By Dr. Anthony Ellis, WCI Columnist
When I was about 50, I read a report called the World Happiness Index. I can’t remember exactly what led me to the site, but it's since published its 10-year anniversary report and it can be found here. The report says it “uses global survey data to report how people evaluate their own lives in more than 150 countries worldwide. The World Happiness Report 2022 reveals a bright light in dark times . . . ” so it may be worth a read if you are curious.
An excerpt: “While interest in happiness has mushroomed over the 10 years of World Happiness reports, the global average of national life evaluations has been relatively stable . . . remarkably resilient during COVID-19. For the young, life satisfaction has fallen, while for those over 60, it has risen—with little overall change. Worry and stress have risen—by 8% in 2020 and 4% in 2021 compared with pre-pandemic levels.”
But the report itself is not exactly what this post is about. In my early 50s (I’m almost 59 now), I was in a period of relative unhappiness and was looking for answers. I remember thinking after I read the report that you could cull the issue down to one question with a ranking on a scale of 1 to 10:
“Rank your happiness and life satisfaction on a scale of 1 to 10 with 1 being ‘I am completely dissatisfied and very unhappy with my life' to 10, being ‘I am completely satisfied and very happy with my life.'”
My initial score was a 6/10, and I remember being a little embarrassed to be below the average level of happiness in the United States, which was 6.8 at that time. I also remember several of the Nordic countries seemed to have about 10% “more happiness or contentment” than the US, clocking in at about 7.6. Despite the pandemic, these numbers have been relatively stable for the past decade. In 2022, the US average is essentially 7 (a bit better), and the range for the perennial “winners” such as Finland, Iceland, Denmark, Switzerland, the Netherlands, and Sweden goes from 7.4-7.8, still averaging about 10% better than the US.
Giving myself a below-average score pushed me to think more about why I was “less than average happy” despite a life that looked pretty good from drone height. I had just taken a job as an associate professor at a university that was developing a psychiatry residency training program. I liked teaching, and I was told I’d be doing a lot of lecturing and curriculum development on a consultation/liaison service. Soon after taking the job, though, the “lunch index” (how many days per week you actually get to eat lunch) declined from 100% to 20%, and the clinical service tripled in size. I was primarily doing evaluations on suicidal patients, psychosomatic patients, and delirious patients in the ICU. It was much harder than I anticipated.
I left the job after just over a year and went to work for a new employer, seeking a better medicine/life balance partly due to changes in the family related to my wife’s father dying rather suddenly. His unexpected passing seemed to “crack open” our minds as to mortality. The whole family was struggling with grief. My wife and youngest daughter were suffering so much that I was worried. I needed to be back closer to home, and I traded the 45-minute commute for a 10-minute drive. It was the biggest career and family challenge to date at that point in our lives.
I started asking patients about their happiness as part of their initial evaluations, and I asked friends and colleagues, as well. The answers were as interesting as my 6 on a scale of 10, and some were about as disappointing.
Results from the Happiness Index
Here's some of what I learned from my questions.
- Psychiatric inpatients ranged from 1 to about 5, averaging about 3/10. Remember, these are patients in a mental health crisis, frequently involving substance use disorders, and many were, frankly, suicidal.
- Psychiatric outpatients at a community mental health center ranged from about 3 to about 7, averaging about 5/10. These were generally patients who had reached some semblance of stability, and this shows what I call the “mental illness burden” dropping their average down from 7 to 5. That is quite a notable drop, and I began to think of 5 and under as more of a “Misery Index.”
- Friends and colleagues ranged from 6 to 9 with an average of about 7.5, suggesting that they were doing better than the US population at large. I surmised that this group was largely college-educated professionals and was stably employed. They had a relative lack of poverty and had a lower amount of “mental illness burden.”
It was interesting to me that I could never get a male that I knew or met out in public to answer higher than 8 on a scale of 10. None. Until, that is, I discussed the idea on The White Coat Investor in a prior post that talked about happiness, and Dr. Jim Dahle said he was a 9/10. Thank goodness the WCI CEO—the published author of several books and many finance courses; the mentor and financial guru; the one who is partially retired from Emergency Medicine; who has what appears to be a happy, healthy family, a long-term marriage, and an eight-figure retirement portfolio; and who reached financial independence before age 45—is a 9/10. There is hope (of course, no one really knows the life or struggles of another person).
