Psychiatric Care: Conceptual Frameworks

Conceptual Frameworks for Psychiatric Care

• These frameworks organize knowledge to understand human behavior
• They relate biological factors, development, and environmental factors
• Frameworks offer a theoretical view of humanity, development, behavior, and mental health

Personality

• It includes an individual's physical and mental qualities interacting with their environment
• Characteristics include distinctiveness, stability, and consistency
• Determinants of personality are psychological, cultural, biological, and familial

Psychoanalytic Theories

• Focus lies on intrapsychic processes and psychosexual development
• Early childhood experiences impact personality development

Personality Structure

• Id: the most primitive component, responsible for instincts, operating by the pleasure principle
• Ego: the reality-based "I" validating and testing reality, uses secondary processes, balancing impulses from id and demands from superego
• Superego: the moral principle or conscience with culturally acquired values and behavior standards

Levels of Awareness/Divisions of the Mind

• Conscious: current awareness, easily recalled experiences, corresponds to "ego" or "self"
• Preconscious/Subconscious: experiences recalled with effort, part of mind storing ideas and reactions
• Unconscious: not available to conscious awareness, stores memories, feelings, and responses throughout life

Freud’s Developmental Stages/Psychosexual Development

• Oral Stage (birth to 18 months): Infants deal with anxiety by gratifying oral needs, primary need is security
  • Gratification area is the mouth
  • Greatest fear is angering anxiety
  • Fixation is caused by insecurity when parting with breast or bottle
  • Tension relieved by sucking or swallowing
• Anal Stage (18 months to 3 years): Toddlers learn muscle and social control, primary need is power
  • Gratification area is bowels
  • Critical for toilet training
  • Retention and expulsion are pleasurable
  • Bowel control around 18 months, daytime bladder control around 2.5 years, nighttime bladder control around 3 years
• Phallic Stage (3 to 6 years): Child establishes sexual identity
  • Gratification area is genital region
  • Major conflict is Oedipus complex (boys attracted to mother) and Electra complex (girls attracted to father)
  • Greatest fear: boys develop castration complex; girls develop penis envy
  • Fixation: failure to resolve Oedipus complex causes guilt

Latency Stage & Genital Stage

• Latency Stage (6 to 12 years): Child establishes same-sex relationships
  • Gratification area is none at this stage. Sexual energy diverted to play activities
  • Marked by expansion of peer relationships and hobbies
• Genital Stage (12 to 18 years): Adolescents establish relationships with the opposite sex
  • Gratification area is secondary sex characteristics, reawakening sexual drives
  • Individuals mature sexually
  • Characterized by opposite sex relationships
  • Focus on peer group, sexual identity, love, and work

View of Mental Illness

• All behavior has meaning, even if unconscious
• Symptoms arise from internal conflicts from unresolved childhood issues
• Adult situations similar to childhood conflicts can cause symptoms
• Defenses are fixed early in development

Interpersonal Theories

• Focus is on interaction between individual and environment
• Theory states personality is shaped through interactions with others
• Children internalize others' approval or disapproval, shaping the self through their views
• Theory emphasizes the influence of social and environmental factors on personality development

Components of Personality

• "Good-me": develops from behaviors approved by parents or others
• "Bad-me": arises from behaviors disapproved by parents or others, causing anxiety
• "Not-me": comes from behaviors generating extreme anxiety in parents or others, denied as part of oneself

Sullivan's Interpersonal Theory

• Infancy (0-18 months): learning to trust others
  • Satisfaction during feeding leads to positive self-esteem
  • Solitary play is central
• Childhood (18 months to 6 years): accepting influence of others
  • Emphasizing a sense of power
  • Parallel play
• Pre-school to later childhood: imitating behaviors, creativity, and curiosity
  • Associative or cooperative play
• Juvenile (6 to 9 years): Forming peer relationships
  • Involves competition, compromise, and cooperation
• Preadolescence (9 to 12 years): friendship with same-sex peers
  • Developing capacity for intimacy
• Early adolescence (12 to 14 years): becoming more independent
  • Establishing relationships with the opposite sex
  • Experiencing sexual urges
• Late adolescence (14 to 21 years): developing enduring intimate relationships with opposite sex

