Chapter time without being trapped in hardship or poverty.

Chapter22.    LiteratureReview 2.1.     Socialwithdrawal: Definitions and PerspectivesSocialwithdrawal is not a new term. For example, the discipline of developmentalpsychology has been witnessing research study in the area of children andadolescents suffering from social withdrawal or social isolation, who arecharacterized by shyness, unsociability, aloneness and peer avoidance.

Empirical studies informed by this theoretical perspective suggest thatsocially withdrawn children or students are more likely to lead a negativedevelopmental trajectory, as they are at major risk of failing to developsocial and interpersonal skills resulted from interactive experiences withpeers. Such studies and theories frame children and youth who are sociallydisengaged from peers as moving away from the social environment, and thusefforts made in the promotion of a more supportive peer environment andcultivation of pro-social or interactive behavior on the side of individualsare considered important in preventing further moving away from the world fromtaking place. From a psychopathological perspective, social withdrawal behaviorand the negative parenting style are largely the targets of professional intervention (Coplan, Prakash, O’Neil, & Armer, 2004).Beingalone does not necessarily mean being lonely. Loneliness is conceptualized asnegative solitude experience because of its painful and potentially harmful naturewhich entails more than social isolation and reflects the sufferings of notconnected to and valued by others. However, solitude or aloneness, if it isplanned and preferred may be productive in nature which may enhance one’sknowledge of one’s self and identity and the social environment, and providesrelief from the pressures involved interacting with other people and living inthe world. If it is the case of involving a greater understanding of oneselfand the world and/or leading to a higher level of concentration, it may be apath to greater meaning and more rewards, which is conducive to generatingpositive benefit.

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For example, with a determination to finish their work, youngauthors of a middle-class background, or with sufficient backup of financialresources, may be able to tune out from social life for a long period of timewithout being trapped in hardship or poverty. This is of course a personalchoice striving for a personal goal which is to be achieved or rewarded sooneror later. Nobody would define this as a social withdrawal problem to beintervened or tackled. In some cases, the benefit of solitude may be consideredas ‘negative’ in the sense of retreating from unpleasant situation before orafter one is burnt out. Productive solitude generating either positive ornegative benefit in the form of withdrawal from social life may be interpretedas a personal choice of young people in managing the extent to which they wantto engage with or disengage from others. No social work professionals canafford to overlook the agency of young people and their meanings attached tothe experience of solitude.

If not, they may fail to appreciate the productiveside of social withdrawal at best, and acknowledge the intention or motivationbehind solitude or seclusion at worst.  Thediscussion so far illustrates that the moving away of young people from thesocial environment may be desirable or undesirable. It all depends on whichperspective one intends to take into consideration and the impact of the movingaway on young people. However,the social environment can be conceptualized as moving away or even againstyoung people who are confronted with increasing challenges not only indeveloping relations with their peers but also in participating in major socialinstitutions deemed important to achieving the purpose of youth transitions toadulthood. Such an understanding goes against the thesis of ‘underclass’ inshaping the ideological ways of thinking about disaffected, dangerous, work-shyyoung men and irresponsible, promiscuous, immoral young women who, together,threaten ‘the survival of free institutions and a civil society’.

Morestructurally-oriented perspectives of youth transitions or stronger forms ofsocial exclusion emphasize the role of policy and organizational efforts inreducing the powers of exclusion against young people. Those young people whoare not in education, employment or training (youth NEET), have personal,emotional, or behavioral problems, and experience discrimination through agelone or combined with other factors like race, ethnicity, disability, singleparenthood, homelessness, etc.. Reaching a thorough understanding ofdisaffection experienced by vulnerable youth groups cannot go withoutdeconstructing the social processes and structures leading to social exclusion.The term ‘social withdrawal’ was originated from the discipline ofdevelopmental psychology, which is obviously more individualist in nature,which places emphasis on assisting socially-withdrawn young people to rebuildself-image and regain self-confidence, and to encourage them to reestablishcommunication and interactions with their friends and peers in particular. Thisis precisely the solutions emphasized by the ‘weak’ version of socialexclusion, which lie in altering those excluded or isolated individuals’disabling characteristics so as to enhance their social inclusion or socialintegration. The studies on the positive and negative notions of solitude oraloneness can inform youth work practitioners the importance of agency inassigning meanings to withdrawal experience and the policy makers and socialwelfare organizations alike in designing measures and delivering programs thatare more tailor-made to serving the specific needs of each youth. That is,youth should not be taken as a homogeneous group, and they are in realitycharacterized by differences and diversity that should not be ironed out bothin terms of policy formulation and service intervention.

