Happiness: Nature or Nurture?


In my December editorial, I noted that the overall happiness quotient for American surgeons is less than desirable, according to a survey of American College of Surgeons Fellows. Although a majority of surgeons are satisfied with their lot in life, far too many are unhappy as manifested by burnout, depression, or both.

Seeking happiness has been the Holy Grail of human existence since mankind emerged from Africa a million or so years ago. But what is this thing we call happiness, and where can we find it?

Webster defines happiness, a word first used in the 15th century, as "a state of well-being and contentment." Although Webster doesn’t tell us where to find happiness, a recent study suggests that we should look in our chromosomes (Institute for Empirical Research in Economics, 2010, Working Paper No. 475). It has been known for some time from twin studies that happiness is, at least in part, heritable. If your identical twin is happy, there’s a pretty good chance that you will also have a smile on your face. The heritable component of happiness has ranged from 36% to 50% in various studies.

This recent analysis has identified a specific gene locus that plays a significant role in our sense of well-being or lack thereof. The serotonin transporter gene (SLC6A4) has two alleles. The longer gene (528 base pairs) transcribes the protein responsible for transport of serotonin into neurons more efficiently than does the shorter allele (484 base pairs).

Interestingly, individuals homozygous for the longer gene are 17.3% more likely to be satisfied with their life than are people with two short genes. Heterozygosis portends an 8.5% higher likelihood of happiness.

Although the heritability of happiness is almost certainly polygenic, this study is the first to define a specific gene locus that plays a part in determining this elusive, but very important, component of our makeup.

Age, gender, and a number of environmental elements have also been shown to contribute to our overall sense of well-being. In virtually every culture studied, happiness is a U-shaped curve, with younger adults and the elderly being happier than those in between. (Indeed, the so-called midlife crisis is a statistically verifiable fact.)

Although women have a slight edge over men in their happiness quotient, they also tend to be more prone to depression.

Several external factors – employment status, income, marital status, education, and religiosity – also correlate with happiness, but none individually accounts for more than 3% of the sum total of well-being.

Multiple investigations have demonstrated a positive relationship between happiness and health. In one study, optimism – which is a cornerstone of happiness – was a highly significant correlate with mortality in elderly Dutch people (ages 65-80 years) (Arch. Gen. Psychiatry 2004;61:1126-35). This relationship was stronger for men than for women. Men in the upper quartile of optimism were greater than 50% more likely to survive another 10 years than were those in the lower quartile.

So what can unhappy, burned-out, or depressed surgeons do to improve their lot? Gene manipulation in the distant future might help to bestow a happier aura on some of the discontented. Until then, changeable factors causing unhappiness in one’s life need to be identified and dealt with. Eliminating or modulating the main stressors in the workplace and developing and finding time for outside interests may go a long way toward increasing satisfaction.

Particularly effective may be new pursuits and passions that can be shared with one’s partner and/or children. Time must be set aside for nurturing relationships with family members, colleagues, and friends. Although frequently reserved for the years surrounding retirement, such endeavors should be taken up early in one’s surgical career.

Already there for us, but often underappreciated, is the satisfaction and joy that should come from knowing that, as a result of one’s efforts, someone else’s life has been made better. If we don’t get it on our own, the gratitude so frequently expressed, overtly or subtly, by our patients should help.

Finally, striving to have a genuinely optimistic outlook on the future may make that future not only brighter, but also longer.

Dr.Layton F. (Bing) Rikkers is Editor in Chief of Surgery News.

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