The Role of Psychological Factors
Marilyn B. Benoit, M.D.
This paper presents a number of psychological issues that could influence the
behaviors of teenagers who become parents out of wedlock. It addresses normative
adolescent psychological development, emphasizing the developmental thrust towards
separation, but juxtaposes the deviant psychological development of teenagers who are
unable to gain control of their childbearing. The impact of early childhood experiences,
the role of parents as models, family experiences, social class, changing societal sexual
mores, urban living, education and a sense of future are explicated. Particular focus is
given to the different experiences of female and male teenagers and the meaning of
parenthood to each. The influence of cognitive challenges and of specific psychiatric
illnesses is also addressed. The paper concludes that social policy should integrate an
understanding of these issues in the crafting of domestic policy on teenage parenthood.
The issue of out-of-wedlock teenage parenthood in the United States has been an
increasingly troubling one. Though the most recent data from the Centers for Disease
Control reveal a downward trend, unwed teenage mothers and their children have been a
major burden on the welfare system. Some 11% of teenage girls between the ages of 15 and
19 become pregnant each year, accounting for approximately 1 million pregnancies. The 104th
Congress took an unprecedented and bold step in crafting legislation, signed by the
president, to begin to contain spending on welfare mothers and their children. The Child
Welfare League of America, the Childrens Defense Fund, and other child advocacy
organizations were outraged by this legislative step endorsed by the president. The
passage of this bill was so unpopular with some of the presidents top appointed
administrators that some left rather than continue to serve in his administration.
The sharpest criticism has been that the legislation has removed the safety net
from the children of welfare mothers who must now seek work two years after initiating
welfare or face loss of benefits. No doubt, such a draconian measure was one born out of
the failure of attempts at varied social programs to effect any large- scale reduction in
teenage childbirth. Education, availability of information, and availability of
contraception have all failed to change the reproductive behavior of those with the most
intractable problems. In her book Dubious Conceptions, K. Luker (1996) states,
"But careful and rigorous review of all the various studies on the matter suggests
that, in general, taking sex education courses has virtually no effect on an
individuals propensity to become sexually active" (p. 186). Because of the
difficulty encountered in "helping" this group of welfare-dependent teenage
mothers to gain control of their fertility and, hence, to exercise better control of their
lives, it is necessary to understand the intrinsic psychological forces that seem to fuel
such socially maladaptive behavior.
Brief Overview of the Adolescent Passage
It is critical to our understanding of teenage parenthood that we understand
that the teenage parents referred to are not adults. First, it is important to
distinguish between adolescence, which refers to the psychological process of
development, and puberty, the onset of sexual maturation. Adolescence, the
psychological process of maturing, spans the years from 12 to 19 (for the average person).
In the pre-industrial, agrarian era there was a convergence of sexual and psychological
maturation. At that time children were considered to be economic necessities. They were
needed to provide labor on the farm and, in that way, they contributed to the economic
survival of the family. Teenage marriages were not uncommon and, without easy availability
of contraception, childbearing took place early. Erik Erikson (1950) states that the
desired outcome of adolescence is identity formation. In the pre-industrial era, young men
and young women, some still in their teenage years, would bring adolescence to closure
with the formation of identities as husbands, wives, parents, and economic providers.
With the decline of the agrarian and industrial eras, the prolonging of
education, the growth of cities, and the mass migration to them, the social infrastructure
within which puberty and adolescence are played out has drastically changed. No longer do
puberty and adolescence converge neatly. In fact, biological maturation is long completed
while teenagers are still battling the conflicts of adolescence and are far removed from
the identity consolidation that tends to come several years later. A brief review of the
intrinsic psychological issues of adolescence seems appropriate at this point.
Uncomplicated adolescence is divided into three stages. The first stage, from 12
to 14 years of age, heralds in the movement toward independence, when friends assume a
very significant role in the youngsters life. Action takes precedence over thought,
and immediate gratification is sought. There is the beginning of an interest in the
opposite sex, but usually a safe distance is kept from members of the opposite sex while
more energy goes into fostering same-sex relationships. This is when the sixth- and
seventh-grade girls travel in packs, and the boys seek safe refuge in their all-male
groups, forming secret clubs, as illustrated in the movie Stand by Me.
