Explain why children in the early-school-aged period may be especially vulnerable to fluctuations in self-esteem and feelings of "worthlessness."
Young children, in the early school aged years are in a developmental stage that is focused on feelings of identity and self-esteem (Nutbrown & Clough, 2009, p 191). It is during the early years of school that children begin to form concepts of identity through a sense of belonging as well as through the demonstration that they are needed by others in their community, and especially those they hold in high regard, peers and teachers. They seek to demonstrate for themselves that they play an important role in their own lives and communities to help them establish a sense of self. In other words they seek almost above all else to establish that they are valuable and have purpose in their community and especially in school as this is often their first intense experience of exposure to peers and socialization on a large scale and everything up to this point has supported in them the feeling that doing well in school is essential to being a "good" child and therefore valuable. Nutbrown & Clough seek through research to demonstrate that including children's voices in the change and development of their own learning environment, in a sense giving then a job that demonstrates real change positively affects levels of self-esteem and a sense of belonging for young school aged children, stemming of the potential for feelings of worthlessness and their vulnerability to it (2009). Children also experience serious vulnerabilities to fluctuations in these two opposing feelings, high self-esteem and worthlessness as a result of the concrete learning stage, "if I am not uniquely needed then I must not be a valuable person or member of my community." Simple or what might seem small social and/or academic problems can in fact seriously affect a child's daily sense of value and therefore high self-esteem. This could be something as seemingly unimportant as being excluded in games by peers, doing poorly on a single assignment or task or feeling socially excluded because of appearance. In Hesketh, Wake & Waters longitudinal research on classifgications of overweight and how it affects the self-esteem of 5- to 10-year-old a common link was found between overweight and low self-esteem. According to Hesketh, Wake & Waters this low level of self-esteem (corresponding with feelings of worthlessness) was greater in those who were classified as overweight (2004). "Childhood obesity, now one of the most common chronic conditions of childhood, is believed to be strongly associated with psychosocial morbidity. For individual children, the immediate psychosocial effects of social isolation, discrimination, and peer problems can accompany childhood obesity," (Hesketh, Wake & Waters, 2004, p. 1233) this then follows many to early adolescence and adulthood as a pervasively lower sense of self-esteem and self value. Though overweight and the potential social implications of it are simply a single example of a factor that can poorly effect children in this early school aged group the social isolation aspect (no matter the cause) is a recognized factor in childhood development that indicates limitations in the development of positive self-identity and can without change, such as change of school environment or adoption by a positive peer group become a pervasive aspect of one's core identity. Though some intervention by adults, such as parents or teachers can mitigate some of the stronger feelings of exclusion, really at this stage peer rejection becomes a problem with pervasive effects, causing the individual to possibly begin to exhibit signs of stress which in young children can play out in behaviors, either self-isolating behaviors, aggressive behaviors or even limitations in achievement attempt behaviors. For example: "They have not included me in the past so why risk the rejected feelings?," Or bullying behaviors, "They don't deserve to have me as a friend so I will be cruel to them.) or even lack of effort for achievement, "Nothing is going well at school so why should I try?" To children at this developmental level it is logical to have concrete ideation about how pervasive a problem is, it is all or nothing or global in perspective which is clearly at the root of the susceptibility to fluctuations in self-esteem and feelings of worthlessness.
2. Describe what is meant by the concept of "a good death." How do hospice care and euthanasia help a person who is suffering a slow, painful death trajectory affect the effort to achieve a good death?
The line of reasoning or definition of a "good death" for many includes the idea that as a living person he or she has a great deal of personal control and is able to make decisions about what will or will not be a part of their life, including vocational, educational, procreativity and so on, but that in the end of life many of these choices are taken away. The definition then of a "good death" to many is one where they are in ultimate control over the decisions of their life in the end. There is also a sense of a good death being one that limits pain and allows the individual to spend as much time as possible in a setting that is comfortable to them (i.e. home) and with loved ones. Though euthanasia and the hospice ideology are almost completely incompatible, i.e. hospice denounces active euthanasia and stresses the need for pain management, comfort and social interaction in palliative care or passive euthanasia (allowing one to die as a natural course of his or her disease state) they still both seek to offer the individual a "good death." According to expert opinion the ideation of a "good death" should be a goal of healthcare and society, as a result of the last 30 years of progress with regard to understanding the impact of death and grief on individuals as well as the development of palliative care and other relatively new medical trends. The commentators describe a "good death" by stating; "While the hours or days before death are important, the focus should be the weeks and months before death when symptoms and needs increase, and interventions can have a significant impact on the well-being of patients and families. Thus, a good death should mean making the last weeks -- not minutes -- of life valuable and meaningful," (Emanuel & Emanuel, 1998, p. SII21)
When comprehensive palliative care is provided by an experienced team of specialists, most symptoms of end-of-life suffering can be effectively managed. However, clinicians note that a persistent proportion of dying patients (5% -- 35%) continue to suffer intolerably in the last weeks of life despite the best palliative care.1,2 A small percentage of these patients will ask their health care providers for assistance in dying in order to escape their suffering. (Schwarz, 2007, p. 1288)
For some individuals the concepts of a "good" death is simply one that they themselves determine, in other words they have up to this point had little if any control over the disease process and have hence been unsuccessful at avoiding death and would like to die a dignified death at a time that they rather than their disease chooses (Schwarz, 2007) Some will go as far as asking for physician-assisted suicide while others will succumb to the disease naturally and even others will do less active but still choice centered and voluntary things to hasten death, such as voluntarily stopping eating and drinking. "Some commentators suggest that the option of voluntarily stopping eating and drinking (VSED) may be a preferable alternative to physician-assisted dying as a means to hasten dying for suffering, terminally ill patients," (Schwarz, 2007, p. 1288) Though the legal ramifications of this act have yet to be explored the main and essential aspect of the definition of achievement of a "good" death is subjective and yet the most common thread for most people, and especially those experiencing terminal illness of self or a loved one is a death that reflects independent choice and is as free of suffering as possible. Additionally, the idea of a "good" death as one that is well thought and decisive may include active and/or passive euthanasia supported by a palliative care team the individual and the individual's family and/or hospice or other such care.
3. Discuss the concept of intimacy. Why is it important in development? What skills may result from achieving intimacy? What are the difficulties in achieving a sense of intimacy? What effect may one's resolution of the crises of intimacy vs. isolation have on later development?
Intimacy is a concept associated with close personal ties with others, usually intimacy refers to the level of trust one has in a relationship with an adult in a primary love relationship but intimacy can also take place in relationships with close peers or even in relationships with siblings and to some degree parents. For the purpose of this work the idea of intimacy refers to the experience of early adulthood that…