Mental Health Fall '12

1. Theorists

2. Many health professionals base their practice on a
conceptual model of psychiatric treatment. A
model is a way of organizing a complex body of
knowledge, such as concepts related to human
behavior.
Models help clinicians by suggesting:
1. Reasons for observed behavior
2. Therapeutic treatment strategies
3. Appropriate roles for patient &
therapist

3.  The developmental process is unique for each
person, and what develops in the future depends
on what has already happened
 General theories of developmental behavior
provide a foundation for examining the
characteristics of the life cycle.
 Understanding the relative norms for important
stages of development in the life cycle enables a
nurse to assess whether a patient has made
satisfactory progress within expected boundaries.

4. Freud’s Stages of Psychosexual Development
 Sigmund Freud (1856-1939) is probably the most well
known theorist when it comes to the development of
personality. Freud’s Stages of Psychosexual Development
are, like other stage theories, completed in a predetermined
sequence and can result in either successful completion or
a healthy personality or can result in failure, leading to an
unhealthy personality.
 Considered the father of psychoanalysis, described
psychosexual development through adolescence.

5.  Oral Stage
 Anal Stage
 Phallic Stage
 Latency Stage
 Genital Stage

6. Oral Stage (Bir th to 18 months).
 During the oral stage, the child if focused on oral
pleasures (sucking). Too much or too little
gratification can result in an Oral Fixation or Oral
Personality which is evidenced by a preoccupation
with oral activities.
 This type of personality may have a stronger
tendency to smoke, drink alcohol, over eat, or
bite his or her nails. Personality wise, these
individuals may become overly dependent upon
others, gullible, and perpetual followers. On the
other hand, they may also fight these urges and
develop pessimism and aggression toward others.

7. Anal Stage (18 months to three years).
 The child’s focus of pleasure in this stage is on
eliminating and retaining feces. Through society’s
pressure, mainly via parents, the child has to learn
to control anal stimulation.
 In terms of personality, after effects of an anal
fixation during this stage can result in an obsession
with cleanliness, perfection, and control (anal
retentive). On the opposite end of the spectrum,
they may become messy and disorganized (anal
expulsive)

8. Phallic Stage ( ages three to six)
 The pleasure zone switches to the genitals. Freud
believed that during this stage boys develop
unconscious sexual desires for their mother.
 Because of this, he becomes rivals with his father
and sees him as competition for the mother’s
af fection. During this time, boys also develop a
fear that their father will punish them for these
feelings, such as by castrating them.
 This group of feelings is known as Oedipus
Complex ( af ter the Greek Mythology figure who
accidentally killed his father and married his
mother).

9.  Latency Stage (age six to puber ty).
 It’s during this stage that sexual urges remain repressed
and children interact and play mostly with same sex
peers.
 Genital Stage (12 to adult)
 The final stage of psychosexual development begins at
the star t of puber ty when sexual urges are once again
awakened. Through the lessons learned during the
previous stages, adolescents direct their sexual urges
onto opposite sex peers, with the primar y focus of
pleasure is the genitals.

10.  A person’s personality consists of three parts:
 Id: the unconscious mind, operates instinctively and without
control
 Ego: The conscious mind, maintains contact with reality,
examining all environmental and physiologic changes
experienced by the person
 Superego: the human conscience that directs and controls
thoughts and feelings

11.  Problems in adulthood can all be
traced back to strong fixations at
psychosexual stages
 Individual differences in personality
due to what happened during the
first five years.

12.  Jean Piaget (1896-1980) was a biologist
who originally studied molluscs (publishing
twenty scientific papers on them by the time
he was 21) but moved into the study of the
development of children's understanding,
through observing them and talking and
listening to them while they worked on
exercises he set.

13.  Sensori-motor Stage (Birth-2 years)
 Differentiates self from objects Recognizes self as
agent of action and begins to act intentionally: e.g.
pulls a string to set mobile in motion or shakes a
rattle to make a noise
 Achieves object permanence: realizes that things
continue to exist even when no longer present to
the sense

14.  (Pre-conceptual 2-4yrs) Learns to use language and to
represent objects by images and words Thinking is
still egocentric: has difficulty taking the viewpoint of
others
 (Intuitive phase 4-7yrs) Classifies objects by a single
feature: e.g. groups together all the red blocks
regardless of shape or all the square blocks
regardless of color. Expands expressive language.

15.  Can think logically about objects and events
Achieves conservation of number (age 6), mass
(age 7), and weight (age 9)
 Classifies objects according to several features
and can order them in series along a single
dimension such as size

16.  Can think logically about abstract propositions
and test hypotheses systematically
 Becomes concerned with the hypothetical, the
future, and ideological problems

17.  Lawrence Kohlberg (1969) modified and elaborated
Piaget's work, and laid the groundwork for the current
debate within psychology on moral development.
 Consistent with Piaget, he proposed that children form ways
of thinking through their experiences which include
understandings of moral concepts such as justice, rights,
equality and human welfare.
 Kohlberg followed the development of moral judgment
beyond the ages studied by Piaget, and determined that the
process of attaining moral maturity took longer and was
more gradual than Piaget had proposed.