Some rule-breaking is common as these early teenagers try to create a world that
excludes both their parents and the childhood world that they struggle to leave behind. It
is, paradoxically, a period of loss and longing for that very world of childhood, when
early dependency needs were unconditionally met. They seek increasing autonomy and may
demonstrate periods of almost adultlike behavior punctuated by some brief episodes of
childish regression. Those adolescents who have "stored up" a reservoir of
sufficiently good caring from their parents and other significant family members are able
to cope with the loss and longing without major dysfunction. For those who have not had
adequate nurturing in earlier years, however, this can be a time of heightened
vulnerability. Emotionally deprived youngsters might attempt to soothe the pangs of
psychological loss by responding to sexual biological urges and by prematurely entering
into intimate physical relationships.
Middle adolescence, from age 14 to 17 (Blos, 1962), is marked by an increasing
intensity of separation from parents, with the emergence of more conflict with parents,
who become devalued in the teenagers perception. This is a period of heightened
narcissism, a feeling of grandiosity, and a sense of invulnerability that is facilitated
by a pervasive use of denial. The teenager at this stage angers parents, who often
complain of his or her selfishness and arrogance. Parents feel exploited and unloved and
experience a heightened anxiety as they learn of their teenagers risk-taking
behaviors. The adolescent experience of loss of the parents intensifies and cognitive
capacities increase as abstract thinking (Pulaski, 1971) becomes a new tool available for
coping with psychological distress. Teenagers who have grown up in environments that
encourage and facilitate expression of thought (oral or written) as an alternative to
action may resort to keeping journals in which they record their sometimes confusing,
conflicting and fluctuating feeling states. Where such a psychologically healthy outlet
(referred to as sublimation) is not available to a youngster, impulsive action may be the
outcome of distressing feeling states.
P. Trad (1995) states that "The epidemic of adolescent pregnancy is augured
by high rates of sexual activity" (p.133). Because heightened sexual urges (and
surges) are characteristic of this stage of biological maturation, an impulsive teenager
without adequate alternatives for sublimation or adequate social constraints to abstain
from sexual behavior may seek outright gratification--without pondering the consequences
of his or her behavior. Teenagers who have a sense of a career in the future begin
thinking about what preparation they must set in motion to achieve their goals. For
example, they consider taking the preparatory college admission tests. They begin thinking
about the extracurricular activities they would need to gain admission to the college of
their choice. This sense of future begins to influence their behavior. It is indeed this
sense of future that serves a moderating function at those times when impulsivity and the
wish for instant gratification push for action. With respect to sexual behavior,
responsible use of contraception might be the step the teenager will take to avoid
unwanted parenthood. For those teenagers who do become pregnant, choosing abortion versus
childbearing may be preferable in order to carry through with career plans for the future
(Luker, 1996). A study by P. Trad (1995) found that among teenage mothers there was a
significant deficit in ability to preview the future.
For middle-class teenagers, adolescence is prolonged for as long as they choose
to stay in school, develop careers, and delay marriage and childbearing. For many poor
youngsters, however, for whom the future holds little or no promise, early school dropout
and unemployment may mark the end of adolescence, which is more likely than their
middle-class counterparts' to come to premature closure with early parenthood. This is not
to say that middle-class teenagers do not engage in sexual behavior that results in
pregnancies. The difference is that there is less likelihood that the middle-class teenage
girl would bring her pregnancy to term because of the interference it is likely to impose
on her future life plans.
The third stage of adolescence spans the years 17 to 19 and results in a firmer
sense of ones identity, a commitment to career development, an ability to make
independent decisions, and a growing capacity for thoughtfulness, reflection, regulation
of emotional states, problem solving, and insight. The psychologically mature teenager
develops a sense of purpose (for example, going to college for some future profession,
learning a trade, getting an entry-level position with the hope of working ones way
up, getting married and having a family) and begins to identify with the broader social
values and cultural traditions.
