The Five Pillars of Happiness

I first learned about the Swiss psychiatrist Carl Jung after listening to the 1983 rock album Synchronicity by The Police.  I wrote about Jung and his concept of "synchronicity" in a previous post a few years ago.  Jung was an associate of the equally famous (perhaps more so) Austrian neurologist, Sigmund Freud. Believe it or not, you probably know more about Jung than you know about Freud.  Have you ever used the term complex (e.g., guilt complex), to describe how you or someone else is feeling?  Jung was the first to describe and use that term.  Would you describe yourself as an extrovert or an introvert?  Again, Jung coined those terms too.  What he is less commonly known for and what I want to focus on today is what he called the five pillars of happiness (see Gretchen Rubin's article in Forbes and Arthur Brooks' article in The Atlantic).  

Jung wrote, "Happiness is such a remarkable reality that there is nobody who does not long for it.  And yet there is not a single objective criterion which would prove beyond all doubt that this condition necessarily exists."  Let's not misunderstand his point here - Jung wasn't saying that happiness as an emotional construct doesn't exist, but rather that happiness likely exists along a continuum of emotions.  More importantly, happiness as a positive emotion exists along one continuum, while unhappiness as a negative emotion exists along a completely separate one (see my post, "Are you happy?" for more on this point).  With this in mind, Jung said, "Even a happy life cannot be without a measure of darkness, and the word happy would lose its meaning if it were not balanced by sadness. It is far better to take things as they come along with patience and equanimity."

Towards the end of his life, Jung shared his own personal strategy for achieving happiness in life, based upon five key pillars:

1. Good physical and mental health:  There have been a number of studies that consistently show that both physical and mental fitness are clearly linked with happiness.  For example, the longest currently running study of happiness - the Harvard Study of Adult Development - showed that four of the most important predictors of a senior citizen's wellbeing are not smoking, drinking alcohol in moderation (or not at all), maintaining a healthy body weight, and exercising regularly.  Arthur C. Brooks, one of the most important authorities on the science of happiness, would argue that good health practices don't necessarily increase one's level of happiness per se, but instead they lower one's level of unhappiness.  I've certainly found that to be the case - there's nothing better after a stressful day at work than a good, hard workout!  And as I reflect back on my own life, the times that I've experienced the most happiness were when I felt like I was in the best healthy shape.

2.  Good personal and intimate relations, such as those of marriage, family, friendships: Again, I am impressed by the number of studies that provide convincing evidence that fostering and maintaining close personal relationships through marriage, family, and friendships is one of the most important drivers of happiness.  Again, the Harvard Study of Adult Development provides important evidence on this point.  Robert Waldinger, who has led the study for over two decades, states, "The surprising finding is that our relationships and how happy we are in our relationships has a powerful influence on our health.  Taking care of your body is important, but tending to your relationships is a form of self-care too. That, I think, is the revelation."  Relationships matter even more than one's heredity (see the article "Good genes are nice, but joy is better" in the Harvard Gazette or Waldinger's TED talk "What makes a good life" for more).  The psychiatrist George Vaillant led the study from 1972 until 2004.  He said, "When the study began, nobody cared about empathy or attachment.  But the key to healthy aging is relationships, relationships, relationships."

3.  Seeing beauty in art and in nature: I have to confess that of all Jung's five pillars, this is the one that most surprised me.  Jung believed that cultivating an appreciation for the beauty in the world was just as important to happiness as physical and mental health and personal relationships.  While both art and nature can be beautiful, nature's beauty is inherent and exists independently of our perception.  The beauty of art, on the other hand, results from human creation and reflect the artist's creativity, emotions, and personal concept of what is meant by beauty.  Artistic beauty is more subjective and open to interpretation.  Natural beauty is more objective.  Regardless, an appreciation for both is a key driver of happiness.  Whether you are the individual creating the art or merely observing and appreciating someone else's creation, the aesthetic experience will help improve our overall degree of happiness.  In regards to nature's beauty, the architect Frank Lloyd Wright said, "Study nature, love nature, stay close to nature. It will never fail you.  In regards to artistic beauty, the philosopher Thomas Merton said, "Art enables us to find ourselves and lose ourselves at the same time."

4.  A reasonable standard of living and satisfactory work: Arthur C. Brooks again emphasizes that steady and satisfactory work (to use Jung's term) that brings an income conducive to an acceptable standard of living likely decreases unhappiness more than it increases the degree of happiness.  However, when work crosses the threshold from being merely satisfactory to become meaningful, there will be an impact on happiness AND unhappiness.  Brooks defines meaningful work as work that yields both earned success, which he defines as a sense of accomplishing something valuable and work that involves service to others.  Importantly, as I've previously discussed in several posts in the past (see "Money can't buy me love, but can it buy me happiness?", "The mathematics of happiness", and "Money, love, and happiness"), the relationship between money and happiness is not as straightforward as one would believe.  The current research suggests that there is indeed a positive association between subjective wellbeing (i.e. happiness) and income, though that relationship peaks at a certain level of income (which depends on the particular study).  In other words, above a certain income threshold, more money isn't necessarily going to make you happier.  The key point is that individuals have an income sufficient for maintaining an "acceptable" standard of living, which Brooks defines as "having the money to pay for experiences with loved ones, to free up time to spend on meaningful activities, and to support good causes."

5.  A philosophical or religious outlook that fosters resilience: I've talked about the need to focus on physical, mental, and spiritual health in the past (see "The Three Dimensions of a Complete Life").  While Jung was a devout Christian, what he defined as a "religious outlook" didn't have to be any specific religious faith.  Actually, it didn't even have to be religious in nature at all.  As Brooks suggests, "everyone should have some sense of transcendent belief or higher purpose", whether religious or purely philosophical in nature.  Brooks further notes, "Religious belief has been noted as strongly predictive of finding meaning in life, and spirituality is positively correlated with better mental health...Secular philosophies can provide this benefit as well."

In The Atlantic article, Brooks states that Jung's five pillars stand up very well alongside modern research findings.  He summarized these findings with the following seven points on how we can best live our best, happiest life:

1. Do not fall prey to seeking pure happiness - instead, seek lifelong progress towards happierness (a word coined by Oprah Winfrey, who co-authored the book, Build the Life You Want with Brooks).

