Elsevier

Journal of Aging Studies

Volume 17, Issue 4, November 2003, Pages 415-426
Journal of Aging Studies

Psychosocial development in the elderly: An investigation into Erikson's ninth stage

https://doi.org/10.1016/S0890-4065(03)00061-6Get rights and content

Abstract

This study investigated Joan Erikson's suggestion [Erikson, E. H. (1998). The life cycle completed. Extended version with new chapters on the ninth stage by Joan M. Erikson. New York: Norton] that there is a ninth stage to Erik Erikson's [Erikson, E. H. (1963). Childhood and society (2nd ed.). New York: Norton.] Theory of Psychosocial Development to address the challenges of extreme later life. Questionnaires to measure resolution of Stages 8 and 9, compiled from original descriptions, were completed by 32 women aged in their 80s or 90s, and 32 women aged in their 60s. Results showed there to be a significant correlation between age and resolution of Stage 9 (P=.01), but not for Stage 8, and a significant difference between the mean scores of the two age groups for Stage 9 (P=.03), but not for Stage 8. Recognition that there could be a stage of psycho-social development applicable to people aged in their 80s and 90s, would be a source of comfort to aging individuals themselves, as well as invaluable to friends, relatives, and carers.

Introduction

In the late 19th century, when increasing numbers of people survived past their useful working life, society (at least in the West) tended to view old age as a time of dependency and decline (Hareven, 1978). Recent surveys indicate that in the European Union, for example, currently 1 person in 15 is aged 75 or over, but forecasts for the year 2020 predict that the figure will have narrowed to 1 in 10 (Walker & Maltby, 1997). At a time when older people are often portrayed as a “burden” on the financial resources of the state, it is important for both those in the caring professions and the aging individuals themselves to understand not just the losses that may occur with advancing years, but also the positive aspects and potential for further development.

Joan Erikson (in Erikson, 1998, p. 105) stated that “Old age in one's 80s and 90s brings with it new demands, reevaluations, and daily difficulties. These concerns can only be adequately discussed, and confronted, by designating a new ninth stage to clarify the challenges.” The present study undertook to investigate whether or not such a stage of psychosocial development could be identified, beyond Erikson's (1963) eighth stage of ego integrity versus despair. We anticipated that confirmation of the existence of a ninth stage in extreme old age could have practical uses for those who work with the elderly. For example, Bartlett and Burnip (1998) surveyed 196 clinical nurse managers of institutions for older people in the Anglia and Oxford region of the UK, the purpose being to identify and prioritise the challenges facing carers in the delivery of quality care. One key finding was a lack of staff awareness of the psychosocial needs of the elderly, and a desire to learn more about this issue.

Erikson (1963) saw personality as a lifelong developmental process. His theory, based as it is on the epigenetic principle, identifies eight separate stages of development spanning from birth (basic trust versus mistrust) to an age commencing at about 65 years (ego integrity versus despair). Although life span stage theories per se are not without their critics, and researchers have disputed the notion that development is always unidirectional, see for example Whitbourne, Zuschlag, Elliot, and Waterman (1992), each of Erikson's stages is reported as having its own time of ascendancy. It is believed to result from interplay of biological pressures within the individual, along with expectations from that person's environment, both social and cultural. At each stage, there is potential for crisis and conflict because of a “radical change in perspective” toward the end of its time for ascendancy (Erikson, 1980, p. 57). In brief, successful resolution of the eighth stage takes place when the individual can accept what has gone before as inevitable and satisfying, and can also accept without fear that death will occur probably in the not too distant future. This will result in ego integrity. If a person feels that his or her life has been a failure, and that it is too late to start in a new direction, then he or she will be filled with despair (Erikson, 1963).

