Abstract
When I first commenced training in psychiatry in 1972, David Maddison, who had been a major influence on my decision to do psychiatry, recommended I read two books. One was the Interpretation of Dreams by Freud [1] and the other was Erikson's Childhood and Society. The latter has influenced my professional practice since by highlighting for me what I later came to understand as the ‘developmental perspective’. Reared on a diet of Freud, I was dissatisfied with the apparent abrupt end of the story at age 6. Surely this could not be so; surely events recurring after the genital stage could have a continuing effect on psychological development. I saw in one's clinical work many individuals with disastrous childhood experiences who remained vulnerable for life, but also those (who for a greater or lesser period of life) transcended such an unpromising start. Erikson's book, and the epigenetic framework it proposed, gave me an intellectual framework within which to understand both groups of people and to plan meaningful psychotherapeutic treatment for them.
The book also was my first direct confrontation with the awareness of the power of culture to influence the behaviour, and even the personality, of individuals and groups through the diverse histories of the two Indian tribes described as Hunters Across the Prairie and Fishermen Along a Salmon River (Chapters 3 and 4). It was through Erikson's writing that I caught a glimpse of what I now realise more clearly – that culture is not a coat that you can take off or put on as the fashion dictates, but rather a skin in which you live your life; it is as much a part of you as you are a part of it. I also came to appreciate another truth: youth and evolution of identity are inextricably intertwined. It was from him that I came to realise that in youth the ego faces the task of synthesising a thousand different conflicts, predispositions, emotions, likes and dislikes into some kind of coherent whole, so that the individual can bring their individual talents to bear on the business of life. I have since come to realise just how long this process can take with today's youth and how disastrous the consequences can be if this does not happen.
On re-reading the text I appreciated better the constant movement of the writer from the individual's feelings and response to family, groups and nations, and the breadth of knowledge of European history that he brought to bear on the task.
A major advantage of Erikson's model is that it is easily and intuitively grasped, students, registrars, and patients all resonate to it. They are aware that the child is the father of the man; and they can understand the fundamental tasks that must be faced at each of the stages. In fact, so persuasive is the message that I am forced in my teaching to remind them that what Erikson has constructed is not the truth but a metaphor, an allegory, a way of seeing ourselves and our patients that accepts the reality of our past, but leaves us with the hope that we will not be doomed by it. Erikson himself was concerned that some were misusing his concepts and implying that, for example, the giving of the sense of trust was an achievement secured once and for all. He wished to remind his readers that mistrust was never banished and remains in the psyche ready to be activated if the series of life events make it adapt and emerge. ‘The personality is engaged with the hazards of existence continuously even as the body copes with disease.’ While it is fair to say that the experimental base for Erikson's theory is fragile and many modern books on developmental psychology pay him and his book scarce attention, its face validity and explanatory power are substantial.
The other advantage of this model is that it has direct relevance to therapy of all types: dynamic, interpersonal and cognitive–behavioual. If individuals have been affected by events in their past, then, as Jerome Frank postulated, helping them to create a ‘plausible explanation’ is one of the goals of all therapies, as is working with the patient to find new ways of dealing with their problems.
One difficulty I have always experienced is the linking of the stage of life to ‘basic virtues’: hope, will power, purpose, competence, fidelity, love, care, wisdom. What are these and why were they chosen? This only became clear to me on reading The Life Cycle Completed [2]. Erikson had proposed a developmental schedule of psychological virtues in Insight and Responsibility [3]. He gave his most recent restatement of the rationale underlying his eight stages this latter book. A more artful and literary approach to his conception may be witnessed in the collection of papers including his own analysis of an Igma Bergman movie edited by Erikson under the title Adulthood [4].
The Latin root of the word virtue is virilitus meaning virility or strength. Coupled with this root is another Latin noun of the feminine gender virtus meaning goodness. It is in the sense of these Latin roots that Erikson employs the term virtue and the specific virtues listed above. At each of the eight developmental stages, one of these virtues is added to the ego's changing and growing sense of continuity, therefore, Erikson uses the term virtue to indicate the capacity of the ego for strength, restraint and courage. In Erikson's own words [3, pp. 18,19]:
I will call virtue then, certain human qualities of strength and I will relate them to that process by which ego strength may be developed from stage to stage and imparted from generation to generation … hope is the enduring belief in the attainability of fervent wishes in spite of the dark urges and rages which mark the beginning of existence. Similarly, will is the unbroken determination to exercise free choice as well as self-restraint in spite of the unavoidable experience of shame and doubt in infancy.