2. Manage as best you can the main sources of misery in your life by attending to your physical and mental health, maintaining employment, and ensuring an adequate income.

3. If you're earning enough to take care of your principal needs, remember that happiness at work comes from not chasing higher income but from pursuing a sense of accomplishment and service to others.

4.  Cultivate deep relationships through marriage, family, and real friendships.  Remember that happiness is love.

5.  If you have discretionary income left over, use it to invest in your relationships with family and friends.

6.  Spend time in nature, surround yourself with beauty that uplifts you, and consume the art and music that nourish your spirit.

7.  Find a path of transcendence - one that explains the big picture in life and helps you comprehend suffering and the purpose of your existence.

I will leave this post with one final quote from Carl Jung, whose five key pillars we discussed.  In regards to our journey towards happierness, he said, "Perhaps this sounds very simple, but simple things are always the most difficult. In actual life it requires the greatest discipline to be simple, and the acceptance of oneself is the essence of the moral problem and the epitome of a whole outlook upon life."

Gen Z and Middle Managers

I came across an interesting article ("Gen Z has turned against taking middle management roles") in the online version of the Financial Times earlier this week (a related article appeared in Forbes magazine).  The article is based upon an unpublished study conducted by the talent solutions firm Robert Walters, which is available on their website.  The firm surveyed more than 2,000 white-collar workers, 800 of whom were Gen Zers (generally defined as individuals born between 1997 and 2012).  They found that over half of Gen-Z professionals don't want to take on a middle management role in their career.  Nearly three-fourths of the Gen-Z professionals stated that they would choose an individual route to career progression and promotion over managing others.

When asked about the reasons for their reluctance (even refusal) to accept a middle management role, Gen-Z professionals stated that these roles were too high stress with too little reward.  They've observed the trend towards flatter, less hierarchical organizational structures (and 30% of them think that's the correct approach compared to only 14% who still believe the traditional hierarchical structure is the right one), and coupled with the high rates of burnout in this group, likely feel that these careers are just not worth the effort and stress. 

Lucy Bisset, Director of Robert Walters North, suggested that "Gen-Z are known for their entrepreneurial mindset - preferring to bring their 'whole self' to projects and spend time cultivating their own brand and approach, rather than spending time managing others."  Bisset also suggests that "More senior professionals have usually committed years to one company, working their way through more traditional levels of management and as such have developed a greater respect for mid-level managers.  Younger professionals, having entered the workforce in a largely remote or hybrid capacity with a huge focus on digital capabilities are less inclined towards complete company loyalty."

My concern is that this reluctance to move into middle management roles will only further stress the individuals who are currently working in middle management.  As the pipeline of middle managers dries up, there will be fewer individuals managing larger teams of employees.  As I mentioned in a previous post ("Layers upon layers of managers managing other managers..."), "...at a time when employee engagement seems to be at an all-time low across the board, do we really want to do something that could decrease the amount of time that employees spend with their direct supervisor?" (at least one person commented on this point).   

Bisset goes on to say that "It's clear that middle management remains a lynchpin of any organization, and to keep these roles filled employers need to innovate their strategies to make them more attractive - from providing more autonomy, to regular workload assessments and clear upskilling opportunities."  She further suggests that "Embracing an 'unbossed culture' could be key in transforming the role from just being seen as an 'unnecessary layer' of management to a 'facilitator' who empowers their team to take their own initiative."  Whether we continue to flatten the hierarchy and remove excess layers of management or embrace an 'unbossed culture' as Bisset suggests, it's clear that organizations will need to double-down on High Reliability Organization principles and develop "Networks of Competence".

The first step is to clearly state the problem...

A fictional television news anchor named Will McAvoy (played by the actor Jeff Daniels) was asked the question, "Can you say why America is the greatest country in the world?"  His response, shown in the video clip from the premier episode of the HBO television series, The Newsroom, which aired on June 24, 2012, may surprise you.  McAvoy replied, "America is not the greatest country in the world."

It's worth reviewing his speech in more detail.  McAvoy cites a list of statistical rankings in which the United States of America (U.S.A.) falls far behind its peers, stating at the outset that "there is absolutely no evidence to support the statement that we're the greatest country in the world."  He then goes on to say that the U.S.A. ranks first in only three categories - the number of incarcerated citizens per capita, the number of adults who believe angels are real, and defense spending ("where we spend more than the next twenty-six countries combined, twenty-five of whom are allies").

I decided to do my own fact checking, as (1) you can never completely believe what is said on a fictional television show ("Trust, but verify") and (2) the show aired more than a decade ago and perhaps a lot has changed since then.  Here is where the U.S.A. ranks on several of the key statistics mentioned (and a few others):

Overall

2024 U.S. News and World Report "Best Countries" Ranking: #3 (actually the highest we've ever ranked since the survey was first launched in 2016)

Economic

2024 Gross Domestic Product (Nominal), according to the International Monetary Fund (IMF): #1

2024 GDP Per Capita (Nominal), according to the IMF: #6

2024 GDP Per Capita, based on Purchasing Power Parity (PPP), according to the IMF: #8

2021 Median Income Per Capita (Nominal), according to the OECD: #1

2022 Income Inequality (as measured by the Gini coefficient), according to the World Bank: #61

2024 Index of Economic Freedom, according to the Heritage Foundation: #25

2024 World Competitiveness Index: #12

2024 Global Innovation Index: #3 

Education

2024 World's Best Education System, according to the World Top 20 Project Network: #31

2024 Math Scores on Program for International Assessment (PISA), OECD countries only: #28

2024 Science Scores Program for International Assessment (PISA), OECD countries only: #12

Health Care

2024 Infant Mortality (World Population Review): #57

2020 Maternal Mortality, according to the World Health Organization: #55

2024 Life Expectancy at Birth: #48

Public Policy

2024 Human Freedom Index, according to the Cato Institute: #17

2023 Global State of Democracy (International IDEA): #46

2023 Democracy Index, according to the World Population Review: #29

2024 Corruption Index, according to the World Population Review: #24

Standard of Living

2020 Organization for Economic Cooperation and Development (OECD) Better Life Index: #10

2024 Human Development Index, according to the United Nations: #20

2024 World Happiness Report: #23

I should emphasize that not all of these rankings include every country (for example, the OECD rankings only include the 38 member countries of the OECD).  In other words, the nominal rankings are probably not as important, as the major point that I am trying to make is that on just about every possible measure, America ranks below many of our peers.  As Will McAvoy says, "America is not the greatest country in the world", at least by these particular measures.

