The elderly patient presented with difficulty walking. The patient was referred to an orthopedic surgeon, who traced the problem to osteoarthritis in the patient’s hips, knees, and feet. An otolaryngologist saw the patient and diagnosed a malfunction of the inner ear, the organ of balance. A consultant neurologist determined that the patient was suffering from peripheral neuropathy. The situation evoked the ancient allegory of the blind men and the elephant. One reaches out and feels the trunk, concluding it is a vine; another the tusk, determining that it must be a sword; and still another the leg, pronouncing it a tree. Who among us—both the poor patient and elephant might ask—apprehends the big picture, and therefore stands a chance of understanding the whole organism? The profession of medicine is full of such stories.

The difficulty can be attributed only partly to a narrowness of perspective. To be sure, each specialist approaches the patient with blinders on, with the gaze confined to a particular part. The ophthalmologist sees only the eyes, the pulmonologist the lungs, and the urologist the kidneys and bladder. But beneath this characteristic divvying up of the body among specialties is a deeper difficulty—the universal impulse to analyze. From the Latin meaning literally “to cut up,” analysis breaks the complex down into the simpler and the whole organism into component organ systems, organs, tissues, cells, cellular organelles, and so on. In an effort to understand in the greatest possible depth, we end up practicing a form of reductionism, producing an understanding that is a mile deep but only an inch wide. It evokes a passage from Solzhenitsyn’s “The Cancer Ward.”

  • The patient’s organism isn’t aware that our knowledge is divided into separate branches. You see, the organism isn’t divided. As Voltaire said, “Doctors prescribe medicines about which they know little for an organism about which they know even less.” How can we understand the patient as a single subject? After all, the anatomist who draws the charts operates on corpses; the living aren’t his province, are they? A radiologist makes a name for himself on bone fractures; the gastrointestinal tract is outside his field, isn’t it? The patient gets tossed from ‘specialist’ to ‘specialist’ like a basketball. That’s why a doctor can remain a passionate beekeeper, all through his career. If you wanted to understand the patient as a single subject, there’d be no room left in you for any other passion. That’s the way it is. The doctor should be a single subject as well. The doctor ought to be an all-rounder.”

Underlying specialization is a foundational idea, often associated with Adam Smith—the division of labor. Of course, this is a very old notion. The ancient Greeks Plato and Xenophon both refer to it. Plato’s Republic, we are told, will require numerous specialists—such as farmers, builders, and weavers—and Xenophon’s “Education of Cyrus” suggests that large cities will outperform small ones, because they permit people to focus on a single trade, such as making shoes, rather than attempting to perform all of the necessary trades for themselves. In the years leading up to Smith, Bernard de Mandeville says much the same in his Fable of the Bees, describing how specialization improves the quality of goods available to all, and in his Treatise on Human Nature, Smith’s friend David Hume extols the virtues of the “partition of employment,” whereby a single ability is brought to its highest expression.

Even Smith’s famous example of the pin-maker is not entirely novel. In 1761, Henri-Louis Duhamel du Monceau published his The Art of the Pin-Maker, in which he traces the surprisingly low price of pins to the great increase in productivity made possible by assigning the various stages in pin production to different specialists. Yet fifteen years later in The Wealth of Nations, Smith picks up the division of labor and the example of the pin factory and develops them beyond any of his predecessors, asking each of his readers to imagine how many pins he or she might be able to craft in a day. The most likely answer, he says, is none, or perhaps one. But by analyzing the process of pin production into its component steps and then assigning a different worker to focus solely on each, the daily productivity of each worker can be magnified by a factor of 4,800:

  • One man draws out the wire; another straights it; a third cuts it; a fourth points it; a fifth grinds it at the top for receiving the head; to make the head requires two or three distinct operations; to put it on is a peculiar business; to whiten the pins is another; it is even a trade by itself to put them into the paper; and the important business of making a pin is, in this manner, divided into about eighteen distinct operations, which, in some manufactories, are all performed by distinct hands, though in others the same man will sometimes perform two or three of them…. Those ten persons, therefore, could make among them upwards of forty-eight thousand pins in a day. Each person, therefore, making a tenth part of forty-eight thousand pins, might be considered as making four thousand eight hundred pins in a day. But if they had all wrought separately and independently, and without any of them having been educated to this peculiar business, they certainly could not each of them have made twenty, perhaps not one pin in a day; that is, certainly, not the two hundred and fortieth, perhaps not the four thousand eight hundredth, part of what they are at present capable of performing, in consequence of a proper division and combination of their different operations.1

