I.

INTRODUCTION

Nurses must have a basic knowledge of human personality development to

understand maladaptive behavioural responses commonly seen in psychiatric clients.
Developmental theories identify behaviours associated with various stages through
which individuals pass there by specifying what is appropriate or inappropriate at each
developmental level. Specialists in child development believe that infancy and early
childhood are the major life periods for the origination and occurrence of
developmental change. Specialists in life-cycle development believe that people
continue to develop and change throughout life, thereby suggesting the possibility for
renewal and growth in adults. Developmental stages are identified by age. Behaviours
can then be evaluated by whether or not they are recognized as age-appropriate.
Ideally, an individual successfully fulfils all the tasks associated with one stage before
moving on to the next stage (at the appropriate age). Realistically, however, this
seldom happens. One reason is related to temperament, or the inborn personality
characteristics that influence an individual’s manner of reacting to the environment,
and ultimately his or her developmental progression. The environment may also
influence ones developmental pattern. Individuals who are reared in a dysfunctional
family system often have retraded ego development. According to specialists in Iife-
cycle development, Behaviours from an unsuccessfully completed stage can be
modified and corrected in a later stage.

Stages overlap, and an individual nay be working on tasks associated with

several stages at one time. When an individual becomes fixed in a lower level
development, with age-inappropriate behaviours focused on fulfilment of those tasks,
psychopathology may become evident. Only when personality traits become
inflexible, and personality functioning becomes individually and interpersonally
impaired, do they constitute personality disorders.

II. DEFINITIONS OF PERSONALITY

 Personality consists of the distinctive patterns of behaviour including thought

and emotions that characterize each individual’s adaption to the situations of
his or her life.
(waller Mishel- 1976)
 Personality is the sum of activities that can be discovered by actual
observations over along enough period of time to give reliable information.
 The combination of character, behavioural, temperamental, emotional, and
mental traits that are unique to each specific individual.

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III. PSYCHOANALYTIC THEORY

a) Introduction

Sigmund Freud (1961), who has been called the father of psychiatry, is credited as
the first to identify development by stages. He considered the first 5 Years of a child’s
life to be the most important, because he believed that an individual’s basic character
had been formed by the age of 5. Freud’s personality theory can be conceptualized
according to structure and dynamics of the personality, topography of the mind, and
stages of personality development.

According to Freud, almost the entire mental life is directed from the
unconscious forces. The conscious level is very small part of the unconscious mind.
Accordingly only 1/10 part of an iceberg remains above the water, while the 9/10 th is
concealed below the water; similarly the conscious level of the man’s mind is very
small part of the unconscious. Thus, most of the human activities are motivated from
the unconscious. Freud devised many methods to explain the unconscious, the
techniques used which is known psychoanalysis.

b) Concepts

1 Psychic determination: All behaviour determined By prior thoughts & mental

process.

2. Psychic structures:

Freud organized the structure of the personality into three major components: the id,
ego, and superego. They are distinguished by their unique functions and different
characteristics.

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ID: The id is the locus of instinctual drives-the “pleasure principle.” Present at birth, it
endows the infant with instinctual drives that seek to satisfy needs and achieve
immediate gratification. Id-driven behaviours are impulsive and may be irrational.

The id is the primitive and instinctive component of personality. It consists of all the
inherited (i.e., biological) components of personality present at birth, including the sex
(life) instinct – Eros (which contains the libido), and the aggressive (death) instinct.

The id is the impulsive (and unconscious) part of our psyche which responds directly
and immediately to the instincts. The personality of the newborn child is all id and
only later does it develop an ego and super-ego.

The id remains infantile in its function throughout a persons life and does not change
with time or experience, as it is not in touch with the external world. The id is not
affected by reality, logic or the everyday world, as it operates within the unconscious
part of the mind.

The id operates on the pleasure principle (Freud, 1920) which is the idea that every
wishful impulse should be satisfied immediately, regardless of the consequences.
When the id achieves its demands, we experience pleasure when it is denied we
experience ‘unpleasure’ or tension.

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The id engages in primary process thinking, which is primitive, illogical, irrational,
and fantasy oriented. This form of process thinking has no comprehension of objective
reality, and is selfish and wishful in nature.

EGO: The ego, also called the rational self or the “reality principle,” begins to
develop between the ages of 4 and 6 months. The ego experiences the reality of the
external world, adapts to it, and responds to it. As the ego develops and gains strength,
it seeks to bring the influences of the external world to bear upon the id, to substitute
the reality principle for the pleasure principle. A primary function of the ego is one of
mediator; that is, to maintain harmony among the external world, the id, and the
superego.

The ego is 'that part of the id which has been modified by the direct influence of the
external world.'

(Freud, 1923, p. 25)

The ego develops to mediate between the unrealistic id and the external real world. It
is the decision-making component of personality. Ideally, the ego works by reason,
whereas the id is chaotic and unreasonable.

The ego operates according to the reality principle, working out realistic ways of
satisfying the id’s demands, often compromising or postponing satisfaction to avoid
negative consequences of society. The ego considers social realities and norms,
etiquette and rules in deciding how to behave.

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Like the id, the ego seeks pleasure (i.e., tension reduction) and avoids pain, but unlike
the id, the ego is concerned with devising a realistic strategy to obtain pleasure. The
ego has no concept of right or wrong; something is good simply if it achieves its end
of satisfying without causing harm to itself or the id.

Often the ego is weak relative to the headstrong id, and the best the ego can do is stay
on, pointing the id in the right direction and claiming some credit at the end as if the
action were its own.

Freud made the analogy of the id being a horse while the ego is the rider. The ego is
'like a man on horseback, who has to hold in check the superior strength of the horse.'

(Freud, 1923, p.15)

If the ego fails in its attempt to use the reality principle, and anxiety is experienced,
unconscious defense mechanisms are employed, to help ward off unpleasant feelings
(i.e., anxiety) or make good things feel better for the individual.

The ego engages in secondary process thinking, which is rational, realistic, and
orientated towards problem-solving. If a plan of action does not work, then it is
thought through again until a solution is found. This is known as reality testing and
enables the person to control their impulses and demonstrate self-control, via mastery
of the ego.

An important feature of clinical and social work is to enhance ego functioning and
help the client test reality through assisting the client to think through their options.

SUPEREGO: If the id is identified as the pleasure principle, and the ego the reality
principle, the superego might be referred to as the “perfection principle.”The
superego, which develops between ages 3 and 6 years, internalizes the values and
morals set forth by primary caregivers. Derived out of a system of rewards and
punishments, the superego is composed of two major components: the ego-ideal and
the conscience. When a child is consistently rewarded for .good’ behaviour, the self-
esteem is enhanced, and the behaviour becomes part of the ego-ideal; that is, it is
internalized as part of his or her value system.

