EXPERIENCING MEANING & SELF-TRANSCENDENCE
Addressing the “Needs” and “Meaning” in Terminal Illness (Cancer):
Abraham H. Maslow’s interest in the human being helped him to develop the Hierarchy of Needs in his classical work of “A Theory of Human Motivation.” Fundamentally, Maslow addresses the stages of human growth in a hierarchal manner; the theory starts with the physiological as the basis of all needs, then moves on to safety, belongingness and love, esteem, and finally, self-actualization, as the prototype (pattern) that human being progress through as inner motivations and needs. The pyramid addresses the level or order of human needs; the primary, most fundamental level of need begins at the bottom and works its way up the triangle to self-actualization, which refers to the utilization of one’s full potential to accomplish all that one can. Specifically, the basis of his “Theory of Motivation,” is that “human beings are motivated by unsatisfied needs, and that certain lower factors needs to be satisfied before higher needs can be met” (Morgan, 2010, p.121). In Maslow’s theory, one must meet the most important human needs prior to reaching the stage of self-actualization; the person strives to seek a higher need when lower needs are fulfilled. Maslow considers that when needs are met, there is satisfaction and when needs are not met, there is frustration.
Maslow became a major figure in American psychology and personality theory with his book “Toward a Psychology of Being” focusing on the being. He said, “If we wish to help humans to become more fully human, we must realize not only that they try to realize themselves, but they are also reluctant or afraid or unable to do so. Only by fully appreciating this dialectic between sickness and health can we to tip the balance in favor of health” (Morgan, 2010, p.119).
Frankl takes this concept a step further, and is often quoting Goethe’s aphorism: “If we take people as they are, we make them worse. If we treat them as if they were what they ought to be, we help them become what they are capable of becoming” (Graber, 2004, p. 68). “The resources of inner strengths are to be found in that dimension [the noetic/spiritual dimension]” (Graber, 2004, p.74). We can help patients to become what they are capable of becoming. It is precisely in the outlook, that regardless of the specific need that may be thwarted, the individual has the capability of “becoming” even in the face of unsatisfied needs.
Specifically in Cancer, or any terminal illness, many of the basic and lower level needs become thwarted, go missing, or are changed all together. The higher level needs become a longing for, but in the face of suffering, often get placed aside. However, this can specifically become the problem why pain and suffering take over one’s identity; there is too much focus on the lower level needs, and not enough on the existential value and meaning inherent in the higher level needs and even beyond.
Herbst (2006), Zalenski & Raspa (2006) adapted Maslow’s Hierarchy of needs to that of Cancer patients, addressing the new types of needs specific to the diagnosis that cancer patients go through, matched to Maslow’s Hierarchy; see in the Conceptual Pictograph (Irwin, 2013).
We have taken this concept a step further, as Frankl had done with his theory, to apply Logotherapy and its techniques to Meaning in Illness coupled with Maslow’s Hierarchy of Needs. This is a tool which can be used in assisting patients to find meaning in illness, as well as assist in constructing a new identity of self, post diagnosis, which focuses on “Being” and “Becoming,” rather than on what was lost or has changed, or limits the patient in any way due to the diagnosis. Both, the needs in cancer can continue to be addressed, while simultaneously working on Meaning in Cancer/Illness. Although this is depicted in the Hierarchy format, lower areas of meaning do not need to be met or progressed through to reach self-transcendence; rather, all of the meaning-making opportunities lead toward self-transcendence and new self-identity post diagnosis.
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