Thomas Jefferson was a master of the memorable phrase. His masterpiece was The Declaration of Independence. The first paragraph is a very powerful introduction to a reason for action,
“When in the course of human events it becomes necessary for one people to dissolve the political bands which have connected them with another and to assume among the powers of the earth, the separate and equal station to which the Laws of Nature and of Nature’s God entitle them, a decent respect to the opinions of mankind requires that they should declare the causes which impel them to the separation.”
That’s an eloquent setup, but he was just getting started. The first line of the second paragraph was drilled into my head when I was in school. I hope it is still in the curriculum.
We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.
When he mentioned “happiness” Jefferson was getting close to stating his reason for the collective action of the colonies. They were not enjoying the freedom or the life they desired, and as a result they were living without the happiness they wished to pursue.
Now, behavioral economists and psychologists are trying to measure happiness around the world. If we could report their findings to Thomas Jefferson, he would probably be disappointed and confused because if you follow the rest of what he wrote it would seem that he believed that if we are free to exercise control over our own lives then happiness is achievable. No matter what the thirty two year old patriot was implying as a hypothesis, at this moment in time our nation must be considered a happiness desert.
The 2019 World Happiness Report was released a few days ago, and once again Americans are way back in the pack of the developed nations of the world. This is the seventh annual report. We slotted in at 19th this year. In 2018 we were 18th, and in 2017 we were 14th. There may be no causal relationship, but it looks like as we struggle to make “Make America Great Again” we are not having much fun. At nineteenth, we sit between Belgium and the Czech Republic. As you might expect, the “socialist countries” of Scandinavia: Finland, Denmark, and Norway are the top three. They are followed by progressive, left leaning places with universal care and burdensome social service safety nets like Iceland, The Netherlands, Switzerland, Sweden, New Zealand, Canada, and Austria. Could it be that the colder it is, the happier you are? It is good to know that we are happier than the French, and much happier than Vladimir Putin’s Russians who were number 66. If you click on the last link, you can download the 136 page PDF. Below I have done my best to show you the “top forty.”
The principal authors describe the continuing motivation behind all seven reports in their introduction to the 2019 findings.
That report [the first one in 2012] presented the available global data on national happiness and reviewed related evidence from the emerging science of happiness, showing that the quality of people’s lives can be coherently, reliably, and validly assessed by a variety of subjective well-being measures, collectively referred to then and in subsequent reports as “happiness.” Each report includes updated evaluations and a range of commissioned chapters on special topics digging deeper into the science of well-being, and on happiness in specific countries and regions.
Allison Chiu wrote an excellent summary of this years report in The Washington Post when it was released earlier this week. In her article she presents the opinions of some of the report’s authors about what is at the root of our problems with happiness.
“By most accounts, Americans should be happier now than ever,” writes Jean M. Twenge, one of the report’s co-authors. “The violent crime rate is low, as is the unemployment rate. Income per capita has steadily grown over the last few decades.”
However, as evidenced by the U.S.’s downward trend, just because the standard of living improves doesn’t mean happiness follows.
Researchers posit the country’s declining happiness is likely due to an “epidemic of addictions,” which includes everything from substance abuse and gambling to social media usage and risky sexual behaviors.
“This year’s report provides sobering evidence of how addictions are causing considerable unhappiness and depression in the US,” Jeffrey Sachs, director of the Sustainable Development Solutions Network and a co-author of the report, said in a news release. “The compulsive pursuit of substance abuse and addictive behaviors is causing severe unhappiness. Government, business, and communities should use these indicators to set new policies aimed at overcoming these sources of unhappiness.”
The study of happiness is relatively new, and is of interest to behavioral economists like Daniel Kahneman. Happiness is the subject of four of the twenty five most popular TED talks, and that does not include the famous 2010 TED talk by Kahneman who is “the father of behavioral economics” and the concept of “thinking, fast and slow.” In his TED talk Kahneman focused on how we think about happiness from the point of view of happiness experienced versus happiness remembered, which are two different things. The World Happiness Report seems to be focused on happiness as experienced. Kahneman’s insight may be of use to those of us striving to improve our Press Ganey scores. Entertainers have long know the wisdom of “leave them laughing.” Kahneman makes his point using the experiences of two patients having colonoscopies.
The other big point that Kahneman makes in his talk is the surprising relationship between money and happiness. He quotes a study from the Gallup organization that shows that below sixty thousand dollars a year we are increasingly more unhappy the poorer we get. What is remarkable is that the curve flattens out at 60K, and more money is not correlated with more happiness. That is probably a relief for many spiritual leaders who have long preached that material possessions do not bring happiness. It is also consistent with Maslow’s hierarchy of needs and much of the unhappiness and distress of the tens of millions of people and families in this country living below 400% of poverty. It is reasonable to imagine that those who lack the resources to secure their basic needs might be unhappy. It is also reasonable to assume that if you lack economic security, you might be more anxious than happy, even if your current needs are covered. At least 40% of Americans live with the anxiety of knowing that they are “insecure.” They are a paycheck away from economic distress even though they appear to be in the middle class. It is hard to accept that 40% of Americans could not cover an unexpected bill of $400 without a loan.