The conscience is formed when the child is punished consistently for “bad”
behaviour. The child learns what is considered morally right or wrong from feedback
received from parental figures and from society or culture. When moral and ethical
principles or even internalized ideals and values are disregarded, the conscience
generates a feeling of guilt within the individual. The superego is important in the
socialization of the individual because it assists the ego m the control of id impulses.

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When the superego becomes rigid and punitive, problems with low self-confidence
and low self-esteem arise.

The superego incorporates the values and morals of society which are learned from
one's parents and others. It develops around the age of 3 – 5 during the phallic stage of
psychosexual development. The superego's function is to control the id's impulses,
especially those which society forbids, such as sex and aggression. It also has the
function of persuading the ego to turn to moralistic goals rather than simply realistic
ones and to strive for perfection.

The superego consists of two systems: The conscience and the ideal self. The
conscience can punish the ego through causing feelings of guilt. For example, if the
ego gives in to the id's demands, the superego may make the person feel bad through
guilt. The ideal self (or ego-ideal) is an imaginary picture of how you ought to be, and
represents career aspirations, how to treat other people, and how to behave as a
member of society. Behaviour which falls short of the ideal self may be punished by
the superego through guilt. The super-ego can also reward us through the ideal self
when we behave ‘properly’ by making us feel proud.

If a person’s ideal self is too high a standard, then whatever the person does
will represent failure. The ideal self and conscience are largely determined in
childhood from parental values and how you were brought up.

c) Topography of the mind

Freud classified all mental content & operations into three categories

• The conscious

• The pre conscious

• The unconscious

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  The conscious includes all memories that remain within individual’s
awareness. It is the smallest of the three categories. Events and experiences that
are easily remembered or retrieved are considered to be within one’s conscious
awareness. Examples include telephone numbers, birthdays of self and
significant others, the dates of special holidays, and what one had for lunch
today. The conscious mind is thought to be under the control of the ego, the
rational and logical structure of the personality.
 The preconscious includes all memories that may been forgotten or are not in
present awareness but with attention can be readily recalled into consciousness.
Examples include telephone numbers or addresses once known but little used
and feelings associated with significant life events that may have occurred at
sometime in the past. The preconscious enhances awareness by helping to
suppress unpleasant or nonessential memories from consciousness. It is thought
to be partially under the control of the superego, which helps to suppress
unacceptable thoughts and behaviours.
 The unconscious includes all memories that one is unable to bring to
conscious awareness. It is the largest of the three topographical levels.
Unconscious material consists of unpleasant or nonessential memories that
have been repressed and can be retrieved only through therapy, hypnosis, and
with certain substances that alter awareness and have capacity to restructure
repressed memories. Unconscious material may also emerge in dreams and in
seemingly incomprehensible behaviour.

d) Dynamics of the personality

Freud believed that psychic energy is ‘Life force or impetus required for mental
functioning. Originating in the id, it instinctually fulfils basic physiological needs.
Freud called this psychic energy (or the drive to fulfil basic physiological needs such
as hunger, thirst, and sex) the libido. As the child matures, psychic energy is diverted
from the id to form the ego and then from the ego to form the superego. Psychic
energy is distributed within these three components, with the ego retaining the largest
share to maintain a balance between the impulsive behaviours of the id and the
idealistic behaviours of the superego. If an excessive amount of psychic energy is
stored in one of these personality components, behaviour will reflect that part of
personality. For instance, impulsive behaviour prevails when excessive psychic
energy is stored in the id. Over-investment in the ego reflects self-absorbed, or
narcissistic, behaviours; an excess within the superego results in rigid, self-
deprecating behaviours.

Freud used the terms cathexis and anticathexis to describe the forces within
the id, ego, and superego that are used to invest psychic energy in external sources to
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satisfy needs. Cathexis is the process by which the id invests energy into an object in
an attempt to achieve gratification. An example is the individual who instinctively
turns to alcohol to relieve stress. Anticathexis is the use of psychic energy by ego and
the superego to control id impulses.

e) Freud’s Psycho sexual Stages of Personality Development

The five stages of development are as follows:

 First Stage : Oral – the child seeks pleasure from the mouth (e.g., sucking).
 Second Stage: Anal – the child seeks pleasure from the anus (e.g., withholding and
expelling feces).
 Third Stage : Phallic – the child seeks pleasure from the penis or clitoris (e.g.,
masturbation).
 Fourth Stage: Latent – the child has little or no sexual motivation.

 Fifth Stage : Genital – the child seeks pleasure from the penis or vagina (e.g.,
sexual intercourse)

Erikson (1950) believes that personality continues to be moulded throughout

the entire lifespan from birth to death. This period has been divided into eight stages
by him. Each stage has its characteristic features marked and affected by emotional
crisis, particular culture of the person and his interaction with the society of which he
is a part.

1. Oral Stage:

This stage expands from zero to one-and-a-half years. During this period mouth
is the sensitive zone of the body and the main source of joy and pleasure for the child.
How the infant is being cared for by the mother makes the infant trust or mistrusts the
world (represented by mother) around him. If his wants are frequently satisfied, he
develops trust and believes that the world will take care of him. In case of frequent
dissatisfaction, mistrust develops leading the infant to believe that the people around
him cannot be believed, relied on, and that he is going to lose most of what he wants.
After the first six months (sucking period), the remaining one year (biting period) is
fairly difficult for the child and mother because of eruption of teeth and weaning. If
properly handled, infant’s trust gets reinforced and he develops an in-built and
lifelong spring of optimism and hope. Persons, who had an unpleasant (abandoned,
unloved and uncared) babyhood, are likely to find parenthood as burdensome and may
express dependent, helpless, abusive behaviour, and angry outbursts i.e., oral
character. To such people, caseworker is like parents, who helps the client to verbalise

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his anger and distrust and later provides emotional support and protective services.
The caseworker has to fill the voids (mistrust) created by the early mother and child
relationship. The caseworker presents himself as a trustworthy person, and, as a by-
product of this relationship the client starts trusting himself and others, around him.
Care should be taken that the client does not feel deprived at the hands of the
caseworker who presents himself as a mothering person to the client. It may be made
clear that the feeling of trust or mistrust (task of oral stage) is not totally dependent
upon mother-child relationship during oral stage. It continues to be modified,
reinforced or impoverished according to the experiences of the client in the
subsequent years of life also.