18.  Kohlberg identified six stages of moral reasoning grouped into
three major levels. Each level represented a fundamental shift
in the social-moral perspective of the individual.
 At the first level, the preconventional level (premoral
level) a person's moral judgments are characterized by a
concrete, individual perspective.
 As in Piaget's framework, the reasoning of Stage 1 is
characterized by ego-centrism and the inability to consider the
perspectives of others.

19.  Individuals at the conventional level of reasoning,
however, have a basic understanding of conventional
morality, and reason with an understanding that
norms and conventions are necessary to uphold
society.
 They tend to be self-identified with these rules, and
uphold them consistently, viewing morality as acting in
accordance with what society defines as right.

20.  The post conventional level (level of principled
moral reasoning) is characterized by reasoning based
on principles, using a "prior to society" perspective.
 These individuals reason based on the principles
which underlie rules and norms, but reject a uniform
application of a rule or norm.

21.  Like Piaget, Erik Erikson (1902-1994) maintained that children
develop in a predetermined order. Instead of focusing on
cognitive development, however, he was interested in how
children socialize and how this affects their sense of self.
 Erikson’s Theory of Psychosocial Development has eight
distinct stage, each with two possible outcomes. According to
the theory, successful completion of each stage results in a
healthy personality and successful interactions with others.
 Failure to successfully complete a stage can result in a reduced
ability to complete further stages and therefore a more
unhealthy personality and sense of self. These stages, however,
can be resolved successfully at a later time.

22.  From ages birth to one year, children begin to learn the ability
to trust others based upon the consistency of their caregiver(s).
 If trust develops successfully, the child gains confidence and
security in the world around him and is able to feel secure even
when threatened.
 Unsuccessful completion of this stage can result in an inability
to trust, and therefore an sense of fear about the inconsistent
world. It may result in anxiety, heightened insecurities, and an
over feeling of mistrust in the world around them.

23.  Between the ages of one and three, children begin to assert
their independence, by walking away from their mother, picking
which toy to play with, and making choices about what they like
to wear, to eat, etc.
 If children in this stage are encouraged and supported in their
increased independence, they become more confident and
secure in their own ability to survive in the world.
 If children are criticized, overly controlled, or not given the
opportunity to assert themselves, they begin to feel inadequate
in their ability to survive, and may then become overly
dependent upon others, lack self-esteem, and feel a sense of
shame or doubt in their own abilities.

24.  Around age three and continuing to age six, children
assert themselves more frequently. They begin to plan
activities, make up games, and initiate activities with
others.
 If given this opportunity, children develop a sense of
initiative, and feel secure in their ability to lead others
and make decisions.
 Conversely, if this tendency is squelched, either
through criticism or control, children develop a sense
of guilt. They may feel like a nuisance to others and
will therefore remain followers, lacking in self-initiative.

25.  From age six years to puberty, children begin to develop a
sense of pride in their accomplishments. They initiate
projects, see them through to completion, and feel good
about what they have achieved. During this time, teachers
play an increased role in the child’s development.
 If children are encouraged and reinforced for their initiative,
they begin to feel industrious and feel confident in their
ability to achieve goals.
 If this initiative is not encouraged, if it is restricted by
parents or teacher, then the child begins to feel inferior,
doubting his own abilities and therefore may not reach his
potential

26.  During adolescence, the transition from childhood to
adulthood is most important. Children are becoming
more independent, and begin to look at the future in
terms of career, relationships, families, housing, etc.
 During this period, they explore possibilities and begin
to form their own identity based upon the outcome of
their explorations.
 This sense of who they are can be hindered, which
results in a sense of confusion ("I don’t know what I
want to be when I grow up") about themselves and
their role in the world.

27.  Occurring in Young adulthood, we begin to share
ourselves more intimately with others. We explore
relationships leading toward longer term commitments
with someone other than a family member.
 Successful completion can lead to comfortable
relationships and a sense of commitment, safety, and
care within a relationship.
 Avoiding intimacy, fearing commitment and
relationships can lead to isolation, loneliness, and
sometimes depression.

28.  During middle adulthood, we establish our careers, settle
down within a relationship, begin our own families and
develop a sense of being a part of the bigger picture.
 We give back to society through raising our children, being
productive at work, and becoming involved in community
activities and organizations.
 By failing to achieve these objectives, we become
stagnant and feel unproductive.

29.  As we grow older and become senior citizens, we tend
to slow down our productivity, and explore life as a
retired person. It is during this time that we
contemplate our accomplishments and are able to
develop integrity.
 If we see our lives as unproductive, feel guilt about our
pasts, or feel that we did not accomplish our life goals,
we become dissatisfied with life and develop despair,
often leading to depression and hopelessness.