¶ … Sister's Keeper -- Case Study Using Developmental Theories Anna Fitzgerald was given a life so that she could keep another person alive, her seriously ill older sister Kate. On the surface that seems terrible cruel and wholly unfair. Looking deeper into the issues surrounding the Fitzgerald family, Anna and her older sister Kate, it is more unfair and cruel than it appears on the surface. There are important ethical issues involved in this novel by Jodi Picoult, but there are also developmental issues that cry out to be addressed. Hence, this paper will review the developmental theories of Erik Erikson, Jean Piaget and Lev Vygotsky, and use instances and circumstances from Picoult's book to link to concepts in the developmental theorists' work. The terribly inequitable theme of this book will be juxtaposed at the outset with what would be considered a "normal adolescent development" for a girl just reaching her teens.

The American Academy of Child & Adolescent Psychiatry explains that there are "…numerous developmental issues that everyone faces during adolescent years," including: a) struggling with identity issues; b) feeling awkward "or strange about one's self and one's body"; c) alternating between "high expectations and poor self-esteem"; d) mood changes and peer group influences; e) identifying faults of parents; f) improving speech and ability to express one's self; g) arguments with parents over independence issues; h) interest in sex; i) capacity for abstract thought; and j) development of "ideals and selection of role models." Anna should have dealt with these issues on a normal human level, but unfortunately, she was not in a position to deal with them in the way typical adolescents deal with development.

Developmental Theories and Anna Fitzgerald

"It is human to have a long childhood; it is civilized to have an even longer childhood. Long childhood makes a technical and mental virtuoso out of man, but it also leaves a life-long residue of emotional immaturity in him…" (Erik Homburger Erikson) (Harder, 2008).

Anna Fitzgerald's childhood was badly arranged and savagely interrupted by her parents, all in the name of keeping her old sister alive. Again and again, her younger guinea pig sister Anna supplies Kate's desperate medical needs. On page 168 of Picoult's novel, the oncologist is discussing Kate's chemotherapy drug, ATRA, which she has been given to try and tame her leukemia. The doctor is saying that the ATRA drug has worked, however just for one month. Now, the doctor has rejected the notion of a bone marrow transplant and instead suggests a "donor lymphocyte infusion" (DLI), an infusion of white blood cells from a matched donor. This is not a sure thing in terms of Kate's survival, just a "stop-gap measure," buying time until Kate's remission comes full force. But how long will it take to get the white blood cells for Kate?

"That depends," says doctor Chance. "How soon can you bring in Anna?" And once again Anna is the body, the resource, and the reservoir from which important human components are harvested in the name of keeping her sister alive. The most pertinent of Erik Erikson's eight stages -- vis-a-vis the quandary of Anna Fitzgerald -- is his latency stage (identity vs. identity diffusion) of development. In this latency stage Erikson posited that it is "a crucial time for the child's sense of industry" (Salkind, 2004, p. 147). In the case of Anna, her industry is always either interrupted or delayed.

Erikson believed that during the identity vs. identity diffusion period the child is on the right track if he or she is mastering the social skills necessary "to compete and function successfully as an adult in his or her society," Salkind continues. If a child is living in an agricultural society, Salkind explains, that child will have the developmental task that is logically associated with farming; and for Anna, she just needs to complete the developmental tasks that an average suburban 13-year-old...

"Cultural expectations take precedence over other needs," Salkind explains, interpreting Erikson; the child's ability "to master certain skills becomes paramount" and when the child achieves a certain level of industriousness that leads to "feelings of completeness or satisfaction" (p. 147).
However, Erikson's identity vs. identity diffusion stage posits that if a child has no opportunity to learn how "to master [her] own world," or if her "efforts to do so are blocked, these unsuccessful experiences lead to a sense of inferiority, or the feeling that they lack worthiness" (Salkind, 147). Erikson believed that an emotionally healthy child in the this period asks herself, "Can I master the skills necessary to survive in my community?" For Anna, doesn't think "…anyone would come to my funeral" but "…At Kate's funeral, everyone will come… they will have to turn mourners away at the cemetery gates" (Picoult, 85-86). Does that sound like a child that has had successful experiences? Hardly, hence, she is off Erikson's charts. He asserts that development will only be successful when the individual "successfully resolves the crisis associated with each stage" in the psychosocial developmental process (Salkind, 148).

Lev Vygotsky and Jean Piaget were both born in 1896, according to Richard M. Lerner's book (Concepts and Theories of Human Development), albeit Vygotsky died at the age of 38 and Piaget died in 1980. Vygotsky placed more emphasis than Piaget did on "language" and on "culture." Vygotsky is known and revered in the field of developmental psychology due to his innovative "Zone of proximal development" (ZPD). The ZPD is a formula for determining what a child can figure our or achieve by itself vs. what that same child can achieve "with guidance and encouragement form a skilled partner" (simplypsychology). In Anna's case, her ability to achieve has been severely limited by the lack of competent adult guidance. Speaking of adult resources, Lynne McKechnie writes that ZPD is actually the distance between the "actual development level as determined by independent problem solving" along with the level of "potential development" as determined through the process of "problem solving under adult guidance or in collaboration with more capable peers" (McKechnie, 2005). On page 49 Anna says she once pretended that she was "just passing through this family on my way to a real one." That doesn't sound like a child that has been embraced by adults in the sense of developmental assistance, or one that has been fortunate to have full adult empathic connections.

Vygotsky laid claim to the idea that learning occurs within the "social realm" and that, while following along with much of the work in the field of developmental behavior, suggests that ZPD is a valid way of measuring how an adolescent's action creates thought. In Anna's case, the way her body was harvested over and over again for the benefit of her sister created thoughts that she must fight back through the lawsuit. On page 391, Anna admits that her family now understands: "I am a monster. I started this lawsuit for some reasons I'm proud of and many I'm not… [and] I want the chance to grow up, even if Kate can't… I hate myself and just want to crawl back to where I was, to the person they want me to be" (Picoult, 391).

Jean Paiget posited that the process an individual goes through during his or her development -- the process of adaptation -- is broken down into two components: assimilation and accommodation (Lerner, 373). Paiget makes the point that when a cell takes in -- assimilates -- food, its structure is "converted into energy" and is altered. Hence, cognitive assimilation functions similarly; when an individual takes in experience and information that is part of the learning process. And accommodation for Paiget's theory means that the individual's cognitive makeup is changed due to the need to deal with the environment at hand; adjusting to the outside world for…