Untapped Richness in Erik H. Erikson's Rootstock

Helen Q. Kivnick, PhD, LP; Courtney K. Wells, MSW, MPH

Disclosures

Gerontologist. 2014;54(1):40-50. 

In This Article

Scaffolding: Structural Principles

Since Vital Involvement's publication, Figure 2 (which did not appear in the book) has become a comprehensive representation of Erikson's theoretical scaffolding for lifelong psychosocial development—rooted in his early work, reflecting all three principles, and illustrating their interdependence. In the article sections that follow, we discuss the principles in detail, including: (1) each principle's own explanation; (2) conceptual linkages to the other principles; and (3) connection to gerontology. Finally, we identify some of the principles' untapped capacity for enriching gerontological understanding in a context of human life, over time, in a diverse world.

Dynamic Balance of Opposites

Erikson uses the word "stage" to refer to a period of lifetime, for example, adolescence; older adulthood. He explicitly clarifies that in each of eight stages, one psychosocial theme is focal, that is, two opposing tendencies (one apparently positive; one apparently negative) must come into balance to produce the stage's central strength. He explains, "… the first two, in infancy, are a sense of trust and a sense of mistrust: their balance, we claim, helps create the basis for the most essential overall outlook on life, namely, hope …" (Erikson et al., 1986, pp. 33). That is, "… a favorable ratio of basic trust over basic mistrust is the first step in psychosocial adaptation" (Erikson, 1950, pp. 271).

He refers to a "balance" or a "favorable ratio" between two opposing tendencies, and describes hope (which this article calls a "central strength") as a product of that balance, that is, a personal capacity that emerges in the process of healthy, theme-related psychosocial development. This balance recognizes the importance of the ongoing presence of the dystonic, as part of a robust dynamic balance between the two tendencies. In this first theme, consider that new parents do not want their infant to be blindly trusting of any adult who approaches and wags a finger in her face, or pinches her cheek. Rather, they want her to develop a reliable sense of basic trust in the dependability and predictability of the world, alongside a reliable sense of whom and what she is wise to mistrust.

Both syntonic and dystonic dispositions must, each in appropriate dynamic balance with the other, exist for all eight psychosocial themes, in all eight stages. "Appropriate", because people are different (temperamentally; bodily) and circumstances are different (culturally; historically). Where healthy adaptation for one infant might include tolerating a household full of loud voices and multiple tongues, healthy adaptation for another might be accomplished in a home dominated by a lone caregiver's murmurs. Not only do people's circumstances differ. Circumstances for any one person change over time, in ways both great and small. What is experienced as a healthy balance between dystonic and syntonic for each psychosocial theme, will change as environments and age-based expectations change. The research team carefully chose the words "Dynamic Balance of Opposites" to connote an old-fashioned balance scale, in which the differently weighted pans rise and fall as their weights shift—in an atmosphere whose conditions also shift.

The individual nature of a balance's "health" or "appropriateness" suggests that explicit consideration of each psychosocial theme, as it reemerges in each individual's older adulthood, can productively inform domains of gerontological practice. For example, consider the expectable later-life event of the death of a long-time partner. This loss requires an elder to review, reconstitute, and move on from a lifelong sense of love, consolidated over many decades of loving balance between intimacy and isolation. Or perhaps the loss permits her to love a new partner quite differently from the way she had loved the one she married five decades earlier.

Social changes in cultural attitude and policy influence the appropriateness of specific thematic balances. For example, 2013U.S. legal changes around Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ) marriage indicate that broadening societal attitudes are providing greater validation of same-sex love as an appropriate personal balance between intimacy and isolation.

Vital Involvement

Erikson expanded his earliest consideration of the dynamics of psychosocial suffering from the pain he saw in individual psychotherapy patients to that of populations uprooted by political and military violence (Erikson, 1964), as he reflected on the plight of emigrants, refugees, and persecuted minorities around the world. Around such suffering, he posed a tension between personal experiences of passivity in response to insurmountable hostile forces, and contrary experiences of activity or agency, as permitted by more hospitable environments. And he described this tension as regulated by a "self" structure (ego) that mediates among conflicting inner forces, as well as between the more embodied self and the environment outside the self's boundaries. Noting commonalities across adaptations to different kinds of psychosocial conflict, his thinking shed increasing light on the multiple stresses that constitute everyday life in increasingly complex societies, in an increasingly global world. At least, implicitly, he began to understand the self's mediating process as central to psychosocial development.

This same mediating process is part of what, in 1986, Erikson and colleagues referred to as vital involvement, described as the self's meaningful engagement with the world outside it. Vital involvement requires a self, an outside environment, and a powerful and reciprocal enough interaction that the influence can be truly mutual. This Vital Involvement construct helps us understand both clinical processes of helping clients deal with pain, anxiety, fear, and trauma, and also the everyday, psychosocial work that constitutes each person's normative psychosocial development, within multiple layers of environment.