2. Anal Stage:

Towards the end of biting period of oral stage, the child is able to walk, talk,
and eat on his own. He can retain or release something that he has. This is true of
bowel and bladder function also. He can either retain or release his bowel and bladder
contents. Now, the child no more depends upon the mouth zone for pleasure. He now
derives pleasure from bowel and bladder (anal zone) functioning, which entails
anxiety because of toilet training by parents. Child is taught where to pass urine and
where to go for defecation etc. In this training of bladder and bowel control, child may
develop autonomy, or shame and doubt. The task of anal is to develop autonomy. If
the parents are supportive without being overprotective and if the child is allowed to
function with some independence, he gains some confidence in his autonomy
probably by the age of three and prefers love over hate, cooperation over willfulness,
and self-expression over suppression. Autonomy, thus, overbalances shame and doubt
and leads to development of confidence that he can control his functions, and also, to
some extent, the people around him. Contrary to this, the child may feel angry, foolish
and ashamed if parents criticise his faeces and over-control his bowel and bladder
functioning during the training for toilet. Observations of sanskaras convey
acceptance to the child and help the parents to train them in appropriate manner. The
children (with more mistrust and doubt in their share) when adults may need help in
accepting failures and imperfection as an inherent part of one’s life. By accepting the
client as he is, the caseworker can reduce his feeling of self-hatred and perfectionism.
Over-demanding adults or those who express temper tantrums when asked to assume
responsibility may need to be helped to control their impulsive acts. They should be
rewarded when they exhibit controls, and one should reinforce their autonomy and
independence when exercised. Autonomy and independence are totally different from
impulsive acts as these involve rationality and not emotionality.

3. Genital (Oedipal) Stage:

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 The task for this period is to develop and strengthen initiative, failing which the
child develops a strong feeling of guilt. This period extends from 3rd to 6th years of
life, i.e., pre-school period. He is now capable of initiating activity, both intellectual as
well as motor on his own. How far this initiative is reinforced depends upon how
much physical freedom is given to the child and how far his curiosity is satisfied. If he
is led to feel bad about his behaviour or his interests, he may grow with a sense of
guilt about his self-initiated activities. Erikson (1950) opines that the child takes first
initiative at home when he/she expresses passionate interest in his/her parent of
opposite sex. The parents ultimately disappoint him/her. They should try to help the
child to identify with the same sex parent, e.g., the girl should be encouraged to
identify with mother and the son with the father. In addition to this initiative, the child
also attempts to wrest a place for self in the race of siblings for parents affection. He
sees the difference between what he wants and what he is asked to do. This culminates
into a clear-cut division between the child’s set of expanded desires and the parental
set of restrictions. He gradually “turns these values (restrictions, i.e.,. don’ts) into self-
punishment”. Slowly and gradually, he extracts more initiative from the conflict and
grows happily if his initiative gets proper and adequate reinforcement. The caseworker
encourages the clients burdened with guilt feelings to take initiative in family as well
as in other situations, and works with his social environment to strengthen his capacity
to take initiative.

4. Latency Stage:

This stage covers the period from 6 to 11 years, i.e., school age. The child can
reason out rationally and can use the tools that adults use. The sexual interests and
curiosity (common in genital period) get suppressed till puberty. If encouraged and
given opportunity, he gains confidence in his ability to perform and use adult
materials. This leads to feeling of industry in him. When unable to use adult
materials, he develops inferiority feelings. Such children may develop problems with
peers. They need to be encouraged to interact with classmates and be less dependent
upon others. If the child has mastered the task of genital period (initiative in place of
guilt) he will be able to master the tasks of latency (industry in place of inferiority)
also provided he is encouraged to undertake and helped to execute the responsibilities
entrusted to him.

5. Adolescence Stage:

This period, regarded as a period of turmoil, usually starts at 12-13 years and
can extend up to 18-19 years. The adolescents, during this transitional process from
childhood to maturity, behave something like an adult and sometimes like a child.
Parents too show their ambivalence to accept them in their new role of an adult in-the-

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making. This stage exhibits all the psycho-social characteristics of earlier period and
only towards the end, all these get resolved into a new set of role (identity) for the
adolescent. In order to develop a personal identity, he becomes fan of some hero,
starts following certain ideologies, and tries his luck with opposite sex. Indecision and
confusion are not uncommon in this stage. Identification with a wrong person shall
create problems for him. The task of this age is to develop identity, i.e., values,
strengths, skills, various roles, limitations, etc., failing which his identity gets diffused
and he fails to know how to behave in different situations. He needs to be helped to
deal with the physiological, emotional pressures along-with pressures from parents,
peers, etc. Group work is more helpful with problem-adolescents. When showing
confusion about their role, they can be helped to emulate the group leader or identify
with group worker. Parents can handle adolescents properly if educated adequately
about the needs and problems of this age. Similarly, tasks for young adulthood,
adulthood and old age are intimacy vs. isolation, generativity vs. stagnation, and ego-
integrity vs. despair. These psycho-analytical concepts are helpful in understanding
behaviour of the individuals. Apart from these, there are some other tasks described
by some other scholars for each stage which according to them are to be achieved for
a normal human development.

Stages of Main Successful

task Examples of
Development characteristics completion Unsuccessful task
completion
1. Oral Use month and Oral gratification Smoking,
Birth-2 years tongue to deal with alcoholism, obesity,
anxiety. nail biting, drug
E.g. Sucking, Addiction difficulty
feeding in hasting others

2.Anal Muscle control in Bowel and bladder Constipation,

2- 3 years bladder rectum, control Perfectionism,
Anus provides obsessive
sensual pleasure. compulsive
Toilet training can disorder.
be a crisis.
3.Phallic Learn sexual Becomes away of Homosexuality
3- 7 years identity and sexuality. transsexuality
awareness of Sexual identity
genital areas as a Problems in general
source of pleasure. Difficulties in

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 The development of accepting authority
Electra complex
and Oedipus
complex occurs
during this stay.
4. Latency Quite stage in Learns to socialize Inability to
7- 11 yrs sexual conceptualize lack
development. of
Motivation in
schools and jobs.
5.General Sexual maturity and Sexual maturity Firelights,
11years- Adult satisfactory importance
hood relationship with premature ejaculate
the opposite sex. unsatisfactory
relationship.

f) Relevance of Psychoanalytic Theory to Nursing practice

Knowledge of the structure of the personality can assist nurses who work in the
mental health setting. The ability to recognize behaviours associated with the id, the
ego, and the superego assists in the assessment of developmental level. Understanding
the use of ego defense mechanisms is important in making determinations about
maladaptive behaviours, in planning care for clients to assist in creating change (if
desired), or in helping clients accept themselves as unique individuals. Erikson’s
theory is particularly relevant to nursing practice in that it incorporates sociocultural
concepts into the development of personality. Erikson provided a systematic, stepwise
approach and outlined specific tasks that should be completed during each stage. This
information can be used quite readily in psychiatric/mental health nursing. Many
individuals with mental health problems are still struggling to accomplish tasks from a
number of developmental stages. Nurses can plan care to assist these individuals in
fulfilling the tasks and in moving on to a higher developmental level. Psychoanalytic
Theory- Freud’s Theory of object relations . Focuses on the relationship between a
mother (or caregiver) and the infant and the effect of this relationship on the infant’s
development of a sense of self Believes that individuals are born with a drive to build
interpersonal relationships. The individual’s sense of self and others affects all
subsequent interpersonal relationships