Erik Erikson, perhaps one of the last great synthesisers in the behavioural sciences, died 12th May 1994 in Harwich, Massachusetts. His latest biography has recently appeared [5]. The originator of the term identity crisis, Erikson knew a great deal about the phenomenon first hand. He had been born on 15th June 1902 near Frankfurt, Germany, where his mother had gone to be with friends after the break up of her first marriage. Erikson himself did not learn about the circumstances of his parentage until his adolescence, that period of the life cycle in which he located identity as the normative crisis. He had been led to believe throughout childhood that his stepfather, Theodore Homburger, was his biological father. In truth, his mother had met and married Homburger after she took an ailing 3-year-old Erik to the paediatrician for a consultation. Erik's birth had resulted from extra-marital liaisons of his mother, and Erikson kept her secret until he was 68. He was known as Erik Homburger until he immigrated to the USA in the early 1930s where he adopted the name Erikson, literally the son of Erik [6].
During Erikson's Vienna years, the early 1930s, he came to the attention of Anna Freud, who invited him to become one her training analysands as a scholarship student. It was also in Vienna that he met and married Joan Serson, herself a dancer and artist and analysand of one of Freud's early followers. The cloud of political turmoil that gathered in Europe by 1933 was the occasion for many psychoanalysts to leave for America. Remarkably, within 10 years of arrival Erikson, had received appointments at premier universities and medical research centres on both the east and west coasts, at Harvard, Yale and the University of California at Berkley.
In 1936, shortly after moving to Yale, he undertook fieldwork amongst the Sioux at an Indian reservation in South Dakota, laying the groundwork for Childhood and Society. In the four parts of that book Erikson brought together many of the aspects of his career up to that point. In Part One, his reworking of Freud's theory of infantile sexuality, Part Two examines childhood through his psychoanalytic insights in the two native American groups with which he did fieldwork, the Sioux and the Yurak, Part Three goes significantly beyond Freud and places Erikson among the top ego-psychologists laying out his developmental chart of eight stages, and in Part Four he turns his attention to youth and the evolution of identity.
His work is both a psychoanalytic ego-psychology and a unique creation that he called a psychosocial life span theory. The focus for Erikson, as for the other ego-psychologists, was on the person's interaction with the significant people in his or her life. Instincts or drives are important, but the chief concern for Erikson is how the person interprets those needs. Erikson also broadened the theoretical focus to include a concern for cultural rituals and values imparted to the developing child in the family.
Central to Erikson's formulation are his concepts of:
Ego-identity formation, by which he means that the ego or person stands outside itself, judging the continuity, the reliability and the consistency of life as it is lived.
Developmental progression of the human life cycle through eight stages, from infancy to old age. A human life is a psychological success for Erikson if the earliest achievement is the acquisition of basic trust in self and others, and the last achievement is a sense that one's life was good exactly as it was lived.
Ego-strengths that mark each of the eight stages and that are actually classical virtues, such as hope, will, purpose and wisdom.
Erikson achieved wide recognition beyond psychoanalysis for his specification of the stages through which an individual ego develops in response to the crises initiated by the biological and social givens of life. The child's ego matures in an epigenetic sequence of combined psychosocial and psychosexual stages. The term epigenetic is drawn from biology and means that the structure of an organism and its sequence of development are precisely laid down in the organism's genetic code. For the organism to reach full development of its potential structure, the environment must provide specific stimulation at key points. The structure that thus unfolds is rigidly predetermined by the organism's genetic endowment, but its unfolding is governed by environmental variables.
Thus, Erikson interpreted human behaviour as product of an interaction between the individual ego, its super-ego struggle, and the external social world.
