THEORIES ON NORMALITY
Lecturer: Anna Josefina Vazquez-Genuino, MD (11-19-2012)
Psychiatry
4 PERSPECTIVES OF NORMALITY
HEALTH
UTOPIA
AVERAGE
PROCESS
6 PRINCIPLES OF EPIGENETIC DEVELOPMENTAL
CONCEPTUAL MODEL
1. Stages in fixed & hierarchical sequence
2. Stages are interconnected Preceding stage
lays foundation for next
3. Stage progression may be speeded up, but
cannot skip stage. No short cuts.
4. Each stage equilibrium between demands of
environment & capacity of individual to 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)
3) DIFFERENTIATION (5-10 months)
Comparative Scanning
(+) Stranger Anxiety (8 mos)
Transitional Object
Checking Back Pattern (7-8 mos)
4) PRACTICING (10-16 months)
Love Affair w/ World
Emotional Refuelling
Low Keyedness
Separation Anxiety (10-18 months)
5) RAPPROCHEMENT 16-24 months
Development of Language
Fusion vs Isolation, Ambivalence
Shadowing & Darting Away
6) CONSOLIDATION & OBJECT CONSTANCY (24- 36
mos)
Object Constancy
PSYCHOSEXUAL STAGES (Sigmund Freud)
1) ORAL (0-1 yrs)
Explore & Feel Mouth, Senses
Oral Erotism vs Oral Aggression
Dependence vs Self Reliance
Over Gratification vs Deprivation
2) ANAL (1 or 1 - 3 yrs)
Anal Retention vs Expulsion
Self Determination, Cooperation
Anal Character: Obsessive Compulsive vs
Passive Aggressive
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3) URETHRAL
Urethral Erotism
Enuresis
Penis Envy Competiveness, Ambition
Pride, Self Competence
4) PHALLIC/ OEDIPAL (3-5/6 yrs)
Castration Anxiety, Penis Envy
Oedipal / Electra complex
Identification with Parent of Same Sex
Superego
5) LATENCY (5/6-11/13 yrs)
Identification w/ Other Figures
Sublimation of Drives
Lack Inner Control vs
Capacity for Mastery, Defined Roles
6) GENITAL (>11/13 yrs)
Reworking of Previous Conflicts
Stable Sense of Identity
Mutually Satisfying Lasting Non-Incestuous
Relations
Integrate Sex & Love
Self Realization in Work
PSYCHOSOCIAL STAGES OF LIFE (Erik Erikson)
Each Stage - Turning Points
1) TRUST VS MISTRUST (0-18 months)
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
2) AUTONOMY VS SHAME & DOUBT (1.53 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
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
Disorder, Anxiety
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 Disorders
 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
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
FIDELITY = Commitment to Beliefs & Goals
Psychosis, Schizophrenia, Gender Identity
Disorder,
6) 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
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
Introspect
CARE = Concern for All, Desire to Help
Vs. Selfishness, Family Dynasty
Mid- Life Crisis: Extramarital Affairs,
Marital Separation & Divorce, Alcoholism,
Gambling
8) INTEGRITY VS DESPAIR (> 60 Yrs)
Retirement: Give Position of Authority to
Younger Ones, Enjoy Grandchildren &
Gratification from Hobbies
Retrospect, Prepare for Death
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
Stages
A. SENSORIMOTOR
B. PRE OPERATIONAL
C. CONCRETE OPERATIONAL
D. FORMAL OPERATIONAL
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1) SENSORIMOTOR Stage (0- 2 yrs)
A. Reflexes (0-2 mos)
B. Primary Circular Reaction (2-5 mos)
C. Secondary Circular Reaction (5-9 mos)
D. Coordination of Secondary Circular
Reaction (9-12 mos)
E. Tertiary Circular Reaction (1-1 yrs)
F. Symbolic Thought (1 - 2 yrs)
A. Simple Reflexes at 0-2 mos
Rooting
Sucking
Grasp
Startle
B. Primary Circular Reaction at 1/2-4/5 mos
Coordinates Own Body & 5 Senses
Curiosity: Activity, Turns, Reach Out
C. Primary Secondary Circular Reaction at
4/5-8/9 mos
Anticipate Consequences of Own
Behavior
Acts Purposefully to Change
Environment
D. Coordination of Secondary Circular
Reaction at 8/9-12 mos
Throws Toys
Open /Close
Intentional Behavior
Look For Hidden Toy (10 months)
E. Tertiary Circular Reaction at 1-1 yrs
Seeks Out New Experiences
Produces Novel Behavior Push
Buttons, Insert Objects in Bottle,
Shake Table to Get Toy
F. Symbolic Thought at 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
2) Stage of PREOPERATIONAL Thought (2- 7 Yrs)
A. Substage 1 Symbolic Function at 2-4 Yrs
B. Substage 2 Intuitive Thought at 4-7 Yrs
A. Substage 1) Symbolic Function at 2-4 Yrs
Egocentrism
Animism
B. Substage 2) Intuitive Thought at 4-7 Yrs
Centration
Cant Grasp Sameness
Defines Words ~ Function
Phenomenalistic Causality
3) Stage of CONCRETE OPERATIONS (7-11 yrs)
Serialize, Classify Objects
Inductive Reasoning
Reversibility of Processes & Relationships
 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