So, why write a column about this topic?
I wanted to tell the story of how I went from a 6 to a 9 on the Happiness Index by formulating a plan, implementing the plan, and “getting my points back.” I had to think about the scale and why I gave myself a 6 to start before clawing my way back up. I was shooting for what seemed impossible at the time . . . a male with a score of 9/10. I had never met or spoken to one ever. At this point, I see one in the mirror most days.
More information here:
Figuring Out My Lost Points
Let me say that I did get answers of 9 on the scale from a dozen or so women (mostly from my work peers and among our friends) and even two perfect 10s. The two who answered a perfect 10 made little sense to me. One was the parent of a disabled child that had grown into adulthood but was still functionally a child and required constant care and supervision. I was very surprised when she said 10 on a scale of 10. She was a very positive-minded person who looked for things to be grateful for. She had made peace with her situation, and she leaned heavily on her faith.
The other perfect 10 was a ward clerk on an inpatient psychiatry unit who had been in that position for decades. She was/is a very positive person, is happily married, and was approaching retirement at that time. Liked by everyone, I had never heard her say a negative thing. She deeply cared about the patients and the care they received, and she was the best at that job that I have ever known. Later, she dropped her answer to a 9/10, showing that the number can change with circumstances. As she neared retirement, she had “one regret,” and this cost her that point. She said: “I think I could have done more with my work and career and should have completed more college.”
Back to my dismal and embarrassing 6/10. To explore this, I did what I told patients to do: ponder the question of, “Where did my points go?” I mean, how was I a 6 when I was happily married, had four healthy and accomplished children, was working a good job with better than average pay for my field, was healthy, had grown a seven-figure retirement portfolio by age 51, was living in a McMansion in a gated subdivision, and had access to making as much “side gig” money on weekends as I wanted?
The answer was partly that I was also a psychiatrist tasked with reducing anxiety, panic, depression, psychosis, mood episodes, and trauma-related symptoms of hundreds of patients, and I was working 12-20 “extra” weekends per year. I had been treating depressed suicidal patients daily for about 25 years. When I was running a consultation/liaison service, I was doing many consultations in ICUs on suicidal adolescents every week. I had to look hard at my situation and figure it out. I wanted to be a 9/10, like my most content female friends (and the male teller at my bank—who, at 8/10, told me he had recently married the love of his life, had purchased a house, and had been promoted).
What was going on during this decade? What happened to my points? Where did they go? What could I change? I did not want to be stuck at 6, one point above my own conception of a Misery Index. I remembered being an 8/10 for the bulk of 2001-2011 as the medical director of an inpatient geriatric psychiatry unit, so I was usually not so close to the Misery Index.
It became clear to me that I had lost at least two, or even three, points:
- One point gone: I wanted to retire from full-time work but saw no way to make it happen. In fact, I wanted to be done with all my work, but I had simply not saved enough. It turns out that, like many doctors and others in emergency and crisis work, I was getting burned out.
- Another point gone: I did not want to live in Michigan. I wanted to live in the mountains. I hated the winters, and I wanted out. In fact, I had wanted to move for quite a while, and my wife of 30 years and I had been scouting locations on many of our vacations. We went on a two-week trip to Peru in 2013, and we crossed a pass in the Andes at 16,000 feet midway on a trek that was more than 100 kilometers long with a guide, a cook, and a mule team. On that trip, I knew I belonged in the mountains. My wife luckily agreed.
- Another point gone: A mixture of circumstances and loss. My father-in-law who had been like a second father to me died suddenly in 2014. He was the loving patriarch of the family and was a mentor to me since my own father died more than two decades earlier. He was an excellent father, friend, and grandfather, and the ripple effects in the family were profound and difficult.
By this time, I had identified the problems and planned to get my points back, but another sad and life-changing event occurred in 2016 after we had helped my mother-in-law put her life back together following the death of her husband of over 50 years. This was the year of the stroke that changed the rest of her life and ours. I won’t go into detail, but suffice it to say that my wife’s retirement was focused on taking care of her mother with some help from the rest of the family.
