. Some- teenager may construe exclusion from awareness of times parents feel obliged to take their children for an entire weekend, spending more time together parental thinking as &dquo;you didn’t care how I feel.&dquo; than parents and children ordinarily need or desire. Unfortunately, in many instances this is an accurate Teenagers may be more interested in their own perception, because the parents have focused largely friends and resent the obligation to see their equally upon their own perspectives. The helplessness ex- perienced by teenagers who are simply informed of ambivalent parent.~9 the divorce decision can be reduced by previous Many divorce financial settlements are made in awareness of marital problems and the opportunity moments of desperation, indifference, or vengeance. for the teenager to express feelings about them. The financial settlement should be enough, but not Many teenagers are in a position to give useful ideas to their parents during the decision-making phase. so much that it becomes unrealistic for a parent to When this occurs, some parents gain a new perspec- continue payments. Many children lose contact with tive and decide against divorce. their fathers, because excessive child support obli- Teenagers also are likely to feel a responsibility to support one parent or both and feel impelled to re- gations may cause the father to leave the state to pair the marriage. This is particularly true when one avoid prosecution. This is a particular issue when parent has leaned heavily upon a teenager for sup- parents remarry and assume the cost of raising two port. This activates an inherent conflict for the teen- families. ager who may be torn by having to take sides. In Physician as Counselor some instances, distraught parents turn to a teenager In order to prevent or minimize pathological re- actions, physicians can play a key role in counseling as a surrogate spouse to the detriment of the young parents and teenagers as they move through the di- vorcing process by helping them understand what person’s development. actually is happening in the. family and resolve the Divorce inevitably has material and practical con- teenager’s role. sequences for both parents and teenagers.’ A dimi- Counseling can be used not only to prevent di- vorce but also to clarify why it is taking place and to nution in financial resources because of the costs of facilitate its course. It is important for a teenager that the divorcing couple agree upon the real reasons for divorce may have a direct impact on a teenager’s standard of living: &dquo;My college money went to pay the divorce so that this information can be shared the lawyers.&dquo; Sale of the family home may be nec- essary, and changes in school during critical school realistically with the teenager. Paradoxically, it is dif- ficult for many divorcing parents to admit to their years may pose obvious problems. children that they don’t like each other and that the Teenagers also may encounter added responsibil- divorce is a result of their being &dquo;bad&dquo; for each other. These parents prefer to say the divorce is occurring ities for rearing younger siblings in newly created under &dquo;friendly&dquo; terms. This approach may mystify single-parent situations. They may assume parental teenagers who may have witnessed the opposite or roles, thus additionally frustrating their own under- may conclude that the parents are withholding the lying dependency needs and interfering with the de- velopmental tasks of adolescence. truth. Visitation arrangements worked out according to The appropriate parental admission of weakness the rights of their parents may be particularly trou- and failure in their marriage is particularly critical blesome for teenagers who have their own plans and for a teenager, rather than the commonly encoun- activities for evenings and weekends. Older teenagers tered projection by parents of blame and responsi- bility on others. Teenagers need to know under- in particular may resent having to spend time with _ standable facts lying behind the divorce in order to a parent rather than peers. On the other hand, vis- assimilate them and come to terms with the divorce itation can mean more positive contact with a parent than existed when the family was intact. The teen- 695

realistically. Frequently, teenagers are angered by ences of the other. When they were brought together their parents’ divorce, either because of their par- in counseling and had an opportunity to obtain a more realistic picture of their son’s role in exagger- ents’ behavior or because the parents were unable to ating their concerns, they dropped their complaints and established regular contact to discuss plans for solve their personal and marital problems without breaking up the family. As one teenager said with their son. disgust, &dquo;Here I am, sitting in your offiice as a patient, because my Mom and Dad didn’t have guts enough In another pattern, one parent and a child con- to straighten out their own heads.&dquo; spire to undermine the other parent. Not infre- It is also helpful for a teenager to know that the quently a child is induced to side with one parent or divorce is calculated to make each of the parents hap- the other. This is seen particularly when custody and pier than they would be if they remained together. visitation are in dispute. As an illustration, the father A teenager’s burdens are increased by feeling that of a 15-year-old girl frequently saw her both at his their parents are going to continue to be unhappy, or unhappier, following what ought to be a problem- home and away on what assumed the form of solving action. Facing these issues openly, although difficult to do, is profitable for the divorcing couple. &dquo;dates.&dquo; He deliberately provoked jealousy in his for- mer wife and promoted his daughter’s defiance of When parents try to discuss their situation with their her mother. The mother petitioned the court to stop the father’s visitations. Investigation of the case led teenager, they discover their own irrational, and the court to honor the mother’s request and help the poorly understood, motivations in the divorce action. daughter recognize that her mother bore the re- sponsibility for her upbringing and that her own in- For the same reason, many parents find themselves terests were being subverted by her father. avoiding discussions with their children in order to Sometimes the perpetuation of post-divorce tur- hide their own uncertainties. bulence arises from the influence off relatives. This After the legal action of divorce, various forms of pattern confirms the popular image of &dquo;meddling in- post-divorce turbulence are encountered as illus- laws.