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
4) Stage of FORMAL OPERATIONS 11/12 yrs Punishment
Scientific, Logical
Abstract Thinking IV. Stage of INSTRUMENTAL RELATIVISM/
Hypothetical Thinking HEDONISM (3-7 yrs)
Golden Rule: Dont do unto others what
Deductive Reasoning
you would not want others to do to you
Adolescent Egocentrism
You scratch my back, Ill scratch your
1) Imaginary Audience Self
back
Consciousness
Tallion Principle An eye for an eye
2) Personal Fable- Uniqueness,
(Immanent Justice)
Invincibility
Good = What is Beneficial to Me
MORAL DEVELOPMENT
CONVENTIONAL STAGES (Know Good vs Bad, Right
Changes in Thoughts, Feelings, Behaviors vs Wrong)
regarding Standards of Right & Wrong
Intrapersonal Dimension: Regulates ones V. Stage of INTERPERSONAL CONCORDANCE/
Activities When Alone CONFORMITY (7-9 yrs)
Interpersonal Dimension: Regulates Social Good boy/ Nice girl - Conform to Rules
Interaction & Arbitrates Conflict (Gibbs 2003, so as to Please Authority
Walker 1996, Walker & Pitts 1998) Soldier in War Blind Obedience,
Respect for Authority
Good = What is Approved & Dictated by
Those He Loves & Respects

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

POST CONVENTIONAL STAGES

VII. Stage of SOCIAL CONTRACT- Legalistic

MORAL DEVELOPMENT (Lawrence Kohlberg) Orientation (1218 yrs)
A. PRE-CONVENTIONAL STAGES Lets decide what is best for us
o Good & Bad Interpreted in Terms of Situation Ethics
External Rewards/ Punishments Realize Relativism of Values &
B. CONVENTIONAL STAGES Impermanence of Rules
o Abide by Certain Internal Standards Voluntary Compliance, Exception to Rules
Dictated by Family, Society, Law Right = Depends on Current
C. POST -CONVENTIONAL STAGES Circumstances
o Recognize Alternative Mores, Explore
Options, Decide on Personal Moral VIII. Stage of UNIVERSAL ETHICAL PRINCIPLES >
Code 18 yrs
Lets decide what is best for everyone
PRE- CONVENTIONAL STAGES Good = Maintains Respect & Dignity for All
Fellowmen, Equality
I. Stage of IMMEDIATE GRATIFICATION (0-6 Right = Self Determined, Autonomous
mos) from Law
I want it now!
e.g. cry, tantrum

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