The stronger versionof social exclusion can shed light on understanding how social environment atlarge moves away or against young people experienced with their transitiontrajectories characterized by ups and downs and fractures. Nevertheless, theemphasis of research in western societies has been placed on examining or tacklingthe problems of young people who are behaviorally anti-social or aggressive (atleast in the eyes of adults and the authority), homeless or of criminalbackground, etc.. There has not been any study in the West explicitly using thesocial exclusion perspective to study the newly emerging yet growing phenomenonof social withdrawal experienced by young people.

Before arguing that socialwithdrawal is an extreme form of social exclusion, the next two sessionsdiscuss the research methodology of the study and then in what way youth insocial withdrawal are different from those young people being disconnected,disengaged or excluded from social institutions understood in a conventionalsense (Coplan, Prakash, O’Neil, & Armer, 2004).2.2.      Shyness, inhibition, and social withdrawalDiscussionsof the study of shyness, inhibition, and social withdrawal have often begun withthe proviso that this research area is plagued by a lack of conceptual clarity.This confusion has been contributed to by the use of a plethora of terms thatare defined inconsistently. Moreover,at various times, these terms have been employed (often interchangeably) torefer temperamental and personality traits, motivational and interpersonalprocesses, and/or observable behaviors.

(Rubin & Burgess, 2001) were the first toattempt to organize these varied constructs in a psychologically meaningful manner.Their conceptual and definitional model provided the “theoretical backbone” forthis research area. Herein, we restate the core components of this conceptualtaxonomy while at the same time updating various components to reflect thecurrent state of theoretical and empirical knowledge We begin with the broad notionof behavioral solitude, which encompasses all instances of children spendingtime “alone” (i.e.

, a lack of social interaction) in the presence of peers(i.e., potential play partners). (Rubin & Burgess, 2001) originally proposedthe distinction between two causal processes that may underlie children’s lackof social interaction. The first is active isolation, which denotes the processwhereby some children spend time alone (in the presence of available playpartners) because they are actively excluded, rejected, and/or isolated bytheir peers. There is a large and growing literature related to a wide range offactors that may lead to active isolation by peers, with perhaps the mostattention paid to the display of non-normative, socially unskilled, and/orsocially-unacceptable behaviors (e.g., aggression, impulsivity, social immaturity.

The second is social withdrawal (which was originally labeled aspassive-withdrawal), and refers to the child’s removing himself/herself fromthe peer group (for whatever reason). In this regard, social withdrawal isviewed as emanating from factors internal to the child.Inmore recent years, a potentially complex relation between these two processeshas been delineated. It now seems clear that whereas some children mayinitially remove themselves from social interaction (i.e., socially withdraw),they also come to be excluded by peers.

Indeed, the two processes likely becomeincreasingly related through transactional influences over time.We wouldmaintain that it is of important conceptual interest to distinguish betweensocial withdrawal and active isolation. Notwithstanding, the joint andinteractive contributions of both of these processes should be considered overtime.  Wehave come to construe social withdrawal itself as an umbrella term used todescribe removing oneself from peer interaction for a variety of different “motivations”.As depicted in Figure 1, researchers have focused primarily on two broadlydefined “reasons” why children may withdraw from social interaction. The firstreason concerns aspects of emotional deregulation specifically related to fearand anxiety, whereas the second reason relates to a non-fearful preference forsolitary activities. This latter construct has only recently begun to receiveattention in the developmental literature; it has become increasingly apparentthat some children engage in less social interaction because they are sociallydisinterested (or unsociable) and may simply prefer to play alone.

