psychiatry - theories on normality 2010

THEORIES ON NORMALITY

ANNA JOSEFINA VAZQUEZ-GENUINO, MD Child, Adolescent & Adult Psychiatrist

4 PERSPECTIVES OF NORMALITY

• HEALTH

• UTOPIA

• AVERAGE

• PROCESS

6 PRINCIPLES OF EPIGENETIC DEVELOPMENTAL CONCEPTUAL MODEL

• 1. Stages in Fixed & Hierarchical Sequence

• 2. Stages Interconnected- Preceding Stage Lays Foundation for next

• 3. Stage Progression may be Speeded up but Cant Skip stage. No short cuts.

6 PRINCIPLES OF EPIGENETIC DEVELOPMENTAL CONCEPTUAL MODEL

• 4. Each Stage – Equilibrium Between Demands of Environment & Capacity of Individual Meet Demands Successfully

• 5. Progression or Regression is Disruption of Current Equilibrium

• 6. Fixation, Deviation, Progression – Circular

SEPARATION- INDIVIDUATION PROCESS

• MARGARET MAHLER

• 1) Normal AUTISTIC Phase 0- 4 wks

• 2) Normal SYMBIOTIC Phase 1- 5 mos


• 3) DIFFERENTIATION 5- 10 months

• Comparative Scanning

• (+) Stranger Anxiety 8mos

• Transitional Object

• Checking Back Pattern 7-8 mos


• 4) PRACTICING 10- 16 months• Love Affair w/ World• Emotional Refueling• Low Keyedness• Separation Anxiety 10- 18 months


• 5) Rapprochement 16- 24 months• Development of Language• Fusion vs Isolation, Ambivalence• Shadowing & Darting Away


• 6) Consolidation & • Object Constancy 24- 36 mos

• Object Constancy

PSYCHOSEXUAL STAGES Sigmund Freud

ORAL 0- 1½ yrs

Explore & Feel – Mouth, Senses

Oral Erotism vs Oral Aggression

Dependence vs Self Reliance

Over Gratification vs Deprivation


ANAL 1 or 1 ½ - 3 yrs

Anal Retention vs Expulsion

Self Determination, Cooperation

Anal Character: Obsessive Compulsive vs Passive Aggressive


URETHRAL

Urethral Erotism

Enuresis

Penis Envy Competiveness, Ambition

Pride, Self Competence


PHALLIC/ OEDIPAL 3- 5 /6 yrs

Castration Anxiety, Penis Envy

Oedipal / Electra Complex

Identification with Parent of Same Sex

Superego


LATENCY 5 / 6- 11 /13 yrs

Identification w/ Other Figures

Sublimation of Drives

Lack Inner Control vs

Capacity for Mastery, Defined Roles

PSYCHOSOCIAL STAGES OF LIFEErik Erikson

• Each Stage - Turning Points

• 1. TRUST VS MISTRUST 0- 18 m0nths

• All Needs Satisfied *Trust Others

• Cry Elicits Response *Trust Self

• Optimism = Present is for the Best, Expects Best Outcome

• HOPE = To Desire w/ Expectation

• Psychosis, Paranoia, Depression

PSYCHOSOCIAL STAGES OF LIFE

• 2. AUTONOMY VS SHAME AND DOUBT 1.5 – 3 Yrs

• *Sense of Mastery over Self Self Confidence

• Rigid Control Defeats Attempts at Independence Doubt Self

• No Control Places Child in Physical Danger Shame, Scared

• WILL = Regulate Impulses Well


• 2. AUTONOMY VS SHAME AND DOUBT

• Power Struggle: Parent Child

• Cooperativeness vs Willfullness

• Loving Good Will vs Hateful Self Insistence

• Self Expression vs Self Restraint, Meek Compliance

• Paranoid Personality, Impulse Control D, Anx


• 3. INITIATIVE VS GUILT 3-5 Yrs

• Allow Child to Decide, Solve Own Problems Purpose, Ambition

• Harsh Criticism/ Censure Guilt Ridden, Overanxious, No Motivation, Phobia, Conversion, Psychosomatic D


• 4. INDUSTRY VS INFERIORITY (5- 13 Yrs)

• *Interest in Learning, Mastery of Skills Enjoyment in Completing Work & Take Pride in Accomplishments

• Provide Opportunity to Discover Talents & Praise Competence, Self- Confidence

• Parental Expectations too High or Difficult to Please Discouraged, Inferior, Low Self Esteem Give Up


• 5. IDENTITY VS ROLE DIFFUSION 13- 21 Yrs

• Who Am I? Where am I going? How do I fit into the scheme of things? Why am I here?

