FREUD (1856–1939)

Sigmund Freud introduced a number of concepts about development that are still used today. The
concepts of the unconscious mind, defense mechanisms, and the id, ego, and superego are Freud’s. The
unconscious mind is the part of a person’s mental life of which the person is unaware. This concept of
the unconscious is one of Freud’s major contributions to the field of psychiatry. The id resides in the un-
conscious and, operating on the pleasure principle, seeks immediate pleasure and gratification. The ego,
the realistic part of the person, balances the gratification demands of the id with the limitations of social
and physical circumstances. The methods the ego uses to fulfill the needs of the id in a socially acceptable
manner are called defense mechanisms. Defense mechanisms, or adaptive mechanisms as they are more
commonly called today, are the result of conflicts between the id’s impulses and the anxiety created by
the conflicts due to social and environmental restrictions. The third aspect of the personality, according to
Freud, is the superego. The superego contains the conscience and the ego ideal. The conscience consists
of society’s “do not’s,” usually as a result of parental and cultural expectations. The ego ideal comprises
the standards of perfection toward which the individual strives. Freud proposed that the underlying
motivation to human development is a dynamic, psychic energy, which he called libido.

According to Freud’s theory of psychosexual development, the personality develops in five overlapping
stages from birth to adult-hood. The libido changes its location of emphasis within the individual from
one stage to another. Therefore, a particular body area has special significance to a client at a particular
stage. The first three stages (oral, anal, and phallic) are called pregenital stages. The culminating stage is
the genital stage. Table 20–2 indicates characteristics for each stage.

Freudian theory asserts that the individual must meet the needs of each stage in order to move
successfully to the next developmental stage. For example, during an infant’s oral stage, nurses can assist
an infant’s development by making feeding a pleasurable experience. This provides comfort and security
for the infant. Freud also emphasized the importance of infant–parent interaction. Therefore, the nurse as
a caregiver should provide a warm, caring atmosphere for an infant and assist parents to do so when the
infant returns to their care.

If the person does not achieve satisfactory progression at one stage, the personality becomes fixated at
that stage. Fixation is immobilization or the inability of the personality to proceed to the next stage
because of anxiety. For example, making toilet training a positive experience during the anal stage
enhances the child’s feeling of self-control. If, however, the toilet training was a negative experience, the
resulting conflict or stress can delay or prolong progression through a stage or cause a person to regress
to a previous stage. Ideally, an individual progresses through each stage with balance between the id, ego,
and superego.
ERIKSON (1902–1994)

Erik H. Erikson (1963, 1964) adapted and expanded Freud’s theory of development to include the
entire life span, believing that people continue to develop throughout life. He described eight stages of
development.

Erikson’s theory proposes that life is a sequence of developmental stages or levels of

achievement. Each stage signals a task that must be accomplished. The resolution of the task can be
complete, partial, or unsuccessful. Erikson believed that the more success an individual has at each
developmental stage, the healthier the personality of the individual. Failure to complete any
developmental stage influences the person’s ability to progress to the next level. These developmental
stages can be viewed as a series of crises or conflicts. Successful resolution of these crises supports healthy
ego development. Failure to resolve the crises damages the ego. Erikson’s eight stages reflect both positive
and negative aspects of the critical life periods. The resolution of the conflicts at each stage enables the
person to function effectively in society. Each phase has its own developmental task, and the individual
must find a balance between, for example, trust versus mistrust (stage 1) or integrity versus despair (stage
8).

Stage one is trust versus mistrust which is birth to 18 months of age. The infant learns to trust the
primary care giver to meet their needs for food, shelter, and personal care. In early childhood age 18
months to three years the development task is autonomy versus shame and guilt. The child begins to
identify with the development of control of bodily functions (Erikson, 1963).

Initiative versus guilt is the developmental task of late childhood. The child is between the ages
of three and five years. At this stage the child becomes assertive and is aware of their own behavior. If this
task is not successfully achieved the child will have a decreased self-confidence and feeling of fear will
result (Erikson, 1963).

From age six to 12 years the developmental task is industry versus inferiority. Successful
attainment indicates the child’s ability to create. A negative response is withdrawal and a sense of
hopelessness (Erikson, 1963).

From age 12 to 20 years the adolescent’s central task is intimacy versus isolation. The individual
is exploring relationships with other individuals while also exploring work experiences. A negative
resolution would be the avoidance of career or relationship.

Adulthood is generativity versus stagnation. The adult age 25–65 years is creative and develops
other interests. From age 65 years to death the individual’s central task is integrity versus despair. The
individual accepts their life and ultimate death (Erikson, 1963).

