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Psychiatric
Nursing
Liza Roda
Claudine J. Turla
Charysse A. Tomolin
Ed Daryll R. Batitang
Ian leonard C. Celebrado

COURSE OBJECTIVES:
GENERAL OBJECTIVE
At the end of the discussion, the
students are expected to have
known the principles and
significance of the different theories
of human development and
behavior.

SPECIFIC OBJECTIVES
At the end of the term, the students are
expected to:
• Have a more comprehensive analysis of
the different theories of personality, their
dynamics and development.
• Gain insights in dealing with different
personality and behavior.
• Show sensitivity to human needs and
problems.
• Show awareness about the importance of
theories to the understanding of
personality.

Contents
• Erikson's Psychological
Development
• Freud's Psychosexual
Development
• Freud's Structural Model of
Personality
• Kohlberg's Theory of Moral
Development
• Piaget’s Cognitive Development

Erikson’s
Psychosocial
Development

What is Psychosocial
Development?
Psychosocial development as articulated by
Erik Erikson describes eight
developmental stages through which a healthily
developing human should pass from infancy to
late adulthood. In each stage the person
confronts, and hopefully masters, new
challenges. Each stage builds on the successful
completion of earlier stages. The challenges of
stages not successfully completed may be
expected to reappear as problems in the future.

Psychoanalyst Erik Erikson describes the physical,
emotional and psychological stages of development
and relates specific issues, or developmental work or
tasks, to each stage. For example, if an infant's
physical and emotional needs are met sufficiently, the
infant completes his/her task -- developing the ability
to trust others. However, a person who is stymied in
an attempt at task mastery may go on to the next
state but carries with him or her the remnants of the
unfinished task. For instance, if a toddler is not
allowed to learn by doing, the toddler develops a
sense of doubt in his or her abilities, which may
complicate later attempts at independence. Similarly,
a preschooler who is made to feel that the activities
he or she initiates are bad may develop a sense of
guilt that inhibits the person later in life.

Stages of Psychosocial
Development in Infancy
and Early Childhood

Psychological Stage 1 - Infancy (Birth -18
months)
• Psychosocial Crisis: Trust vs. Mistrust
• Developing trust is the first task of the ego, and it
is never complete. The child will let its mother out
of sight without anxiety and rage because she has
become an inner certainty as well as an outer
predictability. But when a mother is not present,
the father becomes the inner certainty along with
other relatives usually surrounding the child daily.
The balance of trust with mistrust depends largely
on the quality of the maternal relationship.

• Main question asked: Is my environment
trustworthy or not?
• Central Task: Receiving care
• Positive Outcome: Trust in people and the
environment
• Ego Quality: Hope
• Definition: Enduring belief that one can attain
one’s deep and essential wishes
• Developmental Task: Social attachment;
Maturation of sensory, perceptual, and motor
functions; Primitive causality.
• Significant Relations: Maternal parent

Erikson proposed that the concept of trust
versus mistrust is present throughout
an individual’s entire life. Therefore if
the concept is not addressed, taught
and handled properly during infancy
(when it is first introduced), the
individual may be negatively affected
and never fully immerse themselves in
the world.

Psychological Stage 2 - Toddler (1 1/2 - 3 Years)
• Psychosocial Crisis: Autonomy vs. Shame &
doubt
• If denied independence, the child will turn against
his/her urges to manipulate and discriminate.
Shame develops with the child's self-
consciousness. Doubt has to do with having a
front and back -- a "behind" subject to its own
rules. Left over doubt may become paranoia. The
sense of autonomy fostered in the child and
modified as life progresses serves the
preservation in economic and political life of a
sense of justice.

• Main question asked: Do I need help from
others or not?
• When a child reaches the age of one to the age of
three, Erikson explains, the child is developing a
sense of autonomy . During this age, the toddler
discovers he/she is no longer attached to the
primary caregiver but is a separate individual
(Gonzalez-Mena & Eyer, 2004). Autonomy is the
independence a toddler strives for from
caregivers. Toddlers’ autonomous behavior is a
way of forming their own identity away from their
caregivers (Bigner, 2006). This stage is a time
where a toddler has the “will” to become
independent. Shame and doubt is likely to occur
when the toddler is not given any choices or
boundaries because the toddler is determined to
become independent.

• Parents who are assertive and too
demanding may find themselves in a
power struggle with their toddler
(Gonzalez-Mena & Eyer, 2006). In
addition, parents may be too demanding
for only “good” behavior from their
toddler. Autonomy can be gained for the
toddler when given reasonable choices
and proper guidance from the caregiver.
Parents can give healthy and wise
choices to assist their child to succeed at
this stage.

