On meaning (courtesy Dr. Andy McLean)

In his original “Hierarchy of Human Needs,” Abraham Maslow put physiological needs at his pyramid’s base and “esteem needs” at the top. The level “self-transcendence” was later added to top of the pyramid by the author. This term is somewhat of an oxymoron, as the focus on “self” is actually the antithesis of his meaning. Per Maslow, “Transcendence refers to the very highest and most inclusive or holistic levels of human consciousness, behaving and relating, as ends rather than means, to oneself, to significant others, to human beings in general, to other species, to nature, and to the cosmos.” Maslow’s hierarchy is not meant to be a “ladder.” One can still have unmet needs and yet experience a profound sense of meaning.

One of the more extraordinary examples of this is seen in the life of Victor Frankl, a physician and holocaust survivor. His motto, “He who has a ‘why’ to live can bear almost any how,” aided him in surviving four concentration camps during World War II (and helped him understand why some could not survive.) He went on to write “Man’s Search for Meaning,” which has been translated into over 50 languages. Frankl’s experience has resonated in our own family, as my mother’s older brother was a prisoner of war in WWII who also went on to become a physician.

Transcendence sounds like something only gurus or ascetics experience, or an “event” that requires one to be a scholar of philosophy, psychology, or spirituality to grasp. But it is not so esoteric. It means accepting paradox and uncertainty. It involves contributing to the greater good in a society which often focuses on personal achievement. (And doing so without making oneself a martyr.) While, for Maslow, self-transcendence was the destination, for Frankl, it was the road. The destination is finding meaning.

Frankl believed that the innate drive of human beings was not to pursue pleasure, but to find and sustain meaning and purpose. He felt this could be accomplished through three areas:

• Purposeful work (work can imply career or other contributions)
• Deeply connecting to something (nature, beauty, art) or someone (love)
• Courage in the face of difficulty

We can certainly see how this might relate to those of us in the healthcare profession. The “why” of having chosen our profession might show up frequently in a grateful patient or a successful treatment outcome. However, we might also have to search for reminders in order to manage the “how” of difficult days with courage. Deep connections will help.

Reminder, if you would like to share inspirational quotes, stories, or ideas which might be helpful to others, please feel free to email Dr. Melissa Naslund at melissa.naslund@UND.edu.