The primary duty fell on my wife, and it was probably the hardest thing she had ever done. I worried about the effect of the stress on her. In fact, I thought it was actually killing her. I didn’t ask her the Happiness Index question at the time, but looking back, she said she was depressed. Depression and unhappiness are different; depression can harm your brain. Luckily, we all got through this time of loss, and my wife survived being the primary caretaker for her mother for about five years. She and the whole family got back to their usual selves.
Grief is like that. At least it lessens with time.
More information here:
A New Way of Doing Business (and Saving Tons of Money) in My Retirement
Functional Longevity: What Use Is Retirement If You Can’t Move and Think?
How I'm Doing Now
Some lost points can be planned away:
- Put away more money. Learn more about investing.
- Find a place in the mountains and buy it.
- Do more side work to make it all happen.
- Take more vacations to “destress.”
- Sell the big house and move to a smaller house with fewer expenses.
- Some lost points are “just what is,” and they take time to resolve.
So, fast forward to 2022. I was 58 years old. We sold the big house in June 2022. I dropped to half-time employment in August 2022. We moved to our mountain home in warmer North Carolina that same month. We rested up from the move and refocused our energy on our marriage and our new lives. We have been to Mexico, Tamarindo (Costa Rica), Florida, and back up to Michigan to visit with friends. We have had friends visit. We toured five National Parks in the past month. We plan to go to Portugal and do a 100-kilometer trek (part of the Camino de Portugues) for our 30th anniversary.
I have all my points back and can say “I am completely satisfied and very happy with my life.” I can truly say that I’m a 9/10 now. Of course, happiness and contentment can be fickle and circumstances always change, but identifying your score and then asking “Where did my points go?” can be a starting point to getting to the best place you can be at any point in life. You imagine that, through magic, you have become an 8/10 and then you can take stock of what has to be different to “get your points back.”
For me, I dropped to half-time, moved to the mountains, and reconnected with nature. Of course, happiness is mostly internal. People say you must be happy from within and must not be dependent on external events, or your contentment will always blow in the breeze of good and bad fortune and circumstances. People also say that “parents are only as happy as their least happy child.” Luckily, my children are mostly plugging away at about 7/10 each these days. I wish an 8-9/10 upon them all. Maybe they can reach the elusive 10/10 one day.
One can also practice gratitude, use positive thinking, and cultivate a perspective that optimizes your chances of happiness. But then again, maybe that’s a topic for another column.
What will it take for you to be as happy and content as you can be? What is your Happiness Index score, and what are you going to do about it? Is it possible for you to reach a 9 or a 10? Comment below!
We know you visit The White Coat Investor to learn about investment strategies and planning, and we’ve always strived to teach financial literacy to physicians, high earners, and anybody else who finds their way here. But the COVID pandemic has also shined a light on physician burnout and its dangers. That’s why we feel compelled to run articles and columns like the one you just read—to make sure white coat investors stay mentally healthy. We know mental wellness is what leads to a long, fruitful financial life, and we’ll continue to run pieces like this because combatting burnout has become such an important part of everybody’s financial journey.
Tony great post man! Definitely agree with circumstances can change your score and can be pretty fickle. I would say I’m 9/10 generally but currently stuck in a dance competition auditorium for the next 10 hours as my youngest daughter does dance. She went on at 8am, next routine 11am, the. 2pm and 5pm. I’m kind of 1/10 right now in between her routines!
But a lot of what determines happiness I’ve read is also expectations. For example spinal cord injury patients are generally happier than one would think, and a lot has to do with they didn’t expect to be happy. I assume it is similar with you coworker with the special needs child. Do you think this also applies to the world happiness index, where living in America, the land of opportunity and the wealthiest country in the world, people set the bar too high and expect to be super elated until the day they die by virtue of living in America, whereas living in cold Nordic countries the expectations might be lower?
Also do you think this partly explains your previous 6/10, where being a successful and wealthy physician on paper you expected to feel 10/10?
Thanks Rikki.
You bring up three issues:
1) Situations can have temporary effects on your score. I like to think these are usually 1-3 points and are managed with cognitions and gratitude. “I’m lucky to have a healthy daughter who loves to dance. I’m fortunate to be here today to see her shine. The downtime will allow me to go outside for a walk or see other young people reach for their dreams today. I’ll only have so many days like this, so I’m going to be fully present and enjoy this gift.”
