Virtue ethics emphasizes the importance of self-knowledge and can help us to understand our patients in the context of the totality of their whole lives.
The culture of academic medicine places great emphasis on professional success. We’re encouraged to think of success as something depersonalized and objective, something we can see on a CV and quantify. We’re offered various benchmarks of achievement, such as obtaining an R01 grant, having a high H-index, and being a tenured professor. There’s a tendency for us to see such standards as possessing intrinsic value, as being desirable for themselves, and we spend our lives chasing the targets the system presents to us. As an ambitious early career psychiatrist, I’m keenly aware of this mindset as well as its dark side. There’s increasing discussion of work-life balance, burnout, and physician wellness. However, couching this problem in the language of work-life balance may blind us to the deeper malaise. As I see it, the question is deeply moral and relates to our assessment of the highest goods in life.
Virtue ethics, a tradition of ethics that goes back to the ancient Greek philosophers (particularly Aristotle), encourages us to think of our lives in terms of eudaimonia (flourishing/well-being), euzên (living well), and aretê (excellence, living up to one’s full potential). Virtues are dispositions or habits that are carefully, consciously, and rationally cultivated, to help us achieve eudaimonia. Doing so imbues our everyday life with moral significance. Living well cannot be divided into the personal and the professional—either we flourish as a human whole or we don’t. We wish to live well not because living well would help us accomplish some other goal (such as being a tenured professor), but because living well is the ultimate goal. The social narratives and yardsticks of academic success are only valuable to the extent to which they enable us to achieve eudaimonia. In the right setting, in the right way, they can, and they do. But it is often the case that if these touchstones of success are pursued as being desirable for themselves, we will sacrifice eudaimonia in the process and end up with a Pyrrhic victory.
Healthy ambition is tempered by other values in the context of meaningful life goals. We must be wary of paths to professional success that are littered with oppressive loneliness, alienation, apprehension, and self-indulgent greed. Flourishing will not be found in successful drudgery but in intellectually stimulating and fulfilling work that urges us to be our best selves. Furthermore, our flourishing depends not only on the goals we set for ourselves and on what we desire, but also on our constitution, temperament, and psychological needs. Desires and needs do not always align. If I desire something that I can only achieve with enormous psychic strain, it is likely that it may not bring me any peace even if I achieve it. The virtues that drive us to seek an academic life—curiosity, wisdom, intellect, knowledge, intellectual courage—are not restricted to it. Academic success is valuable only to the extent it offers us the good life.
If you value success for the sake of success, it will never be enough—there will never be enough awards, presentations, and publications. These are hollow achievements by themselves. Kept in the solitude of one’s CV, they are meaningless, a collector’s obsession. Success means little in a vacuum. It needs to be contextualized in the larger narrative of our higher values, such as investing in a community of colleagues and friends. Success becomes meaningful in the context of one’s relationship with a community, a community that one has contributed to and a community that takes pride in one’s achievements.
Living the good life
The good life can take many forms. In an essay on regret, Jonathan Malesic imagines meeting his younger self: “I tell him it’s possible to have an intellectual life without being in academia . . . He won’t lose his identity if he pursues something else . . . I tell him to be more confident in his ability to find a pathway outside academia, which, if he’s honest, is the only version of the good life he’s ever seen.” We could all do with more self-honesty. The good life is created but it is also partly discovered, for we cannot flourish without some measure of self-knowledge.
Enriching the healing relationship
We must work to understand our patients in the context of the totality of their lives, as individuals who are more than their diseases and whose goals are more than mere symptom remission. This takes us back to the wisdom of William Osler:
“Keep a looking glass in your own heart, and the more carefully you scan your own frailties, the more tender you are for those of your fellow creatures.”
The more knowledge we have of the highest goods and goals of our own lives, the more we can enrich the healing relationship by seeing our patients as fellow sufferers deserving of the same goods and goals.