Maslow's hierarchy of human motivation is an often-cited reference in articles on the practice of psychotherapy. When approached to contribute these reflections I realised that I had never actually read Maslow's original work. On then reading this very short booklet, I was surprised to see that it was written in 1942, in the middle of World War II, and yet still seemed up to date and prescient in its content, if not in its wording and style.

‘When we ask what a man wants from life we deal with his very essence’, according to Maslow. While Maslow recognises that an act typically has more than one motivation, he goes on to build a hierarchy of human motivation whereby the appearance of one need usually rests on the prior satisfaction of another need. He states that behaviour is almost always biologically, culturally and situationally determined as well.

I have had clinical experiences of working as a consultant psychiatrist in medical psychotherapy over the past 30 years with a variety of patients, in a variety of settings, and using a variety of constantly evolving therapeutic skills. According to Maslow, the underlying motivation in all humans is the satisfaction of the physiological needs that support homeostasis. He next describes the need for safety, which is especially evident in children as they enjoy and seek a predictable, orderly world in which to thrive. Next comes the need for love, which involves both giving and receiving love, and is not synonymous with sex. When the above needs are satisfied the need for esteem, a desire for stable, firmly based, high and respectful evaluation of the self, comes to prominence. Finally then comes the need for self-actualisation, as a man must be what he can be to be happy, to be self-fulfilled, and be everything that he is capable of becoming.

Maslow anticipated much of the literature that was to begin to follow some 20 years later on child abuse by describing the impact on children of parental quarrelling, physical assault, separation, divorce and death in the family. He noted that completely rejected children may cling to their hating parents more for sheer safety and protection than because of their hope of love. He thus began to anticipate the work of John Bowlby on attachment when he wrote that ‘strong people’ are likely to have been satisfied in their basic needs throughout their lives, particularly in their earlier years, and have developed exceptional powers to withstand present or future thwarting of these needs. Those who have loved and been well loved, and have many deep friendships, can hold out against hatred, rejection or persecution. It seemed probable to Maslow that the most important gratifications come in the first two years of life. People who have been made strong and secure in the earliest years tend to remain secure and strong thereafter in the face of whatever threatens.

This truly is a remarkable work that highlights the development and evolution of a range of important child developmental ideas. I am glad to have finally read it!