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The Eriksonian Model of Human Development and the Evolution of the Pharmacist
The noted psychologist Erik Erikson is famous for his theory of human development. He postulated eight stages of development spanning infancy to old age. Each stage presents a psychosocial crisis, with syntonic or dystonic potential (successful or unsuccessful synthesis of opposing potentials), whose resolution can result in a sympathic strength or an antipathetic counterpart (successful or unsuccessful transcendence of
the relevant psychosocial crisis).
In many ways, the Eriksonian model can serve as a conceptual framework for pharmacists' professional development.
Basic Trust versus Basic Mistrust
The infant's first social achievement is a willingness to let the mother out of his or her sight because she has become an inner certainty, as well as an outer predictability. This parallels the pharmacy intern's activities, which over time require less and less direct supervision by the pharmacist. Gradually, the intern is allowed to take on more responsibility, developing confidence. By the end of the internship, the intern should know the basics of dispensing and consulting.
Autonomy versus Shame and Doubt
This stage of human development is characterized by sudden, violent wishes to have a choice, to appropriate demandingly, and to eliminate stubbornly. Firmness must protect the infant from the potential anarchy of his as-yet untrained sense of discrimination and his inability to hold on or let go with discretion. As the environment encourages him to "stand on his own two feet," it must protect him from meaningless and arbitrary extremes of shame and early doubt. This stage is analogous to the early years of professional practice, in which the pharmacist begins to come into his own, performing an ever-greater range of dispensing, checking, and consulting tasks. He learns to discriminate patient needs for information and support.
Initiative versus Guilt
In every child, at every stage of development, there is a miraculous period of vigorous unfolding, constituting a new hope and a new responsibility. Such is the quality of initiative. A crisis, beset with fumbling and fear,
is resolved in the child's suddenly "growing together." Initiative adds to autonomy the quality of undertaking, planning, and "attacking" a task for the sake of being active and on the move. Dispensing and consulting are tasks that the young pharmacist attacks with vigor. The pharmacist takes pleasure
in the attack and conquest of tasks.
Industry versus Inferiority
In this stage the individual moves out of his familiar place in the family into the disciplined environment of school. He learns to win recognition by producing things. He develops a sense of industry. He adjusts himself to the inorganic laws of the tool world. To bring a productive situation to completion is an act that gradually supersedes the whims and wishes of play. Similarly, the pharmacist adapts himself to the computer and develops competencies required to use electronic and other tools to help achieve his aims.
Identity versus Role Confusion
In puberty and adolescence, all "samenesses" and continuities relied on earlier in life are questioned. During this period of rapid body growth, the growing and developing youth is faced with a physiological revolution within and awareness of tangible adult tasks that lie ahead. He is primarily concerned with what he appears to be in the eyes of others, as opposed to what he feels he is. He is also faced with the question of how to connect the roles and skills cultivated earlier with the occupational prototypes of the day.
The identity of the pharmacist hinges on his identification as an expert on medication. His fulfillment of these duties help him to develop confidence in the practice of his profession. Serving as an information source is an integral part of his professional identity.
Intimacy versus Isolation
The strength acquired at each stage of development is tested by the necessity to transcend it in such a way that the individual can take chances in the next stage with what was most vulnerably precious in the previous one. Emerging from the search for identity, the young adult seeks to merge his identity with others. He is ready for intimacy: the capacity to commit himself to concrete affiliations and partnerships. Commitment to pharmacy occurs
during this stage, in which the pharmacist accepts the caveat of pharmacy, particularly ethical concepts.
Generativity versus Stagnation
The term "generativity" refers to the evolutionary development that has made man the teaching and instituting, as well as the learning, animal. Generativity is primarily concerned with the next generation. Here, pharmacists act as preceptors to each new set of interns, providing for the eventual success of the profession: Older, more experienced pharmacists bring along the younger generation of pharmacists.
Ego Integrity versus Despair
The Eriksonian model holds that those who have in some way taken care of things and people and who have adapted themselves to the triumphs and disappointments inherent to being the originator of ideas will gradually ripen the fruit of the previous stages. It is best described as the ego's accrued assurance of its proclivity for order and meaning. Elderly pharmacists may reach this stage after many years of practice.
I believe the Eriksonian model holds valuable insights for all pharmacists to consider as we strive to achieve our individual and collective goals. By being attuned to the psychosocial context in which we develop and grow, we are
better able to direct the course of our personal growth and development, as well as our collective development as
a profession.
George Taniguchi, PharmD
Consultant Pharmacist
Santa Clara, California
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Did We Strike A Nerve?
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The Consultant Pharmacist is published by the
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