Understanding child psychology through a well-known psychodynamic theory and its applications in dentistry.

1. CHILD PSYCHOLOGY
Dr. Balraj Shukla

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CONTENTS
Introduction to Psychology
Approaching Psychology
Personality
Theories of Child Psychology
Critical Evaluation of the Theory
Psychoanalysis & Dental Treatment
Classical Psychoanalytical Theory/
Psychosexual Theory
Dr. Balraj Shukla

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INTRODUCTION
• 1640s: “Psyche” (Latin) or “Psykhe” (Greek) – An animating principle or entity which occupies
and directs the physical body
• 1650s: “Psyche” (Jewish) – Human Soul
• 19th century: Human Mind
• Survival/Adjustment + Genetics + Experiments on conditioned responses = LEARNING
• “Psychology is the science dealing with human mature function and phenomenon of his soul in
the main”
Dr. Balraj Shukla

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Approaching Psychology
• Biology – The study of the nervous system and its role in behaviour
• Behaviour – Learning and reinforcing behaviours
• Cognitive – Mentally training the mind
• Cross-Cultural Perspective – Influence of culture on human behaviour
• Evolution – Mental processes help in survival
• Humanistic Psychology – Motivation and its role in thought and behaviour
• Psychodynamic – Role of unconscious mind, life experiences and interpersonal relationships
Dr. Balraj Shukla

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PERSONality
• No particular definition exists till date
• Still a controversy if the personality of the person can be changed or not
TEMPERAMENT SECRETION PERSONALITY
CHOLERIC Yellow Bile Determined, Energetic, Passionate
SANGUINE Blood Optimistic, Warm-hearted, Cheerful
PHLEGMATIC Phlegm Slow, Calm, Quiet, Shy, Rational
MELANCHOLIC Black Bile Serious, Fearful, Anxious, Depressed
Dr. Balraj Shukla

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PERSONality
FIVE-FACTOR MODEL OF PERSONALITY/ BIG FIVE PERSONALITY TRAITS
Given by Robert C. Mccrae and Paul T. Costa (1988)
TRAITS PERSONALITY
Openness Imaginative, Curious, Creative, Sensitive
Conscientiousness Self-Discipline, Careful, Dependable
Extroversion vs Introversion Outgoing, Talkative, Sociable, Assertive
Agreeableness Courteous, Kind, Empathic, Caring
Neuroticism Anxious, Hostile, Depressed
Dr. Balraj Shukla

7. • 1928 – John Watson’s book gives the first idea about child
psychology
“Child Psychology is the science that deals with the mental power
or an interaction through the conscious and subconscious element
in a child.”
• Aims of child psychology:
- Understand the child better
- Effective and efficient dealing with the child
- Identify psychosomatic problems in the child
- Train the child in understanding his/her oral hygiene
- Help modify child’s developmental process
Dr. Balraj Shukla

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THEORIES OF CHILD PSYCHOLOGY
Psychosocial Theory – Erik Erikson (1963) Social Learning Theory – Albert Bandura (1963)
Psychosexual/Psychoanalytic Theory – Sigmund Freud (1905)
Classical Conditioning – Ivan Pavlov (1927)
Operant Conditioning – BF Skinner (1938)
Cognitive Theory – Jean Piaget (1952)
Hierarchy of Needs – Abraham Maslow (1954)
Psychodynamic: Relationship between human behaviour, emotions, feelings and life experiences
Learning: Acquisition of knowledge or skills through experience
Separation-Individuation Theory – Margaret Mahler (1975)
Dr. Balraj Shukla

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SIGMUND FREUD
Father of modern-day Psychiatry
Austrian neurologist, Docent in Neuropathology
Born in 1856 to Jewish parents, first of eight children
3 years old – Separated from childhood play
9 years old – Outstanding pupil
17 years old – Graduated with honors. Fluent in 8 languages.
24 years old – Becomes a cigar smoker
25 years old – MD from University of Vienna
26-29 years old – Initial interest in clinical psychiatry (Vienna General Hospital)
30 years old – Begins private practice as a specialist in nervous disorders
49 years old – Psychosexual Theory
54 years old – Founder of International Psychoanalytical Association
67 years old – Diagnosed with leukaemia, Tripartite Structural Model
77 years old – Books burnt, Escapes the Nazis, Flies to Britain in exile
83 years old – Death due to oral cancer
Dr. Balraj Shukla

