Coping with Adversity 283anything. Likewise, there may be no psychiatric symptoms, and children
may be functioning fairly well in terms of school success and other
achievements, but if they are frequently preoccupied by distressing recol-
lections of how horribly they were abused, then this is not a good outcome.
Separation and loss
Attachment is a central theme in developmental psychology and psychi-
atry (see Chapter 32), and many studies have examined what happens
to children when their attachment bonds are temporarily disrupted by
separations, or permanently broken by losses. There is no doubt that
children and adolescents often find separations and losses very upsetting,
but it is less clear whether these unpleasant experiences on their own
have serious long-term consequences for their functioning. Of course, it
is highly desirable to prevent or reduce children and adolescents’ short-
term distress whether or not it has adverse long-term consequences.
Nevertheless, the issue of long-term outcome is important.
Do traumatic separations or early losses predispose an individual to
persisting psychiatric disturbance? In trying to answer this sort of question,
it is crucial to allow for ‘third factors’ (see Chapter 33). For example, when
studying the effects of divorce on children, it is important to ask how far
any adverse effects are due to prior and continuing family discord rather
than to separation from one of the parents. In this regard, it is striking
that long-term psychiatric problems are more likely to follow the loss
of a parent through divorce than through death. This suggests that the
antecedents and consequences of loss are more important than the loss
itself. Similarly, when children are taken into foster care, the poor quality
of their previous care is more important as a predictor of future problems
than the fact that they have been separated from their biological parents.
It is also important to remember that separations and losses may set
in motion a series of adverse events that have lasting consequences of
their own. For example, divorce may be followed by parental depression
or less effective parental supervision, a change to a worse school, and
less money for leisure activities that can promote self-confidence and
friendships. These changes may have long-term effects on the child or
adolescent’s behaviour even if the divorce itself does not. Several lines
of research confirm that the long-term impact of the death of a parent
depends strongly on the quality of subsequent care.
Taking these various issues into account, most research findings suggest
that although they are often extremely upsetting, separations and losses
are not in themselves major risk factors for persistent psychiatric distur-
bance – but their antecedents or consequences often are. This is not to
say that they may not be experienced as very painful and be a defining
point in the individual’s life, and perhaps strongly influence, for example,
how the individual, in turn, decides to bring up his or her own children.
Rather, the evidence suggests that in themselves, separations and losses do
not lead to large and lasting increases in psychiatric disorders or worsening
in psychosocial functioning.