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As a social care worker I have often learned through trial and error what works in the real world, basing my practice on common-sense and not on abstract theories. But I recognise my views are often based on opinion and prejudice rather than evidence-based, peer-reviewed knowledge and as Beckett suggests, “our own theories and ideas about why people are as they are and behave as they behave, are usually quite inconsistent and arbitrary, based on our own experience and on our own needs” (Beckett, 2002:8).
Human growth and development theory is concerned with understanding how people grow and change throughout their lives, from the vital early stages to old age, and therefore is essential for informing social work practice. The theory can be applied to a variety of areas within human life and conduct including social, cultural, emotional and psychological, and also, moral, intellectual, spiritual and biological viewpoints. In this assignment I will focus on the psychological and cultural significance of the stages of development in relation to a 12 year old in foster care.
Jake, a dual heritage British male, was taken into care 4 years ago following him being removed from his mother Maggie an African Caribbean female aged 32. Jake and Maggie lived in a 3rd floor, 2 bedroom flat in an area where drug dealing and drug related crime is common place. In Jake’s bedroom he had a plastic box for his clothes and mattress on the bare floor with a bucket for a toilet as Maggie would lock him in his room when she went out. Maggie had been using drugs for many years and her previous partner (Jake’s father) introduced her to heroin 5 years ago. She quickly became addicted and the relationship broke down shortly afterwards. Jake’s father has not had any contact or attempted to make contact since the break up. Jake and Maggie had been known to Social Services as Maggie was a victim of domestic violence and spent 4 months in a women’s refuge.
Jake has had a number of placement breakdowns and has been unable to form any attachments with any of the foster carers. Jake would often defecate around the house and his last placement broke-down because Jake defecated in the foster carers bed then went on to smear their bedroom walls. Jake displayed difficulties in using a knife and fork and would often get frustrated and either eat with a spoon or his hands. Maggie had been diagnosed as suffering from a severe depression, worsened by her drug addiction. It is thought that whilst Maggie was going through a depressive episode she would physically abuse Jake. Jake was often left on his own for long periods whilst Maggie would be out in search of drugs. When she returned home Jake was subjected to emotional abuse and was often blamed by Maggie for their situation.
Jake has been in the fostering system for a number of years and in that time he has not formed any meaningful attachments. Whilst in placement Jake disclosed events and thoughts which alerted foster carers to the fact that there may be some unresolved issues that need to be addressed before Jake can move on with his own growth and development. Jake would often revert to pulling his hair and banging his head on the wall if he felt he had done something wrong and was going to be blamed for it. For example, when he accidentally breaking a cup. Jake is being assessed by CAMHs as he has been displaying behaviour that indicates there may be an underlying depressive mental health problem. Theories of human development have produced explanations about the origins of mental disorder in the areas of psycho-analysis and child psychology, from the early grand theories of Freud and Bowlby and further developed by Klein and Ainsworth.
Freud saw psychodynamic theory as a more informative model in relating past psychological events to present day symptoms. Freud believed behaviour is not ruled by conscious processes but conflicting unconscious processes, he saw a person’s psychological processes involving counteracting forces competing in an ‘intra psychic conflict’, a concept shared by many theorists of human growth and development. In Freud’s model a child starts life with specific basic instinctual needs, such as for food or sexual gratification. Internally, the id continually seeks to meet these needs, while the ego mediates between the desires of the id and the restraints of the external world, particularly the demands of significant and powerful adults in the child’s life, such as his mother and teachers. According to Freud these adult figures are eventually internalised in the form of the superego, or adult conscience. The child’s ego attempts to negotiate the competing demands placed upon him, developing his own distinct personality and progressing to adulthood (Freud, 1949).
Erikson’s psychosocial stages of development have Freudian psychodynamic origins. The idea that unconscious processes cause conflict within humans is also central to Erikson’s theory. His staged development model is based on the idea that these ‘intra-psychic conflicts’ occur throughout our lives and need to be resolved satisfactorily if we are to avoid psychological distress and mental illness (Erikson, 1995). Erikson’s psychosocial theory of human development builds on Freud’s psychodynamic model, but while Erikson accepts ideas, such as the unconscious, he rejects concepts of the personality which are described exclusively in terms of sexuality. Again, like Freud, Erikson believed childhood was central in the development of personality, but that the personality continued to develop beyond the age of five (Erikson, 1995).