Illness in an Interpersonal Context

• Symptoms linked to conflictual or problematic relationships
• Mental illness tied to past relationships, poor communication, and current relationship crises

Erikson's Psychosocial Theory

• States ego development comes from social interaction
• Developmental tasks are sequential, depend on mastering previous tasks
• Failure to master tasks can be addressed later in life
• Views on mental illness are similar to Freud's

Infancy & Toddler years

• Infancy (Trust vs. Mistrust, 0-18 months): infant learns to trust others
  • Unmet needs cause mistrust, hostility, withdrawal, and fear
• Toddler (Autonomy vs. Shame and Doubt): toddler learns self-control and beginning of independence
  • Result of establishing differentiation between the self and outside influences
  • Develops willpower
• Preschool (Initiative vs. Guilt): children learn assertiveness
  • Major task is proper sex role identification
  • Failure to accomplish leads to bad sex role identity

School age, Adolescence & Young Adulthood

• School Age (Industry vs. Inferiority): learning self-confidence through cooperation
  • Acquiring competence, socialization with peers is important
• Adolescence (Identity vs. Role Confusion): developing a sense of self
  • Focused on fidelity, deciding who they are and will be
  • Beginning to make career choices and accept body image changes
• Young Adult (Intimacy vs. Isolation): developing intimate relationships
  • Intimacy means being close to others as lovers, friends, and society members; based on trust developed during infancy

Adulthood stages

• Middle Adult (Generativity vs. Stagnation): guiding others and contributing to society
  • Generativity is extending love to future generations
  • Major task is ability to care
• Older Adult (Integrity vs. Despair): feeling satisfied with one's life
  • Accepting responsibility for one's life
  • Occurs when adults accept their life's course events
  • Despair means life was wasted

Piaget's Cognitive Theory

• It focuses on the innate development of thinking from infancy to adulthood
• Individuals tend to organize and to adapt to their environment.

Sensorimotor & Preconceptual stage

• Sensorimotor Stage (birth to 18 months): learning about self and surrounding area by senses and motor skills

  • Primary circular reactions (birth to 4 months): infant reacts to environment in an undifferentiated manner
  • Secondary circular reactions (4-12 months): infant engages in actions extending to the environment
  • Tertiary circular reactions (12-24 months): Infants repeat cycle to cause interesting things

• Preconceptual Stage (2 to 4 years): developing language and symbolic play

Intuitive, Concrete and Formal stages

• Intuitive Stage (4 to 7 years): classifying and grouping with egocentric thinking
  • Learning relationships and classes
  • Learning that breaking rules leads to punishment
• Concrete Operations Stage (6 to 12 years): learning systematic reasoning
  • Understanding cause and effect in concrete situations but cannot reason hypothetically
  • Relating to events, classifying objects and people
• Formal Operations Stage (12 to 18 years and above): learning abstract and conceptual thinking
  • Employing logical reasoning, progressing from logical to concrete to logical
  • Problem solving occurs usingscientific method

Cognitive View of Mental Illness

• Belief that distorted thinking causes maladaptive behaviors
• Belief that certain thought patterns are misperceptions

Humanistic Framework

• This theory focuses on “here and now,” including beliefs and values
• Needs organized in a hierarchy

Maslow’s Hierarchy of Needs

• Physiological needs (food, oxygen, rest)
• Safety and Security (self-preservation)
• Love and Belongingness (relationships)
• Self-Esteem (contributing to society)
• Self-Actualization (self-fulfillment)

Mental Illness in Humanistic Theory

• Failure to develop potential causes poor coping
• Lack of self-awareness, unmet needs interfere with security and relationships
• The fear of death leads to existential anxiety