• Allow Freedom to Choose & Decide: Dress, Music, Friends, Career

• Open Communication, Respect Privacy, Guidance, Withdrawal of Privileges


• 5. IDENTITY VS ROLE DIFFUSION 13- 21 Yrs

• FIDELITY= Commitment to Beliefs & Goals

• Psychosis, Schizophrenia, Gender Identity Disorder,


• . INTIMACY VS ISOLATION 21- 40 Yrs

• *Ability to Honor Commitment in Marriage even when that requires Sacrifice & Compromise

• Vs. Self Interest / Indulgent / Absorbed

• LOVE = Generosity of Sharing Self with Others

• Balance Love & Work


• 7. GENERATIVITY VS STAGNATION 40- 60 Yrs

• *Raising Children Responsible & Concerned Citizens Establish Better Society

• *Passing on Knowledge, Skills, Values- Young Sense of Satisfaction, Fulfilment

• Productivity & Creativity Groups, Org, Soc


• 7. GENERATIVITY VS STAGNATION 40- 60 Yrs

• Introspect

• CARE = Concern for All, Desire to Help

• vs. Selfishness, Family Dynasty

• Mid- Life Crisis: Extramarital Affairs, Marital Separation & Divorce, Alcoholism, Gambling


• 8. INTEGRITY VS DESPAIR

• > 60 Yrs

• Retirement: Give Position of Authority to Younger Ones, Enjoy Grandchildren & Gratification from Hobbies

• Retrospect, Prepare for Death


• 8. INTEGRITY VS DESPAIR > 60 Yrs

• Sense of Satisfaction that Life was Productive, Worthwhile Happy

• Vs. Regrets, Not Ready to Die, Depressed

• WISDOM = Acceptance of Past and that All that happened was Good

COGNITIVE DEVELOPMENTJEAN PIAGET

• SCHEMES• ASSIMILATION• ACCOMMODATION• ORGANIZATION• EQUILIBRATION


• Stages • SENSORIMOTOR• PRE OPERATIONAL• CONCRETE OPERATIONAL• FORMAL OPERATIONAL

COGNITIVE DEVELOPMENT

• JEAN PIAGET• I. SENSORIMOTOR Stage 0- 2 yrs

• A. Reflexes 0-2 mos

• B. 1ry Circular Rxn 2- 5 mos

• C. 2ndary Circular Rxn 5-9 mos

• D. Object Permanence 9- 12 mos

• E. 3ry Circular Rxn 1- 1 ½ yrs

• F. Symbolic Thought 1 ½ - 2 yrs



• A. Reflexes 0-2 mos

• Rooting

• Sucking

• Grasp

• Startle


• JEAN PIAGET• I. SENSORIMOTOR Stage 0- 2 years

• B. 1ry Circular Reaction 2- 5 months

• Coordinates Own Body & 5 Senses

• Curiosity: Activity, Turns, Reach Out



• C. 2ndary Circular Reaction 5-9 mos

• Anticipate Consequences of Own Behavior

• Acts Purposefully to Change Environment



• D. Coordination of 2ndary Circular Reaction 9- 12 mos

• Throws Toys

• Open /Close

• Intentional Behavior

• Look For Hidden Toy 10 months

•



• E. 3ry Circular Rxn 1- 1 ½ yrs

• Seeks Out New Experiences

• Produces Novel Behavior- Push Buttons, Insert Objects in Bottle, Shake Table to Get Toy



• F. Symbolic Thought 1 ½ - 2 yrs

• Visual Image or Mental Symbol of Words to Signify for Real Objects or Events in the Environment

• Sun = Ball =

• Reasoning- Use Chair to Get Toy


D E V E L O P M E N T OF O B J E C T P E R M A N E N C E

SENSORIMOTOR STAGE BEHAVIORSubstage 1- Reflexes FF objects x visual field x 180 Ignores

its DisappearanceSubstage 2- 1ry Circular Rxn Look Briefly at Spot where Object

DisappearedSubstage 3- 2ndary Circular Rxn Search for Missing ObjectSubstage 4 – Coordination of 2ndary Circular Rxn

Search Behind Screen for HiddenToy

Substage 5- 3ry Circular RxnSubstage 6- Symbolic Thought

Track Object that Disappears/ AppearsImagine the Missing Object


• JEAN PIAGET

• II. Stage of PREOPERATIONAL Thought 2- 7 yrs

• Substage 1) Symbolic Function 2-4 Yrs

• Substage 2) Intuitive Thought 4- 7 Yrs


• JEAN PIAGET


• Substage 1) Symbolic Function @ 2- 4 Yrs

• Egocentrism

• Animism


• JEAN PIAGET


• Substage 2) Intuitive Thought @ 4- 7 Yrs

• Centration


• JEAN PIAGET


• Cant Grasp Sameness

• Defines Words ~ Function

• Phenomenalistic Causality


• JEAN PIAGET

II. Stage of CONCRETE OPERATIONS 7- 11 yrs

• Serialize, Classify Objects

• Inductive Reasoning

• Reversibility of Processes & Relationships


• III. Stage of CONCRETE OPERATIONS 7-11 Yrs

• Length = 6-7 Yrs

• Liquid Quantity =

• Conservation of: Mass = 6- 7Yrs

• Weight =

• Area = 9- 10 Yrs


• JEAN PIAGET

• IV. Stage of FORMAL OPERATIONS 11/ 12 yrs

• Scientific, Logical

• Abstract Thinking

• Hypothetical Thinking

• Deductive Reasoning


IV. Stage of FORMAL OPERATIONS 11/ 12 yrs

Adolescent Egocentrism

1) Imaginary Audience – Self Consciousness

2) Personal Fable- Uniqueness, Invincibility

MORAL DEVELOPMENTChanges in Thoughts, Feelings, Behaviors regarding Standards of Right & Wrong

