This paper, divided into two parts, is intended to understand April’s case in a “thoughtfully eclectic” way from a social work perspective by applying human behavior theories. The first part shows the use of Ego Psychology to illustrate how loss from April’s father’s death interrupted her development by disrupting her ego function. The second part shows the assessment of April’s biological, psychological, and social-emotional development, the ecological factors which affected her development, and the cultural stereotype expectation on normal development. Question One:
April’s arrival was not expected by her mother; this unexpected pregnancy may have caused stress to the mother (Joy) while she carried April. This was compounded by April’s premature birth followed by other challenges, such as her father’s frequent absence due to deployment and the family’s constant movement and relocation every three years because of the father’s military profession. These pre-tragedy stresses may have impacted her ego function, especially in building up object relation. Still, despite these challenges, April’s caregivers provided her with an “average expectable environment,” which was reasonably protective and gratifying (Hartman, 1939). As a result, she grew up as a normal, even developmentally advanced, girl in many areas. Then tragedy struck. Her father committed suicide.
The impacts of the experiences in April’s short life affected how she dealt with this loss. As Corr and Corr (2004) stated, four primary variables influence a child’s course through the grief process following the death of a loved one: meaning and power of relationship with the deceased, unique circumstances of the death, unique character of the child, nature, and availability of support received from the child’s environment. Clearly, the death of her father was a profound loss to April, the primary loss of an attachment figure. Even though her basic needs might have been met by other family members, her father was the person who nurtured her physically and emotionally, who attended to her needs, who provided protection and security, and who served as an object for her to turn to as an identification figure (Bowlby, 1982; Erickson, 1959). Along with this primary loss came the secondary loss: in many ways, her life was changed as the family dynamic, such as the routine of daily life, living atmosphere inside the physical home, and behaviors of other family characters, was changed. Secondary loss also might have included how the peers and community saw and interacted with them and how the family characters perceived these interactions. All of these changes would also impact her self-esteem and sense of safety. As Silverman and Worden explained, “It is not just dealing with the death of a person but with the death of a way of life” (Silverman, Worden, 1992, p.102). As a five year old child in the pre-operational stage cognitively, April was unable to comprehend the irreversible, inevitable, and universal truth of death, especially since the death was so sudden and unexpected.
She had expected her father to take her to a ball game as he promised when she came home from her grandmother’s house. Therefore, April was already at a severe disadvantage in her efforts to make sense of the event and process its meaning (Hutchison, 2013; Corr & Corr, 2004). She needed help and support. As proposed by Furman and Bowlby, children need specific types of emotional support from adults to mourn the death of a parent. Bereaved children need help and support in understanding why the person died; they also need extra affection, reassurance, and comforting to tolerate the painful feelings of loss (Furman, 1974; Bowlby, 1982). Unfortunately, she did not receive enough help and support. For example, her mother was too preoccupied, primarily by her sense of responsibility to take care of the family and to keep their lives going despite the tragedy. As a result, the family did not talk about the father’s death; they did not express their sorrow, guilt, or any emotions. They simply attempted to move on with life without allowing themselves or each other to grieve. Bowlby pointed out that if children are not given accurate information about a death, they cannot grieve appropriately.
The family did not give April a chance to explore and express her grief over the loss. These choices would impact her ego function. Since she could not make sense of the situation, she could not modulate her affect and behavior in order to cope with the pain of loss. She automatically and unconsciously used one of the most important ego functions – defense mechanism – to cope with the trauma. She went into denial, which interfered with her reality testing. She was told that her father “went to heaven,” which, to her, meant that he was in a distant place. As Silverman, Nickman, and Worden (1992) stated, April, as other children typically display, developed an inner construction of her father that assisted her in coping with her losses and with all of the ensuing changes in her life. She even developed “magic thinking”: a fantasy that her father would return as shown in the picture she drew of her father coming in and out of the house by using the ladder. But with time passing, the reality of her father’s absence becoming increasingly permanent was reinforced. She could not always hold her sadness and fear as shown through her nightmares, crying, or screaming. Sometimes, she regressed to earlier developmental stages, as manifested in her toddler-like behavior, for example, sneaking into her sister’s bed at night or clinging to her mother and hiding behind her in front of the social worker. She even withdrew from activities she normally liked and social interactions with family and friends, such as when she rejected her sister’s invitations to play together.
