Life, your career, and the pursuit of happiness…BMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7115.2 (Published 25 October 1997) Cite this as: BMJ 1997;315:S2-7115
Can it really be true that the happiest people are retired? Carl Gray tackles the big issue -being happy at work
Doctors can be a miserable lot at times, as shown by the high prevalence of stress in doctors and the demand for the BMA's counselling service in its early months. Discordance between successful work, public perceptions, and personal wellbeing is common and the profession has many such cases. We are also credited with low morale, a high divorce rate, and high risks of alcohol and substance abuse.
Pitfalls are to be expected in medical careers: exposure to human suffering and loss, boredom, and some disappointments in exams, jobs, research, or publications are common to us all. Students and young doctors have always had their idealism brutalised by early experience of life and death situations and the sight of their seniors. Of course, problems - of the problem page kind - are inevitable, and into each life a little rain must fall. The traditional heaven - sitting on a cloud, playing the harp, and eating ambrosia - does seem a little dull, even if you like rice pudding. Problems are necessary challenges, and their solution gives satisfaction. People problems can be the worst, but they can be tackled; even long term feuds have their resolution.
But the prevailing medical Zeitgeist is a weary cynicism, which transcends factors as simple as bad jobs and the effects of health service changes. We must look harder at ourselves. What is the nature of our entrenched unhappiness? Can we be happier in our professional lives? How do the jolly ones do it?
Look at the most fulfilled and happy people of your acquaintance. Prosperous, enjoying active lives, and in touch with a rich social network: they are mostly retired! Excellent examples can be found among readers' parents. Prosperity means having sufficient income to cover needs and some desires. Retirement gives the abundance of time to spend it. Active lives have significant content every day, and a social network provides the friends to do it with.
Unfortunately, we can't all retire tomorrow, usually because funds would be insufficient: many portfolios are not designed for early retirement. But the happily retired approach can be brought forward into working life by increasing enjoyment. Work and leisure can be integrated into personal happiness without succumbing to workaholism or lotus eating (although lotuses are very fine in moderation).
What is happiness? Definitions can retreat into semantic truisms but we all know what we mean; or do we? Your happiness may differ from mine and definitions differ with culture and the age. Happiness for an 18th century matron was getting all her daughters married well; for a modern young man or woman it is getting laid by or with a sex god or goddess as specified by a current lifestyle magazine (such as the BMJ). Happiness is more than momentary exultation - sporting, comedic, sexual - or enjoying an episode of success in theory or practice; more than achieving once and forever a single perfect heavenly steady state. It encompasses both the destination and the journey in getting there. Happiness is an appetite no less real than those for food or sex, the arts or sport, and appetites need and deserve regular satisfaction.
“Why should I let the toad work squat on my life?” asked Philip Larkin, and he was right, although later in life he was to plead: “Give me your arm, old toad; help me down Cemetery Road.” Where does work fit into happiness? Why do we have to work at all? The guru of employment, HL Mencken, found, “a sense of relief and pleasure in getting something done.” Charles Handy gives our reasons for working as: interest or satisfaction, social interaction, security and money, the chance of development, and a purpose in life.(1)
Dave Francis analysed nine “career drivers” (see box) that different individuals have to different degrees.(2) Appreciating your own could allow you to steer them in your own direction, rather than be driven off course. Various quizzes will assess your drivers: would you rather rule the world, or heap the dosh; snuggle up with chums or find the meaning of life? Happiness consists - to some extent - in fulfilling these differing fundamental needs.
Francis's career drivers
Material rewards: seeking wealth and a high standard of living
Power/influence: seeking control of people and resources
Search for meaning: seeking things believed to be valuable for their own sake
Expertise:seeking high accomplishment in a specialised field
Creativity:the desire for innovation and originality output
Affiliation:seeking nourishing relations with others at work
Autonomy: seeking independence in one's own decisions
Security: seeking a solid and predictable future
Status: seeking recognition, admiration, and respect from the community
Even a full time job these days takes only one third of the time of one third of your life. This one ninth is the dominant slice of life for many people. It is the vehicle for providing income and, we hope, some beneficial services to society. The job, however, may not be a sufficient basis for total fulfilment. Some indeed have already dropped out - “downshifting” their lives to rural idyll. Many seem most happy sitting on river banks doing nothing much (coarse angling). Others, if they are doing nothing - like Alan Bennett - “like to be doing nothing to some purpose.” The essential need in leisure is to expunge the residual Protestant work ethic which still makes us feel guilty in pleasure. As Jerome K Jerome recognised while messing about in boats, “it is impossible to enjoy idling thoroughly unless one has plenty of work to do.”