…when asked about the secret to being happy, he revealed that it has to do with nurturing our relationships. “It’s primarily spending time with people you love, and who love you back,” he explained. “That’s what makes people happy in the moment.”
He continued: “What makes people satisfied with their lives is much more conventional. It’s having the sense that your life is meaningful. If your sense is that your life is meaningless, then you are probably depressed and you’re certainly very unhappy.”
The World Happiness Report goes beyond updating raw measurements to consider other factors. The 2019 report looks at “community.” The authors state:
This year we focus on happiness and community: how happiness has been changing over the past dozen years, and how information technology, governance and social norms influence communities.
My objective in writing about happiness is not to give you an encyclopedic understanding of the subject. I can’t. It is a new subject for me. I hope to stimulate your interest in starting your own exploration of happiness. Thinking about what makes us happy must be critical for all of us if it is true that 50% of healthcare professionals suffer from burnout. I saw thousands of patients during over forty years of practice, and know for sure that if “happiness” is not a personal issue for you, it is a big concern for many of the patients who come to see you, or get care from your institution. It may also be a concern for a colleague near you.
I think that Daniel Kahneman is onto a helpful concept when he divides “happiness” into “happiness experienced” and “happiness remembered.” When I look back on my years as a medical professional, I am happy with the experience I remember. On balance my memories of the experience are totally positive, although I can remember days that were difficult. I am sure that on those difficult days I experienced great frustration, and could have been called “depressed.”
I have told the story before, but good stories are worth retelling. In the late seventies I was distressed and dissatisfied with many things in my life. I worked up the courage to ask for help from one of the senior psychiatrists at the Brigham. He suggested that I see a friend of his who was a psychiatrist/analyst who was affiliated with Tufts Medical Center. I followed up on his advice, and was soon seeing Dr. Charles Magraw in his home office that was conveniently located about halfway between my home in Newton and my outpatient office in Kenmore Square, not far from the Brigham. (Please click the link to appreciate what a gift it was for me to be cared for by such a socially responsible and caring physician.) My work with him went on for several years and progressed from face to face counseling to an “on the couch analysis,” but perhaps the the most professionally applicable insight that I got during that time came from a “radio psychologist.” She succinctly told me what I was discovering in my work with Dr. Magraw.
It was the late seventies and there was no NPR. I always listened to the local “news radio” station as I drove to and from work. After an early morning appointment with Dr. Magraw, I was headed to work while listening to the radio. As I drove past the home of Mary Baker Eddy on Beacon Street, I heard the announcer say to stay tuned to learn “the three most important determinants of happiness and health.” That intro hooked me. Before I had reached the Chestnut Hill Reservoir, a half mile further down Beacon Street just beyond Boston College, I had my answer. The expert on the radio said that to be healthy, and happy, you must have:
- Someone to love
- Something to do
- Something to look forward to
It’s a pretty simple formula. My first response was to apply this new information to my practice. For the rest of my life as a practitioner, I would always try to determine how each patient was doing in all three domains. I can report that those three questions form a powerful diagnostic tool. You can imagine my surprise when I saw the holy triplet on the wall of my sister’s home in Birmingham during a recent visit. You can see the wall hanging in today’s header.
Just as I found the three themes to be helpful to my understanding of my patients and their symptoms, I soon found benefit in looking at the three domains in my own life. It is easy to feel useless, lost, and alone when there seems to be nothing on the horizon but misery and drudgery. We can be overcome by the experience of the moment and fail to remember that we are really blessed with opportunities. If you are a healthcare professional, you do have an an important purpose in life. You are visited by, and work, with many people whom you care about. There are many great things to anticipate in the future, if we can only support each other to realize that we can collectively work for improvement.
What is hard on our happiness are the tribulations of the moment, but even the difficult experiences on a tough day can be recognized as worthy of our efforts because there are people who need us. We can remind one another of our past experiences that prove that we can make a difference. We have much to do. We have many to love, if we can look beyond our own concerns. Together, we can look forward with the hope of continuous improvement, knowing that no matter the outcome, we tried to make a difference. Remember that Kahneman agrees. He did say:
“It’s primarily spending time with people you love, and who love you back,” he explained. “That’s what makes people happy in the moment.”
He continued: “What makes people satisfied with their lives is much more conventional. It’s having the sense that your life is meaningful. If you sense is that your life is meaningless, then you are probably depressed and you’re certainly very unhappy.”
I was fortunate to have people to love, a purpose to pursue, while sharing a positive look down the road toward a better day. Call it luck. I got advise from a colleague that led me to Dr. Magraw. I worked with colleagues who were joined with me in a sense of purpose and were a constant source of support and learning. I loved my patients, and the experience of being someone’s doctor. I was also convinced that I could look forward to an experience that would continue to teach me more about myself as we tried to make care better for our patients. Every day was not joyous, but in retrospect it was a wonderful life. I was free to pursue happiness.
I know that communities of providers can experience collective professional happiness and fulfillment. I think it is possible when professionals come together for the common purpose of striving to practice in the spirit of the Triple Aim. That’s a hat trick: we have something to do with people we care about while working with a noble purpose in collective anticipation of an important objective.