I actually couldn't find a ranking for the number of adult citizens who believe in angels, though the polls I did find showed that the majority of Americans do, in fact, believe in angels.  In addition, as of 2024, El Salvador (not the U.S.A.) ranks first in the number of incarcerated citizens per capita (America ranks sixth).  McAvoy was right on one point - the U.S. far outspends all of our peer nations on military defense (see my next paragraph).

The Wall Street Journal reported that America does rank first among peer nations in the following metrics: Alcohol and drug use burden, Opioid death rate, Drug death rate, Health expenditures per capita, Total number of guns, Guns owned per capita, Bankruptcy filings, and Defense expenditures.  America also ranks first among peer nations when it comes to the number of millionaires, the number of billionaires, the number of Nobel Prize winners, the number of valuable companies, the number of movies made, the number of clinical trials, the number of top universities, and the number of astronauts.  

So, what can we conclude from all of this?  First, the first step to finding a solution is to clearly state the problem.  I fully believe that there is no one single measure to define a country's "greatness" (similar to the fact that there is no one single measure to define an organization's "greatness").  "Greatness" remains incredibly difficult - maybe even impossible - to define.  I’m not sure that any country has or even could rank first in all of the measures listed above, and even then I’m not sure we could 100% say that that country is "great."  As I've stated in the past, "greatness" is likely best measured, if at all, using a portfolio of different measures, each with the appropriate validity and reliability.    

Second, there hasn't been a recent decline or even a precipitous one with regards to all of the measures I mentioned above.  For example, when I started medical school over 35 years ago, we were already talking about the fact that the U.S.A. spends more on health care than any other nation, yet we do poorly on almost all health outcome measures compared to these same nations.  The simple truth is that America has been struggling with performance on many of these measures for quite a long time.

Third, and I apologize for getting just a little political here, government is not completely to blame for the poor performance (relative to other countries) on these measures.  However, it's also important to recognize that government isn't the only solution for improving performance on these measures either.  America's lack of "greatness" cannot be blamed on any one political party.  Neither should we expect that any one political party can fix all of our problems without partnering with the other.  

Towards the end of the video clip, Will McAvoy pauses for a second after going off on a tirade about how "America is not the greatest country in the world."  He says:

We sure used to be.  We stood up for what was right.  We fought for moral reasons, we passed and struck down laws for moral reasons.  We waged wars on poverty, not poor people.  We sacrificed, we cared about our neighbors, we put our money where our mouths were, and we never beat our chest.  We built great things, made ungodly technological advances, explored the universe, cured diseases, and cultivated the world's greatest artists and the world's greatest economy.  We reached for the stars, and we acted like men.  We aspired to intelligence; we didn't belittle it; it didn't make us feel inferior.  We didn't identify ourselves by who we voted for in the last election, and we didn't scare so easy.  And we were able to be all these things and do all these things because we were informed. By great men, men who were revered. The first step in solving any problem is recognizing there is one - America is not the greatest country in the world anymore.

McAvoy looks back at the moderator and asks, "Enough?"  It's a great video clip, and one that I wished more of our political leaders would watch.  We do have problems, and we can't solve them unless we first recognize that we have a problem, clearly state it, and work together towards a solution.  "Together" is probably the most important word here... 

Ubuntu

I suspect that many of you are familiar with the quotation from the 17th century French philosopher, scientist, and mathematician René Descartes, Cogito ergo sum, translated as I think, therefore I am.  It's one of the fundamental tenets - a core principle, if you will - in the Western philosophy tradition.  In his Meditations on First Philosophy, Descartes tells us that everything we assume to be true can be doubted.  If that is indeed true, then all of our thoughts and beliefs can be doubted.  He goes on to explain, "I have convinced myself that there is absolutely nothing in the world, no sky, no earth, no minds, no bodies. Does it now follow that I too do not exist? No: if I convinced myself of something then I certainly existed...So after considering everything very thoroughly, I must finally conclude that this proposition, I am, I exist, is necessarily true whenever it is put forward by me or conceived in my mind."

The philosophy of Ubuntu was developed by the Bantu and Xhosa people of Southern Africa and popularized by Desmond Tutu and Nelson Mandela.  While Descartes (and most of the Western philosophical tradition) suggests that the individual is the source of all knowledge, Ubuntu would suggest that the source of knowledge is the community.  Rather than cogito ergo sum, Ubuntu would state, umuntu ngumuntu ngabantu, meaning a person is a person through other persons.  The word ubuntu itself is translated as I am because we are.  

The blogger Maup van de Kerkhof describes the central idea of the Ubuntu philosophy as "a thorough recognition of the interconnectedness of human beings while acknowledging the inherent worth of every individual."  In the Ubuntu tradition, "All persons have something to offer, and not one expertise in life should prevail over the other."

It's a beautiful concept, and one that I believe that we need to pay more attention to in today's society.  In my last post ("The Loneliness Epidemic"), I talked about U.S. Surgeon General Vivek Murthy's advisory released last year entitled "The Healing Effects of Social Connection" and the need to foster social connections.  As Dr. Murthy concludes his second term as U.S. Surgeon General, he released "My Parting Prescription for America" which weaves together his personal and professional observations on what is perhaps most ailing society today - the erosion of our sense of community.  It's a quick read, and I think I agree with just about every point that Dr. Murthy made.

Dr. Murthy argues (convincingly so in my opinion) that there are three core pillars to building a sense of community - relationships, service, and purpose.  He goes on to describe how these "three drivers of fulfillment" have been shown to significantly influence health outcomes, including premature mortality, heart disease, depression, and anxiety.  He mentions the philosophy of Ubuntu, which emphasizes our interdependence as well as the responsibility that we all have to one another as human beings.

