Chapter 1
Introduction
Marriage is a pivotal issue in family life. Rather it is a fundamental relationship from
which rest of the relationship develop and expand. It is basic unit of family system and
indispensible to establish one’s existence in a society and identity in a cultural context.
Pakistani cultural system is very much embedded in patriarchal system and members of family
are closely knitted, therefore much emphasis and value is placed on interpersonal relationship.
As said earlier marital relationship is a basic/ fundamental relationship from which other family
relationship emerges, therefore studying this relationship to indentify factors to strengthen it
becomes insensible.
Marital satisfaction is defined as the extent to which one is satisfied with his/her
relationship with spouse. Satisfaction is an umbrella term and encompasses several elements to
contribute in relationship satisfaction. Several factors have been identified that influence marital
satisfaction. In the context of marital life, some researched attachment styles for marital
satisfaction (Driver & Gottman, 2004), conflict patterns (Caughlin, 1999), communication
(Ciarrochi, 2008) and environmental factors such as couple support system, finance,
employment, and illness (Sokolski & Hendrick, 1999). Moreover marital satisfaction also
studied with people having physical illness or mental illness. Within the mental illness group
stigma has been studied as a significant variable not only effecting treatment of mental illness
but also effect marital satisfaction.
Depression is one of the most reported disorder among the psychiatric population
visiting for clinical consultation in adults, and it is more common in women (41.9%) than men
(29.3%), (NIMH, 2018). Depressive disorder like any psychological disorder may cause or be
the end result of marital dissatisfaction. Many studies indicate that Depressive Disorder have an
unsympathetic impact on the social functioning of the patients including partner life (Machell et
al., 2016).
The stigma associated with mental illness as old as human civilization. According to
the World Health Report about 500 million people suffer from mental illness worldwide but
only a small portion received treatment (WHO, 2008). Stigmatization of mental illness has
been recognizing as a serious dilemma affecting individual’s life. The word mental illness has
negative judgments and Stigmatization also have negative connotations (Rossler, 2016).
Stigmatization of mental illness is still an important societal problem. The stigma of mental
illness may affect the patient medication and regular medical checkup. Researchers have
concluded that stigma of mental illness has adverse effects on marital relationship.
Spousal Support is another variable in the domain of interpersonal relationship. An
individual receiving spousal support would contribute to overall satisfaction in relationship of
both partners. Moreover partner`s support is an asset that helps in life`s adversities (Coyne &
Delongis, 1986).
1.1 Marital Satisfaction
People get married for relationships, happiness, love, procreation, physical attraction and
to avoid social isolation (Rao, 2017). Having a satisfactory relationship in which each partner
has feelings of happiness and satisfaction is really blessing. According to Bradbury and Karney
(1995), people who are happy with each other and experience pleasant matrimonial
relationships are less likely to get separation.
1.1.1 Marital satisfaction and depression. Marital relationship seems, by all accounts,
to be identified with both the causes and treatment of depression. According to Whisman (2001)
there is association between marital satisfaction and depression. There have been many
observational researches on marital satisfaction in the treatment of depression. The discoveries
of directionality in the connection between marital satisfaction and depression are blended.
People reported that they had been diagnosed with depression after marriage. In spite of this, it
is clear that depression and marital satisfaction are two critical connections to one another.
1.1.2 Theoretical background of marital satisfaction. Gottman proposed the marital
satisfaction theory as a clinical therapeutic intervention. Gottman couple based therapy focuses
on helping couples shatter through barriers and possess a deeper accepting of each other.
Gottman (1999) has discovered that together with explicit proportional plans, the methodology
couple oversee struggle is imperative for conjugal achievement and fulfillment. According to
Gottman there are four practices that are more destructive to a placated and happy wedding.
Gottman considers these practices the four horsemen. These four horsemen are analysis,
affectability and scorn and slow down. Gottman composes that analysis is any explanation that
implies that there’s one thing internationally amiss with one’s accomplice (1999, p.41).