Fragmentation of the Family
The brief normative development thus described is more likely to take place in
teenagers who have the benefit of growing up in a stable and nurturing family. Because of
the remarkable economic and social changes of the past two decades, there has been
significant fragmentation of the family across all socioeconomic strata. This phenomenon
has occurred in both rural and urban settings. The high divorce rate, the necessity for
both parents to work outside the home, high unemployment, low vocational training and the
mediocrity of the educational system, rising drug abuse, the ravages of AIDS, and domestic
and community violence are all factors that have contributed to the destabilization of the
Family structure has suffered tremendously, and nowhere has the devastation been
more evident than in those families at the bottom of the socioeconomic stratum: those who
are chronically the most vulnerable in society. As a result, whereas the family used to
provide a stable emotional holding environment within which adolescence was negotiated,
now youngsters are left quite early on in life to "fend for themselves" without
the benefit of stable psychological structures in place. Whereas the agrarian and the
industrial family allowed for contributory roles for all able-bodied members, the now
post-industrial family has fewer economic roles for adolescents to assume. In some cases
the parents of adolescents no longer have the skills to stay employed. In the high
technology world that we live in, sophisticated technical skills and at least a high
school diploma are essential for developing any type of career. More recently, President
Clinton has actually proposed that two years of college education should replace the
standard of a high school diploma as a yardstick of the average expected education for all
Psychology of Adolescence
What exactly are the psychological structures that should be in place in order
to negotiate adolescence successfully? Foremost is the emotional stability gained from
having parents who have been consistent and adequate providers of both the physical and
emotional needs of the growing child. In other words, dependency needs must have been
satisfactorily met. This is critically important, because one of the essential conflicts
of adolescence concerns the bipolar tension between the teenagers wishes to regress
and be dependent and his or her wishes to be absolutely grown up and free of any
dependency on his or her parents. The more adequately earlier dependency needs have been
met, the better prepared is the teenager to struggle through this dependency-independence
crisis and emerge as a relatively well-functioning adult.
Where there has been significant early deprivation, however, and the dependency
needs of adolescence are intense (because they really reflect the needs of a much earlier
developmental stage), the teenager is vulnerable to acting out behaviors that, while
playing out those needs, deceptively give the illusion of adult behavior. For example,
becoming pregnant offers that "opportunity" in almost a perfect manner. Engaging
in what seems like "adult" behavior (such as having sexual intercourse) is
appealing and has the capability of temporarily gratifying the earlier childhood
dependency needs for physical closeness and perceived caring. In an intriguing way, having
unprotected sex--that is, not using any contraceptive method--further plays out, and
simultaneously meets, the teenagers conflicting psychological needs. While having
sex may be "acting grown up," to go all the way and plan to do so (as a
responsible adult who takes control of his or her fertility) would be acting too much like
an adult and would allow no room for the "irresponsible child" to do its
(unconscious) acting out. Additionally, the normal tendency of adolescents to engage in
impulsive behavior, simply by reason of their developmental stage, only further
facilitates risky sexual activity.
It is important to realize that control of ones impulsivity--that is,
delaying gratification--is facilitated by the knowledge that, by so doing, one ultimately
has more to gain. But that attitude requires a sense of future: a future into which one
can project oneself with some sense that good things are indeed possible. A few clinical
examples will illustrate the point. One teenage girl, seen by this author in
psychotherapy, demonstrated how psychotherapeutic intervention helped her to avoid sexual
acting out. She had been the product of a teenage pregnancy and, because of her
fathers early and untimely death secondary to drug abuse, had been raised by a
single mother who never remarried. Her paternal grandmother was consistently available as
an important emotional resource. She abstained from sexual behavior throughout early and
middle teenage years.
After high school graduation she entered the workforce at an entry-level office
job. She was a bright, diligent, and highly productive worker who was targeted for career
development in the company. After she had been dating the same boyfriend for several
months, she gave some consideration to starting a sexual relationship with him. The couple
spent a great deal of time discussing initiating such a relationship, and the patient
sought a gynecological consultation to do contraceptive planning prior to their first
sexual encounter. What this young lady admirably demonstrated was an unconflicted
acceptance of herself as a young adult who was exercising responsible and conscious choice
over her sexual behavior. Unconscious, intrinsic psychological issues were not allowed to
play havoc with and drive her sexual behavior.
In another case, a teenager who was sexually active and came from a lower
socioeconomic background was highly conflicted about the issue of becoming pregnant. She
lived in a violent neighborhood and had actually witnessed the murder of someone known to
her. She had graduated from high school and was contemplating going to college. Her
boyfriend, however, fathered a child by another young woman while dating her. It was
surprising to me that her reaction to this event was not outrage at his infidelity-- but,
rather a consideration of having a child herself. One of the reasons she gave for possibly
choosing to do so was the fact that she felt her life could be truncated by a bullet in
the violent neighborhood in which she lived. She stated that should that be the case, at
least she would have left a child behind to carry on. It became clear that in this
particular case a child could represent the only tangible sense of future this teenager
could envision. It is possible that this psychodynamic process may be repeated many times
over in the population of intractably welfare-dependent teenage mothers. Only research
will be able to explore this line of enquiry.