Consistent with some of my recent posts, Dr. Murthy provides a list of the key drivers for the erosion of our sense of community in today's society.  First, we have become a much more mobile society.  Both my wife and I lived in the same house during our entire childhood.  Our own children have been less fortunate, in that we have moved around from city to city as I have pursued different professional opportunities.  Our own family's experience is the norm today.  

Second, as highlighted in my recent post "Why the past 10 years of American life have been uniquely stupid...", technology (and social media, in particular) have actually made us less connected.  Dr. Murthy writes, "Social media has turbocharged a culture of constant comparison that too often undermines our self-worth and makes us feel dissatisfied with our lives...friends have been replaced with followers and confidantes with contacts, with profound consequences for the depth and quality of our relationships."  I would also argue that social media has further polarized our society in such a way that we've lost the ability to have civil discourse with those individuals who don't share our opinions and beliefs.  Dr. Murthy writes, "Outrage now drives online conversations and much of the news we encounter, fueled by an outrage industrial complex that profits from maximizing engagement despite the human cost.  Ultimately, it's hard to connect with each other when we can't talk to each other."

Third, as highlighted by the social scientist Robert Putnam in his book, Bowling Alone: The Collapse and Revival of American Community, the decline in the number of civic organizations such as recreational leagues, youth groups, faith institutions, neighborhood associations, and service organizations has helped accelerate the erosion of our sense of community.  Dr. Murthy writes that "underneath these trends, the pendulum of self-reliance has swung so far to one end that needing others is seen as a sign of weakness, leading to a vicious cycle of stress, isolation, and more stress."

Dr. Murthy calls the loss of community "one of the defining challenges of our time" and suggests that we need a "fundamental shift in how we build and prioritize community."  He goes on to suggest that we should avoid what he calls the "triad of success" (wealth, fame, power) and instead focus on the "triad of fulfillment" (relationships, service, and purpose).  He goes on to say that when these three elements are combined with the core virtue of love, they create an ecosystem for meaning and belonging.  

Fostering relationships requires us to ask the question, "With whom can I connect more deeply?"  The kinds of relationships that Dr. Murthy is talking about here is not just simply those connections with our family, close friends, neighbors, and co-workers.  We need to be courageous enough to build relationships with people who may differ in background and beliefs, but yet who still form an important part of our community.  

Becoming more involved in service requires us to ask the question, "What can I do to help others?"  While service is directed towards the benefit of others, studies have shown that there are profound benefits to those who serve!  There are known benefits to our physical, mental, and spiritual health, but Dr. Murthy also suggests that "service reminds us we have value we bring to the world."  He suggests that we should at least commit to one act of kindness every day.  

Defining our purpose requires us to ask the question, "What gives my life meaning?"  Dr. Murthy defines purpose as the feeling of having an overarching life aim that guides and prioritizes our decisions and actions.  He writes, "It's not 'what' we do.  It's 'why' we do it."  Our purpose lays the foundation for our goals and achievements.  

Lastly, Dr. Murthy suggests that building a sense of community requires love, which he calls that "commanding force with the power to build, strengthen, and heal."  Love can't just be reserved for our family and close friends or even those who share our beliefs and life experiences.  We also have to extend our love to those people with whom we disagree.  Mother Teresa observed that "the most terrible poverty is loneliness and the feeling of being unloved."  Love is what ties us all together.  It is only through love that we can re-build our sense of community.

Dr. Murthy's parting words are poignant.  He says, "Let us never forget that good people with hearts full of love can change the world."  Let us all remember the spirit of Ubuntu - I am because we are.

The Loneliness Epidemic

I've mentioned a few times in the past that leadership can be lonely (see my posts, "Reflections on leadership", "12 O'Clock High", "It's lonely at the top", and most recently, "Fortress of Solitude").  The so-called "loneliness of leadership" has been mentioned in articles ("CEOs Often Feel Loneliness.  Here's How They Can Cope"), books (see in particular the Aubrey/Maturin series by Patrick O'Brian), and podcasts.  It's such a common topic, that one would think that loneliness and leadership are tightly and permanently linked.  What we often neglect, unfortunately, is that loneliness in general has become common for everyone across the board in today's society.  As one Harvard Business Review article recently emphasized, "We're Still Lonely at Work".  Some would even go as far as saying that we are in the midst of a "loneliness epidemic" in this country.  According to recent reports, about half of all adults in the U.S. experience measurable levels of loneliness, even prior to the COVID-19 pandemic.  It's not just Americans that are affected - the 2024 State of the Global Workplace report by Gallup finds that one in five employees worldwide currently feels lonely at work.

The U.S. Surgeon General, Dr. Vivek Murthy, released an advisory last year entitled "The Healing Effects of Social Connection".    According to research highlighted in the Surgeon General's advisory, loneliness significantly and negatively impacts both physical and mental health.  Loneliness, as measured objectively, is associated with greater risks of cardiovascular disease, dementia, stroke, depression, anxiety, and premature death.  Dr. Murthy writes, "The mortality impact of being socially disconnected is similar to that caused by smoking up to 15 cigarettes a day and even greater than that associated with obesity and physical inactivity."

Noonan Hadley and Sarah Wright summarized the research on loneliness in the workplace in a recent article for Harvard Business Review ( "We're Still Lonely at Work"), specifically mentioning a number of misperceptions ("myths") about loneliness that have caused organizations (and perhaps society in general) to apply the wrong or marginally effective solutions to the problem.

Myth #1: Loneliness can be solved with in-person work.  Given the number of employees who have shifted to remote or hybrid working relationships since the COVID-19 pandemic, it's tempting to suggest that the lack of connection to co-workers has created a loneliness epidemic.  Again, however, the research suggests that the loneliness epidemic started before the COVID-19 pandemic, and Hadley and Wright found in their own research that remote and hybrid workers experienced similar amounts of loneliness to those workers who were 100% on-site.

Myth #2: Teams will solve loneliness.  It seems intuitive that working on a team would at least ameliorate some of the loneliness experienced by individual workers.  Unfortunately, the research suggests otherwise.  When teams carefully and deliberately foster relationships, collaboration, and a common bond, individual team members may feel less lonely.  However, merely asking individuals to work together on a team won't necessarily make them feel less lonely.