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IV. INTERPERSONAL THEORY

a) Introduction

Harry Stack Sullivan (1953) believed that individual behaviour and personality
development are the direct result of interpersonal relationships. Before the
development of his own theoretical framework, Sullivan embraced the concepts of
Freud. Later, he changed the focus of his work from the intrapersonal view of Freud to
one with a more interpersonal flavour 1n which human behaviour could be observed
in social interactions with others. His ideas, which were not universally accepted at
the time, have been integrated into the practice of psychiatry through pubIication only
since his death in 1949.

b) Concepts

Anxiety: It is a feeling of emotional discomfort, toward the relief or prevention of

which all behaviour is aimed. Sullivan believed that anxiety is the main factor in the
development of serious difficulties in living. It arises out one’s inability satisfy needs
or achieve interpersonal security.

Satisfaction of needs: It is the fulfilment of all requirements associated with an

individual’s psychochemical environments. Sullivan identified ex.Of requirements as
oxygen, food, water, warmth, tenderness, rest activity, Sexual expression- virtually
anything that, when absent, produces discomfort in the individual.

Interpersonal security: It is the feeling associated with relief from anxiety. When all
needs have been met, one experiences a sense of total wellbeing, which termed
interpersonal security· He believes individuals have an innate need for interpersonal
security.

Self-system: It is a collection of experience, or security measures, adopted by the

individual to protect against anxiety. He identified 3 components of the self system,
which are based on interpersonal experiences early in life:

The ‘’good me” is the part of the personality that develops in response
to positive feedback from the primary care giver. Feeling of pleasure, contentment,
and gratification are experienced. The child learns which behaviours elicit this
positive response as it becomes incorporated into the self system. The “bad me” is
the part of the personality that develops in response to negative feedback from the
primary care giver. Anxiety is experienced, eliciting feelings of discomfort,
displeasures, and distress. The child learns to avoid these negative feelings by altering
certain behaviours. The “not me” is the part of the personality that develops in
response to situation that produce intense anxiety in child. Feelings of horror, dread

13
and loathing are experienced in response to these situations, leading the child to deny
these feelings in an effort to relieve anxiety. These feelings, having been denied,
become ·not me”, but someone else. This withdrawal from emotions has serious
implications for mental disorder in adult life.

c) Dynamisms of Henry Sullivan

Sullivan used the term dynamism to refer to a typical pattern of behaviour.

Dynamisms may relate either to specific zones of the body or to tensions.

• Malevolence – The disjunctive dynamism of evil and hatred is called malevolence,

defined by Sullivan as a feeling of living among one’s enemies. Those children who
become malevolent have much difficulty giving and receiving tenderness or being
intimate with other people.

• Intimacy – The conjunctive dynamism marked by a close personal relationship

between two people of equal status is called intimacy. Intimacy facilitates
interpersonal development while decreasing both anxiety and loneliness.

• Lust – In contrast to both malevolence and intimacy, lust is an isolating dynamism.

That is, lust is a self- centered need that can be satisfied in the absence of an intimate
interpersonal relationship. In other words, although intimacy presupposes tenderness
or love, lust is based solely on sexual gratification and requires no other person for its
satisfaction.

• Self-System – The most inclusive of all dynamisms is the self-system, or that pattern
of behaviours that protects us against anxiety and maintains our interpersonal security.
The self system is a conjunctive dynamism, but because its primary job is to protect
the self from anxiety, it tends to stifle personality change. Experiences that are
inconsistent with our self-system threaten our security and necessitate our use of
security operations, which consist of behaviours designed to reduce interpersonal
tensions. One such security operation is dissociation, which includes all those
experiences that we block from ‘awareness. Another is selective inattention, which
involves blocking only certain experiences from awareness.

d) Sullivan’s Stages of personality Development.

Sullivan described six stages of personality development. An outline of the stages of

personality development according to Sullivan’s interpersonal theory is presented

Infancy: Birth to 18 Months

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During the beginning stage, the major developmental task for the child is the
gratification of needs. This is accomplished through activity associated with the
mouth, such as crying, nursing, and thumb sucking.

Childhood: 18 Months to 6 Years

At ages 18 months to 6 years, the child learns that interference with fulfilment of
personal wishes and desires may result in delayed gratification. He or she learns to
accept this and feel comfortable with it, recognizing that delayed gratification often
results in parental approval, a more lasting type of reward. Tools of this stage include
the mouth, the anus, language, experimentation, manipulation, and identification.

Juvenile: 6 to 9 Years

The major task of the juvenile stage is formation of satisfactory relationships within
peer groups. This is accomplished through the use of competition, cooperation, and
compromise.

Preadolescence: 9 to 12 Years

The tasks at the preadolescence stage focus on developing relationships with persons
of the same gender. One’s ability to collaborate with and show love and affection for
another person begins at this stage.

Early Adolescence: 12 to 14 Years

During early adolescence, The child is struggling with developing a sense of identity
that is separate and independent from the parents. The major task is formation of
satisfactory relationships with members of the opposite gender. Sullivan saw the
emergence of lust in response to biological changes as a major force occurring during
this period.

Late Adolescence: 14 to 21 Years

The late adolescent period is characterized by tasks associated with the attempt to
achieve interdependence within the society and the formation of a lasting, intimate
relationship with a selected member of the opposite gender. The genital organs are the
major developmental focus of this stage.

e) Relevance of Interpersonal Theory to Nursing Practice

The interpersonal theory has significant relevance to nursing practice. Relationship

development, which is a major concept of this theory, is a major psychiatric nursing
intervention. Nurses develop therapeutic relationships with clients in an effort to help
them generalize this ability to interact successfully with others. Knowledge about the

15
 behaviours associated with all levels of anxiety and methods for alleviating anxiety
helps nurses to assist clients achieve interpersonal security and a sense of well-being.
Nurses use the concepts of Sullivan’s theory to help clients achieve a higher degree of
independent and interpersonal functioning.