Erikson’s psychosocial model describes eight stages from infancy and adulthood. At each stage a person encounters new challenges. If they are not successful in meeting these challenges, they may reappear as problems in the future. However, while each stage presents new challenges, they also provide opportunities to deal with the unresolved issues. In Erikson’s model there is no assumption that one stage has to be fully completed or that the most favourable outcome has to be achieved before moving on. In fact, he acknowledges that it is likely that everyone will have unresolved issues from previous stages and there is a ‘favourable ratio’ between favourable and unfavourable outcomes (Erikson, 1987). However, the more unresolved issues carried forward, “will impede successful progressionâ€¦an unfavourable outcome in one stage makes it more difficult to meet fully the challenge of the next stage” (Beckett, 2006:42).
Erikson’s model proposes a first stage that involves establishing a sense of trust (0 – 1 yrs.). If partly or completely unsuccessful at this stage, then it will be more difficult to achieve a sense of autonomy at the next stage (1 – 3 yrs.), and then more difficult still to develop a capacity for initiative in the next stage (3 – 5 yrs). The next stage in Erikson’s model (6 – 11 yrs) involves establishing “a sense of competence and achievement, confidence in one’s own ability to make and do things” (Beckett, 2006: 43). It is difficult to conclude how successful Jake was able to negotiate previous stages, however it has been suggested that “despite adversities some children are able to develop reasonably well-adjusted personalities demonstrating resilience and normal development under difficult circumstances” (Crawford & Walker, 2003: 48).
One of the weaknesses of Freud’s and Erikson’s theories of human growth and development using stages as the model, is the underlying assumption that everyone’s lives follow these particular linear lines, and that we all, more or less, achieve the same milestones at the same time. However, we know this is rarely the case. It appears, for instance, that these theories were based solely on a white, male Eurocentric model, and do not consider specifically customs from other cultures or perspective. Baltes (1987), for example, suggests human development is multidimensional, involving biological, cognitive and social dimensions, and multidirectional, not to be viewed as a single fixed route which represents the norm, but as periods of varying growth and differing paths.
Bowlby differs from Freud in that he saw an attachment between child, and mother or primary attachment figure (which may differ according to the social and cultural background of family), as an essential need in itself and not simply to meet basic needs, such as, food and sex: “Mother love in infancy and childhood is as important for mental health as are vitamins and proteins for physical health” (Bowlby, 1953). Attachment theorists maintain that the way we relate to other people through our lives is influenced significantly by our first relationship with our mother or primary attachment figure (Howe, 1995; Howe et al, 1999). They suggest, like Erikson and Freud, that many problems in adulthood stem from unresolved issues in these early attachment relationships and these early relationships can shape an adults ability to form relationships, to parent, to deal with loss, and influence mental health in adulthood (Bowlby, 1990). While accepting much of his work, critics of Bowlby claim he placed too much emphasis on the child/mother relationship and suggest children may form several attachments which can be equally important (Rutter, 1981; Fahlberg 1991). However, children who experience trauma are sometimes unable to progress without repressing or closing down part of their conscious awareness of these events. We can imagine Jake needing to shut out his experiences of childhood neglect and, according to Freud, automatically and unconsciously repress the events of neglect and abuse. We can see how blocking out these unresolved issues could emerge in the form of depression at some point in the future. There is evidence of the social origins of depression in women, suggesting that specific life events, losses and major long term problems, such as childhood abuse, are significant causes of depression (Brown & Harris, 1978). I feel that this best reflects Maggie’s current situation.
We can imagine Jake experiencing a sense of loss or ‘maternal deprivation’ (Crawford & Walker, 2003) when faced with his mother’s depression. This is a common emotional reaction in carers of adults with depression, “the seemingly most central and common experience was the feeling that the person they had known who had become ill had gone away: they had become someone elseâ€¦there is the loss of the person that was, and secondly, and more complexly, there is the experience of the loss of the previous possibilities” (Jones, 1996: 98-99). Although Maggie may have experienced depression continuously before Jake’s birth, it is more probable that she had periods of respite when her capacity for emotional warmth and attentiveness to her son’s needs was greater than during times of relapse. The difference in the consistency and intensity of a child’s attachment relationships is considered an important factor by a number of attachment theorists (Ainsworth, 1973).
