ABSTRACT | PDF

SEMINAR

Psychosexual development

Diganta Kumar Das
Postgraduate Trainee of Psychiatry
Silchar Medical College and Hospital

Introduction The term ‘sexual’ in psychoanalysis denotes a wide range of activities over the genital performances. In psychoanalysis sexual and genital are not synonymous. All genital events are sexual but not all sexual events are genital. For consideration of sexual function following points are important: 
Sexual life of an individual starts immediately after his birth.
The scope of sexual is wider than genital.
Sexual life consists of the activities of the different zones of the body which bring pleasure to the individual. These activities may or may not co-incide with the function of reproduction.
Sigmund Freud introduced the term libido for the dynamic manifestations of sexual instincts in human mental life i.e. libido is energy of sexual instincts. The libido is made up of sexual instincts that give pleasure from erotogenic zones of the body. First oral zone plays the leading role in the formation of the organization. Oral phase is followed by anal phase, phallic phase, latency period. These phases are followed by genital phase at puberty when whole system matures for reproduction. 
In course of sexual development in a child the phases pass from one stage to another. Some portion of component sexual instincts may remain behind and keep attached to previous zone. This give rise to a condition called ‘fixation’ - the root cause of neuroses. 
As his clinical experience expanded, Freud was able to reconstruct to a certain degree, the early sexual experiences and fantasies of his hysterical patients. Freud thinking about infantile sexuality, even his own self analysis which began in 1897; infantile sexual longings might not be restricted to a pathological development neuroses but normal individual might undergo similar developmental experiences. 
The psychosexual development can be elaborated in:
Freud’s phases of instinctual development.
Erik Erikson’s epigenetic sequences.
Margaret Mahler’s separation-individuation process.

History Child development: Change in the child that occurs over time. Changes follow an orderly pattern that moves toward greater complexity and enhances survival. Periods of development-
Prenatal period: from conception to birth
Infancy and toddlerhood: birth to 2 years
Early childhood: 2-6 years old
Middle childhood: 6-12 years old
Adolescence: 12-19 years old
Domains of development: Development is described in three domains, but growth in one domain influences the other domains.
Physical domain - Body size, body proportions, appearance, brain development, motor development, perception capacities, physical health.
Cognitive domain - Thought processes and intellectual abilities including attention, memory, problem solving, imagination, creativity, academic and everyday knowledge, metacognition, and language.
Social/emotional domain - Self-knowledge (self-esteem, metacognition, sexual identity, ethnic identity), moral reasoning, understanding and expression of emotions, self-regulation, temperament, understanding others, interpersonal skills, and friendships.
6th-15th centuries (medieval period): Preformationism - Children seen as little adults. Childhood is not an unique phase. Children were cared for until they could begin caring for themselves, around. Children treated as adults (e.g. their clothing, worked at adult jobs, could be married, were made into kings, were imprisoned or hanged as adults).
16th Century reformation period: Puritan religion influenced how children were viewed. Children were born evil, and must be civilized. A goal emerged to raise children effectively. Special books were designed for children.
17th Century age of enlightenment: John Locke believed in tabula rasa. Children develop in respoanse to nurturing. Forerunner of behaviourism. 
18th Century age of reason: Jean-Jacques Rousseau - Children were noble savages, born with an innate sense of morality; the timing of growth should not be interfered with. Rousseau used the idea of stages of development. Forerunner of maturationist beliefs.
19th Century industrial revolution: Charles Darwin (1877) - Theories of natural selection and survival of the fittest. Darwin made parallels between human prenatal growth and other animals. Forerunner of ethology. 
20th Century: Theories about children's development expanded around the world. Childhood was seen as worthy of special attention. Laws were passed to protect children.
Psychoanalytical theories - Beliefs focus on the formation of personality. According to this approach, children move through various stages, confronting conflicts between biological drives and social expectations.
Freud - Psychosexual theory (in between 1897-1949) was based on his therapy with troubled adults. He emphasized that a child's personality is formed by the ways which his patients managed his sexual and aggressive drives.
Erik Erikson - Psychosocial theory (1968). Expanded on Freud’s theories. Believed that development is life-long. Emphasized that at each stage, the child acquires attitudes and skills resulting from the successful negotiation of the psychological conflict.
Behavioural and social learning theories- 
John Watson (1928). He is the forerunner of Pavlovian stimulus response model for condition reflex. Published his theory “conditioned emotional reaction” in 1920. 
B. F. Skinner (1904-1990). According to him personality does not differ from other behaviour. Rewards and punishment alter the behaviour. 
Ethology: Konrad Lorenz (1974) - He was awarded Nobel Prize in 1974 for study on imprinting i.e. young animal is highly sensitive to certain stimuli for a certain period of development. Also contributed study on aggression in animal kingdom which can be applied to human being also.
Attachment theory: John Bowlby - According to him attachment constitutes a central motivational force. Mother child attachment is an essential medium for human interaction and for future personality functioning. Attachment is the emotional tone between the child and the care giver.  
Cognitive theories: Jean Piaget ( 1896-1980) - He published his works in 1970. According to his theory, there are four stages of cognitive development 
Sensory motor                 (birth – 2 years)
Pre-operational thought       (2-7 years)
Concrete operation            (7-11 years)
Formal operation              (11-end of adolescence)