&dquo; In one case, the mother’s parents always had trated by the following patternS3: disapproved of their son-in-law, promoting the di- vorce obtained by their daughter. After the divorce In parent-centered, post-divorce turbulence the they encouraged her to demand an increase in sup- parents continue the marital conflicts after the legal divorce action. One parent may try to punish or har- port payments. On the other hand, the father’s par- rass the spouse by discrediting that spouse in the eyes of the court. As an example, the parents of a 13-year- ents also had held long-standing antipathy for their old girl continually quarreled over her management. daughter-in-law and her parents. They supported the Although custody had been awarded to the mother, father in resisting an increase in child support. An active competition existed between the grandparents the father continued to find fault with his former over the favor of the grandchildren. A counselor ultimately arranged to bring the feuding parents and wife’s housekeeping, cooking, and control of their grandparents together in an effort to show them the daughter. He ultimately initiated court action to ob- effect their struggle was having on the grandchildren. tain custody of his daughter. Divorce counseling was required to defuse the parental animosity. This was unsuccessful, but the mother and father A second pattern of post-divorce conflict is child- could see more clearly their need to free themselves centered in origin. In these situations the children from the undermining influence of the grandparents. manipulate their parents to perpetuate continued conflict or to promote reuniting the parents. The Other cases defy categorization aside from being effect is to continue an intense relationship between the parents. For example, a 12-year-old boy visited bizarre. In these situations the divorce is incidental his father on weekends and told him about the harsh to continued and pervasive irrational behavior by the adults concerned. A case in point was a couple who treatment he was receiving from his mother. When had separated from each other l ‘7 times with 3 di- he returned home to his mother, he led her to believe vorces and 18 reconciliations. that he was being overindulged by his father. The , parents developed exaggerated pictures of what went on in their respectives homes. Each parent filed ac- Physician as Friend tion in court complaining about the adverse inn- Finally, the physician’s expression of sustained in- terest in how a teenager progresses in all aspects of 696

life through follow-up is helpful. Although contact 4. Brun G. Children of divorce. Copenhagen, Denmark: Gylen- may be infrequent, the teenager’s awareness of the dals, Boghandel, 1973. interest of an adult outside of the family has symbolic 5. Wallerstein JS, Kelly JB. The effects of parental divorce: the value. adolescent experience. In: Anthony EJ, Koupemik C, eds. The child and his family: children at psychiatric risk. New References York: Wiley, 1974. 1. Westman JC, Cline DW. Divorce is a family affair. Fam Law 6. Schwartzlaerg AZ. Adolescent reactions to divorce. Adolesc Q 1971;5:1-10. Psychiatry 1980;8:379-92. 2. Wallerstein JS, Kelly JB. Surviving the breakup. New York: 7. Westman JC. Effect of divorce on a child’s personality. Med Basic Books, 1980. Aspects Hum Sex 1972;6:38-55. 8. Ramos S. The complete book of child custody. New York: 3. Westman JC, Cline DW, Swift WJ, et al. Role of child psy- chiatry in divorce. Arch Gen Psychiatry 1970;23:416-20. G. P. Putnam’s Sons, 1979. 9. Group for the Advancement of Psychiatry. Divorce, child cus- tody, and the family. New York: Mental Health Materials Center, 1980. Rocky Mountain ~~ol~~ai Fever-United States, 1982* For 1982, a provisional total of 979 cases of Rocky Mountain spotted fever (RMSF) in the United States was reported to CDC. On the basis of this figure, the RMSF incidence rate was 0.42 cases 100,000 population. The South Atlantic states accounted for 521 (53%) of the reported cases. The seven highest RMSF rates were for North Carolina (225 cases, 3.74 100,000 population), South Carolina (106 cases, 3.31 / 1 (143,OOU}, Oklahoma (76 cases, 2.39/100,000), Virginia (73 cases, 1.33j10~?,0t30}, Tennessee (59 cases, 1.27,~1~O,OClt3}, Maryland (50 cases, 1.17/100,000), and Georgia (52 cases, 0.92/100,000). States submitted case report forms for 834 (85%) of reported cases. Of these, 400 (48%) were confirmed by serologic testing (a fourfold increase in antibody titer between acute- and convalescent-phase serum specimens by complement fixation [CF], indirect fluorescent antibody [IFA], indirect hemagglutination [IHA], latex agglutination [LA], or microagglutination [MAI, or a single con- valescent titer 1:16 or higher [CF] or 1:64 or higher [IFA] in a clinically compatible case); by isolation of spotted fever group rickettsae; or by fluorescent antibody staining of biopsy or autopsy specimens. An additional 95 patients (11%) had &dquo;probable&dquo; cases by a fourfold increase or a single convalescent titer I:3~0 or higher in the Weil-Felix (OX-19, OX-2) agglutination tests, or by a single convalescent titer 1:128 or higher by LA or IHA. The other 339 cases (41%) were reported on the basis of clinical diagnoses alone. Fifty-three percent of the patients were under 20 years of age; 61 percent were male and 89 percent were white. Ninety-five percent of patients became ill between April 1 and September 30. Symptoms included fever (98%), headache (89%), rash on torso (88%), and rash on palms of hands or soles of feet (71%). Eighty-one percent were hospitalized. Sixty-seven percent for whom exposure information was available reported a tick bite or attachment within 14 days before onset of illness. The case fatality rate (4.7%) was higher for persons 30 years of age or older (110.2%) than for younger individuals (2.1%), higher for persons with unknown or no tick exposure (7.~%’0} than for persons reporting a tick bite or attachment (3.1%), and higher for persons not reporting treatment with tetra~y~line or chloramphenicol (7.8%) than for those who received such antibiotic therapy (4.3%). Prevention of RMSF entaiis frequent inspection of persons when tick exposure is likely. Ticks are best removed by grasping with tweezers as close as possible to the point of attachment and by pulling slowly and steadily. If tweezers are unavailable, fingers protected with facial tissue may be used. If bare hands touch the tick during removal, the hands should be washed thoroughly with soap and water, because tick secretions can be infective. Routine testing of ticks removed from patients is not recommended. Instead, when a tick bite occurs, the patient and family should be educated about the incubation period of RMSF (3-12 days) and should be instructed to seek medical attention if RMSF symptoms occur. No vaccine against RMSF is currently available. * Centers for Disease Control: MMWIt May 6, 1983;32:229-32. 697