The third case is that of a fatherless preteen girl who became a ward of the
state after abandonment by her drug-addicted mother (herself having been a teenage
mother). Within months after her menarche, this girl began expressing her wish to become
pregnant and have a child. Her fantasies revealed that she expected she would have a
daughter whom she would never leave and to whom she would provide the best care possible.
From a psychodynamic point of view, this girl wished to take corrective action for the
failure of her mother and father as parents by giving birth to a daughter who would really
be representative of herself. By vowing never to abandon her fantasized child, she would
unconsciously repair both the parental failures and her own experience of neglect.
Given that adolescence as a developmental stage has some inherent barriers that
produce resistance to adult, logical thinking, it is unlikely that an education campaign
against teenage parenthood will ever be effective in significantly lowering the
rate of teenage childbirth. The identified welfare-dependent population is vulnerable to
teenage parenthood as an outcome. Based on the above discussion, some of the preexisting,
intrinsic, psychological dynamics that predispose these vulnerable teenagers to early
(1) Unmet early dependency needs--these teenagers are very likely to have been
themselves the children of teenage parents who were not psychologically equipped to take
on the demands of childbearing.
(2) The wish to appear as adults, while simultaneously wanting to remain as
children. This, of course, is a developmental conflict typical of all adolescents. These
particular adolescents, however, are more likely to move precociously into
pseudo-adulthood because they cannot admit to the dependency hunger they experience.
Sexual behavior and parenthood are believed to be open proclamations of ones
(3) Denial of parenthood risk. This holds true for adolescent sexual behavior in
general, and is not exclusive to any social class; nor is denial of risk and vulnerability
limited to sexual behavior (witness the high rate of automobile accidents among
teenagers). Denial as a defense mechanism is inherent in adolescent psychological
(4) Denial of the demands of babies. While this is true for all parents-to-be,
it is exaggerated in teenage parents. Emotionally deprived teenage mothers are especially
susceptible to the maximum use of denial of this aspect of mothering because they
vicariously hope to satisfy their own needs to be taken care of through their babies. In
fact, it is not unusual that having a baby serves to engage the teenagers own mother
into providing mothering to both the teenage mother and her child. Because of the teenage
mothers earlier deprivation, the difficult, negative aspects of childbearing must be
kept out of conscious awareness. For the females, childbearing serves as a psychologically
economical way in which to believe on the one hand that they have grown up, while on the
other hand allowing them to maintain the hope that their children will be better taken
care of than they had been as children. They identify with their own mothers who often
were themselves teenage mothers.
(5) For the males, becoming a father is, in and of itself, an attainment of some
psychological sense of manhood (Anderson,1990). The abrogation of any financial
responsibility for their children could allow for psychological repetition of similar
experiences they themselves have often had as children, when their own fathers rejected
them. This ability to do unto others the negative things that were done unto them is a
phenomenon referred in psychology as "identification with the aggressor."
(6) For both males and females the unconscious acceptance of dependency on the
government to provide for the basic needs of their children and themselves can be a way of
psychologically gratifying their own needs to be taken care of by an all- powerful,
ever-present, consistent, and dependable caregiver. In other words, government can
psychologically become the surrogate parent. Because these are the very people who feel
disempowered (because of poverty or racism, poor education, and unemployment) and have a
view of their world as hostile and unforgiving, there may be unconscious, and perhaps at
times even conscious, triumph over the system that they experience as their oppressor.
Passive dependency gratifies the psyche that feels powerless.
It is important to address other intrinsic psychological cognitive and emotional
factors. Such factors have more to do with the teenagers level of intelligence or
the presence of psychiatric illness (McCue, Horwitz et al., 1991, McGee et al., 1990),
both of which may compromise the teenagers ability to make thoughtful judgments
before engaging in unprotected sex. Low intelligence results in a restricted ability to
understand and master the environment, to plan for the future, to consider alternatives,
and to delay sexual gratification. Learning disabilities may also significantly compromise
the way in which a teenager processes, interprets, and responds to information. Whether or
not and to what extent responsible sexual behavior is affected is a matter of speculation,
but cognitive ability is one variable that does indeed affect judgment.
