- The goal of treatment for depression is not just to survive, but to thrive.
- A successful treatment outcome is evidenced by a new outlook on life and increased resilience.
- With healing comes the ability to use all of one's capacities and capabilities to live life at the highest potential.
When I tell new patients who are severely depressed that not only can they be helped but we are aiming to get them much better than just undepressed, they are puzzled. After all, pessimism and hopelessness are key components of depression and they are pretty sure I have nothing in my bag of tricks to help them. If anything, they are hoping to just get by—to survive. At that point, they can’t really picture a life in which they thrive. Often they find the idea so preposterous that they guffaw. It is the first time they have chuckled in weeks. We are on the road to treatment.
By achieving a better outcome than just being undepressed, I am referencing psychologist Abraham Maslow’s hierarchy of needs. It is a concept he introduced in 1943 and was further described in his 1954 book Motivation and Personality. While his theory, often taught in psychology and sociology classes, has been criticized for lacking empirical evidence, I’ve found it to be clinically helpful when assessing patients as they move toward a full recovery from depression. The ultimate goal of treatment is to help individuals fulfill their greatest potential. It may take months of treatment but, over and over, I have seen my patients regain (or, in some cases, experience for the first time) their most creative and self-actualized selves.
Abraham Maslow's Hierarchy of Needs
Maslow’s hierarchy, often pictured as a pyramid, begins with the lowest level being physiological needs, like food, clothing, sleep, and shelter, followed by safety needs, which include personal security, health, and employment, followed by the need for love and belonging, which is fulfilled through family, friendships, intimacy, and connection, followed by the need for esteem, enjoyed when given respect, status, freedom, and recognition, and, finally at the pinnacle, self-actualization—the desire and ability to become the most that one can be. Years later, Maslow added self-transcendence, also known as spiritual needs, to the top of the pyramid. The fullest realization of the self, he stated, is giving of oneself and going beyond one’s self.
People don’t often think about this hierarchy when they come for treatment. They think about the most minimal survival need to get out of depression. But, in fact, if the treatment goes well, they will have a sense of themselves that far exceeds their most basic physiological and safety needs. They will be capable of love and friendship and establishing intimacy. When people successfully recover from depression, they usually have a better sense of self-esteem and strength and, as Maslow conceptualized it, a greater ability to go about searching after that which makes them feel most self-actualized. With that sense of fullness of identity, they are able to give of themselves.
Overcoming Trauma and Flourishing
When Helen, a 40-year-old publicist, first came to my office she was suicidal after suffering a trauma. She had taken a leave of absence from work, was estranged from her family, and felt alienated from her friends. It took time for us to settle on her optimal medication regimen and a great deal of talk therapy but she gradually went back to work and, ultimately, excelled at her job, moved up the ladder, and was promoted to a senior corporate position. In processing her trauma, she regained a sense of safety and reestablished relationships with friends and family. Like so many people who recover from depression, she became a powerful, magnetic force, with colleagues now eager to seek her opinion and guidance. She blossomed and enjoyed being all she could be. This should not be the exception in treatment.
This isn’t a simple, quick process. There is no one cure-all for treating depression. Sometimes it can take trial and error to land upon the optimal combination of medications to treat the varied symptoms of major depression. While advances in psychotropic medication are remarkable, taking an integrative approach, that includes psychotherapy, meditation or other body/mind practices, and wellness habits, is almost always beneficial. There are, generally, some early signs that treatment is working. A bit of light will shine through the darkness. That light will grow as recovery continues.
Ultimately, a successful outcome should lead to a new outlook on life. That doesn’t always mean life will be filled with rainbows and lollipops. In some cases, it can mean having increased resilience in the face of significant challenges, like having a chronic illness or dealing with financial insecurity. But the new sense of hopefulness and possibility means that individuals recognize that they have options. They no longer feel paralyzed or like they are in a rut. They may decide to seek further education, travel, or just appreciate the blessings that surround them.
Maslow talked about “aha” moments and peak experiences in which one feels enormous happiness, awe, fulfillment, or wholeness, often in relation to creative work, music, art, or nature. As people recover from depression and begin to become fully functioning, moments of insight can be startling and numinous, and, once they occur, can happen with greater frequency.
Treating people with depression—watching them emerge out of the hell of despair and embark on the road to further growth and development—is gratifying. It is exhilarating to see them become the new, emboldened versions of themselves.