“When my mother came home from two weeks in hospital, we really thought that her skin condition was healed. But within a week the symptoms had reappeared, and we were back where we started.”
So begins a familiar tale of despair that I have heard in my practice as a social worker.
It has been estimated that more than 70% of patients in doctors consulting rooms have health problems based on emotional and psychological issues. The general quality of life of most South Africans is poor, even among those people who have more than enough income to satisfy basic survival needs. How do we help people achieve a better quality of life, so that they don’t become sick and make demands on an overburdened health care system? It has everything to do with development on a human scale.
For more than two decades, Abraham Maslow’s “hierarchy of needs” theory has been generally assumed to explain human development. In this theory people are assumed to all follow the same pattern of development, ascending a hierarchy of five levels of needs satisfaction. Once basic subsistence needs are satisfied, attention turns to the need for protection and shelter. Then people want friendships and affection, before ultimately graduating to a desire for recognition and identity, which when satisfied, leads to self-actualisation – the last rung on the ladder.
Many have begun to question the adequacy of this theory, notwithstanding its popularity. It may be true for Western individualists, living in a culture that sanctions and encourages the satisfaction of identity by striving for personal distinction. In non-western cultures that value communal identity more than individual brilliance, Maslow’s hierarchy becomes controversial.
As an alternative, Chilean development economist Professor Manfred Max-Neef set out to develop a theory of human development that more adequately accounted for the realities of poverty, illness and despair in the continent of Latin America. Working with an interdisciplinary team in the Centre for Development Alternatives in Santiago Chile, the assessment of Quality of Life was untangled from purely economic measures like Gross Domestic Product. He makes a simple but profound distinction between satisfiers on the one hand, and human needs on the other. Generally we tend to talk of needs purely in terms of their material manifestations. Water, housing, jobs, electricity,… until we have a shopping list that stretches endlessly. We then classify the ‘needs’ largely in terms of demands for goods and services in the market, and spend the rest of our lives worrying where to get the money to pay for them.
While not disputing the value of the marketplace in efficiently distributing goods and services to satisfying needs, Max-Neef explains that the free market system is not the only domain where human needs are satisfied. Most needs can be very adequately satisfied without large expenditures of money.
His thinking on human needs is in this respect not too different from Maslow’s. However Max-Neef differs fundamentally from Maslow, in terms of the motivational structure that in a sense ‘organises’ the needs. He offers an alternative conceptual approach, arguing that each person, family, community and organisation will develop its own unique pattern or ‘culture’ for satisfying its needs. This makes for a fascinating diversity of cultures as there are an infinite number of possible combinations and styles of (for example) satisfying the need for identity or affection or participation etc. Although Max-Neef was reasoning as an economist, his insight has inspired people from a range of disciplines, from anthropology (‘culture’ takes on a new meaning indicating the way any ethnic group seeks to satisfy it combined human needs) to psychiatry (‘mental health’ is directly associated with appropriate satisfaction of fundamental human needs.)
While ‘satisfiers’ are infinite Max-Neefs proposes that needs are finite and number but a few universal human needs. Ever since Homo Habilus appeared on the earth the needs for subsistence, protection, affection, participation, understanding, creation and leisure (he prefers the word idleness) have motivated human development. At a later stage the need for identity emerged and still later the need for freedom. At the current state of human evolution, these nine needs are proposed as fundamental to our self understanding as human beings. They constitute the benchmarks for determining quality of life, and thus health. They are the ‘lenses’ through which development is amplified to maintain a ‘human scale’.
With this framework, one can begin to understand and diagnose the underlying causes of poor family health. Is the family poor in respect of affection, understanding, leisure, protection, identity, participation? In the South African context a major factor in diminishing the quality of life is of course fear of robbery and attack, given the high crime rate and unemployment. Women and children are the worst victims of this, and the tragedy will recur into the next generation, if the fundamental human needs of children are not satisfied.
What does one do to bring healing and well being to a society sickened by prolonged ‘poverties’ with respect to the needs for protection, affection, understanding, identity, freedom, participation, creation and idleness, as well as subsistence? How do we break the vicious cycle?
At a conference of Human Scale Development practitioners in Chile a few years ago, we learned how Max-Neef’s needs system was been used to great effect in Spain to develop effective measures to care for people dying with Aids. It was inspiring to learn how people whose every fundamental human need had been devastated by the medical and social effects of HIV infection, were helped back to regain a sense of humanity again by the deliberate attention paid to their needs, by the dedicated care givers. At the very least they were able to die with dignity. For most, the question is about living with dignity. How, in our fragmented and ailing society, do we set in motion virtuous cycles that counteract the vicious cycles of fear, despair, disease and suffering?
At a very practical level, he recommends that new satisfiers be conceptualised with the simple recognition of the huge effects and benefits that flow when synergies are created. When a flock of geese flies in formation they are able to fly some 50% further and 70% faster than a goose flying alone. This is what is meant by that oft used but seldom understood word, synergy.
Anne Hope, a distinguished adult educator has modelled the nine needs as spokes of a wheel. The wheel spins true when all needs are present, and satisfied in a balanced way. I have called it the wheel of hope both in recognition of Anne’s insight and to offer families and communities a tool to begin to rethink and restructure their group culture synergistically.
South African families, communities and organisations can become healthy organisms, radiating a quality of life that takes the pressure off the health care system. Perhaps mother never need go to hospital again, because her skin condition – a nervous condition – disappears when the family takes a radical inventory of their quality of life. They realise that commercial television satisfied their need for idleness, but inhibited their need for creation and participation. They rework their menus and diets to ensure their subsistence needs were satisfied and now have great fun on Saturday afternoon creating a vegetable patch in the back garden. They even find themselves able to get up earlier every morning to spend half an hour together reflecting how to make the day as satisfying as possible, for themselves and others. They get to know their neighbours and form a neighbourhood watch that doubles as a babysitting circle, as well as providing a ready pool of players for regular games evenings. This home entertainment reduces pressure on the food and entertainment budgets, enabling longer holidays and weekend getaways to satisfy their need for freedom and idleness, having a great effect in reducing stress and anxiety because all sort of creative and productive ideas pop out in times of relaxation. The revitalised lifestyle is rubbing off at the office too.
Interestingly Max-Neef proposes that a tenth human need is emerging and in our current historical era, is becoming fundamental. He calls it the need for transcendence. Although not himself given to theological reflection, like the great psychiatrist Victor Frankl, Max-Neef points to the potential of a greater ‘system’ beyond the system. South Africa is fertile ground for the creation of a new culture in which the Wheel of Hope turns up things we never dreamed were possible. An Australian delegate at the Human Scale Development conference told a story that approximated the fictitious changed lifestyle I describe. She left us with another memorable line.
“Hope is believing in spite of the evidence: Then watching the evidence change.”
Image at top of article:
The Road to Wellness
Health Promotion and Education Poster developed by graduate students in Occupational Therapy, UCT
“…there is a point where one just has to trust the journey and continue into the unknown rather than regress to Boring Boulevard. Once one turns into Hope Street, more people are interacting and supporting each other. People are engaging in meaningful and purposeful occupations, thinking more positively and have a greater appreciation for the community and environment at large.” Heather Wannacott