The process has much in common with that presented in more recent scholars' discussions of "vital engagement" (Nakamura, 2001; Nakamura & Csikszentmihalyi, 2003). We suggest that the vital involvement construct goes beyond "vital engagement" by being part of a theoretical scaffolding that we understand as undergirding all psychosocial development. Vital involvement explicitly emphasizes the importance of meaningful interaction with the environment as essential to healthy psychosocial development. Helping professionals have long acknowledged that therapeutic and supportive services (both of which may be seen as "environmental" influences) can help heal clients' psychosocial pain (and Dynamic Balance of Opposites, explained previously, describes the internal, psychosocial processes activated by these services). The principle of Vital Involvement goes much further than healing. It clarifies that the internal work of balancing psychosocial themes (including both positive and negative behaviors) is inseparable from a person's meaningful engagement with the people, materials, ideas, and so forth. that constitute the environment/community. That is, ordinary psychosocial development, the process through which a person becomes who she is, takes place as part of vital involvement.

Vital engagement is discussed as "a form of positive behavior" (Nakamura, 2001, pp. 5), a component of resilience, and as drawing together a whole range of positive experiences. The vital involvement construct contextualizes vital engagement more broadly in healthy, lifelong psychosocial development.

Vital involvement's link to healthy developmental processes encourages attention to positive phenomena as they exist (to be promoted) at all stages in life. This expanded context could guide gerontologists to look more broadly for exemplars of multiple expressions of health in the face of adversity, as bases for new interventions. Further, we suggest that in these terms, the vital involvement construct can productively influence gerontological practice, in at least three different ways.

First, the Vital Involvement principle asserts that as we gerontologists are involved with meeting the special needs of an older woman, we are also part of influencing her ongoing development, that is, who she is and is becoming, as she will experience the rest of her life. This double influence (on current needs and ongoing development) suggests meaningful questions for practitioners and program developers, about our own scope of practice, and specific practice elements.

Consider an 83-year-old woman in the independent-living section of a multiple-care-level senior housing community. She seeks help for problems of weariness and arthritis-related difficulty in shopping and cooking. Will we, as case managers or facility-based social workers, learn enough about this particular woman to understand what she values in her life? For example, if this woman follows advice to move to her complex's assisted living wing, will her new space enable her to continue to make and sell the lovely greeting cards from which she now derives so many kinds of satisfaction? Will she still be able to walk to the afternoon Bible study classes she eagerly anticipates each morning?

The principle of Vital Involvement directs us to this woman's need for meaningful involvement in daily life—along with her need for instrumental assistance. Without careful attention to both sets of needs, providers too often violate elders' need for meaning and purpose, while meeting more obvious instrumental needs. Practitioners who are sensitive to vital involvement will consider such disparate issues. Comparable investigators will conduct research that addresses these concepts, the practice elements designed to implement them, and the assessment and outcome measures that reflect them.

Second, the principle of Vital Involvement requires us to recognize that elders are influencing us, as individual professionals and organizations. So, too, are they influencing their own family and community members? Gerontologists could practice in ways that optimize these reciprocal influences. When staff in an effective person-centered care facility are vitally involved with individual residents (examples come from the authors' person-centered care observations), they can structure life in their household to meet residents' needs for purpose, community, and personal vital involvement—while also ensuring residents needed nutrition, shelter, safety, and medical care. Staff can encourage a son's inclination to bring his mother's favorite pie when he comes to visit. They can support his enjoying it with her, and perhaps also with particular household friends. He may, over time, come to bring three pies on his visits, to sweeten the day of everyone in the household. Staff can teach and learn from one another, increasing their own professional competence and vital involvement in their workplace. Such integral professional development enables staff to continue to promote vital involvement in evermore-vital household residents. The earlier brief example of person-centered care practice illustrates the way vital involvement—acknowledged or not—undergirds effective practice. We return to this notion of Eriksonian theory undergirding practice near the paper's end.

Third, gerontologists could practice programming in ways that structure community and institutional life to maximize elders' opportunities for vital involvement and optimal psychosocial health—rather than emphasizing strategies that simply delay institutionalization and permit survival. For example, the film Alive Inside (Rossato-Bennett, 2013) documents surprising improvements in previously nonresponsive Alzheimer's patients in response to listening, on an iPod, to personally programmed musical playlists. The film also notes regulations that mandate coverage for costly, long-term maintenance medication, but prohibit purchasing personal items like iPods. Appropriate vital involvement-driven research could explore multiple patient outcomes and overall therapeutic costs and benefits of interventions like these—for patients, staff, and care facility as a whole.

A growing number of appropriate studies suggest physical, cognitive, and mental health benefits to vulnerable older adults from arts participation (Castora-Binkley, Noelker, Prohaska, & Satariano, 2010; Cohen et al., 2006, 2007; de Medeiros & Basting, 2013; Shye & Griffel, 2010). Vital involvement's inherent person–environment reciprocity may help explain these positive effects on elder participants; reciprocity also provides a conceptual basis for studying program staff, elders' social networks, program sponsors, and overall community arts vitality. Understood as integral to community infrastructure, vital involvement could prove useful in developing more meaningful and comprehensive outcome measures for health promotion and dementia care activities, practices, and programs.