Intrapersonal Dimension: Regulates one’s Activities When Alone

Interpersonal Dimension: Regulates Social Interaction & Arbitrates Conflict (Gibbs 2003, Walker 1996, Walker & Pitts 1998)

INTRAPERSONAL

INTERPERSONAL

MORAL DEVELOPMENT 2

DIMENSIONS

MORAL DEVELOPMENTJean Piaget

TRANSITION7- 10 Yrs Old

MORAL DEVELOPMENTLawrence Kolberg

• PRE- CONVENTIONAL STAGES• Good & Bad Interpreted in Terms of External Rewards/

PUnishments

• CONVENTIONAL STAGES• Abide by Certain Internal Standards Dictated by Family,

Society, Law

• POST -CONVENTIONAL STAGES• Recognize Alternative Mores, Explore Options, Decide

on Personal Moral Code

MORAL DEVELOPMENT• Lawrence Kolberg

• PRE- CONVENTIONAL STAGES

I. Stage of IMMEDIATE GRATIFICATION 0-6mos

• “ I want it now!”

• e.g. cry, tantrum

• II. Stage of END JUSTIFIES the MEANS 6-12 mos

• “ I want it & I don’t care what it takes to get it”

• e.g. biting, grabbing, criminals

MORAL DEVELOPMENT

• PRE- CONVENTIONAL STAGES

• III. Stage of PUNISHMENT & OBEDIENCE Orientation 1-3 yrs

• “Might is Right”

• Avoid Physical Punishment, Unquestioning Deference to Power

• Goodness of Action Determined by Consequence Received

• Child Obeys out of Fear of Physical Punishment

PRE- CONVENTIONAL STAGES• IV. Stage of INSTRUMENTAL RELATIVISM/

HEDONISM 3- 7 yrs

• Golden Rule: “Don’t do unto others what you would not want others to do to you”

• “ You scratch my back, I’ll scratch your back”• Tallion Principle “ An eye for an eye” (Immanent

Justice)

• Good = What is Beneficial to Me

MORAL DEVELOPMENT

• CONVENTIONAL STAGES

• Know Good vs Bad, Right vs Wrong

• V. Stage of INTERPERSONAL CONCORDANCE/ CONFORMITY 7- 9 yrs

• “Good boy/ Nice girl” - Conform to Rules so as to Please Authority

• “Soldier in War” – Blind Obedience, Respect for Authority

• Good = What is Approved & Dictated by Those He Loves & Respects

MORAL DEVELOPMENT

• CONVENTIONAL STAGES

• VI. Stage of LAW & ORDER Orientation 9- 12 yrs

• “ I don’t want to break any rules”• Obeys Rules to Maintain Peace & Social

Order• Complies with his Duty & Responsibility• Morality Dictated by Avoidance of Dishonor• Good = What is Legal

MORAL DEVELOPMENT

• POST CONVENTIONAL STAGES

• VII. Stage of SOCIAL CONTRACT- Legalistic Orientation- 12 – 18 yrs

• “ Let’s decide what is best for us”

• Situation Ethics

• Realize Relativism of Values & Impermanence of Rules

• Voluntary Compliance, Exception to Rules

• Right = Depends on Current Circumstances

MORAL DEVELOPMENT• POST CONVENTIONAL STAGES

• VIII. Stage of UNIVERSAL ETHICAL PRINCIPLES > 18 yrs

• “ Let’s decide what is best for everyone”

• Good = Maintains Respect & Dignity for All Fellowmen, Equality

• Right = Self Determined, Autonomous from Law

• T H E E N D


ORAL 0- 1½ yrs

Explore & Feel – Mouth, Senses

Oral Erotism vs Oral Aggression

Dependence vs Self Reliance

Over Gratification vs Deprivation


ANAL 1 or 1 ½ - 3 yrs

Anal Retention vs Expulsion

Self Determination, Cooperation

Anal Character: Obsessive Compulsive vs Passive Aggressive


URETHRAL

Urethral Erotism

Enuresis

Penis Envy Competiveness, Ambition

Pride, Self Competence


PHALLIC/ OEDIPAL 3- 5 /6 yrs

Castration Anxiety, Penis Envy

Oedipal / Electra Complex

Identification with Parent of Same Sex

Superego


LATENCY 5 / 6- 11 /13 yrs

Identification w/ Other Figures

Sublimation of Drives

Lack Inner Control vs

Capacity for Mastery, Defined Roles

psychiatry - theories on normality 2010

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