Stages of psychosexual development According to Freud, personality develops through a series of stages in which the energies of the id are focused on certain erogenous areas. This psychosexual energy, or libido, was described as the driving force behind behaviour.
The summary below offers a brief overview of these stages of psychosexual development, the approximate age levels for each stage and the primary conflict confronted at each stage.
Oral stage (birth to 1 year). Characteristics - An infant's primary interaction with the world is through the mouth. The mouth is vital for eating, and the infant derives pleasure from oral stimulation through gratifying activities such as tasting and sucking. If this need is not met, the child may develop an oral fixation later in life, examples of which include thumb-sucking, smoking, fingernail biting and overeating.
Objectives - To establish a thusting dependence on nursing and sustaining objects to establish comfortable expression and gratification of oral libidinal needs without excessive conflict or ambivalence.
Pathological traits - Excessive oral gratification or deprivation can results in libidinal fixation that contribute to pathological traits. These traits are narcissism, optimism, pessimism. Such persons are extremely dependent on objects for maintaining their self-esteem.
Character traits - Successful resolution of this phase provides a basis in character structure for capacities to give to and receive from others without dependence and envy and mistrust.
Anal stage (1 to 3 years). Characteristics - Freud believed that the primary focus of the libido was on controlling bladder and bowel movements. Toilet training is a primary issue with children and parents. Too much presure can result in an excessive need for order or cleanliness later in life, while too little pressure from parents can lead to messy or destructive behaviour later in life.
Objectives - This period is essentially a period of striving for independence and separation from dependence and control by the patient. The objectives of sphincter control without over control needed for autonomy and independence without any doubt.
Pathological traits - Mal adaptive character traits are derived from anal eroticism and the defenses against it. Orderliness, stubbornness, willfulness, are features of anal character derived from a fixation at anal function. When defenses against anal traits are less effective these reveals trait of ambivalence, lack of tidiness, defiance, rage as seen in obsessive compulsive neuroses.
Character traits - Successful resolution leads to autonomy, independence, initiative without guilt or self-doubt and lack of ambivalence. 
Phallic stage (3 to 6 years). Characteristics - Freud suggested that the primary focus of the id's energy is on the genitals. According to Freud, boy's experience an Oedipal Complex and girl's experience and Electra Complex, or an attraction to the opposite sex parent. To cope with this conflict, children adopt the values and characteristics of the same-sex parent, thus forming the superego.
Objectives - Focuses on erotic interest in genital area and its funciton. It lays the foundation for gender identity and serves to integrate the residues of previous stages. The oedipal situation is essential for identification - the basis for character organization. 
Pathological traits - Important focus, developmental distortions in this period derived from the patterns of identification that are developed out of the resolution of the oedipal complex. The castration anxiety determines the development of human character.
Character traits - This stage provides sense of sexual identity without embarrassment, initiative without guilt. It provides powerful resources for regulation of drive impulses. The internal source of regulation is the super ego, based on identification with parental figure. 
Latent stage (6 to 11 years). Characteristics - During this stage, the super ego continues to develop while the id's energies are suppressed. Children develop sociall skills, values and relationships with peers and adults outside of the family.
Objectives - This stage allow for the development of ego apparatuses and mastery skills.
Pathological traits - Lack of development of inner control may lead to sublimate energies in the interest of learning and skills.
Character traits - It is a period of integrating previous stages of psychosexual developments. The child can develop a sense of industry and capacity for autonomous function. A sense of initiative without a sense of inferiority.
Genital stage (11 to 18 years). Characteristics - The onset of puberty causes the libido to become active once again. During this stage, people develop a strong interest in the opposite. If developmemnt has been successful to this point, the individual will continue to develop into a well-balanced person.
Objectives - The primary objectives of this period is ultimate separation from dependents and attachment to the parents. Related to this are the achievement of mature sense of personal identity and adult role function in social expectations and cultural value.
Pathological traits - All the previous unsuccessful resolutioons and fixations in the stages of psychosexual developments will produce pathological defects in adult personality.
Character traits - Successful resolution lead to mature personality with a satisfying genital potency, self integrated and consistent sense of identify as an adult person.
Karl Abraham (1877 – 1975) elaborated Freud`s theory of psychosexual development. He devided oral phage into biting and sucking phase and anal stage to (i) anal sadistic phase and (ii) anal erotic phage. Phallic stage was divided into (i) early phage of genital love (true phallic phage) and (ii) later mature phage. According to him obsessive compulsive neurosis resulted from fixation at anal sadastic phage. Karl Abraham also contributed psychodynamic origin of depression. According to him depression originates as a result of defects in infant and mother relation in oral phage.

