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n COMMENTARY
Etiology of Belief–behavior Systems and Hierarchies
Mihal Emberton, MD, MPH, MS1 Perm J 2021;25:20.269
E-pub: 3/3/2021 https://doi.org/10.7812/TPP/20.269
ABSTRACT maintains a democratic belief–behavior system that allows for
Introduction: In order to understand the well documented enhanced problem solving and values each person’s intel-
patterns of mental health, human learning, human behavior, and lectual currency as a resource for learning. is also describes
the mechanics of hierarchies such as academic institutions, po- a true democracy and social justice.5
litical systems, and business organizations, one must discover the Although many evolutionary biologists believe the second
rules and pathways that cause those patterns. My Belief-Behavior
goal of life is to pass on one’s genes through reproduction,
Systems archetype is the first of its kind to reconcile the theories
also known as highest fitness,6 there have been well-recognized
and insights from social sciences, political science, psychiatry, and
evolutionary biology into a unifying paradigm which explains
limitations to this theory. Martin Nowak, PhD, Professor
how socialization and human interactions evolved into the pat- of Mathematics and Biology at Harvard University and
terns we recognized today. More importantly is that this new Director of the Program for Evolutionary Dynamics,
contribution to our understanding of human behavior within recognized that the evolutionary theory of survival for the
hierarchies provides the key insights to guide the restoration and purpose of reproduction cannot be explained by the evolution
repair of our dysfunctional hierarchies which, unfortunately, all of social cooperation because cooperation often leads to
too often oppress, manipulate and exploit our humanity. decreased reproductive fitness.7 In addition, Hudson Kern
Reeve, Professor of Neurobiology and Behavior at Cornell
University, and Paul Sherman, PhD, Professor Emeritus
INTRODUCTION of Neurobiology and Behavior at Cornell University, also
is manuscript is the third in a 3-part series that began recognized the incomplete nature of the theory of survival
with “Learning in Humans Versus Hierarchies,” followed in order to reproduce because this theory conflicts with
by “Unconscious Bias Is a Human Condition, published in behaviors such as “recreational sex, incest avoidance, cigarette
e Permanente Journal.” and alcohol use, adoption, and abortion.”8
Although some scientists might argue that behaviors such
EVOLUTION OF COOPERATION FOR IMPROVED SURVIVAL as cooperation or recreational sex are merely outliers, my
AND QUALITY OF LIFE framework for belief–behavior systems,5 on the other hand,
It is generally understood that, once born, the first goal of addresses these known limitations of the theory that we
life is survival. To survive, individuals must secure suste- survive in order to pass on our genes, by providing inclusive
nance (food and water), protection from the elements understanding about the evolutionary benefit of coopera-
(shelter and clothing), and safety (protection from threats to tion, recreational sex, adoption, and abortion as behaviors
life). And to solve the problem of survival, individuals must that improve individual survival and quality of life (physical
allocate their resources for learning, time, assets, labor, and comfort, intellectual growth, and emotional fulfillment).
knowledge in such a way as to solve the problem of survival. e same resources used to solve the problem of survival—
Societies form to combine the resources of time, assets, time, assets, labor, and knowledge—are also needed and used
labor, and knowledge to secure survival more easily.1-3 e to secure quality of life. And hierarchies also have the ca-
combination of these resources leads to a reorganization of pacity to help us improve our quality of life in addition to
those resources, also known as division of labor, which improving survival.
