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 Transitional Object Checking Back Pattern 7-8 mos 8mos

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- 1 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 - 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 LIFE

Erik 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 DEVELOPMENT
JEAN PIAGET
SCHEMES ASSIMILATION ACCOMMODATION ORGANIZATION EQUILIBRATION

COGNITIVE DEVELOPMENT
JEAN 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 yrs

F. Symbolic Thought 1 - 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 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 - 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 DEVELOPMENT
JEAN PIAGET
DEVELOPMENT OF OBJECT PERMANENCE

SENSORIMOTOR STAGE Substage 1- Reflexes Substage 2- 1ry Circular Rxn Substage 3- 2ndary Circular Rxn Substage 4 Coordination of 2ndary Circular Rxn Substage 5- 3ry Circular Rxn Substage 6- Symbolic Thought

BEHAVIOR FF objects x visual field x 180 Ignores its Disappearance Look Briefly at Spot where Object Disappeared Search for Missing Object Search Behind Screen for HiddenToy Track Object that Disappears/ Appears Imagine 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 Liquid Quantity Conservation of: Mass Weight Area = = 9- 10 Yrs = = = 6- 7Yrs 6-7 Yrs

COGNITIVE DEVELOPMENT
JEAN PIAGET

IV. Stage of FORMAL OPERATIONS 11/ 12 yrs

Scientific, Logical Abstract Thinking Hypothetical Thinking Deductive Reasoning

COGNITIVE DEVELOPMENT JEAN PIAGET

IV. Stage of FORMAL OPERATIONS 11/ 12 yrs Adolescent Egocentrism 1) Imaginary Audience Self Consciousness 2) Personal Fable- Uniqueness, Invincibility

MORAL DEVELOPMENT
Changes in Thoughts, Feelings, Behaviors regarding Standards of Right & Wrong Intrapersonal Dimension: Regulates ones Activities When Alone
Interpersonal Dimension: Regulates Social Interaction & Arbitrates Conflict
(Gibbs 2003, Walker 1996, Walker & Pitts 1998)

INTRAPERSONAL

MORAL DEVELOPMENT

2 DIMENSIONS
INTERPERSONAL

MORAL DEVELOPMENT Jean Piaget

HETERONOMOUS MORALITY 4-7 Yrs Old Rules Unchangeable Handed Down by All Mighty Authority Judges Rightness/ Wrongness of Act by the Consequences Immanent Justice TRANSITION 7- 10 Yrs Old AUTONOMOUS MORALITY 10 Yrs Old Flexible Rules Convenience of All for

Judges Right/ Wrong by Intention

MORAL DEVELOPMENT
Lawrence 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 dont 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: Dont do unto others what you would not want others to do to you You scratch my back, Ill 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 dont 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 Lets 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

Lets 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- 1 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 - 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