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:
Confidence, Achievement, Respect of Others
|LOVE AND BELONGING |
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.