Amongadults, the preference for solitude has been referred to as a solitropicorientation.Allof these terms describe various iterations of the process of withdrawal fromsocial interactions because of underlying fear, anxiety, and social wariness.Is it possible to reconcile these somewhat different (but clearly overlapping)constructs? One approach is to integrate these constructs within adevelopmental perspective. In this regard, we present an albeit simplified versionof this model herein.Approximately15 percent of infants come into the world with an inherent biologically basedpredisposition to respond with wariness and distress in the face of novelty(i.e., behavioral inhibition). In early childhood these wary responses become particularlypronounced in the context of meeting new people (i.

e., fearful shyness). Withthe further development of the self-system and perspective-taking skills, thissocial wariness extends to include feelings of embarrassment and concern in theface of perceived social evaluation (i.e., self-conscious shyness).

As such,and with the onset of formal schooling (and its increasing social stresses), manyshy children continue to feel socially ill-at-ease even after the schoolenvironment becomes more familiar. As a result, these children withdraw fromsocial interactions and display overt signs of anxiety with peers at school(i.e., social reticence or anxious-solitude). For a smaller proportion of thesechildren (perhaps at the most extreme end of the distribution), these feelingsof anxiety continue to escalate over time and become a debilitatingpsychological disorder (i.

e., social phobia) in later childhood or earlyadolescence.Froma theoretical perspective, we certainly acknowledge that it may be conceptuallyuseful to offer “fine-grained” distinctions among these different terms.However, it is also important to assess the practical utility of distinguishingbetween behavioral inhibition, shyness, and anxious-solitude. For example, in asample of preschool-aged children, consider the implications of empiricallyidentifying “extreme groups” of inhibited, fearfully shy, self-consciously shy,and anxious-solitary children. Employing this person-oriented approach, would wenot expect a significant amount of overlap in the membership of these variousgroups? Indeed,we find it difficult to envision many instances where these extreme groupswould not coalesce.

If this is the case, does the field require the use ofthese different terms? In this regard, it is also important to consider issuesrelated to the differential assessment of these different constructs (Coplan, Prakash, O’Neil, & Armer, 2004).2.3.      Status of the HIV/AIDS epidemic HIV affects humans irrespective ofage, race and gender. According to (Ethiopian Public Health Institute (EPHI), 2017)currently, i.e.

2017, there are 665,116 people living with HIV aged 15 and morein Ethiopia. This number is estimated to rise and reach 717,153 in the year2021. With respect to gender currently there are 256,079 males and 409,037 andfemales living with HIV. In the year 2021 this numbers are estimated to rise to275,576 and 441,576 respectively.

The number of new HIV infection per annum is21,551 in 2017 and is expected to reach 20,551 , 20,300 , 20,130 and 19,999in  2018,2019,2020 and 2021 respectively forpeople aged 15 and more (Ethiopian Public Health Institute (EPHI), 2017).Ethiopia’sHIV/AIDS epidemic pattern continues to be generalized and heterogeneous withmarked regional variations. At the national level, the epidemiologic trend overthe past eight years has been stable.

However,HIV prevalence appears to be declining in urban areas, according to analysis ofdata from ANC sites that collected data consistently for more than ten years.For example HIV prevalence among pregnant women attending ANC in Addis Ababahas declined from 23% in 1996 to 10% in 2007. Peri-urban and small market townresidents, young females are the most at risk individuals and affected segmentsof the population by the epidemic.The AIDS epidemic is one of themost serious epidemics known to mankind in causing social and economicchallenges. The effect of the disease is not only pathological but alsopsychological. Due to this HIV patients experience a multitude of psychosocialproblems including stigma and discrimination.

The stigma and discrimination inturn encourages patients to be withdrawn from society and prefer solitude. In areport that studied psychosocial aspects of living with HIV/AIDS, it isidentified that people living with HIV/AIDS experience fear, loss, grief,hopelessness and helplessness syndrome, guilt and self-esteem, anxiety anddepression, denial, anger, aggression and suicide attempts (Fabianova, 2011).  2.4.      Psychosocial Aspects of People Living withHIV/AIDSPeopleliving with HIV/AIDS (PLWHA) feel uncertainty and they have to cope with the situation.Feelings of insecurity have its origin in the fear from the upcoming future andthe people focus on their families and their fob.

