Chapter 7:
Medical assistants routinely interact with patients during a wide range of encounters from routine appointments to emergency treatment, and from acute care to chronic illness. Patient responses to the care and treatment provided are heavily influenced by their developmental stage, cognitive abilities, intellect, and general state of psychological well-being. The interplay between factors that affect both the body and mind in health and illness are interwoven. It is important to understand and apply key information from the study of psychology in daily work with patients. This chapter includes a brief review of the field of psychology, a summary of the major theorists, and the developmental stages that you are likely to encounter.
Psychology refers to the study of the mind. Human psychology includes the thoughts, behaviors, and emotions of individuals across age groups, genders, and cultures. Over the course of time, major schools of psychological study have emerged as scientists continue to explore the wide variability of the human mind from both normal and abnormal perspectives. As a field of science, psychologists conduct research and apply the scientific method to the study of human behavior. A common example is the effort to determine the relative importance of nature (genetic and biological influences) versus nurture (social and cultural influences) on behavior.
One of the earliest theorists to examine and describe the human mind was the Austrian physician Sigmund Freud. Freud was the first to label what he considered the hidden area of the mind, the unconscious. The area was believed to contain thoughts, emotions, and memories of which people are largely unaware. In psychoanalytic therapy, Freud used a technique he named free association of ideas to allow patients to recognize and recall unconscious memories and deal with them in the conscious mind. Freud’s work, referred to as psychoanalysis, is based on his belief that psychological problems are the result of repressed impulses and conflicts stemming from childhood. The goal of psychoanalysis is to bring these issues into conscious awareness so patients can deal with them in the present.
In addition, Freud viewed the structure of the human mind as containing distinct parts that shaped the personality and thus the behaviors of all human beings. He coined the terms ego, id, and superego as the areas of the mind that govern unique processes. The ego is the conscious state that directs the personality and works to deal with the state of reality. The id contains the unconscious memories and impulses, that Freud believed were based on sexual and aggressive drives. The id drives the personality to seek pleasure and instant gratification of unconscious desires. Finally, the superego represents the judgment center of the mind where internalized ideals and values are held. Problems in human behavior and psychological pain occurred as a result of the struggle and interplay of the id, the ego, and the superego. The goal of therapy was to bring repressed information to the conscious mind and allow the patient to handle the conflict.
Freud felt that personality development occurred during the early years of a child’s life. Later problems were rooted in unresolved conflicts from childhood. Freud viewed the developmental stages as psychosexual in nature. During these stages, the id sought pleasure through stimulation of erogenous zones of the body. First, the infant experienced the oral stage where pleasure was sought through sucking, chewing, and biting. Next, from age 18 months to age 3, the child experienced the anal stage when control over bowel and bladder elimination dominated the id. During the phallic stage, from about 3 to 6 years of age, the id focused on the genital area of the body, and the child developed sexual desires. It was during this stage that Freud believed that boys went through an Oedipal complex of loving their mothers and desiring them sexually, while feeling threatened by and fearful of their fathers. Freud felt that eventually children repress these feelings and learn to cope with them by a process of identification with the same sex parent and the values held in the superego. Though much of Freud’s work has been dismissed by modern psychologists, his fundamental contributions to the field remain intact.