Psychological Stage 3 - Play Age (3-6 Years)
• Psychosocial Crisis: Initiative vs. Guilt
• Initiative adds to autonomy the quality of undertaking,
planning, and attacking a task for the sake of being
active and on the move. The child is learning to
master the world around him or her, learning basic
skills and principles of physics; things fall to the
ground, not up; round things roll, how to zip and tie,
count and speak with ease. At this stage the child
wants to begin and complete his or her own actions
for a purpose. Guilt is a new emotion and is
confusing to the child; he or she may feel guilty over
things which are not logically guilt producing, and he
or she will feel guilt when his or her initiative does not
produce the desired results.

• Main question asked: How moral am I?
• The development of courage and independence are what
set preschoolers, ages three to six years of age, apart
from other age groups when Erik Erikson discussed his
third psychosocial stage. Young children in this category,
ranging between three to six years of age, face the
challenge of initiative versus guilt (Boer, 1997)
Importance of adults
• The relationship between parent and child must include a
positive balance between helping the child develop guilt, of
which will encourage self-control, and establishing
independence for the goals the child chooses.
Independence is significant to goal development and child
development in that the child will learn to form a foundation
for decision-making and in taking the steps required to set
goals.

Importance of responsibility
• In order to promote a safe balance between
initiative and guilt, parents must provide the child
with achievable responsibility. Cramer, Flynn, and
LaFave (1997) describe two different outcomes,
both positive and negative, that may occur if a
child is not given responsibilities, such as cleaning
a room or walking a dog; all of which can create
independence and dependability. For a healthy
balance of initiative and guilt, the child should be
able to accept feelings of guilt while understanding
that certain activities and situations he or she
chooses may or may not be permitted by others.

Psychological Stage 3 - School Age (7-12 Years)
• Psychosocial Crisis: Industry vs. Inferiority
To bring a productive situation to completion
is an aim which gradually supersedes the
whims and wishes of play. The
fundamentals of technology are developed.
To lose the hope of such "industrious"
association may pull the child back to the
more isolated, less conscious familial rivalry
of the oedipal time.

• Main question asked: Am I good at what I do?
- According to Allen and Marotz (2003), "children at this age
are becoming more aware of themselves as individuals."
They work hard at "being responsible, being good and doing
it right." They are now more reasonable to share and
cooperate.
- According to Robert Brooks (2001) parents can nurture self
esteem and resilience in different ways:
– a. Understand and accept children's learning problems
(highlight strengths)
– b. Teach children how to solve problems and make
decisions
– c. Reinforce responsibility by having children
contribute
– d. Learn from, rather than feeling defeated by
mistakes
– e. Make the child feel special (create special times
alone with them each week

Psychological Stage 4 - Adolescence (12-18 Years)
• Psychosocial Crisis: Identity vs. Role
Confusion
The adolescent is newly concerned with how
he or she appears to others. Superego
identity is the accrued confidence that the
outer sameness and continuity prepared in
the future are matched by the sameness
and continuity of one's meaning for oneself,
as evidenced in the promise of a career.
The ability to settle on a school or
occupational identity is pleasant.

Psychological Stage 4 - Young Adulthood (19-
40 years)
• Psychosocial Crisis: Intimacy vs. Isolation
Body and ego must be masters of organ modes
and of the other nuclear conflicts in order to face
the fear of ego loss in situations which call for self-
abandon. The avoidance of these experiences
leads to openness and self-absorption.
- According to Erik Erikson the young adult stage,
Intimacy vs. Isolation, is emphasized around the
ages of 19 to 34. At the start of the Intimacy vs.
Isolation stage, identity vs. role confusion is coming
to an end and it still lingers at the foundation of the
stage (Erikson 1950). Young adults are still eager
to blend their identities with friends.

• Psychosocial Crisis: Generativity vs.
Stagnation
Generativity is the concern of establishing
and guiding the next generation. Socially-
valued work and disciplines are expressions
of generativity. Simply having or wanting
children does not in and of itself achieve
generativity.
Psychological Stage 5 - Middle Adulthood (40-65 Years)

Psychological Stage 5 - Late Adulthood (from 65 years)
• Psychosocial crisis: Integrity vs Despair
• One strength of Erikson's theory is that it acknowledges
that development continues throughout the life cycle.
According to Erikson, even older people are not finished
developing. Older people who are coming to terms with
their own mortality have a deep need to look over their
whole lives. A person who can look back on good times
with gladness, on hard times with self-respect, and on
mistakes and regrets with forgiveness, will find a new
sense of integrity and a readiness for whatever life or
death may bring. A person caught up in old sadness,
unable to forgive themselves or others for perceived
wrongs, and dissatisfied with the life they've led, will
easily drift into depression and despair.