V. THEORY OF PSYCHOSOCIAL DEVELOPMENT –ERIKSON’S

a) Introduction

Erikson ( 1963) studied the influence of social processes on the development of the
personality. He described eight stages of the life cycle during which individuals
struggle with developmental “crises.” Specific tasks associated with each stage must
be completed for resolution of the crisis and for emotional growth to occur.

b) Erikson’s Stages of Personality Development

Age
Stage Psychosocial Crisis Basic Virtue
1. Trust vs. Mistrust Hope 0 - 1½
2. Autonomy vs. Shame Will 1½ - 3
3. Initiative vs. Guilt Purpose 3–5
4. Industry vs. Inferiority Competency 5 – 12
5. Identity vs. Role Confusion Fidelity 12 – 18

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 Age
Stage Psychosocial Crisis Basic Virtue
6. Intimacy vs. Isolation Love 18 – 40
7. Generativity vs. Stagnation Care 40 – 65
8. Ego Integrity vs. Despair Wisdom 65+

1. Trust vs. Mistrust

Is the world a safe place or is it full of unpredictable events and accidents

waiting to happen? Erikson's first psychosocial crisis occurs during the first year or so
of life (like Freud's oral stage of psychosexual development). The crisis is one of trust
vs. mistrust. During this stage, the infant is uncertain about the world in which they
live. To resolve these feelings of uncertainty, the infant looks towards their primary
caregiver for stability and consistency of care. If the care the infant receives is
consistent, predictable and reliable, they will develop a sense of trust which will carry
with them to other relationships, and they will be able to feel secure even when
threatened. Success in this stage will lead to the virtue of hope. By developing a sense
of trust, the infant can have hope that as new crises arise, there is a real possibility that
other people will be there as a source of support. Failing to acquire the virtue of hope
will lead to the development of fear. For example, if the care has been harsh or
inconsistent, unpredictable and unreliable, then the infant will develop a sense of
mistrust and will not have confidence in the world around them or in their abilities to
influence events. This infant will carry the basic sense of mistrust with them to other
relationships. It may result in anxiety, heightened insecurities, and an over feeling of
mistrust in the world around them. Consistent with Erikson's views on the importance
of trust, research by Bowl by and Ainsworth has outlined how the quality of the early
experience of attachment can affect relationships with others in later life.

2. Autonomy vs. Shame and Doubt

Autonomy versus shame and doubt is the second stage of Erik Erikson's stages
of psychosocial development. This stage occurs between the ages of 18 months to
approximately 3 years. The child is developing physically and becoming more mobile,
and discovering that he or she has many skills and abilities, such as putting on clothes
and shoes, playing with toys, etc. Such skills illustrate the child's growing sense of
independence and autonomy. For example, during this stage 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. Erikson states it is
critical that parents allow their children to explore the limits of their abilities within an
encouraging environment which is tolerant of failure. For example, rather than put on

17
a child's clothes a supportive parent should have the patience to allow the child to try
until they succeed or ask for assistance. So, the parents need to encourage the child to
become more independent while at the same time protecting the child so that constant
failure is avoided. A delicate balance is required from the parent. They must try not to
do everything for the child, but if the child fails at a particular task they must not
criticize the child for failures and accidents (particularly when toilet training). The aim
has to be “self control without a loss of self-esteem” (Gross, 1992). Success in this
stage will lead to the virtue of will. 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 abilities

3. Initiative vs. Guilt

Initiative versus guilt is the third stage of Erik Erikson's theory of psychosocial
development. During the initiative versus guilt stage, children assert themselves more
frequently. These are particularly lively, rapid-developing years in a child’s life.
According to Bee (1992), it is a “time of vigor of action and of behaviors that the
parents may see as aggressive." During this period the primary feature involves the
child regularly interacting with other children at school. Central to this stage is play,
as it provides children with the opportunity to explore their interpersonal skills
through initiating activities. Children 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. The child takes initiatives which the
parents will often try to stop in order to protect the child. The child will often overstep
the mark in his forcefulness, and the danger is that the parents will tend to punish the
child and restrict his initiatives too much. It is at this stage that the child will begin to
ask many questions as his thirst for knowledge grows. If the parents treat the child’s
questions as trivial, a nuisance or embarrassing or other aspects of their behavior as
threatening then the child may have feelings of guilt for “being a nuisance”. Too much
guilt can make the child slow to interact with others and may inhibit their creativity.
Some guilt is, of course, necessary; otherwise the child would not know how to
exercise self-control or have a conscience. A healthy balance between initiative and
guilt is important. Success in this stage will lead to the virtue of purpose.

4. Industry vs. Inferiority

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 Erikson's fourth psychosocial crisis, involving industry vs. inferiority occurs
during childhood between the ages of five and twelve. Children are at the stage where
they will be learning to read and write, to do sums, to do things on their own. Teachers
begin to take an important role in the child’s life as they teach the child specific skills.
It is at this stage that the child’s peer group will gain greater significance and will
become a major source of the child’s self-esteem. The child now feels the need to win
approval by demonstrating specific competencies that are valued by society and begin
to develop a sense of pride in their accomplishments. If children are encouraged and
reinforced for their initiative, they begin to feel industrious (competent) 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 or her potential. If the child cannot develop
the specific skill they feel society is demanding (e.g., being athletic) then they may
develop a sense of inferiority. Some failure may be necessary so that the child can
develop some modesty. Again, a balance between competence and modesty is
necessary. Success in this stage will lead to the virtue of competence.

5. Identity vs. Role Confusion

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. The individual wants to belong to
a society and fit in. The fifth stage is identity vs. role confusion, and it occurs during
adolescence, from about 12-18 years. During this stage, adolescents search for a sense
of self and personal identity, through an intense exploration of personal values,
beliefs, and goals. The adolescent mind is essentially a mind or moratorium, a
psychosocial stage between childhood and adulthood, and between the morality
learned by the child, and the ethics to be developed by the adult This is a major stage
of development where the child has to learn the roles he will occupy as an adult. It is
during this stage that the adolescent will re-examine his identity and try to find out
exactly who he or she is. Erikson suggests that two identities are involved: the sexual
and the occupational. According to Bee (1992), what should happen at the end of this
stage is “a reintegrated sense of self, of what one wants to do or be, and of one’s
appropriate sex role”. During this stage the body image of the adolescent changes.
Erikson claims that the adolescent may feel uncomfortable about their body for a
while until they can adapt and “grow into” the changes. Success in this stage will lead
to the virtue of fidelity. Fidelity involves being able to commit one's self to others on
the basis of accepting others, even when there may be ideological differences. During
this period, they explore possibilities and begin to form their own identity based upon
the outcome of their explorations. Failure to establish a sense of identity within
society ("I don’t know what I want to be when I grow up") can lead to role confusion.

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Role confusion involves the individual not being sure about themselves or their place
in society. In response to role confusion or identity crisis, an adolescent may begin to
experiment with different lifestyles (e.g., work, education or political activities). Also
pressuring someone into an identity can result in rebellion in the form of establishing a
negative identity, and in addition to this feeling of unhappiness.

6. Intimacy vs. Isolation

Intimacy versus isolation is the sixth stage of Erik Erikson's theory of

psychosocial development. This stage takes place during young adulthood between
the ages of approximately 18 to 40 yrs. During this period, the major conflict centers
on forming intimate, loving relationships with other people. During this period, 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 of this stage can result in happy 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. Success in this stage will lead to the virtue of love.

