How Abraham Maslow Can Help Us Understand Life After TBI

How Abraham Maslow Can Help Us Understand Life After TBI

Abraham Maslow has been rolling around my mind lately. Maslow was a renowned American psychologist known for his theory of human psychological health — Maslow’s hierarchy of needs. It’s based on the premise that humans naturally seek growth but must have basic needs fulfilled before they achieve the highest level of growth, which he calls self-actualization.

These needs are best understood in a pyramid. Once the needs on the bottom are met, a person moves along to the next highest level. Here’s the pyramid:



Morality, Creativity,
Spontaneity, Acceptance,
Purpose, Meaning, Inner Potential

Confidence, Achievement, Respect of Others
Friendship, Family, Intimacy, Sense of Connection
Health, Employment, Property, Family, and Social Stability.
Basic Needs Such as Breathing, Food, Water, Excretion, Sleep, and Sex

As I thought of Maslow’s theory, I realized that before my husband, Hugh, had his accident, he had surpassed the self-esteem rung of the ladder and was working on self-actualization. He was a successful business executive with a loving family. All his basic, safety, love, and self-esteem needs were met. Then, he was struck by a car and sustained a severe traumatic brain injury.

The accident threw him all the way down to the level of physiological needs.

TBI greatly alters a person’s physiological needs. Depending on the level of trauma, a person might need help to breathe, eat, drink, or excrete. Sleep and sexual impulses may be affected for years following a TBI. In short, a person is flung back to the very bottom of Maslow’s pyramid.

Imagine yourself right now — an active, vibrant adult — in a hospital bed, unable to manage such basic needs as feeding yourself. This is the beginning of a life drastically altered for many people with brain injury.

Witnessing a loved one’s struggle with this drastic change is a trauma in its own right. But as time goes on, it’s also human nature to grow tired of the situation, to want to rush things along and see progress happen fast. It’s easy for us to think people could do better after they look better, to want to say, “Please try harder!” But when we see all the needs that must be fulfilled before a person moves from one level to the next, the picture becomes clearer.

It can take well over a year for many survivors to move out of the first pyramid row of Physiological needs. The second row is next, Safety: health, employment, property, family, and social stability. Many survivors will never fulfill all the aspects of good living in this row. Many will be unable to keep a job, and some won’t be able to live on their own. Others may lose friends and family members along the way.

Maslow was one of the founders of humanistic psychology, “guided by the idea that people possess the inner resources for growth and healing and that the point of therapy is to help remove obstacles to individuals' achieving this.”(1)

Rehabilitation is one resource we use to remove obstacles. Employing occupational, physical, speech, and cognitive therapy and creating compensatory strategies for living a fully functional life is the goal. In some cases, rehabilitation leads to employment. But rehabilitation is not available to everyone. It should be. It’s a good bet that it costs “the system” much more to pay for an untreated person with TBI due to a higher probability of continual decline, possible reoccurrences, or crime and drug abuse due to behavioral problems. Statistics show that many inmates in prisons have sustained a TBI.

And neuropsychology is even less available to survivors and families after TBI. In my opinion, participating in neuropsychological counseling is the key to understanding how and why post-TBI life is so different and difficult. Counseling helps individuals, couples, and families cope with ambiguous loss and grief, make use of available resources, and rebuild a life worth living.

How does Maslow’s theory help us understand life after TBI? Maslow says, “If you plan on being anything less than you are capable of being, you will probably be unhappy all the days of your life.” Our happiness hinges on the fulfillment of our potential; in other words, doing our best. As caregivers, if we strive to understand the extent to which a person must dig out after a TBI, not only physically but psychologically, as Maslow’s pyramid so clearly illustrates, we will be better prepared to help that person move back up the ladder of human growth.


Comments (11)

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After I suffered brain damage caused by a small stroke during brain surgery, I was unwittingly flung back down Maslow's hierarchy after having just received a long-awaited job promotion and having finally lived my childhood dream and achieved my lifelong goal of skating in a national competition even if it was by the age of 33. This theory makes perfect sense to me in my recovery since then.