allows for the development of expertise to solve focused In summary, the evolution of cooperation improves
social survival problems more effectively. With the division survival by better solving the problems of securing sus-
of labor also comes the development of hierarchies, creating tenance, acquiring protection from the elements and
supervisors to solve the new problems created by the safety, as well as improving quality of life by improving
combination of resources and the division of labor. physical comforts, emotional fulfillment, and intellectual
An ideal or true hierarchy forms when the people doing the
work (laborers or subordinates) select a supervisor to oversee
Author Affiliations
the division of labor and allocation of resources. Evolu- 1
Department of Adult and Family Medicine, The Permanente Medical Group, Oakland, CA
tionary biologists call this process prestige strategy and note
that the selection of an individual to act as the supervisor results Corresponding Author
from admiration and voluntary deference.4 More specifically, the Mihal Emberton, MD, MPH, MS (Mihal.x.emberton@kp.org)
group tends to elevate a person to a position of power who burnout, engagement, learning process, organizational culture change, overcoming unconscious bias,
successful leadership, teaching collaboration
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The Permanente Journal https://doi.org/10.7812/TPP/20.269 ·
The Permanente Journal For personal use only. No other uses without permission. Copyright © 2021 The Permanente Press. All rights reserved. 1COMMENTARY
Etiology of Belief–behavior Systems and Hierarchies
development. erefore, there is an evolutionary benefit for other alternative is for subordinates to use a resistance
cooperation, the development of hierarchies, and thus belief–behavior system, challenging supervisors on their
development of belief–behavior systems to navigate coop- knowledge or performance gap in an attempt to drive
eration and hierarchies. learning for the benefit of the hierarchy, and thus benefitting
the subordinates who rely on the hierarchy. e resistance
EVOLUTION OF COMPETITION BETWEEN INDIVIDUAL strategy, however, is risky, because often autocratic supervi-
AND HIERARCHY sors view confrontation as insurgency and put more energy
Although there are benefits of forming a hierarchy, such into coercing subordinates to submit to their imperfect
as improved ability to solve survival and quality-of-life solution.10
problems, the creation of a hierarchy at the same time
creates a power differential in relation to the allocation PATHOLOGY OF AUTOCRATIC HIERARCHIES
and control of the resources for learning. In a hierarchy, When subordinates suffer coercion and conformity from
the supervisor generally gains control over the collective autocratic supervisors, the subordinates, justifiably, feel
resources of time, assets, and labor to solve both the focused oppressed and replaceable,5 and show signs of depression
social survival/quality-of-life problems as well as the prob- and anxiety. e fact that 7.1% of adults—17.3 million
lems created by the division of labor (hierarchy), whereas the people—in the US reported symptoms of severe depression
subordinates only generally retain control over their own in 2017,11 and 19.1% of adults—an estimated 46.5 million
knowledge and expertise.5 people—reported symptoms of anxiety,12 does not mean
When the supervisors in a hierarchy are functioning in that 1 in 4 US adults has dysfunctional brain chemistry, but
their democratic belief–behavior systems, they not only value rather that the hierarchies in which we work and live are
the knowledge and expertise of subordinates as intellectual often themselves dysfunctional. e World Health Or-
currency to solve organizational problems, but also they ganization emphasizes this fact in their recognition and
allocate the resources for learning in such a way as to drive definition of “burnout” as an occupational phenomenon.13
organizational innovation and growth. However, the cre- In addition, our understanding about adverse childhood
ation of a hierarchy, a power differential, also comes with a experiences14 and trauma-informed care15 highlight our
very fundamental flaw: it incubates the unconscious bias, the burgeoning realization that dysfunctional hierarchies have
knowledge or experience gap, of the supervisor.9 When a negative effect on subordinates.
supervisors toggle into their autocratic belief–behavior system, A very public incidence of the negative effects of an
they unconsciously overlook the fact that the subordinates’ autocratic hierarchy occurred earlier this year when US
knowledge, insights, and experience are a resource for Navy Captain Brett Crozier was forced to engage his re-
learning, the intellectual currency needed to solve organi- sistance belief–behavior system to highlight the autocracy, the
zational problems, and thus misallocate resources to drive knowledge gap of his hierarchy, to save his crew from a
conformity and status quo. e moment supervisors un- coronavirus outbreak on his ship.16 If Captain Crozier’s
consciously believe they have nothing to learn from their supervisor truly valued Crozier’s knowledge, insights, and
subordinates is the moment they close themselves off to experience, the supervisor would have used Crozier’s
discovery.5 intellectual currency to help solve the problem of the
Even though an autocratic supervisor’s intention is to coronavirus outbreak on the ship. Instead, Crozier had to
protect the common good of the hierarchy, he or she be- work outside the chain of command to challenge his
haves in such a way as to protect the hierarchy at the expense hierarchy to validate and act upon his insights. And as a
of subordinate engagement in problem solving, suppressing result, the autocratic hierarchy felt vulnerable and
subordinates’ intellect. When an idea challenges autocratic threatened; it attacked and blamed Crozier as an insur-
supervisors’ unconscious knowledge gap, they feel vulner- gent, and engaged in coercive behaviors to end Crozier’s
able and threated by the new idea, attack and blame sub- career.17 Alternatively, Crozier could have chosen to
ordinates for making them feel bad, and engage in coercive safeguard his career by using his disengagement belief–
interactions.5 is then forces subordinates to respond in 1 behavior system, letting his hierarchy keep its knowledge
of 2 ways (Figure 1). gap regarding the severity of the coronavirus outbreak on
If subordinates want to protect their place in the hierarchy his ship and maintaining the organizational status quo, but
for individual survival/quality of life, they will use a dis- this would have placed the health and safety of his crew at
engagement belief–behavior system, aligning with autocratic risk for the benefit of his individual survival in the
supervisors to make the autocratic supervisors feel good about hierarchy.
their knowledge or experience gaps, while acknowledging Autocratic dysfunction is not only observed in the mil-
this will also maintain the organizational status quo. e itary, but also it is observed in our other hierarchies.