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CLASSICAL PSYCHOANALYTICAL/ PSYCHOSEXUAL THEORY
October 1885 – 3-month internship with Jean-Martin Charcot (neurologist) to study hypnosis
Free Association – Encourage patients to talk freely, without censorship or inhibition, about
whatever ideas occurs to them. This helps in analysing the patient’s unconscious and repression.
Psychoanalysis – Studying the relation between conscious and unconscious mind and bringing
repressed fears and conflicts into the conscious mind.
Archaic Discharge – When the storage of emotion (psi neurons) combines with conditioning of the
emotion (phi neurons), it results in a behaviour/emotion.
Dr. Balraj Shukla

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CLASSICAL PSYCHOANALYTICAL/ PSYCHOSEXUAL THEORY
• NEUROSIS – Functional derangement of neurons without losing touch of reality (psychosis)
• HYSTERIA – Psychological stress and its effect on change in self-awareness
• DREAMS – Inherent wishes and desires
• CONSCIOUS – Present perception memories, thoughts and fantasies
• PRECONSCIOUS – Available memory that can be easily brought to the present
• UNCONSCIOUS – Source of our motivations and neurotic compulsions
Dr. Balraj Shukla

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Superego
Id
P
S
Y
C
H
O
S
I
S
External World
Transference Neurosis (first interaction
between therapist and the patient)
New symptoms do not arise. New
impulses and fantasies do.
Narcissistic Neurosis (rarely used in
modern psychoanalysis)
Lack of object relations and fixation in
early childhood were initially explained by
narcissistic neuroses.
Psychosis
Confusion, hallucinations, delusions arise
when a patient is unable to differentiate
between what is real and what is not.
Dr. Balraj Shukla

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THE ICEBERG - ID
A feeling or mood manifesting in motor or
glandular activity is called EMOTION.
An instinctual component of psych that drives
the emotional desires, impulses and immediate
satisfaction (Pleasure principle).
It is the most primitive and inaccessible part of
our personality.
Dr. Balraj Shukla

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THE ICEBERG - ID
Id is activated by the Primary Process of Emotion/Thinking.
It is also known as hallucinatory gratification.
It is largely symbolic, illogical and does not last for a long time.
Urge to eat something sweet in the
middle of a lecture
Day dreaming and
fantasizing about a cake
or cookie
Dr. Balraj Shukla

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THE ICEBERG - SUPEREGO
Any change observed in the functioning of an
organism is called BEHAVIOUR.
Superego has 2 subparts:
• Conscience - moral and ethical component
of mind (Morality principle)
• Ego Ideal – What one ideally can be and how
one ought to behave
Develops around the age of 5 years.
Neutralizes the id to advocate socially
appropriate behaviour. Produces feelings of
shame and guilt.
Dr. Balraj Shukla

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THE ICEBERG - EGO
Assesses the reality of the external word and
acts upon accordingly (Reality Principle).
It develops between 2-6 months of age and is
associated with memory, language, judgement,
intelligence and creativity.
Dr. Balraj Shukla

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THE ICEBERG - EGO
Ego is activated by the Secondary Process of Emotion/Thinking.
It helps in delaying gratification.
A proper secondary process can result in socially appropriate behaviours.
Its main role can be seen during the conflict between the id and the ego.
Urge to eat something sweet in the
middle of a lecture
Day dreaming and
fantasizing about a cake
or cookie
Heading to your
favourite cake shop
after the class
Dr. Balraj Shukla