Research has shown that successful resolution of psychosocial crisis stages is related to life satisfaction. Woods and Witte (1981) obtained a positive correlation between scores on a scale to measure the first six Eriksonian stages and those on a life satisfaction questionnaire administered to adult participants. Lowis and Raubenheimer (1997) likewise obtained a positive correlation between scores on an ego integrity measure and those on the Life Satisfaction in the Elderly Scale (Salamon & Conte, 1984), in their study of retired males.

It does appear from his earlier writings that Erikson believed that negative outcomes of the earlier stages would result in an adverse prognosis for the later ones. For example, Erikson (1963) commented that the ripening of the fruit of the previous seven stages was necessary for the development of ego integrity. A few years later, he added that for normal development, the positive resolution of psychosocial health must persistently outweigh the negative resolutions of ill health (Erikson, 1967). Hannah, Domino, Figueredo, and Hendrickson (1996) sought empirical support for the notion that successful resolution of Stage 8 was dependent on an equally positive outcome on each of the preceding seven stages. Using participants aged 55–84, the authors found significant and positive correlations between the scores of all eight stages, the highest value being between Stages 7 and 8. They also reported that there were no meaningful differences between men and women on the prediction of ego integrity. Hannah et al. noted that they had presumed that an age of 60 plus implied that an individual had now reached the crossroads of ego integrity versus despair. In other words, one needs to have experienced the previous seven crisis stages before the eighth can become relevant and meaningful.

In later life, Erikson himself appears to have revised his thinking on this matter, as evidenced by some of the literature reports. During a conversation with Hall (1983), responding to the specific question of whether or not the integrity–despair crisis can be successfully resolved without there having been a favourable outcome for all the previous stages, Erikson said, “You couldn't possibly imagine a person who has resolved all the previous crises equally well…” (p. 27). In his 84th year, and having lived through all the life stages himself, Erikson commented that the outcome of stage eight “… is not predetermined or foreclosed by the way life has been lived up to this point” (Erikson, Erikson, & Kivnick, 1986, p.40). This is quite an interesting change of direction, although perhaps not fully a U-turn, and shows that Erikson was prepared to modify his views in the light of his own experience of aging. Perhaps it is therefore not surprising that as he himself entered his ninth decade, his thoughts might be leading him toward the notion that there may be something beyond the formality of the eighth, and previously assumed final, developmental stage of life.

In a posthumous, extended version of his earlier work, The life cycle completed (Erikson, 1982), his wife and collaborator Joan took the theory one step further and added a new ninth stage (Erikson, 1998). This, she believed, had been overlooked in the original theory, but was now evidenced by her own experience of aging, her witness of her husband's later years, and her perusal of her husband's annotated copy of The life cycle completed. Joan Erikson believed that it was not until their late 80s and early 90s that both she and her husband really confronted their aging selves, and this led her to the belief that development beyond the eighth stage, accompanied by continued life satisfaction, is possible in (extreme) later life.

In outlining the potential for further psychosocial development beyond the eighth stage, Joan Erikson drew extensively on the work of Tornstam, 1989, Tornstam, 1992, Tornstam, 1996 whose theory of gero-transcendence is based on both qualitative and quantitative studies. This theory suggests that living into old age and facing its challenges brings about a shift in meta-perspective from a materialistic and rational view to a more cosmic and transcendent one. This is normally accompanied by an increase in life satisfaction. Tornstam believed that wisdom is identified with gero-transcendence, but noted that Erikson was vague when describing the strength of wisdom in the eighth stage. He speculated that “…Erikson, without understanding the meta-theoretical shift of paradigm necessary in order to fully comprehend the meaning of gero-transcendence, has come close to it” (Tornstam, 1989, p. 60).