Myth #3: Lonely employees are needier socially than others at work.  Hadley and Wright measured both "belonging" and "loneliness" and found no correlation.  They write, "Loneliness can affect anyone, regardless of how much they desire social connection in a work setting. We also found that introverts are more likely to be lonely at work than extroverts, even though they tend to have less need for connection."

Myth #4: Loneliness is a personal problem, not an organizational problem.  Aside from its adverse impact on physical and mental health, loneliness can also result in lower productivity, higher rates of absenteeism, and higher employee turnover.  

Hadley and Wright summarize their findings and write, "It is time to stop blaming work loneliness on remote arrangements, particular jobs, and certain personal characteristics. As our prior research has shown, anyone—from the young entry-level worker to the seasoned CEO—can feel lonely on the job."  They offer a number of suggestions on how organizations can address loneliness at work.  However, loneliness occurs outside of work too.  The U.S. Surgeon General offered a number of high-level interventions that we can all focus on in order to address the loneliness epidemic:

1. Strengthen social infrastructure in local communities.  The American political scientist Robert Putnam argues in his book Bowling Alone: The Collapse and Revival of American Community that our society today has undergone an unprecedented collapse in civic, social, associational, and political life since the 1960s, with serious negative consequences.  Americans are spending less time in community groups, church, civic groups, clubs, and community organizations than ever before.  Perhaps we should reconsider and go back to the way it was before (see Putnam's follow-up book, Better Together: Restoring the American Community).

2. Enact pro-connection public policies.  While I'm less confident than Dr. Murthy that government can solve this problem alone, there are certainly things that local, state, and the federal government can do to foster more social connection.

3. Mobilize the health sector.  If objective measures of loneliness exist (and they do), and we know that those measures impact physical and mental health, perhaps it's time that health delivery organizations pay more attention to loneliness than they have in the past (or even currently).  We know that the social determinants of health account for nearly half of all health outcomes.  Loneliness is an important part of the equation here too.

4. Reform digital environments.  Rather than making us feel more connected, social media has actually made us less so.  Technology can help address loneliness, but it can also make it worse.  

5. Deepen our knowledge.  As the saying goes, "Knowledge is power."  There's another saying that suggests that recognizing there is a problem is the first step to solving it.  We need more research on the impact of loneliness on physical and mental health, and we need more research on how best to address the loneliness epidemic.

6.  Cultivate a culture of connection.  Hadley and Wright also highlight the importance of fostering a culture of connection.  Over the last several years, our society has become highly polarized, which has certainly contributed to our lack of connection.  We need to re-connect with our peers, even the ones who may not agree with us on every single issue.

Dr. Murthy writes, "Each of us can start now, in our own lives, by strengthening our connections and relationships.  Our individual relationships are an untapped resource - a source of healing hiding in plain sight.  They can help us live healthier, more productive, and more fulfilled lives.  Answer that phone call from a friend.  Make time to share a meal.  Listen without the distraction of your phone.  Perform an act of service. Express yourself authentically.  The keys to human connection are simple, but extraordinarily powerful."  Indeed.

Bring a book anywhere...literally

Apparently the book, Inner Excellence: Train Your Mind for Extraordinary Performance by Jim Murphy skyrocketed to Amazon's best seller list over the last few weeks.  Philadelphia Eagles wide receiver (and now Super Bowl Champion) A.J. Brown was caught reading the book on the sidelines during a recent NFL game.  Brown told reporters that reading the book helped him reset and refocus himself between game drives.  He told ESPN's Sal Paolantonio, "It just spoke to me because certain challenges I face as an athlete keep recurring in my career.  And it's not like tough challenges but on the mental side."

Brown further explained that he reads the book regardless of what happened the previous drive.  In other words, no matter if he catches a pass and scores a touchdown or if he drops the ball, he will still go back to the sidelines and open up the book and read.  He wrote on X, "This game is 90% mental and 10% physical for me. I bring it to every game and I read it between each drive.  I use it to refocus and lock in despite what may transpire in the game good or bad."

Eagles head coach Nick Sirianni both defends and applauds the practice.  He told a Philadelphia morning sports talk show, "I'm definitely OK with it.  The crazy thing is, he's been reading this book on the sideline for a long time. It just so happened a camera saw it this week.  Some guys pray in between, some guys meditate in between. A.J. reads in between. Whatever these guys need to do to put their mind in a place where they can play with great detail and great effort, I fully encourage them to do that."

I absolutely loved this story when I first heard about it.  As the author Lemony Snicket once said, "Never trust anyone who has not brought a book with them."  What book do you carry around that helps you to refocus and reset?

Layers upon layers of managers managing other managers...

I came across a blog post in Becker's CEO Report (see "Big companies shrink manager, executive ranks: Bold or bad idea?") that highlighted what could be an interesting trend.  U.S. companies are decreasing the ranks of their middle managers in order to cut costs and improve efficiency.  According to Vanessa Fuhrmans, writing for The Wall Street Journal ("Where have all the managers gone?"), "Corporate America is on a mission to thin its management ranks in pursuit of greater efficiency."  Employment-data provider Live Data Technologies analyzed a database containing over 20 million white-collar workers and found that U.S. companies have decreased the number of middle managers by 6% since the end of 2021.  Every sector has been impacted, including health care.  Notably, Becker's reported that four health systems were eliminating and/or combining C-suite roles on December 31, 2024.  

Jack Kelly, a senior contributor at Forbes magazine ("Why corporate managers are being shoved out the door") writes that "Middle management roles have been steadily shrinking in recent years, with significant impacts on organizational structure and employee workload."  He cites a Gartner research study that found that managers today supervise, on average, three times as many employees as they did in 2017.  The buzz word today is "agile", and many business leaders feel that leaner, flatter hierarchies with fewer layers can facilitate easier communication and faster decision-making, streamline operations, and ultimately decrease the costs of doing business.