With such dramatic increases in productivity in view, it is easy to see why Smith calls the division of labor “the greatest improvement in the productive powers of labor, and the greatest part of skill, dexterity, and judgment with which it is anywhere directed, or applied.” And such specialization pays dividends far beyond mere increases in productivity and lower per-unit costs. If a musician had to play all the instruments in an orchestra, the time necessary to become proficient with each would be dramatically expanded, but by focusing on only one, the period of study is considerably shortened. Moreover, some musicians may be better suited to certain instruments than others, enabling them to concentrate on those to which they are best adapted. This also enhances the prospects for innovation, since those who know their instrument well can draw on a superior repertoire of technique in experimenting with it.

Yet there are important downsides to the division of labor, which can redound to the detriment not only of those on whom workers labor, such as patients, but also workers themselves. Imagine the worker who does nothing but install the passenger-side rear hubcap on an automobile for eight hours per day; or a medical specialist such as an ophthalmologist who does nothing all day but make an incision to remove the clouded lenses of cataract patients; or an academic whose sole classroom responsibility is to deliver a lecture on Marx’s theory of the estrangement of labor. Such individuals might soon become bored with their work, gradually losing interest and engagement and over time sliding into burnout. Called upon to perform the same repetitive task day after day, year after year, they begin to feel more like machines than human beings.

Smith recognizes this problem and the toll it can take on the laborer. The division of labor may function very well when it comes to increasing efficiency, productivity, and quality, but its effect on the worker can be highly deleterious:

  • The man whose whole life is spent in performing a few simple operations, of which the effects are perhaps always the same, or very nearly the same, has no occasion to exert his understanding or to exercise his invention in finding out expedients for removing difficulties which never occur. He naturally loses, therefore, the habit of such exertion, and generally becomes as stupid and ignorant as it is possible for a human creature to become. The torpor of his mind renders him not only incapable of relishing or bearing a part in any rational conversation, but of conceiving any generous, noble, or tender sentiment, and consequently of forming any just judgment concerning many even of the ordinary duties of private life.

In Smith’s account, workers may not only lose interest but also lose themselves in their work. Because they are called upon to do little more than mindlessly repeat the same few motions over and over again, they become mindless. As their task becomes ever more deeply engrained in muscle memory, they no longer need to think, becoming “stupid” and “ignorant.” A “torpor” of the mind sets in, whereby discussion, virtues of character, and the faculty of discernment wither away all but completely. Over time, such workers tend to become what they are treated as: automata. Their employer, or the system at large—prizing efficiency and profit over humanity—treats them as something less than they are and thereby turns them into something less than they are meant to be.

Similar concerns, applied to the welfare of a democratic society, can be found in Tocqueville’s Democracy in America.2 Considering the plight of the pin maker, Tocqueville muses on the prospects for democratic self-government of a people composed of such specialists. Simply put, people who do nothing but put heads on pins all day are liable to become pinheads themselves.

  • When a workman is unceasingly and exclusively engaged in the fabrication of one thing, he ultimately does his work with singular dexterity; but at the same time he loses the general faculty of applying his mind to the direction of the work. He every day becomes more adroit and less industrious; so that it may be said of him that in proportion as the workman improves, the man is degraded. What can be expected of a man who has spent twenty years of his life in making heads for pins? And to what can that mighty human intelligence which has so often stirred the world be applied in him except it be to investigate the best method of making pins’ heads? When a workman has spent a considerable portion of his existence in this manner, his thoughts are forever set upon the object of his daily toil; his body has contracted certain fixed habits, which it can never shake off; in a word, he no longer belongs to himself, but to the calling that he has chosen.

Again, workers become machines, adapted to nothing but the specialized task to which they devote themselves for half their waking hours or more at work. He does not determine how to perform his motions. He does not pay attention to what the other workers on the assembly line are doing. He may not even understand the finished product, at least not in terms of the many steps involved in its construction. From the point of view of those who employ him, he is little more than an economic entity, an interchangeable part in a production process who can be replaced at will. He is but a unit of production from whom his employer naturally aims to extract maximal value. He becomes what Aristotle described as a slave, that is, a human tool—seen, heard, treated, and valued strictly for what he can produce.