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The Permanente Journal https://doi.org/10.7812/TPP/20.269COMMENTARY
Etiology of Belief–behavior Systems and Hierarchies
Figure 1. Subordinate survival and quality-of-life belief–behavior systems in autocratic environment: disengagement vs resistance. Copyright 2020 by Mihal Emberton,
MD, MPH, MS
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Etiology of Belief–behavior Systems and Hierarchies
Historically, as many American businesses began to procure of suffocation and status quo for the subordinates, which
profits at the expense of subordinates, a national movement impacts subordinates’ survival and quality of life negatively,
to advocate for and protect America’s subordinate workers creating subordinate disenfranchisement. Once a hierarchy
from the antisocial behaviors of their hierarchies began with has created a significant level of disenfranchisement, it
the establishment of the American Federation of Labor in becomes susceptible to manipulative–exploitive belief–behavior
1886,18 followed by the establishment of the US Depart- systems (Figure 2).
ment of Labor in 1913,19 and continued with the enactment When a disengagement belief–behavior system (collabora-
of additional policies to protect the survival and quality of tive interactions with conformity process) is no longer used
life of subordinate workers.20 ese movements and to survive supervisors’ autocratic belief–behavior system, but
policies, however, have not been enough to correct the rather is used to harness the power from the disenfranchised
autocratic dysfunction of many of our hierarchies. e for individual survival/quality of life at the expense of the
current Teachers’ Union contract in San Francisco, for hierarchy, it becomes a manipulative belief–behavior system
example, highlights that the knowledge, insights, and that describes, for example, cults and fascism. A dema-
experiences of teachers must not be interpreted as in- gogue, recognizing when an autocratic political system has
surgency and must rather be valued and protected, when it created disenfranchised constituents, aligns with the dis-
states the following: enfranchised around that truth, telling them that if they give
“e District and the Union agree that academic freedom the demagogue power, the demagogue will right the policy
[the right and responsibility to study, investigate, present, wrongs that oppress them. UK Conservative Party Advisor
interpret, and discuss all the relevant facts and ideas in the Dominic Cumming’s “Take back control” slogan around
field of his or her professional competence] is essential to the UK’s 2016 Brexit referendum,22 and Donald Trump’s
the fulfillment of the purposes of the San Francisco Unified “Drain the swamp,23” are classic and recent examples of this
School District, and they acknowledge that fundamental pattern of alignment. e demagogue, however, cannot
need to protect teachers from unreasonable censorship or right the policy wrongs, because it was the existence of the
restraint which might interfere with their obligation to pursue disenfranchised in the first place that allowed the dema-
truth in the performance of their jobs with the District.”21 gogue to gain power, and thus the demagogue must
In addition to oppressing subordinates and driving or- maintain the status quo to maintain disenfranchisement to
ganizational conformity and status quo, autocratic super- maintain his or her power.
visors tend to promote further autocracy within a hierarchy. is is also where the development of false hierarchies and
When supervisors are in their autocratic mind-set, subor- manipulative collaboration comes into play. In order for the
dinates who make them feel good about their knowledge demagogue to try to relieve the sense of oppression that the
gaps are subordinates who use their disengagement belief– disenfranchised are experiencing, the demagogue invents a
behavior systems, and thus those subordinates are more false hierarchy, telling the disenfranchised that it is okay for
likely to be promoted than subordinates who try to drive them to oppress another group because this “other group” is
change through their resistance belief–behavior system. truly at the bottom of the social hierarchy and is the reason
Subordinates who use their disengagement belief–behavior for their disenfranchisement (eg, sexism, racism, agism,
systems to survive within the hierarchy do not gain much xenophobia, etc) in the first place.
experience in how to facilitate or participate in learning Such a demagogue, who harnesses the power of the
processes, so that when they are promoted to supervisor, disenfranchised for individual gain at the expense of the
they often do not have the understanding or skills to hierarchy, may also toggle toward the resistance belief–behavior
toggle into their democratic belief–behavior system. side of the axis—coercive interactions to drive a learning
Without the knowledge, experience, and skills for fa- process—that becomes an exploitive belief–behavior system
cilitating learning processes, disengaged subordinates- when it is used to gain resources and power at the expense
turned-supervisors tend to mirror the autocracy that got of the disenfranchised, and, thus, at the sociopolitical level,
them promoted in the first place, creating a hierarchy of describes slavery, imprisonment, and war.