Tech companies are certainly leading the way.  Amazon Chief Executive Andy Jassy announced a goal to increase the ratio of workers to managers.  Google CEO Sundar Pichai told his staff that he wanted to cut managerial roles by 10% in order to cut costs.  Meta CEO Mark Zuckerberg called 2023 Meta's "Year of Efficiency" and expressed concerns about his team's multi-tiered organizational structure, where managers oversee other managers who oversee even more managers.  Zuckerberg told his employees that "flatter is faster" and "leaner is better."  He went on to say, "I don't think you want a management structure that's just managers managing managers, managing managers, managing managers, managing the people who are doing the work."

The Gartner study also found that more organizations are using generative artificial intelligence (AI) to replace middle managers.  They predict that within the next two years, one in five companies will use AI to flatten their organizational structures.  Whether this comes to fruition remains to be seen, but suffice it to say that, at least for now, multi-tiered, multi-layered organizational structures are out of and flatter hierarchies are in vogue.  I have stated my support for flatter hierarchies in a number of previous posts (see most recently, "Better, stronger, faster, and flatter?" and "Networks of competence"), but I also recognize that there are some legitimate downsides to this type of organizational structure.  

First and perhaps most importantly, at a time when employee engagement seems to be at an all-time low across the board, do we really want to do something that could decrease the amount of time that employees spend with their direct supervisor?  Decreasing the number of management layers will necessarily force managers to oversee even more employees.  A LinkedIn Workforce Confidence survey suggested that at least 30% of employees feel that their bosses are too overwhelmed to provide them with adequate support.  Providing mentorship, giving feedback, and helping employees grow and develop professionally takes time.  If a manager has to supervise even more employees, she or he will have to spend less time doing these important things (which, in my opinion, may be one of the most important jobs a leader does).  

Fewer management positions also means that there won't be as many promotional opportunities within an organization.  One of the drivers of low engagement that I frequently hear about is the lack of professional growth and development opportunities.  As promotions slow, highly motivated and talented employees may start to feel that they are stuck in their current role, thereby seeking opportunities to grow and develop elsewhere.  The competition for limited managerial positions can create tension and change the culture within an organization.  

The experience at multinational pharmaceutical and biotechnology company Bayer is noteworthy (see "Cutting middle management: Bayer's costly experiment one year later" which appeared in Forbes magazine last week).  In order to cut costs by $540 million, Bayer CEO Bill Anderson cut most of the company's management roles last year and implemented a management model that he called "Dynamic Shared Ownership".  Last March, Bayer eliminated half of its executive level leadership positions and 5,500 management positions, organizing the workforce into self-managed teams (also known as self-organizing teams).  Unfortunately, Bayer's market cap has fallen by more than 44% and its stock price hit an all-time low in November.  Forbes contributor Chris Westfall writes, "Getting rid of management is a strategic move but, with a company that has over 95,000 employees and operates all over the world, many factors contribute to the company’s fortunes — or misfortunes, as the case may be. Anderson needs time to prove out his approach."  

It's not likely that the experience at Bayer will discourage other companies from flattening their hierarchies by removing management layers, at least not yet.  These kinds of organizational structures are likely to become even more common in the future - perhaps even becoming the dominant form of organizational structure.  As the saying goes, "Once is a coincidence, twice is a trend."  McKinsey's Scott Keller and Mary Meaney said it best (see their article "Reorganizing to capture maximum value quickly"), "The history of organizations is the history of humankind.  Each generation seeks better ways to organize itself - from tribes ruled by all-powerful leaders to hierarchical corporations with clear divisions of labor to matrixed, cross-functional structures promoting complex forms of work and value creation.  We might now be on the verge of another major advance, toward self-organizing, decentralized, and adaptive organizations."  

While the jury is still out, I remain convinced that "flatter can be better", even if companies don't necessarily fully adopt the concept of self-managed teams.  Given the number of articles and blog posts on this subject, I believe that the coming years will bring more clarity to this question, as more organizations test these types of organizational structures and their variations with the goal of greater efficiency and better communication and decision-making.  Time tends to tell all and answer all...

"All shall be well..."

As I have mentioned in a few recent posts, I've been paying a lot of attention to the Harvard Business School professor Arthur C. Brooks lately.  Dr. Brooks is a social scientist who teaches a class at Harvard called "Leadership and Happiness".  In his "spare time", Dr. Brooks also writes a column for The Atlantic called "How to Build a Life" and has a podcast called "The Art of Happiness".  I recently read a book that he co-authored with Oprah Winfrey, Build the Life You Want, and I am currently enrolled in his MOOC on EdX called "Managing Happiness".  I am currently listening to episode #14 of his podcast ("Happy Monkey"), in which Dr. Brooks interviews his intellectual hero, colleague, and friend, Dr. Martin Selgiman, positive psychology expert and author of several books, including The Hope Circuit and Learned Optimism.  In this particular episode, they talk a lot about Dr. Seligman's research on "learned helplessness" and "learned optimism".  I found the episode particularly insightful, as the interview occurred during the middle of the COVID-19 pandemic a few years ago.

While there were several interesting points made in the podcast (which I am confident will be the subject of a future post), I was particularly intrigued when Dr. Seligman compared and contrasted two very old philosophical concepts.  First he mentioned a famous poem by the Irish poet William Butler Yeats called "The Second Coming".  Yeats wrote the poem in 1919, shortly after the end of World War I and during the middle of the Influenza Pandemic that lasted from 1918 through 1920.  The so-called "War to End All Wars" changed the geopolitical landscape and resulted in an estimated 40 million military and civilian casualties (dead and wounded).  In addition, the Great War contributed to the spread of the influenza virus that infected nearly 500 million people (1/3 of the total global population) and killed anywhere from 17 million to 50 million people (some reports estimate the number of deaths as high as 100 million).  Needless to say, the times during which Yeats wrote his poem were volatile, uncertain, chaotic, ambiguous, and turbulent.  

