Theory of Psychosocial Development

INTRODUCTION

• Erik Erikson was a psychoanalyst who developed the theory of psychosocial development.
• He was born on June 15, 1902 in Karlsruhe Germany.
• His classic work "Childhood and Society" set forth his theory of the life cycle.
• Young Man Luther, Identity: Youth and Crisis, and Gandhi's Truth are his other influencial works.
• He believed that the achievements and failures of earlier stages influence later stages, whereas later stages modify and transform earlier ones.
• Erikson's conceptualization of psychosocial development based its model the epigenetic principle of organismic growth in utero.
• Erikson views psychosocial growth occurs in phases.

EIGHT STAGES OF THE LIFE CYCLE

• Erikson explains 8 developmental stages in which physical, cognitive, instinctual, and sexual changes combine to trigger an internal crisis whose resolution results in either psychosocial regression or growth and the development of specific virtues.
• Erikson defined virtue as "inherent strength".

Psychosocial Stage	Age	Virtue	Related Psychopathology
Trust vs. mistrust	birth–18 months	Hope	Psychosis Addictions Depression
Autonomy vs. shame and doubt	~18 months–	Will	Paranoia Obsessions Compulsions Impulsivity
Initiative vs. guilt	~3 years–	Purpose	Conversion disorder Phobia Psychosomatic disorder Inhibition
Industry vs. inferiority		Competence	Creative inhibition Inertia
Identity vs. role confusion	~13 years–	Fidelity	Delinquent behavior Gender-related identity disorders Borderline psychotic episodes
Intimacy vs. isolation	~20s–	Love	Schizoid personality disorder Distantiation
Generativity vs.stagnation	~40s–	Care	Midlife crisis Premature invalidism
Integrity vs. despair	~60s–	Wisdom	Extreme alienation

Trust Versus Mistrust (Birth to About 18 Months)

• The infant is taking the world in through the mouth, eyes, ears, and sense of touch.
• A baby whose mother is able to anticipate and respond to its needs in a consistent and timely manner despite its oral aggression will learn to tolerate the inevitable moments of frustration and deprivation
• A person who, as a result of severe disturbances in the earliest dyadic relationships, fails to develop a basic sense of trust or the virtue of hope may be predisposed as an adult to the profound withdrawal and regression characteristic of schizophrenia (Newton DS, Newton PM, 1998).

Autonomy Versus Shame and Doubt (About 18 Months to About 3 Years)

• "This stage, therefore, becomes decisive for the ratio between loving good will and hateful self-insistence, between cooperation and willfulness, and between self-expression and compulsive self-restraint or meek compliance." - Erikson
• This oral-sensory stage of infancy, marked by the potential development of basic trust aiming toward the achievement of a sense of hope.
• Here, the child will develop an appropriate sense of autonomy, otherwise doubt and shame will undermine free will.
• An individual who becomes fixated at the transition between the development of hope and autonomous will, with its residue of mistrust and doubt, may develop paranoic fears of persecution (Newton DS, Newton PM, 1998).
• Other disturbances of improper transition of this stage results in perfectionism, inflexibility, stinginess and ruminative and ritualistic behavior of obsessive-compulsive personality disorder.

Initiative Versus Guilt (About 3 Years to About 5 Years)

• Here, the child’s task is to develop a sense of initiative as opposed to further shame or guilt.
• The lasting achievement of this stage is a sense of purpose.
• The child's increasing mastery of locomotor and language skills expands its participation in the outside world and stimulates omnipotent fantasies of wider exploration and conquest

Industry Versus Inferiority (About 5 Years to About 13 Years)

• Here the child is in school-age , so called stage of latency.
• He tries to master the crisis of industry versus inferiority aiming toward the development of a sense of competence.

Identity Versus Role Confusion (About 13 Years to About 21 Years)

• At puberty, the fifth stage, the task of adolescence is to navigate ther “identity crisis” as each individual struggles with a degree of “identity confusion.”
• The lasting outcome of this stage can be a capacity for fidelity.

Intimacy Versus Isolation (About 21 Years to About 40 Years)

• Young adulthood, at the stage of genitality or sixth stage, is marked by the crisis of intimacy versus isolation, out of which may come the achievement of a capacity for love.

Generativity Versus Stagnation (About 40 Years to About 60 Years)

• "Generativity is primarily the concern for establishing and guiding the next generation."-Erikson
• Care is the virtue that curresponding to this stage.
• This failure of generativity can lead to profound personal stagnation, masked by a variety of escapisms, such as alcohol and drug abuse, and sexual and other infidelities.Mid-life crisis may occur.

Integrity Versus Despair (About 60 Years to Death)

• "The acceptance of one's one and only life cycle and of the people who have become significant to it as something that had to be and that, by necessity, permitted of no substitutions."
• The individual in possession of the virtue of wisdom and a sense of integrity has room to tolerate the proximity of death and to achieve.
• When the attempt to attain integrity has failed, the individual may become deeply disgusted with the external world, and contemptuous of persons as well as institutions.

NURSING IMPLICATIONS

• Application of Erikson's stages of psychosocial development helps in analysing patient's symptomatic behavior in the context of truamatic past experineces and struggles with current developmental tasks.
• When patients' resolutions of previous psychosocial stages have been so faulty as to seriously compromise their adult development, they have the opportunity to rework early development through the relationship with the therapist. (Newton DS, Newton PM, 1998).
• "The object of psychotherapy is not to head off future conflict but to assist the patient in emerging from each crisis "with an increased sense of inner unity, with an increase of good judgment, and an increase in the capacity `to do well' according to his own standards and to the standards of those who are significant to him." (Erikson in Identity: Youth and Crisis)

ERIKSON'S WORKS

• Erikson E: Childhood and Society. Norton, New York, 1950.
• Erikson E: The dream specimen of psychoanalysis. J Am Psychoanal Assoc 2:5, 1954.
• Erikson E: The first psychoanalyst. Yale Rev 46:40, 1956.
• Erikson E: Freud's "The Origins of Psychoanalysis." Int J Psychoanal 36:1, 1955.
• Erikson E: Gandhi's Truth. Norton, New York, 1969.
• Erikson E: Hitler's imagery and German youth. Psychiatry 5:475, 1942.
• Erikson E: Identity and the Life Cycle. Norton, New York, 1980.
• Erikson E: Identity: Youth and Crisis. Norton, New York, 1968.
• Erikson E: Insight and Responsibility. Norton, New York, 1964.
• Erikson E: Life History and the Historical Moment. Norton, New York, 1975.
• Erikson E: Observations on Sioux education. J Psychol 7:101, 1939.
• Erikson E: The problem of ego identity. Psychol Issues 1:379, 1959.
• Erikson E: Young Man Luther. Norton, New York, 1962.
• Erikson E, Erikson J, Kivnick H: Vital Involvement in Old Age. Norton, New York, 1986.

REFERENCES

1. Erikson E: Insight and Responsibility. Norton, New York, 1964.
2. Erikson E: Identity: Youth and Crisis. Norton, New York, 1968.
3. Newton DS, Newton PM in Kaplan HI & Sadok BJ's Synopsis of psychiatry-behavioural science or clinical psychiatry.9^th edn. Hong Kong.William and Wilkinsons publications. 1998.