They feel even more uncertainand are more concerned because of the quality of life and life expectancy aswell the treatment´s outcome and the reaction of the society. All concerns areunpredictable, and therefore they should be discussed. Above all, positivethinking and faith of is recommended. Thesituation is very special for children, who have lost their family and home.The HIV positive child must react to this uncertainty and make severaldecisions to adapt to the current situation. Even if it seems, that the childdoes not react at all, it can be the very adaptation to the illness by denyingit.

People begin their adaptation process from the day they learnt about it.Their daily life reflects the tension between uncertainty and coping with thesituation. It is the tension, which raises a lot of psychosocial responses ofbigger and smaller intensity.Fearof HIV/AIDS is closely associated with fear of our own death, which belongs tothe most basic of fears.

It is the fear which most of us are trying to fightwith by constantly running away from the idea of self-termination or byinventing a series of comforting ideas. Escapeand rationalization will help only to cultivate the fear of death. Above all,people have to be settled with self-extinction, with own death and thus perhapswould help those who just need help in the process of dying. Incountries with high rate of infected people are found amongst doctors and otherhealthcare staff.

PLWHVA are pushed to the margins of the society, and areisolated. They are forced to leave their job, they, lose their homes, oftentheir family and friends. They are not given adequate health care and by theprovided health care they are confronted with rejection. All of this happensbecause of an illness which cannot be transmitted by common contact. Thisattitude of professionals who are unable to overcome prejudices and refuse to providehealth care is a deep misunderstanding of their mission. The reasons for thiskind of handling is fear of being infected with HIV and, ultimately, fear fromdeath itself. Anotheraspect associated with HIV/AIDS is a loss. People in the developed stage ofAIDS are worried because of the loss of their life, their ambitions, physicalperformance and potency, sexual relations, loss of their position in the society,financial stability and independence.

With the increasing essential need ofsystematic tendency they lose their sense of privacy and control over theirlives.  Perhaps the most problematicissue is the loss of confidence. It may affect the future, anxiety originatingfrom a relationship with a loved one or caregiver and negative reactions fromthe society. Formany people finding out about their HIV/AIDS status it is the firstopportunity, to realize their mortality and psychological vulnerability. Theyface social isolation due to the inability to perform all daily activitieswhich they used to do. Relationships within the family change more frequently,one loses their colleagues and the attitude of acquaintances and friendschanges frequently as well.

Many are afraid of the loss of memory, their concentrationand ability to make decisions. Deathof a relative, who dies of a deadly disease, presents an extreme burden foreach human being. He tends to surrender the pressure of the situation, whichseems to be insolvable. Mental failure is accompanied by significant behavior,changes in physiological and psychological processes in the body, which have sometimespermanent effects on health. This persistent extreme burden leads to disruptionof relationships with the social environment.Somepeople react to news about their HIV/AIDS status by denying it.

For some ofthem, such refusal may present a constructive way to handle the shock of thediagnosis. However, if this condition persists, the denial can becomeunproductive, because these people refuse also the social responsibilityassociated with HIV positivity. This reaction is typical for children, in the caseof the death on a parent. Anger and aggression are typical aspects which accompanypeople in situations of bereavement. Some individuals become angry andaggressive. They are often very upset about their fate. They continuously havethe feeling, that they are not treated decently and tactfully enough.

Anger cansometimes escalate into self-destruction: suicide. Aggression is one of themost frequently reported reactions in frustrating situations. In thefrustrating situations, an individual may focus his anger, remorse, indignation,outrage, hostility on other people that are considered as suitable object.There is another possibility, presented by the concept of self-accusation,which the aggressive reaction are aimed at oneself. Thereis an increased risk of suicidal attempts for HIV positive people. They may seethe suicide as a way out from pain and difficult situation, out of their shameand grief for their loved ones. Suicide may be active (e.

g, causing a fatalinjury) or passive (planning or preparation of such a situation, which couldresult in fatal complications of HIV/AIDS). HIV positivity presents a riskfactor, particularly amongst adolescents. There are significant complicationsin the development of personality in adolescence age and it can be perceived asan unacceptable problem. Suicidal behavior is associated with a wide range ofmental disorders, HIV positive children and adolescents suffer primarily fromdepression (Fabianova, 2011).