Yeats paints a deeply disturbing and mysterious picture that describes an alternative to the Christian idea of the Second Coming - Jesus's prophesied return to Earth as a savior announcing God's celestial and holy city, the New Jerusalem, and the Kingdom of Heaven.  The poem's first stanza describes a world of chaos, confusion, and pain.  Here we have one of the poem's most famous lines: "Things fall apart; the center cannot hold; Mere anarchy is loosed upon the world..."  The second stanza is longer and provides a vision of the future - in this case Jesus's return as savior is replaced with the arrival of a grotesque beast: "And what rough beast, its hour come round at last, slouches towards Bethlehem to be born?"  Rather than providing a message of hope, Yeats provides one of despair.  Civilization, as we know it, has ended forever.  Time is up for humanity.  It's easy to imagine why Yeats felt the way that he did, given what was going on in the world at that time.  Yeats' image of the future is a depressing and pessimistic one.  His phrase, "slouching towards Bethlehem" has been used by a number of authors (e.g., it is used as the title for a collection of essays by Joan Didion) to describe the coming of the apocalypse, one that will change our world forever.

Dr. Seligman suggests that during the height of the COVID-19 pandemic, many of us probably were thinking, "This is how it all ends."  Similarly, given everything that we are going through as a society today, it's easy to be sad, depressed, and pessimistic about the future.  However, Dr. Seligman offers an alternative viewpoint, one that comes from a fourteenth century theologian, Julian of Norwich.  What's interesting here is that Julian's real name was Juliana - her Revelations of Divine Love are the earliest surviving English-language works attributed to a woman (she was known by Julian, as it was easier during those days for a work to be published if it was written by a man).  Julian lived her entire life in the English city of Norwich, which at that time was a center of commerce and religion.  The city went through a number of crises during her lifetime, including most notably the Black Death of 1348-1350.  Julian became seriously ill in 1373 and had a number of mystical visions, which she wrote about after making a miraculous recovery.

Julian of Norwich writes, "God did not say, You shall not be tormented, you shall not be troubled, you shall not be grieved, but God said, You shall not be overcome...All shall be well, and all shall be well, and all manner of things shall be well."  Interestingly enough, the Catechism of the Catholic Church references this particular passage (I believe it comes from two different texts, but I am not certain) when asked the question, "Why does God allow suffering and evil in this world?"

These are two completely different viewpoints of the world.  One (the Yeats view) is very pessimistic, while the other (Julian's) is optimistic.  It is the latter viewpoint that both Drs. Brooks and Seligman recommend.  One of the most important things that we can do as leaders is to restore optimism and hope during difficult, turbulent times.  As former President and CEO of IBM, Ginni Rometty once said, "A leader's job is to paint reality and give hope" (more on that later).  I am reminded, once again, of the famous poem "Lincoln, Man of the People" by Edwin Markham.  The last stanza of the poem begins with an iconic view of leadership:

So came the Captain with the mighty heart;

And when the judgment thunders split the house,

Wrenching the rafters from their ancient rest,

He held the ridgepole up, and spiked again

The rafters of the Home.   He held his place—

Held the long purpose like a growing tree—

Held on through blame and faltered not at praise.

"Networks of Competence"

I recently read a series of four articles by Steve Denning, Senior Contributor to Forbes magazine that validate and confirm, in my mind at least, some of the leadership concepts that I have been posting about.  The first article, "How Networks of Competence Are Crushing Hierarchies of Authority" explains the difference between two vastly different organizational structures.  The first ("Hierarchies of Authority") is the more traditional organizational structure that has its roots in Frederick Taylor's theory on scientific management (see The Principles of Scientific Management) developed in the early 20th century.  According to Denning, 80% of firms today are structured in this way, where there is a clear hierarchy of leadership with a single individual (the Chief Executive Officer) at the top.  He explains further, "There is only one genuine leader.  Everyone else in the organization is reporting to, and subject to the instructions of, someone in the level above."  The second type is what he calls "Networks of Competence" (think of General Stanley McChrystal's Team of Teams), in which "everyone can be, and should be a leader."  While only 20% of the firms today are structured in this way, organizations are starting to appreciate the significant advantages of this type of structure in the VUCA (or BANI) world of today.  "Networks of Competence" are more agile and less siloed than their counterparts.  Denning argues that employees are more engaged in these kinds of organizations.

In his second article ("Understanding Why Networks of Competence Crush Hierarchies of Authority"), Denning addresses several of the questions and criticisms that he received following the first article.  Both articles are complementary and should be read together.  Denning argues that "in a knowledge economy, decisions based on competence outperform decisions based on positional title" (that sounds a lot like the HRO principle of deference to expertise).  Denning claims that a number of high-performing organizations are structured as "Networks of Competence", or at least moving in that direction, including Apple, Microsoft, Alphabet, Meta, Amazon, and Tesla, among others.  Virtually every sector of industry seems to be moving in this direction (he provides a list at the end of the second article that provides a link to several articles/posts that he has written further comparing and contrasting these two organizational structures).

Denning highlights in the third article ("How networks of competence now dominate business"), "Hierarchies of Authority" view the organization as a machine, while "Networks of Competence" view the organization as a living organism, commonly referred to as a "Complex Adaptive System" - please see my posts "The myth of the ant-queen" and "A flock of starlings" for more on how organizations are gaining insights from the science of complexity.  He also suggests that, "even in firms that are predominantly networks of competence, hierarchy still has a role...hierarchy is needed to set up and maintain the network of competence" (see also my recent post "The Death of Command and Control").  He goes on to build upon this concept in his fourth article, "How networks of competence achieve superior competitive advantage" and provides a case study of how Amazon developed and further leveraged the concept of "networks of competence".  

Denning suggests that creating a culture of innovation, agility, and rapid decision-making is all about "generating a uniform culture that also requires a passion for creating value for stakeholders, particularly customers, autonomous self-organizing teams, and a whole set of processes that are radically different from the standard processes in hierarchies of authority." I suspect that we will see more organizations moving towards the "Networks of Competence" structure in the future, even if they aren't specifically called by that name.  These four articles are concise and clear - "Networks of Competence" are becoming more common because they are more effective than the traditional "Hierarchies of Authority".

The very first "Org Chart"

Daniel McCallum is often credited with having developed the first modern organizational chart.  McCallum took over operations of the New York and Erie Railroad in 1854, which at that time was one of the longest and most extensive railroad systems in the world with nearly 500 total miles of track.  Once he took charge, McCallum quickly discovered that railroad operations were very inefficient.  The problem wasn't necessarily about communication, as by this time the railroad operators had access to real-time data and information via telegraph.  The problem was one of coordination, or the lack thereof.

