Introduction
In this paper, I would like to introduce Sarah, a 15-year-old girl, mid-adolescent, 9th grader, who seems to have a rather normal life on the surface, but is definitely in need of help if one examines closely. One of the attributes that is alarming is that she is extremely school phobic, which is perhaps understandable for a first grader, but unusual and wrong for a somewhat grown-up 9th grader.
Sarah is a high school girl studying in a co-ed high school in her town. She had to take a remedial course because of her struggles with school work. She has a distant dream of going to college, but is unsure if can make it. What is sad is that, albeit knowing her case, there has been scarcely any effort from her end to make things work. She basically lacks the motivation to study and progress.
Sarah lives in a regular house with her family that includes her mother Lily, step-father James, and an elder step-sister Lisa. She owns a pet cat named Gerrad, whom she secretly calls Nija, meaning “god of death” in Polish. However, Sarah always lies on being asked what does Nija means as fears being interrogated. She hardly speaks generally and prefers talking to herself. Sarah has only one school friend, Alba. Although they are friends, Alba consciously keeps her distance from Sarah in front of peers. Sarah’s sister Lisa is in the same school and is a senior and a rather famous girl. Lisa is a pretty, blond, tall and athletic girl, who is also good in studies. Sarah, on the other hand, is a non-entity, plain, and black-haired, who struggles with any task requiring expertise and concentration. Lisa does not connect with Sarah either as a friend or a sister. Mostly, Lisa prefers ignoring Sarah, more so because Sarah does not seem bothered about it. Surprisingly, Sarah bounds well with James, her step-father. He is the only person she talks to, whenever that happens. The relationship between Sarah and Lily is rather complex. Although it seems very like that between a school girl and a busy working mother, there is a certain aloofness that is hard to explain. Lily however cares a lot about Sarah, more so because she seems to need it a lot.
Sarah started showing signs of school phobia when she was 12. She would cry, hyperventilate, and have seizures. Anticipation of a school day keeps her awake and crying the night before. She shows anxiety symptoms with extreme mood swings. She also has panic attacks at social events, especially those that require her to do some socializing or conversations. She often complains of vomiting, nausea, dizziness, headaches, abdominal pain, diarrhea, trembling, and palpitations. Sarah shows fearfulness, crying episodes, temper tantrums, and threats of self-harm. She is resorting to taking anti-anxiety and anti-depression medication based on her internet research as she does not want to see a doctor.
Sarah’s school friend Alba reports that she is very sensitive to any type of peer pressure, cruelty, and bullying by others, who constantly attempt to tease her as she is an easy victim. Sarah feels inferior and depressed; she is highly critical of herself and a pessimistic. In school, she looks intimidated and scared and never participates in any school activities. Depression is one reason because of which she cannot concentrate on studies, as she is always disturbed with morbid thoughts. Often lacking energy and feeling tired, Sarah cites them as reasons to skip school and social events. Her social anxiety could be because she is extremely self-conscious and believes that others judge her, laugh at her, and finds fault with everything she does.
Sarah’s phobia for the school can also be correlated with the detachment or little interaction among family members and her sense of isolation with people outside the family. Her non-existent communication with family members makes it difficult for her to express herself about her difficulties and needs.
Excerpts from Sarah’s secret diary reveals that she wants intimacy with another soul and wants to be sexually attractive. She wants to be seen as an individual and not to be compared with her sister or mother. She wants to be accepted by everyone. She wants other to support her decision and show confidence in her. She hates being compared and receiving critical statements about her appearance and personality. She has certain plans in mind with respect to the future, but she fears being labeled unreasonable or a loser if she ever discusses the same with anyone.
Having gone though Sarah’s case, major and evident issues with her can be summarize as follows: Issues with family members, except the step-dad; fear of opposite gender; jealousy; lack of motivation; fear of social situations; fear of performing and being questioned; love for her pet; frequent lies; repressed communication; timidity; lack of intimacy; lack of confidence; and depression among others.