How well equipped, Tocqueville asks, will such human tools be for self-government? Will they jealously guard their own liberties? Will they respect the liberties of others? Will they take any interest in or even see their neighbors? Will they recognize what they share in common? Will they feel any sense of responsibility for those they work and live with? From Tocqueville’s point of view, the answer is no, and such a contraction of the human field of vision and sphere of responsibility can only result in a reduction of human beings generally. Such human beings will prove to be poorly fitted for self-government and ripe for the machinations of tyrants. Treated strictly as wage earners and consumers, mere economic entities, they will lack the education and experience necessary to thrive as citizens and neighbors and members of a society of free and responsible individuals.

To avoid the pitfalls of the division of labor and thereby preserve the liberty and responsibility of laborers and the society they make up, several steps are called for. First, we must do what we can to ensure that, as much as possible, people are spared work that dehumanizes. In some cases, this means substituting automation for highly repetitive tasks. While such automation may reduce costs and increase productivity, we should never lose sight of the fact that one of its primary purposes is to avoid dehumanization. To be sure, the capabilities of workers vary, and work that one might regard as menial might be well suited to the capabilities of another. Having work is good in itself, but we should wherever possible ensure that workers are not scorned or derided for their work and that work is never designed in such a way that it inevitably stunts and diminishes the worker.

What might this look like in practice? I think of a member of the housekeeping staff of a hospital whose job description consisted primarily of mopping floors, a position that she had held for approximately three decades. When her supervisors monitored her work, they quickly realized that she spent as much time leaning on her mop as she did pushing it. But her apparent lack of productivity did not stem from sloth or disability. Instead, she spent a good bit of her time talking with and enriching the experiences of others—coworkers, visitors, families, and patients. She brought to her work a sympathetic ear and a kind word for everyone. When she left a room or a hallway, the days of those with whom she came into contact were almost invariably brightened. Technically, she was doing work that many might consider menial, but she was engaged and contributing in ways that far exceeded her job description.

“No matter what kind of work someone does, it should provide opportunities to engage, thrive, and contribute as a human being.”

No matter what kind of work someone does, it should provide opportunities to engage, thrive, and contribute as a human being. In drafting job descriptions, we should ensure that there is room to study, experiment, and improve the work, thereby making it meaningful to the worker and even more important to others. It should also provide opportunities for a sense of achievement—not just that a worker broke the record for the most widgets produced in an hour, but that workers contributed to our understanding of the job and its purpose and how to make it better. Every worker deserves the opportunity to make a difference, and to do so, workers must bear responsibility for their work, including such aspects as when, where, how, by whom, why, and even what gets done. With such trust comes the opportunity for real human growth.

When we design jobs, we should envision them not just for units of labor but for citizens, neighbors, friends, and family members. We don’t merely want a society in which the shelves of big box stores overflow with low-cost, high-quality manufactured goods. We also, and much more deeply, long for a United States in which our fellow Americans are well-prepared and deeply committed to carrying on this great experiment in self-government. When we think of a job description, we need to envision the effect such work will have on the worker, and in particular, the fitness of workers as members of a society of free and responsible individuals. Every job is more than just a job. It is also an opportunity to help another human being develop as a member, a contributor, and perhaps even a leader in a society dedicated to freedom and responsibility.

For more on these topics, see

This gets at a key feature of the work experience to which Smith and Tocqueville each allude—namely, that work should provide an opportunity for human flourishing. It should neither be so easy that no one needs to try nor so difficult that all effort is futile, but sufficiently challenging that workers feel the need to concentrate and invest themselves in it. Professions such as medicine and higher education should not stunt human development but foster it, and not just by cramming more and more facts into heads but by calling forth such human excellences as courage, honesty, compassion, and wisdom. This means engaging not just the worker’s hands and feet or memory and calculation but also the whole creative person. When we divide labor, we risk slicing up and reducing the laborer, but by keeping the whole worker in mind, we can promote work that is both productive and humanly fruitful.


[1] Adam Smith, An Inquiry into the Nature and Causes of the Wealth of Nations, 1776. Library of Economics and Liberty.

[2] Alexis de Tocqueville, Democracy in America, 1840. Online Library of Liberty.

*Richard Gunderman is Chancellor’s Professor of Radiology, Pediatrics, Medical Education, Philosophy, Liberal Arts, Philanthropy, and Medical Humanities and Health Studies at Indiana University. He is also John A Campbell Professor of Radiology and in 2019-21 serves as Bicentennial Professor. He received his AB Summa Cum Laude from Wabash College; MD and PhD (Committee on Social Thought) with honors from the University of Chicago; and MPH from Indiana University.