Flow as the secret to happiness

Issue: BCMJ, vol. 64, No. 9, November 2022, Page 373 Editorials

One of the most meaningful things I have learned about finding happiness is the value of “flow.” Perhaps you have already heard of flow. It is a term coined by Dr Mihaly Csikszentmihalyi (pronounced mee-high cheek-sent-me-high-ee) and clearly, I am late to the game.[1] Dr Csikszentmihalyi’s TED Talk has over 7 million views, and his breakout book, Flow: The Psychology of Optimal Experience, is a bestseller endorsed by a myriad of high performers and world leaders.[1,2]

Flow experiences are those during which one’s sense of time seems to vanish and “effortless actions” create bursts of creative energy, leading to some of the best moments in life.[3] Flow can arise only when one has a clear set of goals and access to immediate feedback. A person’s skills must be almost equal to the action, such that the task remains challenging enough to demand undivided attention. If the goal is too easy, one gets bored; if it is too hard, one experiences frustration, which leads to anxiety. Writing about Dr Csikszentmihalyi in 1986, a Washington Post reporter said, “We don’t ‘go’ with that kind of flow. We summon it unconsciously, experience it and feel good as a result of it.”[4] Some common activities during which one might experience flow include playing music, computer programming, rock climbing, and surgery. My flow state comes while I’m wake surfing (the watersport where boats make annoyingly gigantic waves for a surfer who does not require a towrope). I love trying new tricks, riding revert or heelside, and just feeling the shape of the water. It’s blissful … until I inevitably bail and give my kids something to really laugh about. They have taken to calling my 360 “the banana peel” because that’s what it most often resembles.

I was introduced to the concept of flow through a McGill University course I took during the pandemic, called Human Motivation. The professor, Richard Koestner,[5] taught us how autonomous motivation can be either intrinsic or extrinsic. Those who are intrinsically motivated do things consistent with their core values, interests, and personal morals. In contrast, extrinsically motivated people are driven to behave by external sources such as grades, rewards, or the admiration of others.[6] Intrinsic motivation tends to lead to more enjoyable experiences and lasting satisfaction, although it can be diminished by external pressures.

I have reflected on how physicians might cultivate flow, as intrinsic motivation is undoubtedly what drew many of us to medicine in the first place. During my fellowship I recall having frequent flow experiences during surgery. Under the watchful eye of my attending, I got tremendous personal fulfillment from operating; I was helping patients, honing my skills, and enjoying the work. Although I still love my job, flow is understandably harder to come by these days as the most-responsible-physician, concurrently balancing the daily pressures of running a practice while practising medicine.

Flow is a means to experiencing what we all really want: happiness. After learning of the concept, intrigue led me down an Internet rabbit hole of neuroscience and motivational psychology. While I fully endorsed the mental health benefits of flow experiences, mine seemed to take a lot of energy. (To my dismay, I learned that you cannot be in flow while watching reruns of The Office with a glass of wine in hand.)

Dr Csikszentmihalyi found that flow is possible to achieve in almost any job, but it takes a committed effort.[7] To get into the flow state “on purpose and with purpose,” Diane Allen’s TED Talk explains how to dissect your own flow experiences and find a flow strategy that you can apply to many facets of your life.[8] Her flow strategy, for example, is harnessing the unity of connecting with others, originally through music, and transferring that to finding unity in daily activities. She reassures us that shutting down your prefrontal cortex and finding flow is not an esoteric concept reserved for the elite; your brain can do it too! If you are creeping toward burnout or feeling under-fulfilled, perhaps it’s time to ask yourself, when was the last time I felt truly immersed in something? Therein may lie the secret to happiness.
—Caitlin Dunne, MD, FRCSC


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1.    Risen C. Mihaly Csikszentmihalyi, the father of “flow,” dies at 87. New York Times. Accessed 3 October 2022. www.nytimes.com/2021/10/27/science/mihaly-csikszentmihalyi-dead.html.

2.    Csikszentmihalyi M. Flow, the secret to happiness. TED. Accessed 3 October 2022. www.ted.com/talks/mihaly_csikszentmihalyi_flow_the_secret_to_happiness?language=en.

3.    Csikszentmihalyi M. Flow: The psychology of optimal experience. New York, NY: Harper & Row; 1990.

4.    Cross R. Ideas. Washington Post. Accessed 3 October 2022. www.washingtonpost.com/archive/lifestyle/1986/05/16/ideas/b2f111e2-7206-428a-a0d7-2f7778277cb9.

5.    Koestner R. McGill, Department of Psychology. Accessed 3 October 2022. www.mcgill.ca/psychology/richard-koestner.

6.    Deci EL, Flaste R. Why we do what we do: Understanding self-motivation. New York, NY: Penguin Group; 1996.

7.    Oppland M. 8 traits of flow according to Mihaly Csikszentmihalyi. Positive Psychology. 16 December 2016. Accessed 3 October 2022. https://positivepsychology.com/mihaly-csikszentmihalyi-father-of-flow.

8.    Allen D. How to find “flow” (and lose yourself in it). TED. Accessed 3 October 2022. www.ted.com/talks/diane_allen_how_to_find_flow_and_lose_yourself_in_it.

Caitlin Dunne, MD, FRCSC. Flow as the secret to happiness. BCMJ, Vol. 64, No. 9, November, 2022, Page(s) 373 - Editorials.

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