7. Generativity vs. Stagnation

Generativity versus stagnation is the seventh of eight stages of Erik Erikson's

theory of psychosocial development. This stage takes place during during middle
adulthood (ages 40 to 65 yrs). Generativity refers to "making your mark" on the world
through creating or nurturing things that will outlast an individual. People experience
a need to create or nurture things that will outlast them, often having mentees or
creating positive changes that will benefit other people. We give back to society
through raising our children, being productive at work, and becoming involved in
community activities and organizations. Through generativity we develop a sense of
being a part of the bigger picture. Success leads to feelings of usefulness and
accomplishment, while failure results in shallow involvement in the world. By failing
to find a way to contribute, we become stagnant and feel unproductive. These
individuals may feel disconnected or uninvolved with their community and with
society as a whole. Success in this stage will lead to the virtue of care.

8. Ego Integrity vs. Despair

Ego integrity versus despair is the eighth and final stage of Erik Erikson’s stage
theory of psychosocial development. This stage begins at approximately age 65 and
ends at death. As we grow older (65+ yrs) and become senior citizens, we tend to slow
down our productivity and explore life as a retired person. It is during this time that

20
 we contemplate our accomplishments and can develop integrity if we see ourselves as
leading a successful life. Erikson described ego integrity as “the acceptance of one’s
one and only life cycle as something that had to be” and later as “a sense of coherence
and wholeness” Erik Erikson believed if we see our lives as unproductive, feel guilt
about our past, or feel that we did not accomplish our life goals, we become
dissatisfied with life and develop despair, often leading to depression and
hopelessness. Success in this stage will lead to the virtue of wisdom. Wisdom enables
a person to look back on their life with a sense of closure and completeness, and also
accept death without fear. Wise people are not characterized by a continuous state of
ego integrity, but they experience both ego integrity and despair. Thus, late life is
characterized by both integrity and despair as alternating states that need to be
balanced.

c) Relevance of Psychosocial Development

Erikson’s theory is particularly relevant to nursing practice in that it incorporates

socio cultural concepts into the development of personality. Erikson provides a
systematic, stepwise approach and outlines specific tasks that should be completed
during each stage. This information can be used quite readily in psychiatric/mental
health nursing. Many individuals with mental health problems are still struggling to
achieve tasks from a number of developmental stages. Nurses can plan care to assist
these individuals to fulfil these tasks and move on to a higher developmental level.

VI. THEORY OF OBJECT RELATIONS

a) Introduction

Margaret Mahler (Mahler, Pine, & Bergman, 1975) formulated a theory that
describes the separation individuation process of the infant from the maternal
figure (primary caregiver). She describes this process progressing through three
major phases, and she further delineates phase III, the separation-individuation
phase, into four sub phases.

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 b) Stages of Development in Mahler’s theory of object relations

Phase 1: The Autistic Phase ( Birth to 1 Month)

The autistic phase, also called normal autism, the infant exists in a half-sleeping, half-
waking state and does not perceive the existence of other people or an external
environment. The fulfilment of basic needs for survival and comfort is the focus and is
merely accepted as it occurs.

Phase II: The Symbiotic Phase (1 to 5 Months)”

Symbiosis is a type of “psychic fusion of mother and child. The child views the self as
an extension of the mother, but with a developing awareness that it is she who fulfils
the child’s every need. Mahler suggested that absence of, or rejection by, the maternal
figure at this phase can lead to symbiotic psychosis.

Phase III : Separation – Individuation( 5 to 36 Months)

This third phase represents what Mahler calls the psychological birth” of the child.
Separation is defined as the physical and psychological attainment of a sense of
personal distinction from the mothering figure. Individuation occurs with a
strengthening of ego and an acceptance of a sense of ‘self,” with. Independent ego
boundaries. Four sub phases through which the child evolves in his or her progression
from a symbiotic extension of the mothering figure to a distinct and separate being are
described.

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Sub phase 1: Differentiation (5 to 10 Months)

Differentiation phase begins with the child’s initial physical movements away from
the mothering figure. A primary recognition of separateness commences.

Subphase 2: Practicing (1O to 16 Months)

With advanced loco motor functioning, the child experiences feelings of exhilaration
from increased independence. He or she is now able to move away from, and return
to, the mothering figure. A sense of omnipotence 1s manifested.

Subphase 3: Rapprochement (16 to 24 Months)

This third subphase. Rapprochement, is extremely critical to the child s healthy ego
development. During this time, the child becomes increasingly aware of his or her
separateness from the mothering figure, while the sense off fearlessness and
omnipotence diminishes. The child, now recognizing the mother as separate
individual, wishes to re-establish closeness With her but stuns the total re-engulfment
of the symbiotic stage. The need is for the mothering figure be available to provide
“emotional refuelling’ on demand.

Critical to this subphase is the mothering figure’s response to the child. If the
mothering figure is available to fulfil emotional needs as they arise,the child develops
a sense of security in the knowledge that he or she is loved and will not be abandoned.
However, if emotional needs are inconsistently met if the mother rewards clinging,
dependent behaviours withholds nurturing when the child demonstrates independence,
feelings of rage and a fear of abandonment develop and often persist in to adulthood.

Subphase 4: Consolidation (24 to 36 Months)

With achievement of the consolidation subphase ,a definite individually, and sense of

separateness of self established. Objects are represented as whole, with the child
having the ability to integrate both good” and “bad , A degree of object constancy is
established as the child is able to internalise a sustained image of the mothering figure
as enduring and loving, while maintaining the perception of her as a separate oerson in
me outside world.

c) Relevance of Object Relations Theory to Nursing “Practice

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 Understanding of the concepts of Mahler’s theory of object relations helps the nurse
assess the client’s 1evel of individuation from primary caregivers. The emotional
problems of many individuals can be traced to lack of fulfilment of the tasks of
separation/individuation. Examples include problems related to dependency excessive
anxiety. The individual with borderline personality disorders is thought to be fixed in
the rapprochement phase of development, harbouring fears edge is important in the
provision of nursing care to these individuals.

VII. COGNITIVE DEVELOPMENT THEORY

a) Introduction

Jean Piaget (Piaget & Inhelder, 1969) has been called father of child psychology. His
work concerning cognitive development in children is based on the premise that
.human intelligence is an extension of biological adaptation, Or one’s ability to adapt
psychologically to the environment. He believed that human intelligence progresses
through a series of stages that are related to age, demonstrating at each successive
stage a higher level of logical organization than at the previous stages. From his
extensive studies of cognitive development in children Piaget discovered four major
stages, of which he believed to be a necessary prerequisite site for the one that
follows.

