Development across the life cycle.

* Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil. E-mail: [email protected] Financial support: none. This paper was developed for the written test of the competition examination for the position of locum tenens Professor of Child and Adolescent Psychiatry at the Department of Psychiatry and Legal Medicine of Universidade Federal do Rio Grande do Sul, held on July 17, 2013 (the original, handwritten draft is available as online supplementary material). Suggested citation: Kieling C. Development across the life cycle. Trends Psychiatry Psychother. 2014;36(2):59-62. http://dx.doi.org/10.1590/2237-6089-2014-1001 concept in psychiatry.”4 The same author, a prominent critic of psychoanalysis in the 1970s, published another paper in the British Journal of Psychiatry in the 1980s, criticizing the existence of two kinds of psychiatry: one brainless and the other mindless.5 Eisenberg, towards the end of his life, declared that he regretted having been such a harsh critic of psychoanalysis – arguing that psychoanalysis did have a value in teaching his students to listen to their patients. Eisenberg’s major argument was that, from a developmental point of view, it is possible to integrate different areas of knowledge with the ultimate aim of understanding how, why, and why precisely a family seeks help – in addition to giving us hints of why it was not possible for that child, the adolescent, and the family to resolve the problem without resorting to a mental health professional. In this sense, an understanding that takes into consideration biological, psychological, and social aspects – i.e., a biopsychosocial understanding – is essential in psychiatric practice, especially in psychiatric practice dealing with children, adolescents, and their families. Therefore, it is essential to have knowledge of the development of the central nervous system from as early as fertilization, with the growth of 250 thousand neurons per minute over the 9 months of pregnancy, the process of neuronal and synaptic pruning in the first years of life, and the progressive myelination of the central nervous system.6 Similarly, Freud’s lessons about psychosexual stages (oral, anal, phallic, latency, and genital phases) is A primary issue in psychiatric clinical practice is the definition of normality. Normality may be defined as utopia, as health (which is more than the absence of disease, as recommended by the World Health Organization), as average. Using a simplistic definition of normality is certainly not the best way to go, as we learn from Brazilian writer Machado de Assis in The alienist, a novel in which physician Simão Bacamarte ends up alone in the Green House asylum after having defined normality as majority.1 It is precisely in this arena that a deep knowledge of the typical, expected human development across the life cycle acquires major relevance for child and adolescent psychiatric practice. Beyond that: we live in an age where several trends and theoretical models have developed – and it is now necessary to bring them together. The very notion of childhood and family as we conceive them today is recent, as shown in the work of Philippe Ariès.2 The study of the mind and brain has also seen an explosive growth in the 20th century, with the first half of it focusing essentially on the intrapsychic, and the second on neurobiology. At the same time, the study of social, community, and family aspects has been growing, to the point that the individual, or better, the child, is not just simply a child anymore, but rather a child and his/her circumstances, to paraphrase Ortega y Gasset.3 Leon Eisenberg, professor of Child and Adolescent Psychiatry at Harvard, deceased a few years ago, wrote a classical article entitled “Development as an unifying O desenvolvimento ao longo do ciclo vital