Anthony Costello

Twenty five years ago Professor Malik Mubbashar, psychiatrist and vice-Chancellor of the University of Health Sciences in Lahore, Pakistan leaned back in his leather chair and asked me an intriguing question.

“Tony.  Do you know the stages of your career?”

I didn’t.

“Well let me explain. First there is learning. This takes ten years.” He was quickly into seminar mode. “Then there is doing. Ten years. After this you move to directing. Ten years. Then you move on to advising, ten years.” He paused.

“That’s four,” I said. “What’s the fifth?”

“Reflecting” he said.

Of course these epochs overlap. If you’re any good at anything you never stop learning.  And probably you dont stop doing either.  But the point he was making,  as I was about to take on a course director’s role in a university after years of doing my own thing, was that transitions require a change in our mindset. Big time. For instance, I remember as a senior house officer working for a really great senior resident doctor in the newborn intensive care unit. She was always available at night, happy to help with difficult procedures, and a constant reassuring presence.  Soon she moved on to a consultant post and I met one of her registrars at a conference a year later.

“You’re lucky, I said. “Suzanne’s a great boss isn’t she.”

He looked at me with incredulity.

“No. She’s a frigging nightmare. Always around. Never lets us do anything.”

I remembered this incident years later when Mubbashar taught me about the stages of my career. Being a front-line junior doctor or researcher was completely different from being a consultant or doctoral supervisor. You had to let go. To be supportive without constant interference. To accept that everyone has different ways of doing things. And that your juniors learn quickest by making their own mistakes.

Being a director is about creating teams, supporting both the group and individuals,  and creating an environment within which others can grow. Some great football players make great managers. In football Pep Guardiola, Diego Simeone, Zinedine Zidane and Johan Cruyff were certainly both. But many great managers of big teams were not necessarily great players – think Jose Mourinho, Arsene Wenger or Alex Ferguson. And many great players have spectacularly failed as managers – Bobby Charlton, Diego Maradona, Paul Gascoigne, Alan Shearer and Gary Neville. The skill-sets are not the same. In the film industry and theater, Alfred Hitchcock, Quentin Tarantino and Martin Scorsese made undistinguished cameos in otherwise great films. John Osborne, Harold Pinter and Alan Ayckbourn were great writers and directors, rather less so as performers.

And the transition from director to adviser, from CEO to chair, from professor to Dean, is different again. When I arrived as a director at the World Health Organisation I realised that the co-ordinators in my department really controlled the projects and their budgets. My role was to advise, to advocate, and to do the politics and diplomacy that would help them to succeed. They didn’t want me to micro-manage. It’s a difficult transition if you like to be hands-on, to plan the details, to get your feet dirty. I had learnt this lesson from my old Provost at University College London, Malcolm Grant, who taught me that creating a culture of celebration, can-do and support led to much greater productivity among the staff than targets, top-down plans and tick boxes. People like to be appreciated. The adviser must manage by wandering around, make him or herself available, and  create a culture where staff feel valued. Again this is a different skill-set than direction.

And the transition to reflection is also a tricky ridge to traverse. The temptation is to never stop working if you are in a job you love. “Retirement at sixty-five is ridiculous. When I was sixty-five I still had pimples.” said the comedian George Burns who was doing gigs in his late eighties. The cellist Pablo Casals said ‘to retire is to die’.  But reflection, and the opportunity to discover old talents and new arenas, is an opportunity for many people whose jobs did not mean everything. After all, graveyards are full of ‘indispensable men’. Lives stretch on average at least twenty years beyond retirement. It’s a time for laughter, travel, grandchildren, art, literature, clubs, dance and crafts. And people, in the age of reflection, must avoid the peril of loneliness. Among the elderly loneliness is endemic. More than half of over-75s live alone. In the UK, five million older people say that television is their main company. Loneliness has crept up on them, slow or unexpected, caused by the death or divorce of a spouse, a move to a new home, children leaving, the onset of disability or chronic illness, retirement from work, or friends migrating. Loneliness brings stigma, a sense of vulnerability and a big increase in the risk of depression. Many lonely people, at any age, will not admit to being so. Fourteen percent of elderly people meet the criteria for major depression^[i], and clinical depressive symptoms are present in about 20% of over-75s^[ii]. In Germany, a study of non-dementing people over the age of 75 showed an association between social integration and depression. They concluded that for elderly people increased social networks and enhanced social integration reduce depression.^[iii]

The author CS Lewis observed: “As soon as we are fully conscious we discover loneliness. We need others physically, emotionally, intellectually: we need them if we are to know anything, even ourselves.” Social integration is good for physical health and a sense of well-being. Governments spend billions to unravel the genome and smash atoms in the hunt for theoretical particles. Might a fraction of this money go into the science of sympathy and support groups to make sure we end our lives without isolation?

References

^[i] Licht-Strunk, E., H. W. J. Van Marwijk, T. Hoekstra, J. W. R. Twisk, M. De Haan, and A. T. F. Beekman. “Outcome of Depression in Later Life in Primary Care: Longitudinal Cohort Study with Three Years’ Follow-Up.” BMJ, no. 7692 (2009): 463-66.

^[ii] Luppa, Melanie, Tobias Luck, Hans-Helmut Konig, Matthias C. Angermeyer, and Steffi G. Riedel-Heller. “Natural Course of Depressive Symptoms in Late Life. An 8-Year Population-Based Prospective Study.” Journal of Affective Disorders 142, no. 1-3 (2012): 166-71

^[iii] Schwarzbach, Michaela, Melanie Luppa, Claudia Sikorski, Angela Fuchs, Wolfgang Maier, Hendrik van den Bussche, Michael Pentzek, and Steffi G. Riedel-Heller. “The Relationship between Social Integration and Depression in Non-Demented Primary Care Patients Aged 75 Years and Older.” Journal of Affective Disorders 145, no. 2 (2013): 172-78.