2) Why are the happy countries happier than us? Lower expectations or less worrying about basic needs like healthcare, childcare, access to higher education, better work:life balance, or something else?
3) I always expected to be happy as a successful doctor and think many people can get to the 8-9 range. I tend to think happiness is an important goal in life and might be the most important. I got off track for a while and had to right the ship.
2. Nobody wants to talk about this but there is a lot of data out there suggesting it is due to more uniformity in the population. Same race, same values, same culture etc. The US is much more of a conglomeration of multiple races, religions, cultures etc. This fact has been used to explain a lot of things from rates of violence to happiness. The additional social support in Northern European countries probably helps promote uniformity. Our more capitalistic system adds an additional factor, vast differences in wealth. That probably doesn’t help either. Data suggests we are happier when we are the wealthiest among our social circle. We’d rather make $100K a year and live around people making $50K a year than make $200K a year and live around people making $300K a year.
Homogeneity is a reasonable explanation as is the higher degree of “cooperative good” policies (more socialistic). Certainly most of these happier countries share these two characteristics.
I also think there are only so many cookies here and we are encouraged to get ours and compete with others for theirs…feels very competitive.
There is a Finnish comedian who said he “felt bad when he heard “and “figured I was one of the few unhappy Fins”.
This has been my focus recently as well. While practicing full time OB my happiness was probably 6-7 as well. I dropped OB in 2020 and cut back to a 4 d 33 hour week GYN only schedule. I vacation every winter month away from the Midwest city I live in – and take 8-9 weeks of vacation per year. Hit 7 figure retirement account at 47 (8 years ago). I could do this schedule for a long time- plenty of uninterrupted sleep and 3 day weekends every week. I have Appreciative patients and helpful colleagues. I am no longer calculating days to retirement. I knew regular sleep was important – but now am finally living it.
Your solution seems to fit you.
I have seen a lot of OB/GYN doctors drop off the OB due to the stress and sleep deprivation.
I’m glad to hear you have found a work:life balance that is conducive to happiness.
Certainly for me, this was a crucial change.
OB in OB/GYN is a lot like night shifts in EM. It’s really a young person’s game. Best to make it pay so well that the young docs with the need to save up a nest egg and pay off debt do it voluntarily. Then when there is less need for money, it gets dropped.
This is the best post I’ve read in months! Congratulations on the positive changes, and well written!
Happiness is largely based upon external factors, is it not? You had to change your circumstances to get your score back up. I struggle with that because I want to be happy, but I also understand that contentment comes from within and happiness more from external factors. These external factors may or may not be controllable, but you can control what is going on inside your own head (surprisingly–neuroplasticity and all).
You mention affirmations, optimism, and gratitude. I would love to hear more about the internal changes you found helpful to increase your score. Any changes in your routine thinking patterns that improved the overall mood?
My issues were external in many ways with an internal corollary in parentheses below:
1) I want to work a lot less (so I can more fully pursue hobbies and interests while I am physically able).
2) I want to live in the mountains in a state that is warmer and has more sunshine (so that I can hike and generally be outside more as I find this calming and regenerative).
3) Grief work and reconnecting with my wife of 30 years was the rest (I needed more time to contemplate, cook, hike, do yoga, write, read, pursue hobbies, and go on couples vacations).
Gratitude practices are very helpful. I think of all the things I have to be grateful for every week. The list is long. I think writing them down occasionally helps.
Happy marriage, healthy family, no significant money worries, good personal health, current abilities, and service to others are the main ones.
Having more time to think and reflect allowed me to see the absolute wonder of our good fortune. I also had to continue to throw off the residual family legacy of unhappiness that was ingrained in me. At times, it had tried to throw a shadow on me. Sadly, I appear to be the only person in my family of origin that is happy.
Dr. Ellis – this is one of the most insightful posts I’ve read and I’ll immediately be implementing this question into my annual physicals. Thank you
Thank you 😊 Dan.
You are going to be in for an interesting adventure with this question.
It does so much to let patients know you care about their happiness and you will learn, like I did, how fortunate most of us are.
It also stimulates an internal review that can be an ongoing personal marker to explore and adjust. Armed with “where your points went” you can always try to get them back if possible.