Sigmund Freud’s Conceptualization of Sarah’s Case
Early childhood experiences impact behavior later in life. During the oral stage (birth to 2 years), Sarah needed undivided attention from her mother, which she did not receive because Lily started work soon after Sarah’s birth. During the sadistic-anal phase (age 2–4 years), when Sarah was beginning to understand the stark contrast between natural urges and societal norms, she again lacked sufficient supervision, especially in toilet training. Her mother was re-married just then and was super busy trying to tend to Alba as well. This led to Sarah feeling repeatedly embarrassed in public, for which she was sometimes punished. Memories of punishment lead Sarah to withhold elimination or expression in life, which affected her behavior later in life. In the phallic stage (age 4–7), Sarah faced intense societal demands, for which she harnessed more drives. She began to identify with James, her step-father, in her attempt to appeal to her mother. Not having known her real father, she developed deep hatred for Lily as a competitor. Finally, in the genital stage, Sarah continued to cope with balancing all her psychological forces. After puberty, she was sexually developed with strong sexual instincts. She was trying to adjust these natural psychic drives as per societal regulations. However, by now, the way her parents and others handled her during each growth stage had a profound and lasting impact her overall psyche development. She lacked confidence, could not express herself, fought for attention, compared herself to everyone in school and could see how much she lacked in terms of beauty, brains, and personality, causing her to fall into depression.
Freud theorized that children who smoothly transition through the stages grow to be calm, well centered adults and that an unsuccessful completion meant that a child would become fixated on that particular phase and either over or under-indulge throughout adulthood. Sarah needed help at every stage of her development to allow her to experience her feelings without guilt or excessive pressure to conform to preconceived ideas.
Phobias are unreasonable, long-lasting fears of particular objects or situations. These fears can be so serious that it can make one severely limit their lives to avoid the dreaded object. Phobias are caused by deeply hidden conflicts in the mind.
At 12, Sarah believed that her fears were for real; but, presently, she understands that her extreme fears do not make sense, yet she is unable to control how she feels about them. The situation she fears brings on severe anxiety that manifests as fear or nervousness. People often avoid the object of their fear as the only solution to fend it off. However, if the situation is a common one, it can limit their activities. What’s more, the severity of the anxiety increases many fold as the frequency of avoidance increases. This explains why Sarah’s condition worsened with time, as she continued trying avoiding the school. Sarah’s has social phobia (or social anxiety disorder), which makes her sensitive to being judged, criticized, or embarrassed, leading her to completely avoid social situations. Sarah comes across as shy and timid, but her phobia is more severe than it looks. That explains why Sarah palpitates and hyperventilates on being asked questions in class. Anticipating such a situation makes it hard for her to go to school or make friends. If left untreated, school phobia-associated anxiety may become so severe that Sarah would refuse to leave her home forever. On being forced or when accompanied by a family member, she may still feel great distress.
Sarah has difficulty complying with the societal regulations at her school, forcing her to repress certain aspects of herself into her unconscious mind, which includes inner urges that are disturbing for the conscious mind and society. Her withdrawn nature indicates that she sublimates these secrets into a region that she cannot face directly or express.
Sigmund Freud believed that jealousy is not only normal but also a desirable behavior. It is good for Sarah to be jealous of her pretty half sister, this feeling gives her space to express her insecurities. If she understands the reasons well behind the insecurities, she may have something to work on and fix.
Freud believes that girls have a sexual attraction to their fathers. Sarah may have had unconscious thinking patterns during growing up; this may continue until the same is eliminated by a normal and healthy development sexually.
Sarah seeks or requires certain desires for procreation and bodily pleasures, which manifests her instinct, fueling her natural bodily inclinations. Considering that her requirements are not being met because of various reasons, she lacks motivation in general to do well in studies and otherwise.
Sarah’s unconscious mind is comprised of instincts: the life instinct (Eros) that pushes her to improve her skills, become a better people, succeed, develop her personality, and adopt more effectively to the social environment. The death drive (Thanatos) pushes her toward rest or the ultimate rest “death.” These components are involved in frequent and ferocious battles. The death drive forces her to live in deterioration and the life drive forces them to “get back.” In her case, the death drive has surpassed the life drive, which needs correction.
One’s personality development is driven by the desire for immediate resolution of the problems one faces. Sarah’s personal progress is dampened by the repeated failures and lack of any resolution of her problems in school, be it in studies, with peers, teachers, or tasks. Whenever she tries to push the limit, she never finds satisfaction or resolution, only discomfort, further slackening her will. The dominant death drive in Sarah makes her indulge in sublimated cathexes, an array of activities that she secretly engages in and which serve as her outlets, like writing in a diary, escaping situations by lying, and vying for her step-father’s affection.