• The fundamental question is, "What kind
of life have I lived?"
A positive outcome of this crisis is achieved
if the individual gains a sense of fulfillment
about life and a sense of unity within
himself and with others. That way, he can
accept death with a sense of integrity. Just
as a healthy child will not fear life, the
healthy adult will not fear death.
• A negative outcome of this crisis causes
the individual to despair and fear death.

Freud's
Psychosexual
Development

What is psychosexual
development?
• The concept of psychosexual
development, as envisioned by
Sigmund Freud at the end of the nineteenth
and the beginning of the twentieth century,
is a central element in the theory of
psychology. It consists of five separate
phases: oral, anal, phallic, latency, and
genital. In the development of his theories,
Freud's main concern was with
sexual desire, defined in terms of formative
drives, instincts and appetites that result in
the formation of an adult personality.

Freud's Model of
Psychosexual
Development

Stages Age Range Erogenous
zone(s)
Consequences of Fixation
Oral 0-18
months
Mouth Orally aggressive: Involves
chewing gum or ends of pens.
Orally Passive:
Involves smoking/eating/
kissing/fellatio/
cunnilingus
Anal 18-36
months
Bowel and
bladder
elimination
Anal-retentive: Obsession with
organization or excessive
neatness
Anal-expulsive:
Reckless, careless, defiant,
disorganized, Coprophiliac
Phallic 3-6 years Genitals Oedipus complex
Electra complex

Stages Age Range Erogenous
zone(s)
Consequences of
Fixation
Latency 6 years-puberty Dormant
sexual
feelings
(People do not tend to
fixate at this stage, but
if they do, they tend to
be extremely sexually
unfulfilled.)
Genital Puberty and
beyond
Sexual
interests
mature
Frigidity, impotence,
unsatisfactory
relationships

Oral phase
The oral stage in psychology is the term used by
Sigmund Freud to describe the child's development during
the first eighteen months of life, in which an infant's
pleasure centers are in the mouth.
Anal phase
The next stage of psychosexual development is centered
around the rectum, but can also include bladder functions.
This phase usually occurs from eighteen months to thirty-
six months of age. In this stage children learn to control
the expulsion of feces causing their libidinal energy to
become focused in this area. The added awareness of this
erogenous zone arises in children from concentrating on
controlling their defecation.

Phallic phase
At thirty-six months to about seventy-two months of age the
libidinal energy shifts from the anal region to the genital region. At
this point, according to Freud's model, the Oedipus or Electra
complex can develop. The Oedipus complex is central to the
psychodynamic fixations in this time period for men; the Electra
complex for women.
Around this time in males, according to Freud, the young boy falls
in love with his mother and wishes that his father was not in the
way of his love. At this point he notices that women have no penis
and fears that the punishment of his father for being in love with
his wife is castration. This fear is enhanced if he is castigated for
masturbation at this stage. Once the fear of retaliation has
subsided the boy will learn to earn his mother's love by becoming
as much like his father as possible. Thus, the superego is born.
He will adopt his father's beliefs and ideals as his own and move
on to the latency stage.

Latency phase
The latency period begins sometime around the age of six
and ends when puberty starts to begin. Freud believed that
in this phase the Oedipus complex was dissolved and set
free, resulting in a relatively conflict-free period of
development. In this phase, the child begins to make
connections to siblings, other children, and adults. This
phase is typified by a solidifying of the habits that the child
developed in the earlier stages.
Genital phase
The genital stage starts at puberty, allowing the child to
develop opposite sex relationships with the libidinal energy
again focused on the genital area. According to Freud, if
any of the stages are fixated on, there is not enough libidinal
energy for this stage to develop untroubled. To have a fully
functional adulthood, and to accomplish "appropriate"
heterosexual maturity, the previous stages need to be fully
resolved.