Furthermore, she also developed somatic symptoms, such as not eating or experiencing headaches, as defense. For April, the defenses that she used at the beginning might be adaptive to help her preserve psychic integrity and ensure survival under the pressure of stress and fears. But when she used them in a rigid fashion, her responses also limited her ego function to perceive reality or to cope effectively and thus became maladaptive. Since defenses serve a protective function, April might also have resisted efforts directed at modifying her defenses if there was no other protective agency available (Goldstein, 2011). In order to help April to cope with the loss more effectively and reach optimal ego development, the ego-oriented social workers can, on one hand, use supportive and modifying approaches to help April restore, maintain, and enhance her here-and-now ego functions and promote her ego mastery and problem-solving coping capacities. On the other hand, they also can incorporate environmental change which support and facilitate April’s progress; in doing so, the change needs to direct attention to understanding the nature of April’s maladaptive defenses and behavior, her basic attitudes toward self and others, her patterns of relating to her families and others, and new relationship experiences, providing space and support to help April’s “capacity to mourn” (Miller, 1971).
Since adaptive capacity is a fundamental attribute of healthy ego functioning, these individual and environmental interventions can help to repair, strengthen, and expand April’s inner adaptive capacity during the change process (Goldstein, 2011). Successful adaptation will help children achieve high levels of ego integration (Hartman, 1939). She also needs help to master stage-specific development tasks and crises (Erikson, 1959). Successfully resolving this big crisis will facilitate her ego development, leading to high levels of ego integration. Ego psychology not only helps us to understand April’s case beyond the intra-psychic structure/forces but also gives an important role to the interaction between environmental influences and internals forces in a developmental process across the life circle. It also helps us to hold a more optimistic view about April’s potential by addressing her strengths and resilience (Schamess, & Shilkret, 2011; Goldstein, 2011). However, in spite of its impressive utility, like all theories, ego psychology does have significant limitations. First of all, since ego psychology focuses on how rather than why people’s minds work as they do, we cannot really understand the process of adaptation. Second, even though ego psychology recognizes the importance of object relations and self-esteem for ego functioning, it does not consider their centrality and the developmental significance as the primary focuses. Additionally, ego-oriented intervention also does not have sufficient evidence to supports its efficacy (Schamess, & Shilkret, 2011; Goldstein, 2011).
Furthermore, ego psychology, as a theory rooted in individualistic culture, sees the goal of mourning as detaching ties from the deceased love object through an internal separation-individuation process in which the self is no longer tied to the object image. It would see April’s continuing bond with her father as maladaptive defense. But in an interdependent culture, such as the one from which April’s family came, it is very important to keep the continuing connection with the deceased loved ones (Laurie, Neimeyer, 2008). The more recent post-modern theories may benefit April and her family, wherein the aim of mourning is not the cutting of the tie with the deceased but changing that attachment into an internal force that sustains the grieving survivor who continues living, a force that then becomes interweaved into the grieving survivor’s internal world (Baker, 2001). As a result, ego psychology tends to pathologize the grief reaction, but only if there is only one correct way to grieve deserves questioning. The pathologizing might mislead and limit the practice of grief intervention. Question 2
No matter what standard we use – Piaget’s, Freud’s, or Erickson’s – in most areas, April was able to reach the developmental milestones successfully before she confronted her father’s death and aftermath (Hutchison, 2013). With the help of her grandmother, as well as her older sister’s acceptance, April’s parents managed to create an “average expectable environment” in which April’s basic needs for nurturance, protection, care, and stimulation could be met. This helped her normal biopsychosocial-emotional development unfold. Thus, she resolved each stage-specific successive crisis and reached an age-appropriate ego identity and ego function. Concerning her biological development, April was born a healthy baby despite the fact that she was born six weeks premature. With her family’s adequate provision of nourishment and care, April’s self-regulation, sensory abilities, reflexes, and motor skills were all age-specifically appropriately developed. She developed regular rhythms of sleeping, eating, and eliminating even during the first three months (Davies, 2004). She slept fifteen hours or so a day, was fed by bottle and grew up healthy. By six months, April could roll over and often grabbed things.
She walked before she turned one year old. When she was two years old, she learned how to throw a baseball, which normally most four-year-olds can do (Hutchison, 2013). With her healthy psychological development, April’s psychological development would be considered advanced compared to normal milestones. She was already turning to the sound of her family member’s voices, especially her sister’s, by three months; thus, she had developed the cognitive capacity to differentiate one object from another and to track the location of an object (Bahrick, Lickliter, ; Flom, 2006). In Piaget’s stages of cognitive development, this was supposed to occur in the next sub-stage, Secondary Circular Reaction (Piaget, 1952). She started babbling early at six months, and by fifteen months, she was very verbal and able to construct short sentences like “Carry me.” Normal children can put two or three words together when they reach two years old. As a central element of cognition, April’s advanced language development would facilitate both thinking and communicating, which enabled her to attend preschool by age three and later kindergarten successfully. That language development and the related thinking and communication capacities were also important to her interaction with people and facilitated her social-emotional development as well (Hutchison 427). Regarding her social-emotional development, in her five years, April faced vital developmental tasks in the emotional and social arenas, these early stage developments, which Erickson believed became the foundation for social-emotional development during all other development ages (Erickson, 1959). In Erickson’s first trust versus mistrust stage (ages birth to 11?2), interacting with a safe environment that her caregivers created for her, April was able to develop a sense of trust and develop an emotional bond with her family members when she was an infant, She was a pleasant baby, who cooed and laughed, smiling at her family often; she was not just enamored by her father, but the whole family “doted on her.”
