The Merriam Webster dictionary defines survival as “to remain alive or in existence.” This requires the very basic necessities of life, such as food, water, oxygen, shelter, and sleep. However, humans are quite complex beings; they may be able to survive with when their fundamental needs are met, but they require far more in order to thrive. Thrive, as defined by the Merriam Webster dictionary, encompasses “flourish, prosper, and grow vigorously.”          

What is essential in order to thrive?

Theories on this abound. In 1954, psychologist Abraham Maslow created the hierarchy of needs, which is organized into a pyramid. At the base are the Physiologic Needs as described above. The second level includes the Safety Needs, such as security and freedom from fear. The third and fourth tier encompass the “Higher Needs,” such as love, belonging, and esteem as well as the pursuit of achievement and mastery. The apex of the pyramid is Self-Actualization, where the individual realizes their potential and finds personal fulfillment.

However, more recently, Ed Diener, PhD, surveyed over 65,000 people in over 123 countries. He discovered that “the needs most closely linked to everyday satisfaction are the interpersonal ones, such as love and respect.” This coincides most closely with my experience as a clinician, as the grief stemming from an actual or perceived loss of a loved one, is one of the most common triggers for self-injury, depression, suicidality, homicidally, and anxiety just to name a few.

It all begins in early childhood, with attachment and the ability to trust that one’s physical and emotional needs will be met. In Harlow’s experiments with monkeys, young rhesus monkeys were given a choice between two different “mothers.” One was made of soft terrycloth but provided no food. The other had a bottle but was made of wire. Not surprisingly, the baby monkeys spent the majority of their time with the soft terrycloth “mother,” even though she did not provide food. In humans, “Failure to Thrive,” is a medical diagnosis estimated to occur in 8% of the pediatric population. It occurs when a young child (usually under a year) fails to grow or maintain an appropriate weight. This is commonly attributed to neglect, poor attachment, and “psychological, social, or emotional problems within a family.”

As the youngster enters childhood, the desire for love and acceptance predominates, at times even transcending the physiologic needs. However, pathology becomes quickly evident when the home is not viewed as stable or safe due to abuse (physical, sexual or emotional) or neglect. Studies have shown that the most important predictor of the quality of adjustment to change during the formative years, is dependent upon the caregiver. Thus, even children who have undergone several geographic relocations (through the shelter system), have not been traumatized, as long as the care giver was viewed as reliable, safe, loving, and able to provide protection.

Teenagers are well known for their shift of focus from family to friends. In order to successfully navigate the intricacies and drama prevalent during the teenage years, the fundamental needs of love, belonging, and a proper self-esteem should have been met in the earlier years. If accomplished successfully, this leaves the young adults to adroitly begin the pursuit of self-actualization (achievement and mastery).

Erik Erickson classifies psychosocial development into stages starting from infancy. These include Trust vs Mistrust (infants), Autonomy vs Shame and Doubt (toddlers), Initiative vs Guilt (preschool), Industry vs Inferiority (school age), Identity vs Confusion (adolescence), Intimacy vs Isolation (young adulthood), Generativity vs Stagnation (middle adulthood), and Integrity vs Despair (Maturity). If one successfully completes their developmental stage, they can move forward in a healthy and productive manner. Healthy adults have ideally reached the stage of Generativity verses Stagnation. There, they can focus on career and family, contributing to their world by being active in both their home and community. However, those who fail to progress beyond this stage, often feel unproductive and uninvolved in the world.

The elderly who must transcend Integrity vs Despair reflect on their life. The hope is that their final years will be spent surrounded by loved ones who revel in their accomplishments and strive to learn from their past experiences.

All of us in the mental health field, have seen the causalities of those who are struggling to survive, let alone thrive. When survival is called into question, we must utilize hospitals and day programs to ensure safety. At times, the safety net of shelters, foster care, Child Protective Services, and case management must be called to assist with the physiological needs of those who are vulnerable. Once that is established, our next goal is to help our patients thrive in whatever manner is important to them. Some seek stable relationships, where the balance of independence and cooperation is reached. Others look for prestige in a high-power executive position, where morals and directives may conflict. However, in whichever way one seeks self-actualization, the appropriate use of proper coping skills, accepting one’s successes and limitations, and allowing oneself to love and be loved are the building blocks which surpass survival and allow one to thrive. As a clinician, I hope that all my patients achieve success and accomplish their individual goals.

Pamela P. Siller, MD is a board-certified child, adolescent and adult psychiatrist who provides medication management as well as individual and family therapy to children and adults. She maintains a private practice in Great Neck, New York. Dr. Siller is also the director of child and adolescent psychiatry at the Interborough Developmental and Consultation Center in Brooklyn and an assistant professor of psychiatry at New York Medical College. Additionally, she provides psychiatric evaluations for the NYC Department of Education. Dr. Siller can be reached at 917-841-0663