autocratically minded supervisors. Unfortunately, autoc- Although the Diagnostic and Statistical Manual of Mental
racy breeds autocracy. Disorders is an extensive collection of the patterns of mental
health signs and symptoms,24 it is far from describing the
AUTOCRACY LEADS TO VULNERABILITY AND FURTHER causes for those patterns. e Diagnostic and Statistical
DYSFUNCTION IN HIERARCHIES Manual of Mental Disorders, for example, describes the
Autocracy, the fundamental flaw of hierarchies, is also what patterns of personality disorders such as histrionic, anti-
makes hierarchies vulnerable to additional dysfunction. social, narcissistic, and borderline as maladaptive, creating
Once a hierarchy toggles into autocracy, it harbors a culture social disfunction,25 without explaining that it is the drive
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The Permanente Journal https://doi.org/10.7812/TPP/20.269COMMENTARY
Etiology of Belief–behavior Systems and Hierarchies
Figure 2. Harnessing the disenfranchised to improve individual survival and quality of life at the expense of the hierarchy: manipulative vs exploitive. Copyright 2019 by
Mihal Emberton, MD, MPH, MS
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Etiology of Belief–behavior Systems and Hierarchies
for individual survival and improved quality of life at the emotional fulfillment and intellectual growth to the parent as
physical or intellectual expense of others, at the expense of the well. And aren’t we generally content if our children do
disenfranchised and the hierarchy, that creates the patho- not have children of their own if that is the quality of life
logical social dysfunction. they want and choose? In addition, abortion and rec-
Although the development of belief–behavior systems reational sex, for example, also generally improve survival
evolved to help us collaborate around improved survival and and quality of life and are thus evolutionary adaptations,
quality of life, these same belief–behavior systems can also rather than outliers to the theory that our goal in life is to
become a social liability. When the behaviors for individual reproduce our genes.
survival and quality of life are used at the expense of others’ Although evolutionary biologists Reeve and Sherman try
survival and quality of life, those belief–behavior systems to redefine adaptation as “a phenotypic variant that results in
become pathological or antisocial. Now that the rules and the highest fitness among a specified set of variants in a
pathways for belief–behavior systems are clear, it is self- given environment”8 my work—defining the dichotomies,
evident that a true or ideal hierarchy—made up of demo- continua, and evolution of human behavior—reinforces the
cratically minded supervisors—is what protects and harnesses interpretation of evolutionary theory by Kampourakis and
the evolutionary advantage of cooperation, avoiding the Offer that humans can use a variety of belief–behavior systems
creation of disenfranchised subordinates and preventing the (phenotypes and adaptations) to survive and improve their
dysfunction or corruption from autocratic–manipulative– quality of life based on their environment (place in the
exploitive belief–behavior systems. hierarchy and type of hierarchy). Einstein noted, “A theory
is the more impressive the greater the simplicity of it
EVOLUTIONARY LEGACY: GENES OR KNOWLEDGE? premises, the more different kinds of things it relates and
Some evolutionary biologists interpret Darwin’s and the more extended its area of applicability,” 29 which
Spencer’s theories of evolution as processes that describe the describes my belief–behavior systems archetype accu-
evolution of the mind, rather than the reproduction of rately. e next step is to use this archetype to refine our
genes. Kostas Kampourakis (Biology Faculty at the Uni- educational, business, political, and social hierarchies to
versity of Geneva, and editor of a book series on science) become true democracies, not only to improve their
and colleagues discuss Darwin’s theory of natural selection function, but to improve the health and well-being of
as a “creative process” that favors the accumulation of those who live and work within those hierarchies—in
adaptations.26 John Offer, Professor of Social eory and essence, to restore and rebuild our humanity.
Policy at the Institute for Research in Social Sciences and
School of Criminology, Politics, and Social Policy at the Disclosure Statement
University of Ulster, UK, describes Spencer’s theory of e author has no conflicts of interest to disclose.
evolution of individual life and social life as a process of
individual adaptations to one’s environment such that one Authors’ Contributions
can pass on their acquired characteristics27 to others. One e author conceived and designed the analysis, col-
does not “acquire” genes during one’s lifetime, but one does lected and analyzed the data, copyrighted the belief–behavior
acquire knowledge, insight, and experience, which we do systems archetype, and wrote the manuscript.
pass on to others—our children, subordinates, peers, and
leaders—to improve our social survival and quality of life. Funding
We can think of our evolutionary legacy in our role as e author did not receive any funding. v
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