Erik Erikson’s epigenetic principle Erik Erikson made a major contribution to the psychoanalytic concept of development in his study of relationship between instinctual zones and development of ego functioning. He postulates an epigenetic time-table of instinctual psychosexual development and specific phases of ego or psychosocial development. During libidinal development certain erotogenic zones become loci of stimulation for development of corresponding modalities of ego functioning. If successful resolution of a particular stage does not occur, all subsequent stages reflects that failure in the form of physical, cognitive, social and emotional mal adjustment. 
There are eight stages of lifecycle- 
(i) Stage I (birth to 18 months): Trust versus mistrust; the crisis of trust vs. mistrust is the first psychosocial crisis the infant has to face. The infant’s primary orientation to reality is focused on oral zone through feeding given by the mother who plays a vital role as female. Any defect in her identity has got consequences for quality of interaction between the mother and the infant. Successful resolution of this initial phase entails a disposition to trust others, basis for trust on self and capacity to receive trust from others. 
(ii) Autonomy versus shame and self-doubt (18 months to 3 years): The second stage is anal erotism. Biologically marked by formation of fuller stool and sphincter control. This stage is source of pleasure by retaining or releasing. Psychologically this period is marked by self awareness as a separate and independent unit and associated with increasing capacity for autonomous self expression and self regulation. Corresponding defect is this stage lead to domination by others and excessive rigidity and compulsive personality leading to low self esteem and sense of shame. 
(iii) Initiative versus guilt (3 to 5 years): During this period the child attain locomotion and language. The child becomes vigorous and intrusive. These lead to growing sexual curiosity and pre-requisite for masculine or feminine initiatives. If the crisis of initiatives is successfully resolved, a sense of responsible dependable mature personality develops in future. This stage is crucial for development of super ego based on introjections of authoritive, parental prohibition. 
(iv) Industry versus inferiority (9 to 11 years): The period of infantile sexuality and the period of adult sexuality, (puberty) are separated by a so called latency period in which the child’s interest is generally diverted to other matters. Here children are sent to school, they learn skills and generally they become involved in developing necessary technology for adult living. They assimilate to value of applications and diligence and a sense of industry. Lack of fulfilling demands in school, society and inability to resolve psychosocial crisis lead to inferiority. 
(v) Identify versus identify confusion (adolescent): Passage to adolescent years leads to growth and sudden maturation of genital organ. The adolescent begins to shape to future role in adult society. Adolescent needs to maintain a confident sense of self awareness and continuity.    
(vi) Intimacy versus isolation (young adult): Adulthood is marked by psychosexual maturity and establishment of significant interpersonal relationship. The intimate association of male and female in a close interpersonal union through culturally approved institution i.e. marriage take place. Inability to resolve psychosexual crisis isolation  takes place. 
(vii) Generativity versus stagnation (Middle adult) : Generativity means ability to establish and  guiding succeeding generations. According to Erikson it is ability, and instinctual power in various forms of caring by a man to generate and leave behind. At this point, a midlife crisis may occur. So generativity has goal for enrichment of life for others exclusive of any concern over self interest. 
(viii) Integrity versus despair (older person): Integrity marks the development of acceptance of one self in all aspects of life and integration of these elements into a stable pattern of living. It is acceptance to life itself and acceptance of end of the life in death. Inability to achieve ego integration results often in a despair and unconscious fear of death.

Bibliography
1. Comprehensive Textbook of Psychiatric - Kaplan & Sadock’s.
2. Synopsis of Psychiatry - Kaplan & Sadock’s.
3. Introduction to Psychology - Morgan & King.
4. Postgraduate Textbook of Psychiatry - Ahuja.
5. www.google.com.

 

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