Affectability is sketched out as any attempt to shield oneself from an apparent assault (Gottman,
1999, p.44). He says that scorn is any announcement or nonverbal conduct that put oneself on a
superior planes that one’s accomplice (Gottman, P.45). Ultimately stonewalling happens once
the perceiver pulls back from the discussion (Gottman, P.46). Consistent with Gottman hatred is
not seen with in the effective and happy relational unions. Anyway the contrary three horsemen
are blessing, in spite of the fact that at a way lower rate than one would acknowledge in less
fruitful or happy relational unions.
1.2 Stigma
A marked (with something that cause shame) individual possesses, or is appeared to possess
an attribute, or set of characteristics that marks them as completely different and leads them to
reduced the value of by others through the use of negative evaluation and stereotype (Major &
O’Brien, 2005). In alternative, the stigmatized individual incorporates a mark that tell apart
them from traditional society and also the person is seen as but human.
1.2.1. Mental illness stigma. The process of mark of shame begins with knowledge of
negative prejudice concerning about an individuals who experiences psychological issues and
covering, also as those looking for treatment. Peoples then move from being tuned into the
stereotypes to basic cognitive process they’re true. From there many act either unconsciously or
consciously on those negative stereotypes that cause discrimination against peoples that have
psychological state downside.
The Experiencing of mark of shame for having a psychological state drawback has
been related to enlarge problem in looking for mental health treatment and it continues to do
hard or annoying thing during treatment. It may also be barrier to forming purposeful
relationship in personal and skilled setting. Stigma may additionally interfere with the
flexibility to seek out purposeful employment, adequate financial gain, and housing.
1.2.2. Theoretical perspective of stigma. Goff man 1963 introduced the popular
thinking “presentation of self” with the symbolic interaction called dramaturgical approach
sometimes known as dramaturgical analysis. Dramaturgical analysis is a social interaction in
term of theatrical performance. If you stigmatized a person you have got provided that person
a label that’s limiting in a way. In ancient Greece, mark of shamed was a brand burned into a
slaves or criminals skin to show (by using a physical object to represent an idea or emotions).
Goff man cast light upon however stigmatized individual manage their blemished identities.
Goff man explains the personality relation to stigmatization into three classes
I.
Stigmatized are individuals who endure the mark of shame
II.
Normal are those peoples who do not endure the mark of shame
III.
Intelligent are those among the normal’s who are accepted by the mark as wise to
their condition
1.2.3. Phelan and link stigmatization model. Phelan and Bruce Link proposed that
stigmatization exists when the following four specific components congregate.
In this model of stigmatization be as well additionally depending on right to use to
political power, Social, economic with the aim of enables the popularity of variations, erection of
prejudiced, division of label person hooked on separate groups, and also the full execution of
disapproval, rejection, exclusion, and discrimination. During in this model the word stigma
(mark of shame) is practical once tagging, making prejudiced, disentanglement, loss of status,
and unfair treatment based on skin color, age etc all exist inside an influence scenario that
facilitates mark of shame to happens.
1.2.4. Stigmatization and Depression. Depression could be a serious illness of those
patients shouldn’t be reluctant however it is difficult to avoid. The stigma of depression is
completely different from that of others mental sickness and mostly due to negative nature of the
illness that create depressive appear unattractive and unreliable. Disapproval makes patients
shameful and incommunicative and it may stop proper treatment. A serious contributive issue is
that depression for those who haven’t its difficult to understand and can be seen as a sign of
weakness (Wolpert, 2001)
1.2.5. Depression. Depression is a disorder with at least one symptom of low mood or
loss of concentration or pleasure, additionally comprising of major symptoms of weight loss or
gain, insomnia or hyper insomnia, psychometric anxiety or retardation, fatigue, feeling of
worthlessness, inability to think or give attention to and suicidal ideation. These symptoms have
to be alarming enough that require clinical attention and should have not been present due to any
other medical or physical condition. The symptoms should have present for last 2 weeks
(American Psychiatric Association, 2013).