Freud's Structural Model of
Personality
(id, ego, superego )

Id (Pleasure Principle)
According to Freud, we are born with our Id.
The id is an important part of our personality
because as newborns, it allows us to get our
basic needs met. Freud believed that the id is
based on our pleasure principle. In other words,
the id wants whatever feels good at the time,
with no consideration for the reality of the
situation. When a child is hungry, the id wants
food, and therefore the child cries. When the
child needs to be changed, the id cries. When
the child is uncomfortable, in pain, too hot, too
cold, or just wants attention, the id speaks up
until his or her needs are met. i

Ego (Reality Principle)
Within the next three years, as the child interacts
more and more with the world, the second part of
the personality begins to develop. Freud called
this part the Ego. The ego is based on the reality
principle. The ego understands that other
people have needs and desires and that
sometimes being impulsive or selfish can hurt us
in the long run. Its the ego's job to meet the
needs of the id, while taking into consideration the
reality of the situation.

Superego (Moral Principle)
By the age of five, or the end of the
phallic stage of development, the
Superego develops. The Superego is
the moral part of us and develops due
to the moral and ethical restraints
placed on us by our caregivers. Many
equate the superego with the
conscience as it dictates our belief of
right and wrong.

Kohlberg's Theory of
Moral Development

What is Kohlberg's stages of
moral development?
• Kohlberg's stages of moral development
are planes of moral adequacy conceived by
Lawrence Kohlberg to explain the
development of moral reasoning. Created
while studying psychology at the
University of Chicago, the theory was inspired
by the work of Jean Piaget and a fascination
with children's reactions to moral dilemmas.
He wrote his doctoral dissertation at the
university in 1958, utlining what are now
known as his stages of moral development.

Pre-Conventional
Stage one (obedience and punishment driven) individuals focus on
the direct consequences that their actions will have for themselves.
For example, an action is perceived as morally wrong if the person
who commits it gets punished. The worse the punishment for the
act is, the more 'bad' the act is perceived to be. In addition, there is
no recognition that others' points of view are any different from
one's own view. This stage may be viewed as a kind of
authoritarianism.
Stage two (self-interest driven) espouses the what's in it for me
position, right behavior being defined by what is in one's own best
interest. In stage two concern for others is not based on loyalty or
intrinsic respect. Lacking a perspective of society in the pre-
conventional level, this should not be confused with social contract
(stage five), as all actions are performed to serve one's own needs
or interests. For the stage two theorist, the perspective of the world
is often seen as morally relative.

Conventional
Stage three (interpersonal accord and conformity driven), the
self enters society by filling social roles. Individuals are receptive
of approval or disapproval from other people as it reflects
society's accordance with the perceived role. They try to be a
good boy or good girl to live up to these expectations, having
learned that there is inherent value in doing so. Stage three
reasoning may judge the morality of an action by evaluating its
consequences in terms of a person's relationships, which now
begin to include things like respect, gratitude and the 'golden rule’
Stage four (authority and social order obedience driven), it is
important to obey laws, dictums and social conventions because
of their importance in maintaining a functioning society. A central
ideal or ideals often prescribe what is right and wrong, such as in
the case of fundamentalism.

Post-Conventional
Stage five (social contract driven), individuals are viewed as
holding different opinions and values. Along a similar vein, laws
are regarded as social contracts rather than rigid dictums. Those
that do not promote the general welfare should be changed when
necessary to meet the greatest good for the greatest number of
people.
Stage six (universal ethical principles driven), moral
reasoning is based on abstract reasoning using universal ethical
principles. Laws are valid only insofar as they are grounded in
justice, and that a commitment to justice carries with it an
obligation to disobey unjust laws. Rights are unnecessary as
social contracts are not essential for deontic moral action.
Decisions are not met hypothetically in a conditional way but
rather categorically in an absolute way (see Immanuel Kant's '
categorical imperative').

Piaget’s Cognitive
Development

What is Theory of Cognitive
Development?
The Theory of Cognitive Development, one of the most
historically influential theories was developed by
Jean Piaget, a Swiss psychologist (1896–1980). His theory
provided many central concepts in the field of
developmental psychology and concerned the growth of
intelligence, which for Piaget, meant the ability to more
accurately represent the world and perform logical
operations on representations of concepts grounded in the
world. The theory concerns the emergence and acquisition
of schemata—schemes of how one perceives the world—in
"developmental stages", times when children are acquiring
new ways of mentally representing information.