Tornstam's theory differs from Erikson's in that it portrays development as looking beyond oneself and forward into the future. Tornstam (1989) believed that the effects of increased transcendence on the personality are often misinterpreted as a negative disengagement but, when the observation paradigm changes, then the picture also changes. Psychosocial theory holds that the individual who favourably resolves the eighth crisis stage and attains ego integrity looks back over his or her past life with satisfaction, and can now accept the inevitably of death without fear (Erikson, 1980). Tornstam, 1989, Tornstam, 1992, however, believed that the individual on the path to gero-transcendence looks forward and outward beyond the self. This can involve a decline in self-centredness and an increase in the amount of time spent in quiet reflection. There is a move beyond all fear of death rather than mere acceptance of its inevitability, and a redefinition of time, space, and objects may take place. Furthermore, withdrawal is freely chosen and can be positive, in contrast to the negative withdrawal suggested for example by Cumming and Newell (1960) in their much-debated Disengagement Theory.

In the ninth developmental stage, it is argued that previously resolved crisis points are again confronted. With the first stage, basic trust versus basic mistrust, for example, placing the syntonic element (i.e., trust) first supports the potential for development, in that the infant develops ego strength of trust if and when this stage is favourably resolved. In later life, with a growing awareness of mental and physical decline, the increasingly frail older person may begin to lose trust in his or her ability to maintain independence, and so there is again a crisis involving the same feature. Joan Erikson stated that she had “… therefore placed the dystonic element (i.e., mistrust) first in order to underscore its prominence and potency” (Erikson, 1998, p. 196), and she stressed the importance of recognising that conflict and tension could be a source of growth and strength.

With regard to the eighth crisis stages of ego integrity versus despair, Joan Erikson wrote that the difficulties faced by individuals in their 80s and 90s involve a constant battle with the dystonic element, and that despair is confronted daily. Just getting through each day is difficult enough and “… one may no longer have the luxury of retrospective despair.” (Erikson, 1998, p. 113). She added that if elders could come to terms with the dystonic elements in their life experiences in the ninth stage, they might successfully make headway on the path toward gero-transcendence.

Published evidence does suggest that development continues beyond the resolution of the eighth stage, but that it is often misinterpreted as a further resolution of that same situation rather than a new developmental phase. Agren (1998) reported on her longitudinal study where 85-year-olds were allocated to seven separate categories of adjustment, ranging from self-realising to withdrawing. Seven years later, with the participants being now aged 92, almost half remained in their original adjustment category, but there was a change in both positive and negative directions. Agren believed that her participants employed “cognitive pragmatics” (Baltes, 1993) to allow personality growth despite a decline in level of functioning with age, and there was a reduction in time perspective so that emphasis was centred on the present day. Other evidence comes from Johnson and Barer (1993), who found among their 85-year-old participants a selective withdrawal to an inner world, and a philosophical view of death as a transition point to something else. Nilsson, Ekman, Ericsson, and Winblad (1996) noted a decrease in both self-centredness and interest in material possessions, among their male and female participants aged in their 80s.

Our first objective was to see if an instrument with acceptable reliability and face validity could be developed to measure the resolution of the postulated Eriksonian Stage 9. Secondly, we were guided by the hypothesis that for individuals aged 60 and above, there will be no significant change in the resolution of Erikson's Stage 8 with advancing age, but that favourable resolution of Stage 9 will significantly increase with age. Should these aims be fulfilled, we believed that support would have been obtained for the existence of this additional stage of life span development.

Section snippets

Method

This study was conducted as a self-report survey with individuals either completing questionnaires themselves or being assisted to do so through closed question interviews. Responses were suitable for coding and subsequent quantitative analysis. Additional qualitative data were obtained through open questions.

Results

All quantitative data were coded and processed with the aid of Statistical Package for the Social Sciences computerised programme.

Discussion

This study set out to establish if confirmatory evidence could be found for a ninth stage of psychosocial development that occurs only in the very elderly, as suggested by Erikson (1998) based on previously unpublished notes left by her late husband Erik, Tornstam's (1996) notion of gero-transcendence, and Schroots' (1996) comments on this, as well as on Joan Erikson's own observations. To the extent that scores on a scale based on original descriptions by these authors were significantly

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