The theories of human growth and development discussed above suggest that Jake’s experience of abuse as a child may prevent him from developing into a mentally healthy adult. He may have automatically and unconsciously repressed the trauma of these events, only to experience the mental distress of depression in the future. Jake may have experienced physical abuse from an early age and failed to successfully achieve a sense of trust or autonomy or develop a capacity for initiative while growing up. Even relatively short periods of physical abuse at crucial stages may have placed severe pressures on his relationship with his mother. Jake may have only known his mother as depressed, but their relationship may have determined Jake’s future capacity to form relationships, for instance, with foster carer’s or at school with friends and teachers.
The method of intervention in Jake’s life could be usefully informed by research that links mental distress with experiences of powerlessness. It has been suggested that mental distress may be seen as “extreme internalisations of powerlessness” placing “a paralysing power both over those who may experience such forms of distress, and those who share their lives” (Tew, 2005: 72). Using social models, Tew suggests two complementary ways to understand mental distress, “internalisation or acting out of stressful social experiences” and “a coping or survival strategyâ€¦to deal with particular painful or stressful experiences” (Tew, 2005: 20).
A person’s mental health needs may, to a certain extent, be determined by their membership of certain social groups that experience systematic oppression (Fernando, 1995; Gomm, 1996). Oppression, exclusion and powerlessness are the central themes of many social models of mental health needs, related to structural inequalities in terms of age, gender, race and class and so on, and involving families in terms of abuse. As social workers we occupy a relatively powerful position and may collude with the systematic oppression of black people with mental health needs: “Factors such as oppression, injustice, social exclusion or abuse at the hands of powerful others may be implicated in the sequences of events that lead up to many people’s experiences of mental and emotional breakdown. Power issues may also shape the reactions that people receive from professionals and the wider community-for example, evidence suggests that African-Caribbean people may be more likely than many ‘white’ groups to be dealt with more coercively” (Tew, 2005: 71).
When coming to a stage where we may be better able to understand Jake’s current circumstances and making initial judgments about the type of intervention most effective in this case, we need to recognise the limitations of our insights and avoid the pitfalls of making uncritical assumptions. Tew suggests that empowerment can be an integral part in the process of Jake’s recovery. He outlines a model of power in terms of protection and co-operation and oppressive and collusive: “In its more negative forms (oppressive or collusive power) it may be seen to play a role in constructing social situations which contribute to distress or breakdownâ€¦in its more positive forms (protective or co-operative power) it starts to define the territory for effective partnership working, anti-oppressive practice and the enabling of recovery and social inclusion” (Tew, 2005, p. 86).
According to the psychodynamic model of human growth, Jake may have grown up with many ‘intra-psychic conflicts’ which may be emerging in the form of a neurotic or reactive depression. He may have many conscious and unconscious needs which she has suppressed and repressed. In denying and blocking out the fulfilment of these needs, he may have shut down areas of his consciousness which allows him to: experience emotion; interact with others in a spontaneous way; or experience fulfilling close and intimate relationships with carer and their spouse. Depending on the extent of physical abuse he encountered during his upbringing, it would be reasonable to assume that he may have been completely or partly unsuccessful in: achieving a capacity for trust with his parent; achieving autonomy; or developing a capacity for taking initiative, as described in Erikson’s psychosocial model. For these reasons, it seems likely he will have failed to maintain a healthy, consistent and sustained relationship with his mother or other primary attachment figure in the abusive situation he found himself.
Intervention must aim to address issues of power and powerlessness, both in the foster carer/child relationship and outside it. As a man, as a person with mental health needs, and as a member of a black or minority ethnic group, Jake may experience oppression, abuse and social exclusion. To address these issues elements of empowerment and partnership should be part of the approach with an intervention designed to address Jake’s mental health needs should involve building on his efforts to achieve his own full potential. This will include his ability to form and maintain healthy relationships with others, that would lessen any dependence on formal agencies and develop an alternative source of positive support and increase social inclusion.
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