1.2.6. Depression in women. Women experienced depression more than twice to men.
Between 10 to 25& women experienced depression at some point of their life. Women have got
several life roles like wife, mother, daughter, employee, friend, sister, care giver and so on. The
difficulty of all these roles can cause ups and downs throughout life. Sometimes change in mood
maybe due to an argument with friend or maybe due to hormonal changes. Women tend to be
emotional, experienced more guilty feelings and unhappy when they have stress and social
pressure (Christina, 2017).
1.2.7. Depression in men. Researcher estimated that minimum six million men in the
U.S suffer from emotional disturbance once a year. Men do not usually understand or
acknowledge their own symptoms of depression. Depression was known as female disorder. This
stereotypical concept still lingers but men who have the acceptance of illness recognizing it and
took appropriate treatment. Men with depression have aggression, apathy, irritable mood and
sometimes hostile (Christina, (2017)
1.3 Spousal Support
There are only few studies on spousal support and also the quality of marital satisfaction
with attention on socially anxious couples and their idealistic relationships. Social support
would possibly check with the means of relieving depression, stress and anxiety. Spouse
equivalent support refers to the perception of taking care of each other, and resources may
embrace nurturing tangible or intangible emotions to providing a way of happiness among
individuals (Levy et al., 2017).
Studies explore the issues that are associated with the marital satisfaction but support by
partner it could be a successful marriage. When spousal support is functioning as an intervening
variable it could be decrease the effect of anxiety and depression symptoms (Rodin et al., 2007).
Researcher investigated that wives who were glad with their spouse shows
relatively higher level of positive relations, intimacy and competition in their marriage and
state lesser distrustful feelings than those wives who were less happy by their husbands
(Pina & Bengston, 1993).
1.3.1 Types of Support. There are five types of support described by Schaefer, Coyne
and Lazarus (1981).
Emotional Support is identified that incorporate caring, empathy and sympathy (coyne,
1981). Emotional support from partner indicates to understanding, caring and expression of
intrigue. Expression of interest and getting empathy from spouse, having support from life
partner, particularly emotional support, is the most significant indicator of an individual’s
emotional and psychological well being (Schaefer & Coyne, 1981).
Esteem Support is characterized as the message that assistance to promote one’s
aptitudes, capacities, and inborn esteem (Cutrona & Suhr, 1992). Such sort of support is show as
far as support for certainty. Highlighting the strength and possibilities individuals unable to
bring up they have, is really regarded support, or basically told them that you trust them. Various
therapist and life coaches proposed such sort of help to acknowledge their customers that they
trust them.
Social network support is characterized as the message that help to improve one’s
feeling or having a place with the particular gathering with comparable interests or
circumstances (Cutrona & Suhr, 1992).
Information Support refers to message that incorporate information or facts, for
example guidance or feedback on activities (Cutrona & Suhr, 1992).
Tangible Support refers to captivating the commitment/ duties regarding another
person or effectively take an interest to help someone in dealing with their issues, they are
encountering their life, consequently they can viable adapt to life suffering (Cutrona & Suhr,
1992).
1.3.2 Relationship between Spousal Support and Marital Satisfaction. It is a standard
conclusion that spousal help influences the marital satisfaction. Marital satisfaction was depends
on support by life partner (Levinger & Film maker, 1990). Husband and wife help each other in
stressful situations, cope with personal difficulties and share responsibility of life has been
determine to influence relationship satisfaction (Lawrence et al., 2008). Receiving spousal
support may also make contribution to guide the recipient perception of the relationship like
heaven and at ease base (Boeding et al., 2014).
1.3.3 Relationship between spousal Support and Depression. Spouse/ Partner support
has been found to significantly affect physical wellbeing results and other prosperity. Partner can
give support assess to tangible or intangible resources (Berkman & Glass, 2000). Studies suggest
that depressive symptoms might be related with strain in the supportive relationship in an
individual life. Depressive symptoms are likewise essentially less common among partnered
male than single male adults, recommending that partner support might be an important
protective factor (Choi & Ha, 2011).