It is difficult for someone who has not experienced this to empathize with someone who has and it is perhaps draining on a relationship for this reason. It is very difficult to explain how important having your job back is to someone who wishes they didn't have to work or who hates their job. They actually think you should feel lucky that you can't go back to work and diminish how important it is to you. Frustration would be an understatement, especially when success perpetually seems just beyond your reach.

Having suffered a traumatic brain injury on April 26,1980, and given little chance of any substantial recovery, I understand the need for a greater understanding of TBI by others. I was blessed to have a 'generally' accepting family who wanted the best for me.

Most of my, outside family, relationships disappeared and developing new relationships after a TBI is nearly impossible. After nearly 40 years I am finally married and feel close to another person. Patience in our recoveries is important and we may not reach a similar level as before our injury.

I believe Hutchinson is on the right track. I was fortunate to run into a surgeon who was ahead of his time. Given the prospect of death or possibly life, fortunately my parents decided to let the surgeon perform a life saving proceedure similar to that mentioned in the article. I survived and am living.

Although not the type of life I had envisioned, prior to the TBI, I am leading a life filled with love from my wife and family.

I had my TBI halfway through nursing school. Everything I was being taught was based on Maslow. I was able to recognize where others fell on the hierarchy and meet them where they were and help them get to the next level. Unfortunately my self awareness had been stripped by my TBI and I could not see that I was falling down the pyramid. Sadly, I was surrounded by healthcare professionals who didn't see it either. I lost most of the people in my life after my injury. Of everyone I miss myself the most. I am grateful for those that have weathered the storm (class 5 hurricanes at times) and I am mourning the loss of of who I was and learning to be better at who I am now every single day. Maslow was right in the order of needs to sustain life, I might rearrange some things in order to enjoy life. Then again, I can't enjoy a life I can't sustain....

Dear April 20th...too many losses for one person. My heart is with you. I'm so glad you have your animals--they are truly wonderful and loyal creatures.

Wish you well, Rosemary

Very provocative. Well done. I was very successful physician, Then came the TBI and  I was unemployed physician.  My sense is that  my happiness came before my worldly success in  life. I don't believe in Maslow's ladder of moving from one level to another higher level.  The levels have tunnels between each other. I view the levels more as layed out in a circle rather than a pyramid. The implication is that your recovery can start at any level and move around to the area of least resistance. GG 

Speaking as a TBI recipient, Cannabis helps me in a big way here in Colorado.  Highly recommended. For the win!

This helps me articulate the stage of TBI recovery of sorts I called the "warm and dry" stage. If we have our physical needs met, it becomes our definition of wellbeing. Sometimes moving beyond to second or third stage, but in my case its not sustainable. I just focus on what I can do to be happy. Before my wreck I was self-actualized. I think its now what helps me with now.

It's harder to go any further with a TBI if you hit a plateau while striving for a ! Normal life also. How can you get over it? By pushing harder and being strong.

Thank you for sharing this. As a caregiver to someone with TBI I always commented to neuropsychologists that the family relationship is key to rehabilitation. So much emphasis is placed in returning to or obtaining employment. But, I disagree. Relationships are the most important need in that particular grouping in maslow's triangle.

My life before my TBI was successful and happy in a 27 year happy marriage and a successful veterinary hospital manager. After my brain aneurysm and 5 months of recovery I've tried to continue the life I was used to....unfortunatley it was not possible and I received intensive neuropsychological therapy for almost 2 years which was very helpful for myself and accepting and understanding my limitations. My husband started cheating and left me, lost my home and my daughter and several friends distanced themselves from me....lost my job (due to my memory loss and neuro-fatigue). Also "I was too boring" Been living alone now for almost 3 years with my animals. at least they don't judge me. God bless EVERYONE with a TBI that still has family support and understanding people in their lives

I know of Maslow's work but I never made the connection. This will help me help my daughter recover. After almost 4 years she is still at the bottom level of the pyramid. Thanks for sharing this information.