It was in one of those rare unstructured times during my vacation last summer that I stumbled upon Obliquity. My family is, by now, used to me hunting down the bookstores in any new place we travel and getting lost among the shelves. Sadly, Borders is going out of business as I write, and many people now have Kindles, Nooks, iPads, iPhones, and iBrains (1). I still love the smell of newly printed books and the feeling of turning real pages with my real hands. A librarian tried to convince me, backed by scientific evidence, that the smell of decomposing cellulose in aged papers is what makes us addicted to printed materials because it is reminiscent of breast milk (2). I am not sure if I was enacting pre-Oedipal strivings, but when I saw this book sitting in the window by Gladwell's Outliers, I felt tempted to go into the store and get to know it. Obliquity is one of the most influential books I have read so far, one that I will keep giving as a gift to friends and colleagues.

John Kay is an economist and visiting professor at the London School of Economics and a fellow at St. John's College of Oxford University. He is also the research director of the Institute for Fiscal Studies and a regular contributor to the Financial Times. This book was structured upon an essay that first appeared in the Financial Times in 2004. It is well written, enjoyable, and most of all, thought-provoking. Kay's thesis is that the best things in life are achieved in an oblique way. The happiest people are not the ones who explicitly seek happiness, the most profitable companies are not those that prioritize the bottom line, and the wealthiest people are not the misers but individuals who dedicate their lives to a larger purpose and serve those around them. Of course, this conceptual framework will appeal to many psychiatrists because we are champions at serving others while delaying our own gratification. So perhaps Kay is onto something here; after all, very few of us chose medicine as a way to keep ourselves happy but knew instinctively that it would prove to be a very rewarding, enriching path.

Kay gives examples of pharmaceutical companies that, by investing in research teams, developed successful medication after medication, dominating the market and making huge profits. On the other hand, companies whose vision was “creating value for customers and shareholders through market leadership, technological edge, and a world competitive cost base” ceased to exist a decade later (p. 26). Boeing became the most commercially successful aircraft company under the leadership of a chief executive whose motto was to “eat, breathe, and sleep the world of aeronautics” but lost its unique position when the corporate culture shifted toward profit (p. 27). The heartbreaking story of a rich heiress who unsuccessfully sought assistance from a charity hospital for her son's knee infection highlights the same point. The infection spread, and the son's leg had to be amputated (p. 39). For all I know, today's pharmaceutical and health insurance companies could learn something from these lessons. The emphasis on cost savings—taking precedence over the concern for patients' needs—is revolting. Every January, I cringe when I see the insurance formulary changes, which are becoming more and more restrictive. Somehow the meaning of health care seems to have changed from caring for patients to nursing the bottom line.

With vignettes from business, politics, sports, art, and science, this book teaches us a great deal about progress in human societies while also being an entertaining read. The author makes the distinction (p. 48) between high-level objectives (accomplishments, such as self-fulfillment, contributing to society, or the creation of a fine business), intermediate goals (described by achievements, for example, wealth or a comfortable home), and basic actions (associated with momentary feelings, such as pleasure or reward). He compares the direct and oblique approaches to decisions and problem solving with regard to objectives and goals, interpersonal interactions, complexity level, and tolerance of uncertainty (p. 74). The oblique approach involves multidimensional high-level objectives. The path to accomplishing these objectives is not easily predictable, and it may need to be mapped in the process (i.e., the means help us discover the end). Some ambiguity has to be tolerated, and interpersonal interactions are nuanced and meaningful.

Oblique approaches help us learn and adapt to an ever-changing landscape. Even though we do not always know where we will be in 5 or 10 years, as long as we do not cut moral corners and remain true to our values, the high-level objectives will be fulfilled.

According to Kay, obliquity “is the best approach whenever complex systems evolve in an uncertain environment and whenever the effect of our actions depends on the ways in which others respond to them” (p. 195); this sounds just like the world we live in. I highly and unobliquely recommend this book.