The toughest point takers I’ve seen are 3-4 points for homelessness, or 3-4 points for losing one’s children due to substance use disorders or the loss of a child. These can really knock a person down. Chronic pain mixed with significant health issues and subsequent depression is similar. Point killers.
Very insightful. Agree that happiness is largely “an inside job,” though circumstances reveal the extent of one’s ability to “roll with the proverbial punches.” Faith matters.
Having a daughter in periodic crisis affirms my wife’s (Child and Adolescent Psychiatry) discounted Happiness Index, as well as mine (Family Doc). My daughter is weighing if she really wants to complete her residency in Family Medicine. Delaying gratification seemed much easier for us — her parents.
As an 8/10, I hope to get to “10” by selling my business soon (letter of intent signed yesterday!), increase my back-country days in the Wasatch Mountains, and visit my 80-year-old mother in Michigan as often as possible. We’ve already started our planning for bike trips in Europe, more medical outreach as volunteers, and church activities.
Passive investing is the key to your financial freedom – making money while you sleep. If ever I can help you with ideas, please contact me.
Thank you for your editor role with WCI!
Sounds like you are on your way to 9/10 in short order.
Congratulations on the sale of your business.
Spending time in the mountains and biking in Europe sound like my idea of fun!
Thank you and best wishes on your transition to less work!
Absolutely loved this Tony! Happiness is my most passionate area of study and self reflection as it seems as close to the meaning of life as I can find.
I have recently reached a 9/10 after leaving dentistry. I think the highest I ever reached during clinical practice was a 7/10 with some years in the 5s and 6s. Changing careers has allowed me to work from home, prioritize my physical health, be logistically and emotionally available to my kids, be a more engaged and equitable partner, travel, ski, hike, and socialize more often, and generally feel like my work fills in around my life rather than my life fills in around my job.
I’m so happy to hear you are at a 9/10. I hope you stay there or continue to ascend as you continue along your journey!
Does anybody else think there is something magical about changing things up? It strikes me as a special elixir–at least in this country where as Dr. Dahle pointed out, we are large population with enormous variety of culture, wealth, and spending habits.
Consider the advancement through the medical field: you go to college for 4 years, med school for 4, residency ~3-7 depending on speciality. It’s really exicting to feel progress and change: every subsequent 4 years you’re like a senior who is off to new things. But then one day, poof! You become an attending. You think you’re done, you make a great income, yet a surprising many of us have lower happiness.
Micheal,
I do think that medical training is compartmentalized as you pointed out.
Few of us expect to be financially well off or 10/10 happy during those segments. I certainly had a few times that reached the 10/10: getting in to medical school, landing a residency, and the first “real” job.
We go out and get our first attending job and our wages go up like a rocket. Mine went from $80,000 a year (with extensive moonlighting) in my 4th year in Psychiatry residency to $175,000 first year attending wage. I remember the salary was $135K and I earned a productivity bonus of about $40K.
Now, you have a “real job” and your delayed gratification has paid off. Your dreams have come true. You usually have a house, a decent car, someone to love, and four weeks of vacation.
Why is that not an automatic 10/10? First off, almost no one says 10/10, always leaving room for improvement. Second, that situation comes with a whole new set of responsibilities and life is no longer on auto pilot.
I tell people I was good at three things: finishing med school and training, staying married, and maxing out my retirement accounts. Those three things set up the rest.
But I still had to make adjustments in various five year chunks to not drop below a 6 or 7/10, and like the post says, in order to get to 9/10, I had to drop full time work.
As you say, many positive transitions offer a two point boost, but they can be transient and not stick.
Tyler, I’m glad you enjoyed it. You appear to have arrived at the happy place at a fairly young age. Good for you!
I had not read your February post until now, thinking it was only for dentists.
I read it just now and loved it. Humorous, and engaging, you are an excellent writer.
Your journey is inspiring. I wish you and your family the very best.
Great post, Dr. Ellis! Just curious if you used any tools/books or therapy on your “figuring out my lost points” journey.
As an example, the strongest evidence based therapy for mental health is ACT (acceptance and committment therapy). The value exercises therein were quite satisfying.
Micheal, I listened to 200 books on tape during my hour long commute to/from the geriatric unit I ran for eleven years (2001-2011).