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EGO DEFENSE MECHANISMS
Ego Defense
Mechanism
Mechanism Example
Denial Blocks external events to awareness
Smokers refusing to believe that smoking is injurious
to health
Displacement Satisfy an impulse with a substitute
Being angry because of Person A and showing the
anger on Person B
Projection
Attributing one’s own unacceptable thoughts and
feelings to someone else
Disliking a person thinking that he or she dislikes them
too
Rationalization
Cognitive distortion of facts to make it less
threatening
People believing in their lies to avoid confrontation
Reaction Formation
Reacting in a way completely opposite to one’s
own emotion
Laughing when angry
Regression Stress Thumb sucking, Bed Wetting
Repression Preventing a disturbing thought to dominate
Being afraid of spiders because of a bad past
experience
Sublimation
Transforming one emotion through an unrelated
activity
Punching a boxing bag when angry
Identification
Incorporating an external entity into one’s own
personality
Imagining oneself like a superhero after watching a
superhero movie
Dr. Balraj Shukla

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EXAMPLES
ID SUPEREGO EGO
A girl wants to buy an expensive
necklace
She cannot buy it as it is too expensive She can take permission from her
parents before buying
A man on diet is hungry while he is
driving his way back home
He cannot eat street food as it is not in
his diet plan
He can satisfy his hunger by waiting till
he gets home
A player is angry and wants to punch his
coach because he scolded him
It is not appropriate to punch your coach
else you might get suspended
The player can try to focus and meditate
and let go of the anger
A boy does not want to wake up when
the alarm goes off
He knows he might be late if he sleeps
too much
He presses the snooze button
Temperament comprises of two basic processes: Reactivity & Control.
The way a child reacts to a situation based on these two processes is
reflective of his or her id, ego and superego.
Dr. Balraj Shukla

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EROGENOUS ZONES & FIXATION
Pleasure zones in the body that are stimulated in order to eliminate or reduce tension
are called erogenous zones. These are directly related to Id which demands immediate
gratification.
The failure to halt this gratification after a certain age results in Fixation. Fixation refers
to the theoretical notion that a portion of the individual's libido has been permanently
'invested' in a particular stage of his/her development.
Dr. Balraj Shukla

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PSYCHOSEXUAL STAGES OF DEVELOPMENT
Oral Stage (0-1.5 years)
• Erogenous Zone: Mouth
• Gratifying activities: Nursing, eating, sucking, biting, swallowing
• Interaction with external environment: The mother’s breast
represents not only a source for food and drink but also
represents her love.
• Id is the only psych trait present at this stage. Both insufficient
feeding and forceful feeding can result in oral fixation.
• Fixation results in: Oral eroticism (sucking, eating, dependency,
cheerfulness)& Oral sadism (Nail biting, Smoking, Chewing,
Cruelty, Cynical)
The mouth is the erogenous zone
because at birth, reflexes like
rooting reflex, sucking,
swallowing, gag and crying are
present which are related to the
oral cavity.
Dr. Balraj Shukla

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Anal Stage (1.5-3 years)
• Erogenous Zone: Anus
• Gratifying activities: Bowel movement and its
control
• Interaction with external environment: Toilet
training
• Anal-expulsive personality: Sloppy,
disorganized, reckless, careless.
• Anal-retentive personality: Clean, orderly and
intolerant to those who are not clean.
The erogenous zone is anus as there is an increase
in voluntary activity over the sphincters,
particularly the anal sphincter. A control over the
anal sphincter can also improve neuromuscular
control and help the child understand the
importance of hygiene.
Dr. Balraj Shukla

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Urethral Stage (3-4 years)
• Erogenous Zone: Transitional stage (anal &
phallic)
• Gratifying activities: Urination
• Interaction with external environment: Toilet
training
• Poor urethral control: Competitiveness &
Ambition
• Urethral competence: Self-competence &
sense of pride
The presence of urethral erotism as this age leads
to urination being a gratifying activity. This stage
also helps the child in realizing the importance of
discipline.
Dr. Balraj Shukla

