When I started working in social care, I remember being told about Maslow’s hierarchy of needs. Maslow represented human needs in a pyramid, with basic, physiological needs such as the need to eat at the bottom, followed by the need for safety, the need to feel loved and like you belong, with the need to “self-actualise” – to be all that you can be – at the top. He believed that you had to meet your base needs before you could pursue higher needs, with self-actualisation something you are only in a position to pursue when your physical and psychological needs are fully met. Maslow has been criticised from a number of directions: firstly, putting self-actualisation at the top of the pyramid reflects the aspirations of an individualistic society and particularly perhaps a particular male view of achievement. It was suggested that someone from a more collectivist society might value community acceptance above expression of self. Others have questioned whether there is any real evidence for human needs to be arranged hierarchically at all.
It’s always struck me as one of those ideas which hides a lot of dangers within its common-sense appeal. It’s a short step from recognising that it’s hard to pursue self-fulfilment when your basic needs are not met, to assuming that people who struggle with the most basic functions may not also have the “higher” aspirations. This is self-fulfilling: when people with severe impairments were placed in de-humanising institutions, it was often indeed hard for them to aspire to anything beyond meeting their basic needs and easy to write people off who were able to confound those expectations when they moved to a different environment (see A box of buttons, below).
And it’s not just collectivist societies who might question Maslow’s view of self-actualisation as being at the peak of human aspirations. Maslow saw sex as one of the base needs, rather than as part of an emotional need and he saw family, belonging and being valued by others as simply needs to be met before moving onto ‘higher’ things. Placing things in that order of importance doesn’t seem very compatible with an enlightened or sophisticated view of ourselves and our place within our families and communities, but it is still to some extent the order in which many social care interventions place aspirations. Whilst it was right, I think, to prioritise enabling individual choice and self-actualisation, as part of breaking down de-humanising institutional cultures, I think you could argue that the ability to make our own choices is a more ‘basic’ need than the need to achieve full citizenship, with the sense of responsibility which that status entails. In other words, individual choice is a means not an end: it helps us create the space in which to develop a sense of responsibility towards others.
So, when you apply Maslow’s pyramid to social care, it is compatible to some extent with a rights-based view of the goals of care and support: with personalised social care having the goal of meeting individual needs as best as possible. But it’s hard to place an individual’s responsibilities within the pyramid – for me, the achievement of genuine citizenship, in which I have responsibilities as well as rights, floats somewhere above the top.
The issue of responsibilities has come up in a number of conversations recently, not least in relation to my role looking at prevention, for the Caring for our Future engagement exercise. In my next blog, I’ll touch on one of those conversations, which challenged my way of thinking.