As has been described, there are many aspects of Erikson's own identity formation which can be understood by considering the facts of his own development, but in terms of his clinical sources of the identity hypothesis. Erikson's main source was when he left Nazi-dominated Europe and worked for a time at the Mt Zion Veteran's Rehabilitation Clinic in San Francisco. In treating military casualties he first coined his now famous phrase ‘identity crisis’ to describe the chaotic, profoundly confused mental state of soldiers hospitalised for battle neurosis. As Erikson described these soldiers it was as if their egos had lost their shock-absorbing capacity.
Similarly, he achieved his anthropological sources of the identity hypothesis from his work on a field trip to South Dakota to study child-rearing practices at the Pine Ridge Indian Reservation. The express purpose of the trip was to try to find out whence came the tragic apathy with which Sioux Indian children quietly accepted and then quietly discarded many of the values taught them in the immensely thoughtful and costly experiment of Federal Indian Education.
To understand the behaviours such as truancy, stealing, apathy and excessive sexual activity, Erikson undertook a historical investigation of the Indian's tribal identity. The members of the tribe lived on land allocated to them by the Federal Government in a final act of political and economic subjugation. This policy of establishing reservations for the Indians, guiding the education of Indian children, and attempting to assimilate the Indian culture by foisting the larger society's values on this subculture resulted in the dissolution of the Indian identity. The crux of the problem, in Erikson's estimation, was the shock of contact between the two cultures, and valuable insights to help us understand issues of indigenous mental health move closer to home.
Erikson's work on culture led him to hypothesise on a parallel pair of ritualisations and ritualisms that reflect the ego's growing sophistication in cultural context to master biological and social realities. A ritualisation is an orienting or socialising mechanism, formally prescribed by the culture in which the child matures. They are experienced as ‘the only proper way to do things’, that is, as formalisations of custom. The term was borrowed by Erikson from Julian Huxley's description of evolutionary ceremonial acts of certain animals, such as the greeting ceremonies of some birds species. But Erikson uses the term for humans with less emphasis on evolutionary history and more on the informal and yet prescribed interplay between persons who repeat the ritualisation at meaningful intervals and in recurring contexts. On the negative side, each of these ritualisations is balanced by a ritualism, which is a form of estrangement from the self and from one's community.
For example, the ritualisation characteristic of the trust–mistrust stage centres on the significance of the mutual recognition and affirmation of mother and child. The infant experiences in its mother the ritualisation of her repeated presence, evidenced by her facial expression, voice quality and the feel of her touch. On the other hand the ritualism possible at this stage is idolism, a distortion of the consistent care turned into reverence, then adulation. An illusionary image of perfection is created by mother and child that binds the idolising infant to the mother, leading eventually to a narcissistic idolisation of the self. Erikson has proposed under each of the stages a ritualisation and a ritualism capacity.
During the various phases in the acquisition of these ego strengths or virtues, the maturing person will also be exposed to age-appropriate ritualisations and ritualisms, through which come a special kind of learning, the mastery of the only proper way to experience and to do things in one's culture. In the trust– mistrust stage there is ritualisation of mother–child recognition. In the autonomy–doubt stage the child learns good–bad discriminations, followed by acquisitions of the ability to elaborate dramatically conflicts and concerns in the initiative guilt phase of middle childhood. By school age, the ritualisation of methodical performance is acquired, allowing the child to progress into adolescence with a more or less perfectly formed worker image that will be further shaped by the ritualisation of shared convictions with other adolescent children. Young adulthood brings exposure to the complementary identity of one's intimate partner with whom by mature adulthood the person seeks to perform the ritualisation of transmitting values to the next generation. Old age finally sees the return, in Erikson's view, to the playfulness of childhood in the wise old person's affirmation of the life he or she has led.
Erikson's theory is probably the most widely taught, written and read about theory in contemporary psychology. He was a man of great erudition with a humanist eye for the uniqueness of the personality, the psychoanalyst's ear for the unconscious personal meaning and the artist's flair for bold, but elegant, statement. His theory deals with universals, his conception of the stages and phases asserts a universal human developmental scheme. He even reiterated Freud's anatomy as destiny dictum and thereby earned a great deal of criticism. By the same token, Erikson has argued convincingly that each of us solves the crisis of the developmental stage uniquely in terms of our given social, historical and familial context. In Erikson's work, as in few other theories, we find the idiographic perspective well balanced with normothetic principles.