Psychiatry - Theories on Normality 2010
-
Upload
carl-kevin-julao -
Category
Documents
-
view
22 -
download
2
Transcript of 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
SEPARATION- INDIVIDUATION PROCESS
• 3) DIFFERENTIATION 5- 10 months
• Comparative Scanning
• (+) Stranger Anxiety 8mos
• Transitional Object
• Checking Back Pattern 7-8 mos
SEPARATION- INDIVIDUATION PROCESS
• 4) PRACTICING 10- 16 months• Love Affair w/ World• Emotional Refueling• Low Keyedness• Separation Anxiety 10- 18 months
SEPARATION- INDIVIDUATION PROCESS
• 5) Rapprochement 16- 24 months• Development of Language• Fusion vs Isolation, Ambivalence• Shadowing & Darting Away
SEPARATION- INDIVIDUATION PROCESS
• 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
PSYCHOSEXUAL STAGES Sigmund Freud
ANAL 1 or 1 ½ - 3 yrs
Anal Retention vs Expulsion
Self Determination, Cooperation
Anal Character: Obsessive Compulsive vs Passive Aggressive
PSYCHOSEXUAL STAGES Sigmund Freud
URETHRAL
Urethral Erotism
Enuresis
Penis Envy Competiveness, Ambition
Pride, Self Competence
PSYCHOSEXUAL STAGES Sigmund Freud
PHALLIC/ OEDIPAL 3- 5 /6 yrs
Castration Anxiety, Penis Envy
Oedipal / Electra Complex
Identification with Parent of Same Sex
Superego
PSYCHOSEXUAL STAGES Sigmund Freud
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
PSYCHOSOCIAL STAGES OF LIFE
• 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
PSYCHOSOCIAL STAGES OF LIFE
• 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
PSYCHOSOCIAL STAGES OF LIFE
• 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
PSYCHOSOCIAL STAGES OF LIFE
• 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
PSYCHOSOCIAL STAGES OF LIFE
• 5. IDENTITY VS ROLE DIFFUSION 13- 21 Yrs
• FIDELITY= Commitment to Beliefs & Goals
• Psychosis, Schizophrenia, Gender Identity Disorder,
PSYCHOSOCIAL STAGES OF LIFE
• . 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
PSYCHOSOCIAL STAGES OF LIFE
• 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
PSYCHOSOCIAL STAGES OF LIFE
• 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
PSYCHOSOCIAL STAGES OF LIFE
• 8. INTEGRITY VS DESPAIR
• > 60 Yrs
• Retirement: Give Position of Authority to Younger Ones, Enjoy Grandchildren & Gratification from Hobbies
• Retrospect, Prepare for Death
PSYCHOSOCIAL STAGES OF LIFE
• 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
COGNITIVE DEVELOPMENTJEAN PIAGET
• 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
COGNITIVE DEVELOPMENT
• JEAN PIAGET• I. SENSORIMOTOR Stage 0- 2 yrs
• A. Reflexes 0-2 mos
• Rooting
• Sucking
• Grasp
• Startle
COGNITIVE DEVELOPMENT
• 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
COGNITIVE DEVELOPMENT
• JEAN PIAGET• I. SENSORIMOTOR Stage 0- 2 yrs
• C. 2ndary Circular Reaction 5-9 mos
• Anticipate Consequences of Own Behavior
• Acts Purposefully to Change Environment
COGNITIVE DEVELOPMENT
• JEAN PIAGET• I. SENSORIMOTOR Stage 0- 2 yrs
• D. Coordination of 2ndary Circular Reaction 9- 12 mos
• Throws Toys
• Open /Close
• Intentional Behavior
• Look For Hidden Toy 10 months
•
COGNITIVE DEVELOPMENT
• JEAN PIAGET• I. SENSORIMOTOR Stage 0- 2 yrs
• 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
COGNITIVE DEVELOPMENT
• JEAN PIAGET• I. SENSORIMOTOR Stage 0- 2 yrs
• 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
COGNITIVE DEVELOPMENTJEAN PIAGET
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
COGNITIVE DEVELOPMENT
• JEAN PIAGET
• II. Stage of PREOPERATIONAL Thought 2- 7 yrs
• Substage 1) Symbolic Function 2-4 Yrs
• Substage 2) Intuitive Thought 4- 7 Yrs
COGNITIVE DEVELOPMENT
• JEAN PIAGET
• II. Stage of PREOPERATIONAL Thought 2- 7 yrs
• Substage 1) Symbolic Function @ 2- 4 Yrs
• Egocentrism
• Animism
COGNITIVE DEVELOPMENT
• JEAN PIAGET
• II. Stage of PREOPERATIONAL Thought 2- 7 yrs
• Substage 2) Intuitive Thought @ 4- 7 Yrs
• Centration
COGNITIVE DEVELOPMENT
• JEAN PIAGET
• II. Stage of PREOPERATIONAL Thought 2- 7 yrs
• Cant Grasp Sameness
• Defines Words ~ Function
• Phenomenalistic Causality
COGNITIVE DEVELOPMENT
• JEAN PIAGET
II. Stage of CONCRETE OPERATIONS 7- 11 yrs
• Serialize, Classify Objects
• Inductive Reasoning
• Reversibility of Processes & Relationships
COGNITIVE DEVELOPMENT
• III. Stage of CONCRETE OPERATIONS 7-11 Yrs
• Length = 6-7 Yrs
• Liquid Quantity =
• Conservation of: Mass = 6- 7Yrs
• Weight =
• Area = 9- 10 Yrs
COGNITIVE DEVELOPMENT
• JEAN PIAGET
• IV. Stage of FORMAL OPERATIONS 11/ 12 yrs
• Scientific, Logical
• Abstract Thinking
• Hypothetical Thinking
• Deductive Reasoning
COGNITIVE DEVELOPMENTJEAN PIAGET
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
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
PSYCHOSEXUAL STAGES Sigmund Freud
ANAL 1 or 1 ½ - 3 yrs
Anal Retention vs Expulsion
Self Determination, Cooperation
Anal Character: Obsessive Compulsive vs Passive Aggressive
PSYCHOSEXUAL STAGES Sigmund Freud
URETHRAL
Urethral Erotism
Enuresis
Penis Envy Competiveness, Ambition
Pride, Self Competence
PSYCHOSEXUAL STAGES Sigmund Freud
PHALLIC/ OEDIPAL 3- 5 /6 yrs
Castration Anxiety, Penis Envy
Oedipal / Electra Complex
Identification with Parent of Same Sex
Superego
PSYCHOSEXUAL STAGES Sigmund Freud
LATENCY 5 / 6- 11 /13 yrs
Identification w/ Other Figures
Sublimation of Drives
Lack Inner Control vs
Capacity for Mastery, Defined Roles