A doctor who treats himself has a fool for a patient, but he is perhaps his own best euphoriologist. Paraphrasing Woody Allen, have a consultation with some one you love (or should love). Happiness really has an audience of one - you the consumer can choose the ingredients and design the product required. Happiness comes from the active content of life - skills exercised, new experiences gained, effort rewarded - in the context of opportunity and time, enough funds, and friends to tell all about it. Which of these is lacking in your life? All can be remedied by effort and ingenuity over a period of time. The key is self esteem and this can be developed by active techniques.
Confident doctors who value themselves are able to improve their lives by matching aspirations to achievement, but many unhappy folk set their horizon of aspirations too low, and their time scale too short. Low self esteem breeds poor performance in a vicious circle of disappointment. You can have what you want, but it will take time and effort to get there. Skills can be acquired and new people met and befriended. But the architect of these changes is yourself. Give it a try: it would be very unhappy indeed to be unnecessarily miserable.
What to do about it?
Traditional agony aunt advice is generally available in the media - “Get rid of him/her,” “We're all shy, love, get out a bit more”- and finding the perfect partner is outside the scope of Career focus, except perhaps through the on line discussion groups for like-minded career connoisseurs. Aside from sex'n'drugs and rock'n'roll, formal counselling approaches include coming to terms with past events, looking to the future with optimism and accepting one's personality as it is. The support of a partner, friends, and mentoring can all help a person to gain self awareness, accept their lot and improve themselves and their self worth. Self improvement was a respectable aim throughout the 19th century from mechanics' institutes upwards and we might well strive anew.
Devise a life strategy, with some goals and distance to go. Just as children need an element of deprivation in their upbringing, a happy adult life should include some striving against resistance - and not just your colleagues - both intellectually and physically.
Many doctors have had a narrow science based education and find it hard to get their bearings in modern culture. Unidimensional activity leads to boring lives. It's strange in this media age that we bemoan the lack of intellectual stimulation at a time when there have been exiting advances in science and the arts. Look into the new physics, genetics, cosmology, time theory, and the neurobiology of consciousness. Doctors universally urge patients to eat less fat and take more exercise. How many of us take our own advice?
Develop your own life content, opportunities, money, and friends in the proportions required. The task is yours: no one will hand you these on a plate. All right, you might receive a timely legacy or it could be you in the lottery;but would you be happier? Decide on directions and start with small projects and social contacts: see box for some suggestions. Protect the necessary time and exercise your cultural and intellectual muscles. Then tell someone all about it.
Increase exercise (swimming, walking, or cycling);take up a musical instrument, attend a season of plays; go bird watching, change newspapers; read a canon of literature such as Trollope or Dickens; take a “cultural” trip; read up the new physics
Increase the physical and cognitive content of life
Avoid bores; take out some half days and your full holiday entitlement; travel widely; attend more courses in your specialty; wire into the Internet; work for another organisation; broaden your portfolio; develop a neglected talent
Make wider opportunities
Increase social contacts of all kinds: join a club or society; take an evening class in an unlikely subject; have a programme of lunches; go on a social holiday; take up a social pastime; join a multistage course; take a mentor; perform as a lecturer; write some articles; revisit lost friends
Develop social life
Solve people problems; attend to those niggling health problems; rearrange life to suit yourself; think positively; sort out environmental difficulties; facilitate everyday life; if the job is awful, move on!
Trounce negative factors
Finally We place too much emphasis on work in our careers. Employment is only a job: life is the career and its purpose is the pursuit of happiness. Develop your career strands as you choose, and get out and seek the skills and people necessary. Balance work and play - this means more play - and enjoy the best of both. Do something differently today: think a new thought, speak to your enemy, start a new cultural project, meet someone new. Go on, cheer up!