The Power of Habit: Why We Do What We Do, and How to Change
Author: Charles Duhigg

Synopsis

Habits, as defined by this book, are ‘the choices that all of us deliberately make at some point, and then stop thinking about but continue doing, often every day’ (page xvii). The book shows how habits govern most of the decisions we make, and how they determine our health, productivity, financial security, and happiness (page xvi-xvii). Whilst habits free the brain from ‘thinking constantly about basic behaviors‘, thereby enabling it to focus on more demanding activities, the automatic routines they create dominate our lives ‘at the exclusion of all else, including common sense‘ (pages 17- 25).

The book describes the habit-formation loop which converts a sequence of actions into automatic routines. This loop consists of the cue, the routine, and the reward (page 19), and is powered by cravings (page 55). Worryingly, a cue may be ‘almost anything, from a visual trigger such as a candy bar or a television commercial, to a certain place, a time of day, an emotion, a sequence of thoughts, or the company of particular people‘ (page 25). The book explores the neurological underpinnings of habit-formation, such as how the basal ganglia ‘stores habits even while the rest of the brain went to sleep’, and how this is ‘central to recalling patterns and acting on them’ (page 15).

The author makes the point that habits have a powerful influence, not only on individuals, but also on organisations. They do this by creating influential routines which determine the success or failure of the institution (pages 100-105). These keystone habits are potentially beneficial because they create small wins which lead to a cascade of good habits spreading throughout the organisation (pages 108-112). The author illustrated this with the example of Starbucks coffee which successfully used this principle in ‘turning self-discipline into an organizational habit’ (page 141). On the other hand, the malign power of destructive organisational habits was evident in the example of Rhode Island Hospital, a place the author said was ‘riven by internal tensions‘, and characterised by ‘terrible mistakes‘ (pages 154-157).

The book explored the strategies that may help to change bad habits, but it stressed that habits can only be replaced and not eradicated. The author asserts that almost any habit can be transformed by creating new routines but maintaining the old cues and rewards (pages 62 and 92). He demonstrated this golden rule of habit reversal with the striking examples of the 12 steps to achieving sobriety practiced by Alcoholics Anonymous (pages 69-89, and the LATTE method of willpower employed by Starbucks when responding to complaints (pages 145-151). The book shows how giving workers a sense of autonomy and control enhances their willpower to develop good habits, and how leaders can change organisational habits by learning ‘to seize the right opportunities’ (pages 178-180).

To support his arguments, the author cites many scientific studies such as the Stanford Marshmallow experiment, which showed that ‘willpower is the single most important keystone habit for individual success’ (pages 131-133). He referenced the experiments of Larry Squire on how habits unconsciously influence our actions (page 25), and the work of Wolfram Schultz on how habits create neurological cravings (pages 43-50). He cited the Pepsodent marketing strategy of Claude Hopkins to demonstrate how habits can be designed by using simple cues and clearly defined rewards (pages 32-36); the work of Mark Granovetter on how weak social ties create widespread social habits (pages 222-226); and the MRI studies of Reza Habib on the neurology of pathological gambling (page 264).

The author discussed the influence of habits on a wide range of subjects, from sticky songs to the spread of social movements (pages 200 and 239). He also referred to several relevant concepts such as inflection points (page 146), subconscious virtuousness (page 185), and habit reversal therapy (page 77). The book is laced with many interesting stories which the author used to good effect to illustrate his arguments. Two of these anecdotes demonstrate the important function of the temporal lobes in the habit forming process. The first was the story of Patient HM, or Henry Molaison, who had bilateral temporal lobe surgery for intractable epilepsy, and the second was the story of Patient EP, or Eugene Pauly, whose temporal lobe was damaged by viral encephalitis (pages 4-10).

Opinion

Habits are at the core of many health disorders, and it is important to understand how they form, and how they may be transformed. The contents of the book will help health care practitioners to influence the behaviour of their patients, and to develop practical health care policies. The author is exhausting in his research, dedicating 60 pages just to notes. There is very little to criticise about the book which is lucid, comprehensive, and very well-written.

Overall assessment

This book has covered all aspects of a topic which has a great impact on health care. It demonstrates how knowledge of habit-formation can improve individual and organisational culture, and it has a great potential to improve health. The author has explored this important subject in detail and I highly recommend the book to all doctors.

Book details

• Publisher, Place, Date: William Heinemann, London, 2012
• Number of chapters: 9
• Number of pages: 371
• ISBN: 978-0-434-02036-2
• Price: £5.84
• Star rating: 4