B. F. Skinner’s Conceptualization of Sarah’s Case
B. F. Skinner maintained the assumption that human behaviors are determined by learning and reinforcement, which forms the core to all behaviorisms. Whether by classical conditioning or operatant conditioning, individuals acquire new skills, which affect their interaction with their environment. If an action proves to have a positive outcome, an individual is more likely to continue repeating this behavior. However, if the outcome is negative, an individual is less likely to repeat the behavior.
Sarah’s phobia for the school is therefore associated with negative outcomes she had experienced at every stage and in most attempts. Growing up, with insufficient supervision and support, Sarah failed in any activity she participated in, what was worse was that she was teased and taunted about these failures along with constantly being compared with the winner to make her feel inapt and lacking. This gradually made her feel vulnerable and insecure in presence of others, wishing no association with anyone who may laugh at her. Her failures in school activities did not help her in her associations with other girls and boys in the class. Her teacher was disinterested in her and this hurt her too. With each new obstacle and a new day at school, she began liking the school lesser. The support that could have been given to her at this point was non-existent as her. Her family had an idea about her condition, but was too self-absorbed to pay much attention. Her mother tried to intervene, albeit too late, as by now, Sarah did not trust her mother or her words. All together, the negative reinforcement worsened her phobia of school and any social event.
As per Skinner, there exists a pattern of positive and negative reinforcement that establishes links between stimuli and their environmental antecedents and consequences. These associations between stimuli, actions, and responses can explain every aspect of Sarah’s behavior and interaction, especially her issue with communication. Language, including private communication and internal discourse, is a behavior that develops in the same manner as other skills. Skinner said that a sentence is merely part of “a behavior chain, each element of which provides a conditional stimulus for the production of the succeeding element.” Having learned through many episodes of being ignored that she is not being heard was sufficient to stop her from continuing with it. As per Skinner, the probability of a verbal response depends on reinforcement, stimulus control, deprivation, and aversive stimulation, and the interaction of these elements in a child’s environment leads to particular associations, which is the basis of communication. Differential social reinforcement from others in a society or the school develops, strengthens or weakens the dependency relationship between stimulus variables and verbal responses. Sarah’s trouble to communicate or express herself is a result of lack of stimulus to communicate, which in turn is a result of negative reinforcement. Finding the same outcome at both the school and home, gives her no options but to keep to herself. This also explains her affection for her pet, whom she talks too without any expectations. Also, the fact that Sarah’s “belief” is fortified by the reinforced responses to a speaker's words as the metaphorical expressions of a speaker reflect the kinds of stimuli that control his behavior. This can explain how and why Sarah ceased to verbalize.
Skinner demonstrated that learning occurs when these reinforcements accompanies or follows a specific behavior. The response garnered is reinforced specific means; this is called operant behavior, which is different from respondent behavior, because the latter is elicited by a stimulus.
Sarah’s behavior at time determined the subsequent behavior in a conversation. The rate of response and its temporal pattern in the temporal vicinity of the one who reinforces is dependent on the schedule of reinforcement. Just like how in a negative reinforcement, a subject on receiving unpleasant results that causes it discomfort, learns to find ways to escape the same, Sarah has learned various ways of escapism, like resorting to lies, talking to herself in second person, and talking to her pets. By indulging in these, her need to go out and gain and seek affection is met without exposing her to discomfort and hurt. Her phobia for school is also a way to escape discomfort that she anticipates and is scared of. Also, on having learned that it works for her to not go out, she repeatedly resorts to means that can keep her away from school, which includes faking sickness and making up stories.
Punishment is defined as the opposite of reinforcement because it weakens or eliminates a response. Punishment can work, like reinforcement, by directly applying an unpleasant stimulus such as a shock after a response or by removing a potentially rewarding stimulus. Punishment as a child, when she would pee in her bed and could not control her bladder, had strongly inflicted on her a dread of something similar happening in future.
Every person is under the control of his or her cultural, evolutionary, and immediate behavioral or operant contingencies. What is needed is a frank admission of this reality and to resolve the issue. Sarah needs counseling, basically someone who can make her come out of her shell and talk and express herself. Talking about how much pain she stores in herself, all her dread would find an outlet, that is the beginning of the healing process. Her school phobia is a manifestation of a collection of unpleasant events on her sensitive psychic. Sarah’s treatment should include consultation and behavior strategies, family interventions, and pharmacotherapy. Parental involvement and exposure to school in a positive manner by correcting the situation and strengthening Sarah’s will to face trouble and come out of it would help her in the long run. Love, case, support, and understanding are what she needs the most.