Major psychiatric illness in an otherwise not cognitively compromised person
also interferes with judgment and mastery of the environment. For example, teenagers who
have been victims of sexual abuse (and may have an underlying chronic, unresolved,
post-traumatic stress disorder) may engage in impulsive, promiscuous sexual behavior. Such
behavior may result in unplanned pregnancies in an unconscious effort to maladaptively
gain some psychological mastery over their sexual victimization (Fine, 1992). A depressed,
lonely teenage girl may seek solace and comfort in sexual behavior, while a hypomanic
teenager (male or female) may be sexually promiscuous as an expression of hypersexuality
that is part of the symptom complex of bipolar mood disorder (DSM IV, 1994). Those who
have impulse control disorders, which may coexist with or are exacerbated by substance
use, are extremely susceptible to engaging in high-risk sexual behavior without any
concern about the consequences. When one considers that this population already lives
under poor social conditions that are a breeding ground for feelings of hopelessness and
helplessness, the risk increases even further (Trad, 1995).
Some social issues that further compound the intrinsic factors at work are the
prevailing social values of the neighborhood and of society at large. Where, in
neighborhoods, it is socially acceptable for teenagers to bear children, and there may
actually be elevated social status attained by reason of early parenthood, there are no
intrinsic deterrents such as guilt and shame to prohibit behavior leading to teenage
childbearing. In one example brought to the attention of this author, a young, unmarried
mother whose child was the product of a teenage parenthood was pressured by the women in
her inner-city, poor neighborhood to quit her job, go on welfare, and stay at home in
order to be respected as a good mother by her peers. She was attempting to take some adult
education courses and prepare herself for upward social mobility. She had to tolerate
tremendous conflict, however, as she struggled with the feelings of isolation resulting
from her rejection of the values of her social peers, who accused her of trying to be
"uppity." The support of her supervisor at work proved to be critical and
invaluable in helping her to resist such social and psychological pressure. She managed to
arrange a satisfactory day-care arrangement, which the childs father assisted in
implementing, and continued her schooling. Though she continues the pursuit of her
education, it is interesting to note in follow-up that she went on to give birth to yet
another child as an unwed mother. Her behavior demonstrates that she remains conflicted
about her choices.
The population of teenagers with children on AFDC represents a group that, in
spite of the rhetoric of equal opportunity for all, feels disenfranchised and powerless to
attain the goals of higher education and decent job opportunities that children of the
middle and upper classes believe they can attain. In other words, their perception of
available alternatives is extremely constricted. This holds true for both the teenage boys
and the girls.
I wish to emphasize (for those who will argue that opportunities do indeed
exist) that the powerful intrinsic psychological dynamic that is operant here is the
adolescents perception. Those of us who are raising, have raised, or have
friends who have teenagers know that even teenagers whom we designate as relatively normal
and who perceive that they have access to opportunities still have a perception of reality
that can get pretty distorted. Such is the nature of adolescence. Simply informing
teenagers that job opportunities exist does not necessarily mean that they have become aware
of such opportunities. For those in the lower class who have difficulty perceiving
themselves as having membership and, hence, acceptance in mainstream society, such
perception is further compromised.
Over the past 30 years we have witnessed a significant and radical shift in the
societal acceptance of premarital sex and of children born out of wedlock. This holds true
across all socioeconomic strata. This change in values has removed what was once a
powerful extrinsic social sanction against unmarried, single motherhood. The result has
been a diminunition of a powerful intrinsic psychological deterrent: the anticipation and
fear of shame. No more is anyone supposed to endure the humiliation of Hester in the Scarlet
Letter. The attitudinal and sociocultural changes of the magnitude that took place
with the introduction of the birth control pill into the middle and upper classes have had
far-reaching, unanticipated social consequences. As Erik Erikson points out so well in his
book Childhood and Society (Erikson, 1950), there is a powerful dynamic interaction
between the prevailing societal values and the children we raise in any given society.
If we are to effect any significant, long-term improvement in our teenage
parenthood rates, and ultimately on the number of welfare-dependent teenage mothers, we
must design efforts to address all the aforementioned powerful, intrinsic psychological
issues at work. Some local efforts are currently claiming initial success with teenagers
where the focus is on sexual abstinence, delay of sexual activity beyond the teenage
years, and use of condoms for the sexually active. It is impossible to provide
psychotherapeutic intervention to all the teenagers at risk. It is possible, however, to
craft intervention that integrates a significant psychological (psychodynamic and
behavioral) component, along with the other programmatic details of providing
transportation, food, social-skills training, job training, parent- readiness training,
and child-development classes. Simultaneously, on a broader community and societal level,
plans for long-term attitudinal changes similar to those successfully achieved with the
anti-smoking campaigns must be given serious consideration. Meanwhile, much tolerance and
patience will be required while, as a society, we ethically attend to the needs of the
vulnerable children who are born as a result of impulsive and irresponsible sexual
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