The authors believe that the very complexity of Erikson's theory offers promise for maturing a more effectively interdisciplinary gerontology. Eriksonian theory requires that we simultaneously consider (and work with) the person, and the environment, and the mutual influence they have on one another. But most professionals are trained to work with one—not all three—of these. Recognizing current fragmentation and discontinuities in the field highlights the value of clarifying that we can, as well as must, conceptualize and evaluate practice interventions as they engage person, environment, and their ongoing, reciprocal interactions. Exemplar programs, practices, and lives hold enormous potential as a collective source of the kind of information that can ground integrative research, and can advance practice, evaluation, and measurement.

Life in Time

Returning to Figure 2, this principle begins to explore the developmental processes (psychosocial work) that take place in those chart cells lying above and below the diagonal, that is, cells that earlier versions of the chart showed as empty (it also challenges traditional understandings of development as a rigid sequence of stage-specific crises). The chart "… suggests that the individual is never struggling only with the tension that is focal at the time. Rather, at every successive developmental stage, the individual is also increasingly engaged in the anticipation of tensions that have yet to become focal and in reexperiencing those tensions that were [focal earlier]…" (Erikson et al., 1986, pp. 39–40).

Figure 2's numbered cells highlight this principle by enabling us to refer unambiguously to any cell in the chart. Development is a lifelong process, and all psychosocial themes are operational throughout the whole life cycle. The issue is one of thematic permeation at each stage, rather than presence versus absence. Reworking, reresolving, reviewing, renewing, reexperiencing, and refacing earlier balances around each theme—these take place in every cell above the diagonal. Erikson and colleagues (1986) clarify that "in old age, many of the developmental concerns of earlier and earliest stages are being refaced" (pp. 53) as earlier-acquired capacities may diminish, and earlier involvements give way to new possibilities.

Corresponding to this reworking, a person's age-appropriate previewing, preworking, or anticipating of themes that have yet to become focal appears below Figure 2's diagonal. Moving down from cell 64's older adulthood focus on balancing integrity with despair, the chart's far right-hand column (cells 8, 16, 24, 32, 40, 48, 56) includes issues involved in the lifelong anticipating of integrity & despair. Rudimentary wisdom and perspective become part of an infant's efforts (cell 8) to balance experiences of trustworthiness and untrustworthiness in the world. So, too, are they related to a toddler's sense (cell 16) that she and the world are dependent on one another but are also separate entities? In play and school ages (cells 24 and 32), experiences of loss and death prompt anticipatory balancing of despair with integrity. Relationships with and observations of older adults promote additional thematic previewing. Learning deeper lessons from childhood losses and disappointments (balanced with triumphs and joys) become part of adolescent wisdom (cell 40). These lessons shade into young adulthood's attention to past and future (cell 48), grounded in this stage's position approaching the chronological center of a currently expectable life span.

Continuous, ongoing processes of anticipating and renewing minimize the importance, in any theory, of universal, age-specific markers for sequential stages. Biology does determine individual physiological capacities, but social relationships and community/culture-based expectations are equally important in establishing when a particular theme permeates a person's psychosocial life. This permeation constitutes the essential difference between "working" on a focal theme, and "pre-" or "reworking" themes that are not currently focal (remember, that environmental forces also influence the relative health or pathology of any thematic balance; prompting thematic reworking).

As the middle adult exercises responsibility for older and younger generations (cell 56), she distills personal meaning from life's losses (e.g., people and dreams) and gains (e.g., experiences had; lessons learned), at the same time as she acknowledges the already-developed personal strengths and commitments on which she will keep building. It is too late to change past mistakes, but she can expect decades of future in which to make newly appropriate choices. The middle adult ages into older adulthood (cell 64), experiencing increasing personal vulnerability and twinges of mortality, along with expanding and deepening senses of time and space. She may choose to translate housekeeping skills into arts practice, or to extend lifelong crafting into learning about art history—without producing anything at all. According to the principle of Life in Time, her engagement with the personal present must find a dynamic balance with gerotranscendence's involvement in an infinite continuum of future and past (cf. Tornstam, 1997). To promote psychosocial health in older adulthood, gerontologists must support both everyday and gerotranscendent involvements.

The principle of Life in Time may help explain ambiguous findings of empirical research seeking to document either operationalized age- and task-specific life stages or to link the existence of such stages with measures of the quality of individual, conflict-specific resolutions (Vaillant, 2002). The principle may also help clarify various mechanisms that underlie the positive relationship between generativity and well-being throughout the life cycle (An & Cooney, 2006; McAdams, de St. Aubin, & Logan, 1993). Finally, as it has for Ryff (1989; Ryff & Singer, 2008), this principle could productively help shape the needed updating (de Medeiros & Basting, 2013; Geron, 2012a; Geron & Kivnick, 2012b) of our conceptual and operational understanding of constructs such as well-being, quality of life, and life satisfaction. This principle also seems to suggest that proposed substages of middle and older adulthood (e.g., Cohen, 2005; Levinson, Darrow, Klein, Levinson, & McKee, 1978) may more meaningfully reflect aspects or issues within Erikson's two themes of integrity & despair and generativity & stagnation/self-absorption than accurately identify universal developmental stages.

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