Even her older sister would be always there to soothe her when she needed comforting while she was a baby. In autonomy versus shame and doubt (ages one and one-half to three years) stage, with the positive encouraging and supportive parenting from her parents, she began to strive for independence and self-control. She could eat with little assistance and could sleep by herself through the night by three. She then became a young child who formed relatively secure attachment (Hutchison, 2013). She could keep the connection with her families yet also keep her independence to some extent. She could make friends at school and reach out to play with other children sometimes, such as when her family took her to the park. In the initiative versus guilt (ages three to six years) stage, April started this stage well as usual. She started to learn to get satisfaction from completing tasks either at school or in the games she played. She enjoyed playing “pretend” games with her families; this helped her to develop a big imagination and fantasy, and she learned to handle guilt about these fantasies as it showed after her father’s death. With the assistance provided by her caregiver for emotion management (Siegel, 1999), her emotion expression and affect regulation were age-specific appropriately developed. For example, she cried only when she was wet or hungry and was easily comforted and soothed. By age three and a half, she knew how to express her worry and concern about her father when he was sent to Afghanistan.
She could follow her mother’s suggestion to regularly send her father the letters and pictures regularly. So far, as we see, according to those milestones established traditionally, April had been meeting the expectations for normal and even advanced development. But from the earliest moments, while April had been interacting with her parents and family members and practicing related family dynamics, her growth had been constantly impacted by a larger ecological environment, including her neighborhood, peers, other adults, schools, social services, and more important, the environment elements related to her father’s military deployment and reassignment. Her father’s irregular presence, his in and out absence, and their family’s constant relocation every three years would impact her, especially on her capacities to build up strong bonds with people, as we see in the vignette. We also see that April seldom showed her sense of security, her trust of coherence of other people’s presence, and this was also impacted by her family’s financial, social situation and family dynamics, especially after her father came back from Afghanistan, injured physically and psychosocially, losing many of the benefits after discharged by the Marines. All of these stresses would serve as risk factors especially when April had to confront the huge crisis of her father’s suicide. But there are some strengths in the family system even when they had to go through so many tough situations. As Froma Walsh (2006) stressed, the core of family resilience was manifested in family belief systems, organizational patterns, and communication process. First and most importantly, the value that her family put on family was also very important for her development.
For example, even with the constant moving, April’s mother worked hard to create a home for them; furthermore, after her husband’s death, under great stress financially, psychosocially herself, she never gave up her children and family. Secondly, the family members came from an African-American culture which put a lot of emphasis on interdependence. April’s grandmother became a strong supporter whenever her family needed help: for example, two weeks after April was born when her father had to leave on deployment, grandmother (Violet) came to stay with them to help her daughter (Joy). Then she later decided to move to the city where they lived so that she could often visit and help them. Finally, after April’s father’s death, she moved in permanently and provided much needed help. Third, even though it was so hard for April’s mother Joy to communicate with her father when he was severely traumatized, Joy never gave up trying to communicate with him. After George’s death, even though she could not understand April’s response and had not paid much attention to her own needs, she still paid close attention to her little girl and sought professional help to help her child. All of these developed great strength to help April cope with the age-specific development tasks and cope with crisis as well. But we have to recognize and realize that similar to the limitations we addressed for the first question, the developmental milestones are also socially constructed. The dominant U.S. culture is thought to be extremely individualistic, in which the personal growth is individual fulfillment. That belief would not just impact the standard of those “normal” milestones but also would impact how the parents would raise their children. As we saw in this case, even coming from an African-American family, April’s parents adopted the mainstream parenting values, seeing those developmental tasks, which led the child to independence and autonomy in choice and action, as intrinsically important for their daughter’s growth. They encouraged her in behaviors that would enable her to function on her own at the earliest age possible.
She was trained to sleep alone, to feed herself. The goal of these activities is to enable a child to separate without too much distress (Hanson, 1992) . In a more interdependent culture, the “normal” milestones might be different from that of the individualistic culture; the goal of parenting put more emphasis on the importance of meeting societal expectations. This emphasis on close connections and collaboration over personal self-development is thought to be fostered by social involvement, such as extended family and kinship-help patterns, family co-doing activities, following the societal rules, playing more social games etc. (Maschinot, 2008). Conclusion
April’s development was not just a result of her own internal interaction of the executive arm of the personality-the ego-and other aspects of the personality, but the interaction with the external environment in a specific culture. We cannot understand April’s “normal” development and her response to the stresses and crisis, or give her the appropriate help she needs, if we could not understand those interactions.
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