McCallum solved this coordination problem by developing the first modern organizational chart, which is shown below (it's easier to see the details of the structure in the online version here).

My first impression of this chart is how very different it is compared to the organization charts that we see today.  Rather than a pyramid-shape, we have a flowery diagram that looks more like a tree.  I might even go as far as saying that the overall structure of this chart reminds me a little of the Mandelbrot set (at least when you start to zoom in on the fractal geometry of the Mandelbrot set).  What's not readily appreciated, however, is the fact that McCallum deliberately placed the Board of Directors at the root and the executive leadership team at the trunk.  In other words, he turned the organizational structure (at least the traditional ones used today) upside down!  

As Caitlin Rosenthal, writing for The McKinsey Quarterly, described it, "Critically, McCallum gained control by giving up control, delegating authority to managers who could use information in real time."  McCallum knew that the amount of data generated by front-line operations was far too much for any one individual to be able to process.  Rather, he empowered his front-line managers with the necessary authority to make decisions in real-time.  The executive leadership team would in turn review system-wide metrics and hold front-line managers accountable to performing to their targets on those metrics.

It's clear that McCallum was well ahead of his time in using what we frequently call "Deference to Expertise" or "Pushing authority to information" (as opposed to pushing information to authority in the traditional top-down, pyramid, hierarchical structure of today's organizational charts).  It's amazing to me that it has taken us this long to grasp the significance of McCallum's original organization chart.

Artificial intelligence?

I grew up during the beginning of the digital age.  I remember when the first personal computers came out.  I was always fascinated by a computer game called ELIZA, an early natural language processing game in which the computer played the role of a psychotherapist and the user would ask for help with his or her problems of the day.  Here is an example of how a conversation might go:

Little did I know that ELIZA was one of the early forerunners of artificial intelligence.  I was reminded of ELIZA (or at least I felt like I was talking to it again) just the other day when I was calling my health insurance provider (name withheld to protect the innocent) in order to submit a recent claim.  My provider coverage changed slightly at the beginning of the calendar year, and I had a claim to submit for service that occurred during the second week of December.  In this particular case, I paid out of pocket with the expectation that I would submit a claim later.

The website and app (which I usually use for these kinds of transactions) weren't able to assist me, so I called the service line directly.  As is usually the case, I was talking to an artificially intelligent virtual assistant.  The conversation went something like this (the first several questions were to verify my identity, which I am leaving out for obvious reasons):

Virtual Assistant: How can I help you today?

Me: I need to submit a claim.

Virtual Assistant: Okay.  You need to submit a claim.  Is that correct?

Me: Yes.

Virtual Assistant: What was the date of your service?

Me: December 6, 2024.

Virtual Assistant: Did you say "December 6, 2024"?

Me: Yes.

Virtual Assistant: One moment please.  I'm sorry, there is not a claim for that service.

Me: Correct.  That is why I need to submit the claim.

Virtual Assistant: I'm sorry.  I didn't get that.  How can I help you today?

Me: I need to submit a new claim.

Virtual Assistant: Okay.  You need to submit a claim.  Is that correct?

Me: Yes.

Virtual Assistant: What was the date of your service?

Me: December 6, 2024.

Virtual Assistant: Did you say "December 6, 2024"?

Me: Yes.

Virtual Assistant: One moment please.  I'm sorry, there is not a claim for that service.

Me: Can I speak to customer service?

Virtual Assistant: I can help you.  Would you like me to repeat the menu?

Me: Hang up.

Now, I realize that my issues weren't necessarily straightforward.  However, there was no easy way to request to speak with a living, breathing human being who would know how to help me.  I ended up going through a member of our HR team to help me submit my claim.  

I know that artificial intelligence has come a very long way since ELIZA, and I know that my health insurance provider's virtual assistant wasn't a true representation of what artificial intelligence can really do.  However, my experience did raise a few questions in my mind that inspired me to do a little research.  I read about something known as the Winograd schema challenge, a test of artificial intelligence developed by Hector Levesque in 2011 (and named after fellow computer scientist Terry Winograd), supposedly to improve upon the classic Turing test, which was originally developed by the computer scientist Alan Turing to test whether a computer could exhibit intelligent behavior equivalent to a human.   These tests are essentially questions that computers are terrible at answering, and here is a great example:

A large ball crashed through a table because it was made of steel.  What was made of steel?

The question would be easy for a human to answer (the ball crashed through the table because the ball was made of steel), but apparently artificial intelligence would have difficulty answering the question.  I guess we need to add one more question to the Winograd schema challenge - "What was the date of your service?"  I am reminded of an essay that Nicholas Carr wrote on October 5, 2012 entitled "The ennui of the intelligent machine" (I can't find it online, but it included in his book, Utopia is Creepy, a collection of his essays, articles, and blog posts).  Carr was writing about neural networks and how Google was using artificial intelligence for some of its speech recognition and image recognition tasks.  He quoted one of Google's engineers, Jeff Dean, who said, "We are seeing better than human-level performance in some visual tasks" (specifically identifying house numbers on satellite images for Google's Street View application) and how Dean thought that the real Turing test has less to do with what we think of intelligence and perhaps more to a computer's inability to experience boredom.  As you can imagine, some of these tasks are fairly mundane.  

Dean went on to say, "It's probably that the task is not very exciting, and a computer never gets tired."  Carr added that it takes real intelligence to get bored.  He added, "Forget the Turing Test.  We'll know that computers are really smart when computers start getting bored.  If you assign a computer an overwhelmingly tedious task like spotting house numbers in video images, and then you come back a couple of hours later to find the computer checking its Facebook feed or surfing porn, you'll know that artificial intelligence has truly arrived."

What is clear is that artificial intelligence is most definitely here to change how we work and how we live.  As I talked about in a recent post (see "Six tests (plus one challenge) for physicians and health care leaders..."), artificial intelligence will be integral to just about every facet of health care in the future.  Health care leaders (and physicians) will need to embrace it or be left behind.