When using Erikson’s developmental framework, nurses should be aware of indicators of positive
and negative resolution of each developmental stage. According to Erikson, the environment is highly
influential in development. Nurses can enhance a client’s development by being aware of the individual’s
developmental stage and assisting with the development of coping skills related to stressors experienced
at that specific level. Nurses can strengthen a client’s positive resolution of a developmental task by
providing the individual with appropriate opportunities and encouragement. For example, a 10-year-old
child (industry versus inferiority) can be encouraged to be creative, to finish schoolwork, and to learn how
to accomplish these tasks within the limitations imposed by health status.
 Erikson emphasized that people must change and adapt their behavior to maintain control over
their lives. In his view, no stage in personality development can be bypassed, but people can become
fixated at one stage or regress to a previous stage under anxious or stressful conditions. For example, a
middle-aged woman who has never satisfactorily accomplished the task of resolving identity versus role
confusion might regress to an earlier stage when stressed by an illness with which she cannot cope.

HAVIGHURST (1900–1991)

Robert Havighurst believed that learning is basic to life and that people continue to learn throughout
life. He described growth and development as occurring during six stages, each associated with 6 to 10
tasks to be learned (Box 20–2).

Havighurst promoted the concept of developmental tasks in the 1950s. A developmental task is “a task
which arises at or about a certain period in the life of an individual, successful achievement of which leads
to his [sic] happiness and to success with later tasks, while failure leads to unhappiness in the individual,
disapproval by society, and difficulty with later tasks” (Havighurst, 1972, p. 2).

Havighurst’s developmental tasks provide a framework that the nurse can use to evaluate a person’s
general accomplishments. However, these tasks are presented as very broad categories and some nurses
find them of limited use when assessing specific accomplishments, particularly those of infancy and
childhood. Also, in a multicultural society, the definition of success of tasks may vary with values and belief
systems (e.g., not all individuals may wish to marry or bear children), making these tasks less relevant for
some.
PECK

Theories and models about adult development are relatively recent compared with theories of infant
and child development. Research into adult development has been stimulated by a number of factors,
including increased longevity and healthier old age. In the past, development was viewed as complete by
the time of physical maturity, and aging was considered a decline following maturity. The emphasis was
on the negative aspects rather than the positive aspects of aging. However, Robert Peck (1968) believes
that although physical capabilities and functions decrease with old age, mental and social capacities
tend to increase in the latter part of life.

Peck proposes three developmental tasks during old age, in contrast to Erikson’s one (integrity versus
despair):

1. Ego differentiation versus work-role preoccupation. An adult’s identity and feelings of worth are
highly dependent on that person’s work role. On retirement, people may experience feelings of
worthlessness unless they derive their sense of identity from a number of roles so that one such
role can replace the work role or occupation as a source of self-esteem. For example, a man who
likes to garden or golf can obtain ego rewards from those activities, replacing rewards formerly
obtained from his occupation.
2. Body transcendence versus body preoccupation. This task calls for the individual to adjust to
decreasing physical capacities and at the same time maintain feelings of well-being. Preoccupation
with declining body functions reduces happiness and satisfaction with life.
3. Ego transcendence versus ego preoccupation. Ego transcendence is the acceptance without fear
of one’s death as inevitable. This acceptance includes being actively involved in one’s own future
beyond death. Ego preoccupation, by contrast, results in holding onto life and a preoccupation
with self-gratification.

GOULD

Roger Gould is another theorist who has studied adult development. He believes that transformation is a
central theme during adulthood: “Adults continue to change over the period of time considered to be
adulthood and developmental phases may be found during the adult span of life” (Gould, 1972, p. 33).
According to Gould, the 20s is the time when a person assumes new roles; in the 30s, role confusion often
occurs; in the 40s the person becomes aware of time limitations in relation to accomplishing life’s goals;
and in the 50s, the acceptance of each stage as a natural progression of life marks the path to adult
maturity. Gould’s study of 524 men and women led him to describe seven stages of adult development:

Stage 1 (ages 16–18). Individuals consider themselves part of the family rather than individuals and
want to separate from their parents.

Stage 2 (ages 18–22). Although the individuals have established autonomy, they feel it is in jeopardy;
they feel they could be pulled back into their families.
Stage 3 (ages 22–28). Individuals feel established as adults and autonomous from their families. They
see themselves as well defined but still feel the need to prove themselves to their parents. They see this
as the time for growing and building for the future (Figure 20–4 •).

Stage 4 (ages 28–34). Marriage and careers are well established. Individuals question what life is all about
and wish to be accepted as they are, no longer finding it necessary to prove themselves.

Stage 5 (ages 34–43). This is a period of self-reflection. Individuals question values and life itself. They see
time as finite, with little time left to shape the lives of adolescent children.

Stage 6 (ages 43–50). Personalities are seen as set. Time is accepted as finite. Individuals are interested
in social activities with friends and spouse and desire both sympathy and affection from spouse.

Stage 7 (ages 50–60). This is a period of transformation, with a realization of mortality and a concern for
health. There is an increase in warmth and a decrease in negativism. The spouse is seen as a valuable
companion (Gould, 1972, pp. 525–527).