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 b) Stages of Cognitive Development theory

Stage l: Sensorimotor (Birth to 2 Years)

The beginning of his or her life, the child is concerned only with satisfying basic
needs and comforts. The self is not differentiated from the external environment. As
the sense of differentiation occurs, with increasing mobility and awareness, the mental
system expanded. The child develops greater undemanding regarding objects within
the external environment and their effects upon him or her. Knowledge is gained
regarding the ability to manipulate objects and experiences within the environment.
The sense object permanence-the notion that an object will continue to exist when it
is no longer present to the senses-is initiated.

Stage 2: Preoperational (2 to 6 years)

Piaget believed that preoperational thought is characterized by egocentrism.

Personal experience are thought to be universal, and the child is unable to accept the
differing viewpoints of other language development progresses, as does the ability to
attribute special meaning to symbolic gestures (eg- bringing a storybook to mother is
a symbolic invitation to have a story read). Reality is often given to inanimate objects.
,Object permanence culminates in the ability to conjure up mental representations of
objects or people.

Stage 3: Concrete Operations ( 6 to 2 Years)

The abili t)’ to apply logic to thinking begins in this stage: however ·concreteness still
predominates. An understanding of the concepts of reversibility and spatiality is
developed. For example, the child recognizes that changing the shape of objects does
not necessarily change the amount, weight, volume, or the ability of the object to
return to its original form. Another achievement of this stage is the ability to classify
objects by any of their several characteristics. For example, he or she can classify all
poodles as dogs but recognizes that all dogs are not poodles.

The concept of a lawful self is developed at this stage as the child becomes
more socialized and rule conscious. Egocentrism decreases, the ability to cooperate in
interactions with other children increases, and understanding and acceptance of
established rules grow.

Stage 4: Formal Operations ( 12 to 15+ Years)

At this stage, the individual is able to think and reason in abstract terms. He or she
can make and test hypotheses using logical and orderly problem solving. Current

25
 situations and reflections of the future are idealized, and a degree of egocentrism
returns during this stage. There may be some difficulty reconciling idealistic hopes
with more rational prospects. Formal operations, however, enable individuals to
distinguish between the ideal and the real. Piaget’s theory suggests that most
individuals achieve cognitive maturity, the capability to perform all mental operations
needed for adulthood, in middle to late adolescence.

c) Relevance of Cognitive Development Theory to Nursing Practice

Nurses who work in psychiatry are likely to be involved in helping clients,

particularly depressed clients, with techniques of cognitive therapy. In cognitive
therapy, the individual is taught to control thought distortions that are considered to be
a factor in the development and maintenance of mood disorders. In the cognitive
model, depression is characterized by a triad of negative distortions related to
expectations of the environment, self, and future. In this model, depression is viewed
as a distortion in cognitive development, the self is unrealistically devalued
development, the self is unrealistically devalued, and the future is perceived as
hopeless. Therapy focuses on changing “automatic thoughts” that occur spontaneously
and contribute to the distorted affect Nurses who assist with this type of therapy must
have knowledge of how cognition develops in order to help clients identify the
distorted thought patterns and make the changes required for improvement in affective
functioning.

VIII. THEORY OF MORAL DEVELOPMENT

a) Introduction

Lawrence Kohlberg’s (1976) stages of moral development are not closely tied to
specific age groups. Research was conducted with males ranging in age from 10 to 28
Years. Kohl berg believed that each stage is nees, saiy and basic to the next stage and
that all indivicluah must progress through each stage sequentially. He defined three
major levels of moral development, each of which is further subdivided in to two
stages.

b) Levels of moral development

Level I: Pre conventional Level (Prominent front Ages 4 to IO Years)

Stage 1: Punishment and Obedience Orientation

At the punishment and obedience orientation stage, the individual is responsive

to cultural guidelines of good or bad and right or wrong, but primarily in terms of the

26
known related consequences. Fear of punishment is likely to be the incentive for
conformity.

Stage 2: Instrumental Relativist Orientation

Behaviors at the instrumental relativist orientation stage are guided by

egocentrism and concern for self. There is an intense desire to satisfy one’s own
needs, but occasionally the needs of others are considered. For the most part, decisions
are based on personal benefits derived.

Level II: Conventional Level (Prominent From Ages 10 to 13 Years and Into
Adulthood)*

Stage 3: Interpersonal Concordance Orientation

Behavior at the interpersonal concordance orientation stage is guided by the

expectations or others. Approval and acceptance within one’s societal group provide
the incentive to conform.

Stage 4: Law and Order Orientation

In the law and order orientation stage, there is a personal respect for authority. Rules
and laws are required and override personal principles and group mores. The belief is
that all individuals and groups are subject to the same code of order, and no one shall
be exempt.

Level III: Post conventional Level (Can Occur From Adolescence Onward)

Stage 5: Social Contract Legalistic Orientation

Individuals who reach stage 5 have developed a system of values and principles
that determine for them what is right or wrong; behaviours are acceptably guided by
this value system, provided they do not violate the human rights of others. They
believe that all individuals are entitled to certain inherent human rights, and they live
according to universal laws and rights, and they live according to universal laws and
principles. However, they hold the idea that the laws are subject to scrutiny and
change as needs within society evolve and change.

Stage 6: Universal Ethical Principle Orientation

Behavior at stage 6 is directed by internalized principles of honor,justice, and

respect for human dignity. Laws are abstract and unwritten, such as the “Golden
Rule,” “equality of human rights,’ and “justice for all.” They are not the concrete rules
27
 established by society. The conscience is the guide, and when one fails to meet the
self-expected behaviours, the personal consequence is intense guilt. The allegiance to
these ethical principles is so strong that the individual will stand by them even
knowing that negative consequences will result.

c) Relevance of Moral Development theory to Nursing Practice

Moral development has relevance to psychiatric nursing in that it affects critical

thinking about how individuals ought to behave and treat others. Moral behaviour
reflects the way a person interprets basic respect for other persons, such as the respect
for human life, freedom, justice, or confidentiality. Psychiatric nurses must be able to
assess the level of moral development their clients in order to be able to help them in
their effort to advance in their progression toward a higher level of developmental
maturity.

IX. A NURSING MODEL- HILDEGARD E. PEPLAU

a) Introduction

Peplau (1991) applied interpersonal theory to nursing practice and, most specifically,
to nurse-client relationship development. She provided a framework foa
“psychodynamic nursing,” the interpersonal involvement of then urse with a client in
a given nursing situation. Peplau stated, Nursing is helpful when both the patient and
the nurse grow as a result of the learning that occurs in the nursing situation. Peplau
correlated the stages of personality development in childhood to stages through which
clients advance during the progression of an illness. She also viewed these
interpersonal experiences as learning situations for nurses to facilitate forward
movement in the development of personality. She believed that when there is
fulfilment of psychological tasks associated with the nurse-client relationship, the
personalities both can be strengthened. Key concepts include the following:

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b) Peplaus Stages of Personality Development

Ps1chological t o.shs are developmental lessons that must be learned on the way to
achieving maturity of the personality. Peplau (1991) identified four psychological
tasks that she associated with the stages of infancy and childhood described by Freud
and Sullivan. She stated:

Psychological tasks are successfully learned at each era of development,

biological capacities are used each era of development, biological capacities are used
productively and relations with people lead to productive living. When they are not
successfully learned they over into adulthood and attempts at learning continue in
devious ways, more or less impeded by conventional adaptations that provide a
superstructure over the baseline of actual learning.