Piaget divided schemes that children use
to understand the world through four
main periods, roughly correlated with and
becoming increasingly sophisticated with
age:
• Sensorimotor period (years 0–2)
• Preoperational period (years 2–7)
• Concrete operational period (years 7–11)
• Formal operational period (years 11 and
up)

Sensorimotor period (years 0–2)
Sensorimotor period is the first of the four periods. According
to Piaget, this stage marks the development of essential
spatial abilities and understanding of the world in six sub-
stages:
• The first sub-stage, known as the reflex schema stage,
occurs from birth to six weeks and is associated primarily
with the development of reflexes.
• The second sub-stage, primary circular reaction phase,
occurs from six weeks to four months and is associated
primarily with the development of habits.
• The third sub-stage, the secondary circular reactions
phase, occurs from four to nine months and is associated
primarily with the development of coordination between
vision and prehension.

• The fourth sub-stage; called the co-ordination of
secondary circular reactions stage, which occurs
from nine to twelve months, is when Piaget (1954)
thought that object permanence developed.
• The fifth sub-stage; the tertiary circular reactions
phase, occurs from twelve to eighteen months and
is associated primarily with the discovery of new
means to meet goals.
• The sixth sub-stage, considered "beginnings of
symbolic representation", is associated primarily
with the beginnings of insight, or true creativity.

Preoperational period (years 2–7)
• The Preoperational stage is the second of four stages of
cognitive development. By observing sequences of play,
Piaget was able to demonstrate that towards the end of the
second year a qualitatively new kind of psychological
functioning occurs.
• (Pre)Operatory Thought in Piagetian theory is any
procedure for mentally acting on objects. The hallmark of
the preoperational stage is sparse and logically inadequate
mental operations. During this stage the child learns to use
and to represent objects by images and words, in other
words they learn to use symbolic thinking. Thinking is still
egocentric: The child has difficulty taking the viewpoint of
others.

The Preoperational Stage can be further broken down into the
Preconceptual Stage and the Intuitive Stage
• The Preconceptual stage (2-4 years) is marked by
egocentric thinking and animistic thought. A child who
displays animistic thought tends to assign living attributes
to inanimate objects, for example that a glass would feel
pain if it were broken.
• The Intuitive(4-6 years) stage is when children start
employing mental activities to solve problems and obtain
goals but they are unaware of how they came to their
conclusions. For example a child is shown 7 dogs and 3
cats and asked if there are more dogs than cats. The child
would respond positively. However when asked if there are
more dogs than animals the child would once again
respond positively. Such fundamental errors in logic show
the transition between intuitiveness in solving problems and
true logical reasoning acquired in later years when the child
grows up

Concrete operational period
(years 7–11)
• The Concrete operational stage is the third of four stages
of cognitive development in Piaget's theory. This stage,
which follows the Preoperational stage, occurs between
the ages of 6 and 11 years and is characterized by the
appropriate use of logic. Important processes during this
stage are:
• Seriation—the ability to sort objects in an order according
to size, shape, or any other characteristic. For example, if
given different-shaded objects they may make a color
gradient.
• Classification—the ability to name and identify sets of
objects according to appearance, size or other
characteristic, including the idea that one set of objects can
include another. A child is no longer subject to the illogical
limitations of animism (the belief that all objects are alive
and therefore have feelings).

• Decentering—where the child takes into account multiple
aspects of a problem to solve it. For example, the child will
no longer perceive an exceptionally wide but short cup to
contain less than a normally-wide, taller cup.
• Reversibility—where the child understands that numbers
or objects can be changed, then returned to their original
state. For this reason, a child will be able to rapidly
determine that if 4+4 equals 8, 8−4 will equal 4, the original
quantity.
• Conservation—understanding that quantity, length or
number of items is unrelated to the arrangement or
appearance of the object or items. For instance, when a
child is presented with two equally-sized, full cups they will
be able to discern that if water is transferred to a pitcher it
will conserve the quantity and be equal to the other filled
cup.

Formal operational period (years
11 and up)
• The formal operational period is the fourth and final of the
periods of cognitive development in Piaget's theory. This
stage, which follows the Concrete Operational stage,
commences at around 12 years of age (puberty) and
continues into adulthood. It is characterized by acquisition
of the ability to think abstractly, reason logically and draw
conclusions from the information available. During this
stage the young adult is able to understand such things as
love, "shades of gray", logical proofs, and values. Lucidly,
biological factors may be traced to this stage as it occurs
during puberty (the time at which another period of neural
pruning occurs), marking the entry to adulthood in
Physiology, cognition, moral judgement (Kohlberg),
Psychosexual development (Freud), and psychosocial
development (Erikson).

References
Internet:
• http://en.wikipedia.org/wiki/
Theory_of_cognitive_development
• http://allpsych.com/psychology101/
moral_development.html

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