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Phallic Stage (4-5 years)
• Erogenous Zone: Genitals
• Gratifying activities: Genital fondling
• Interaction with external environment:
Attraction to parent of opposite gender
(Oedipus Complex and Electra Complex)
• Beginning of formation of superego.
• Men: Anxiety and Guilt, interest in one’s own
features
• Women: No possible fixations result from this
stage but women will always carry a sense of
envy and inferiority.
In this stage a child has unusual fantasies of the
opposite sex without any embarrassment. The
child gets more attracted to the parent of the
opposite gender. Parents of the opposite
gender are likely to teach maintenance of
proper oral hygiene to their child in this stage.
Dr. Balraj Shukla

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Latency (5 years - puberty)
• Interaction with external environment:
Suppression of sexual feelings, acquiring
new life skills, adjusting to social
environment, developing same sex
friendships, sports etc.
• Better control over ego
• Fixation: Sexual repression and
sublimation
Various hormonal changes and life experiences
affect the body in general during this stage
and hence there is no particular erogenous
zone.
Dr. Balraj Shukla

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Genital Stage (Puberty Onwards)
• Erogenous Zone: Genitals
• Gratifying activities: Heterosexual relationships
• Interaction with external environment: memories
of the past, physical manipulation of erogenous
zones and hormonal secretions.
• If there is any fixation in this stage, it is largely due
to difficulties experienced in previous stages.
A person develops the sense of
identity and realizes the
importance of reproduction and
survival.
Dr. Balraj Shukla

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APPLICATIONS
Gender Role Development
Psychoanalysis Therapy
Attachment
Moral Development
Aggression
Personality
ASSUMPTIONS
Behavior origins are unconscious
Psychic Determinism
Unconscious mind is always in a struggle
Adult behaviours are rooted in childhood experiences
CRITICAL EVALUATION OF THE THEORY
Dr. Balraj Shukla

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STRENGTHS
Defense Mechanisms
Projective Tests
Free Association
Importance of Childhood
Importance of Unconscious Mind
CRITICAL EVALUATION OF THE THEORY
LIMITATIONS
Cannot be Generalized
Not empirical
Little free will
Biased sample
Unfalsifiable
Dr. Balraj Shukla

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PSYCHOANALYSIS & DENTAL TREATMENT
Source: Freeman R; A fearful child attends: a psychoanalytic explanation of children’s responses to
dental treatment; Int J Ped Dent; 2007
Dr. Balraj Shukla

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CONCLUSION
A dynamic psychology studies the transformations and exchanges of energy
within the personality. Subsequently, it attempts to explain or interpret
behaviour or mental states in terms of innate emotional forces or processes.
Psychoanalysis is a controversial topic whose scientific basis is often
challenged. In children, the application of Freud’s theory that is based on
sexual drives has often been frowned upon and led to the “Freud Wars.”
Even though it is not empirical and unfalsifiable, Freud’s psychoanalysis
remains a crucial part of psychiatry.
Dr. Balraj Shukla

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REFERENCES
• Muthu MS, Sivakumar N. (2011). Pediatric Dentistry Principles & Practice (2nd edition). New Delhi. Elsevier
India.
• Koch G., Polsen S., Espelid I., Haubek D. (2017). Pediatric Dentistry – A Clinical Approach (3rd edition). John
Wiley & Sons Ltd. Chichester.
• Costa, Paul & McCrae, R.R. (1999). A five-factor theory of personality. The Five-Factor Model of Personality:
Theoretical Perspectives. 2. 51-87.
• Freeman R. (2007). A fearful child attends: a psychoanalytic explanation of children's responses to dental
treatment. International journal of paediatric dentistry, 17(6), 407–418.
Dr. Balraj Shukla

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REFERENCES
• Horacio Etchegoyen, R. (1991). Fundamentals Of Psychoanalytic Technique. London: Routledge.
• Marwah N. (2019). Textbook of Pediatric Dentistry (4th edition). New Delhi. Jaypee Brothers Medical
Publishers.
• Tandon S. (2018). Paediatric Dentistry (3rd edition). New Delhi. Paras Medical Publishers.
• Kalachanis K. & Michailidis I. (2015). The Hippocratic View on Humors and Human Temperament. European
Journal of Social Behaviour 2 (2): 1-5
Dr. Balraj Shukla