In the context of nursing, Peplau (1991) related these four psychological tasks to the
demands made on nurses in their relations with clients. She maintained that:

Nursing can function as a maturing force in society. Since illness is an event that is
experienced along with fee lings that derive from older experiences but are re-enacted
in the relationship of nurse to patient, the nurse-patient relationship is seen as an
opportunity for nurses to help patients to complete the unfinished psychological tasks
of childhood in some degree.

Peplau· s psychological tasks of personality development include the four stages

outlined in the following paragraphs. An outline of the stages of personality
development according to Peplaus theory is presented

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 1) Learning to Count on Others

Nurses and clients first come together as strangers. Both bring to the relationship
certain “raw materials, such as inherited biological components, personality
characteristics ( temperament) , individual intellectual apacity and specific cultural or
environmental influences. Peplau relates these to the same ‘raw materials with which
an infant comes into this world. The newborn is capable of experiencing comfort and
discomfort. He or she soon learns to communicate feelings in a way that results the
fulfilment of comfort needs by the mothering figure who provides love and care
unconditionally. However, fulfilment of these dependency needs is inhibited when
goals of the mothering figure become the focus, and love care are contingent on
meeting the needs of the care giver rather than the infant.

Clients with unmet dependency needs regress during illness and demonstrate
behaviours that relate to this stage of development. Other clients regress to this level
because of physical disabilities associated with their their illness. Peplau believed that
when nurses provide unconditional care, they help these clients progress toward more
mature levels of functioning. This may involve the role of surrogate mother, in which
the nurse fulfils needs for the client with the intent of helping him or her grow,
mature, and become more independent.

2) Learning to Delay Satisfaction

Peplau related this stage to that of toddlerhood, or the first step in the development of
interdependent social relations. Psychosexually, it is compared to the anal stage of
development, when a child learns that, because of cultural mores, he or she cannot
empty the bowels for relief of discomfort at will, but must delay to use the toilet,
which is considered more culturally acceptable. When toilet training occurs too early
or is very rigid, or when appropriate behaviour is set forth as a condition for love and
caring, tasks associated with this stage remain unfulfiiled.

3) Identifying Oneself

“A concept of self develops as a product of interaction with adults. A child learns to

structure self-concept by observing how others interact with him or her. Roles and
behaviours are established out of the child’s perception of the expectations of others.
vVhen children perceive that adults expect them to maintain more-orles permanent
roles as infants, they perceive themselves as helpless and dependent.

4) Developing Skills in Participation

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Peplau cited Sullivan’s (1953) description of the ‘’.juvenile” stage of personality
development (ages 6 through 9). During this stage, the child develops the capacity to
“ccmpromise, compete, and cooperate with others. These skills are considered basic to
others. These skills are considered basic to one’s ability to participate collaboratively
with others.

c) Relevance of Peplaus model to nursing Practice

Peplaus model provides nurses with a framework to interact with clients, many of
whom are fixed in-or because of illness have regressed to-an earlier level of
development. She suggested roles that nurses may assume to assist clients to progress,
thereby achieving or resuming their appropriate developmental level. Appropriate
developmental progression arms the individual with the ability to confront the
recurring problems of life. Nurses serve to facilitate learning of that which has not
been learned in earlier experiences.

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X. SUMMARY

Growth and development are unique with each individual and continue throughout the
life span. Personality is defined as the combination of character, behavioural,
temperamental, emotional, and mental traits that are unique to each specific
individual. Sigmund Freud, who has been called the father of psychiatry, believed the
basic character has been formed by the age of 5. Freud’s personality theory can be
conceptualized according to structure and dynamics of the personality, topography of
the mind, and stages of personality development. Freuds structure of the personality
includes the id, ego, and superego. Freud classified all mental contents and operations
into three categories: the conscious, the preconscious, and the unconscious. Harry
Stack Sullivan, author of the Interpersonal Theory of Psychiatry, believed that
individual behaviour and personality development are the direct result of interpersonal
relationships. Major concepts include anxiety, satisfaction of needs, interpersonal and
self-system. Erik Erikson studied the influence of social processes on the development
of the personality. Erikson described eight stages of the life cycle from birth to death.
He believed that individuals struggled developmental ‘crises,’ and that each must be
resolved for emotional growth to occur. Mahler formulated a theory that describes the
separation-individuation process of the infant from the maternal figure (primary
caregiver). Stages of development describe the progression of the child from birth to
object constancy at 36 months. Jean Piaget has been called the father of child
psychology. He believed that human intelligence progresses through a series of stages
that are related to age, demonstrating at each successive stage a higher level of logical
organization than at the previous stages. Hildegard Peplau provided a framework for
psychodynamic nursing,” the interpersonal involvement of the nurse with a client in a
given nursing situation.

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XI. CONCLUSION

Nurses must have a basic knowledge of human personality development to

understand maladaptive behavioural responses commonly seen in psychiatric clients.
Developmental theories identify behaviours associated with various stages through
which individuals pass there by specifying what is appropriate or inappropriate at each
developmental level. Specialists in child development believe that infancy and early
childhood are the major life periods for the origination and occurrence of
developmental change. Specialists in life-cycle development believe that people
continue to develop and change throughout life, thereby suggesting the possibility for
renewal and growth in adults. Developmental stages are identified by age. Behaviours
can then be evaluated by whether or not they are recognized as age-appropriate.
Ideally, an individual successfully fulfils all the tasks associated with one stage before
moving on to the next stage (at the appropriate age). Realistically, however, this
seldom happens. One reason is related to temperament, or the inborn personality
characteristics that influence an individual’s manner of reacting to the environment,
and ultimately his or her developmental progression. The environment may also
influence ones developmental pattern. Individuals who are reared in a dysfunctional
family system often have retraded ego development. According to specialists in Iife-
cycle development, Behaviours from an unsuccessfully completed stage can be
modified and corrected in a later stage.

Stages overlap, and an individual nay be working on tasks associated with

several stages at one time. When an individual becomes fixed in a lower level
development, with age-inappropriate behaviours focused on fulfilment of those tasks,
psychopathology may become evident. Only when personality traits become
inflexible, and personality functioning becomes individually and interpersonally
impaired, do they constitute personality disorders.

33