They included some self help books, business books, and some must have been about happiness. Unfortunately, I don’t remember any specific titles. They tended to meld together. I remember sort of being sick of self help books.
The funny thing is I got more out of answering this question and thinking about what I really wanted…about what was missing. Where had my points gone? Was 9/10 possible?
I wanted a smaller financial footprint and flexibility that would allow me to enjoy two decades of leisure. I wanted to convene with nature before dying. I wanted to be closer to my spouse and children. I wanted to not worry about money so much. I wanted to be freed from the purchasing of “stuff”.
What pushed me to be brutally honest with myself were the deaths of my father-in-law and several friends my age.
They were all surprised by death. The life I have now was partly envisioned, planned, and implemented due to the immediacy of death that came from these losses and taking to literally thousands of suicidal individuals.
All I have to do at this point is live it to the fullest and practice gratitude.
That’s pretty amazing to boil it down to that one question. I love it. You could write a book called “where had my points gone!”
I love this post!
I am a very similar age to you. I was cruising calmly along at a 7 to 8 with all the boxes ticked but not quite firing on all cylinders: happily married, empty nesters, kids adulting, pretty much FI even if I clearly missed RE. So better than OK. Feeling good. But not great. I’d known great and knew the difference. The rough plan for my husband and I was to coast along in our self employed consulting for another year or so then stop.
Three months ago an idea came to me. For a new business. I pushed it off but it kept coming back. I circled it, attempted to poke holes and find its flaw.
Within a week I was asking my husband how he felt about me investing $$$ to start (another) business. Part of me hoped he’d be the one to shut it down. But no, he liked it. So I started. I was not looking for this, I was so ready to be done working.
I have so so enjoyed starting this one. It has taken me to new places IRL and online, To new professional relationships, to new clients, to learn new skills and build a new website,. I have a constant list of tasks to get through. I feel like a kid cramming for finals and tuning in a final report, and showing up for group project all at once. But I am enjoying it all.
I feel like I am back at a happiness 9 for the first time in years.
It sounds like you really enjoy the creative startup phase of a new endeavor. Building something is almost always fun.
I hope it continues to be a source of happiness and you stay at the great spot (9/10) you find yourself. Best wishes.
Ha ha, yes!
It is all rainbows and optimism and excitement. Must be the infatuation phase. 🤣
Dr. Ellis, your article on the World Happiness Index and your personal journey has bowled me over like a perfect strike! It’s not often that we can pinpoint the exact moments when our happiness takes a hit, but you’ve managed to identify the gutter balls in your life and turn them into spares by making meaningful changes.
Your story is a fantastic reminder that life isn’t always a perfect game, but it’s about how we pick up the pins and continue rolling. Sometimes, we find ourselves in the proverbial bowling alley of life, trying to navigate the slippery lanes and unpredictable pin action. But as you’ve demonstrated, the key to happiness lies in our ability to adapt and make the necessary adjustments in our approach.
It seems that you’ve taken the time to polish your metaphorical bowling ball and focus on the factors that truly contribute to your happiness, both personally and professionally. You’ve truly stepped up to the line and thrown a curveball at life’s challenges, ultimately knocking down the pins that once stood in the way of your happiness.
Your willingness to share your story with such candor and vulnerability is a testament to your strength, resilience, and commitment to personal growth. It’s an inspiration to all of us who are trying to find our own perfect roll in the pursuit of happiness.
Here’s to hoping we all can find our own personal 300 game in happiness and life satisfaction!
Tom, that was pretty funny.
Are you a bowler by chance?
I felt like your review was right in the pocket and reset the pins for other metaphorical commentary.
I’m glad you enjoyed it and wish you a life full of strikes and spares and a paucity of splits and gutters.
May you roll well and often.
Good post. Congrats on reclaiming those points! I like the gratitude shout-out at the end, too!
By coincidence, Arthur Brooks in The Atlantic wrote last week about “via negativa” which he defines as “recognizing that when you don’t know the right way forward, you might succeed by focusing on what you know to be wrong instead.” You’re on the same of wavelength in trying to figure out where your lost points went so figured I’d send along the link to his article in case you’re interested:
https://www.theatlantic.com/family/archive/2023/03/goals-negativity-bias-new-years-resolution/673408/
Thanks!
I tried to read that article but you have to be a subscriber to The Atlantic, I think.