Not all here

Question: What’s the biggest health problem in the country today?

Answer: It’s not what you think.

It’s not obesity, diabetes, heart disease, low back pain or cancer.

If you're thinking depression, you’re getting warm, but that’s still not quite on the mark.

My claim will surprise you, because it’s not biomedical in the conventional sense. It’s almost impossible to measure or track, but it’s very real and has profound consequences across the spectrum of human performance, health and experience.

In fact, the greatest health problem in the country today is presenteeism, the lack of engagement with physicality, life and the body. Allow me to explain…

Presenteeism is a term taken from workplace studies, a variation on the word absenteeism. Presenteeism refers to the condition in which people bring their bodies to the workplace, but leave their attention at home. They’re present, but they’re not really participating in a substantive way. It’s estimated that presenteeism costs American business billions of dollars annually and is even more costly than absenteeism.

Presenteeism in the workplace is bad enough, but there’s another sense of presenteeism that people bring, not just to work, but to their bodies. That is, many of us are markedly disengaged from our physicality; we live in our bodies as passive spectators. We use our bodies as locomotor devices to get from place to place, to fulfill obligations or to sample shallow pleasures, but rarely do we participate fully in the act of being totally physically alive.

Physical presenteeism has now become a genuine epidemic with vast numbers of people who never engage their bodies in any consistent or substantive way. They have vital signs, but are only half alive. They live passively in their bodies, like ghosts.


Full participation and engagement with the physical body has been the historical norm for the vast majority of human history, but modernity has weakened our engagement with ourselves. The process began with technological innovations that made physicality increasingly optional. When motors and engines do all our work for us, there’s no compelling reason to get our bodies involved and people begin to withdraw from their physicality.

Increasing medicalization of human life has also contributed to our non-participation.  The invention of antibiotics, technical and pharmaceutical medicine and a highly trained class of body experts leaves the average person out of the loop. When it comes to matters of the body, many of us are now content to leave it to others. Our bodies, it seems, are just not a part of our job description.

Finally, much of our physical presenteeism stems from our experience and relationship with TV and other passive media. The medium promotes disengagement: All you have to do is show up and press a button; no participation or risk is required. As millions of disengaged people spend billions of hours absorbing media, we create a spectator culture. We sit back and become weak, passive spectators of our own bodies.

a disease in itself

It’s almost certainly the case that physical presenteeism leads to biomedical afflictions such as obesity, diabetes, heart disease, low back pain, fibromyalgia and other disorders. After all, when we withdraw our attention and engagement from our physicality, we also take away a powerful source of vitality and energy; in turn, our bodies become more vulnerable to the challenges of the world. Presenteeism also leads to a loss of meaning, a vulnerability to depression and a general weakening of the organism as a whole. It seems probable that a huge percentage of our modern "lifestyle diseases" are either caused or exacerbated by our failure to engage in a meaningful physical relationship with our bodies.

But while the link between presenteeism and disease is almost certainly real, this fact misses the deeper point. That is, quite apart from the health consequences, physical presenteeism is a disease in and of itself, a state of diminished vitality and life. How else would you describe a condition that somehow leads a person to give away a substantial proportion of his or her most precious life experience? Call it an existential disease if you must, but the fact remains: physical presenteeism is not a minor side-effect of the modern human experience. It is a major, debilitating disease that wrecks millions of lives every year.

Ironically, the fitness industry itself promotes this epidemic of physical disengagement by bowing down to the prevailing cultural narrtative that “exercise is boring.” To remedy this presumption, they set up treadmills and other cardio equipment with wide-screen TVs. In this environment, customers can mount the machine, turn off their attention and go unconscious until the buzzer goes off. This is nothing less than a prescription for physical disengagement. Even worse, the whole thing turns out to be a net negative for the exerciser. Any gains made in cardiovascular fitness are offset by the deepening habit of disengagement that people build up in front of the TV. As Jim Loehr put it in his bestselling The Power of Story,

“There’s a staggering amount of waste created every day in gyms across America as seemingly dedicated patrons run on treadmills or climb StairMasters while watching CNBC or ESPN or listening to their iPods, not at all connecting with the physical activity they’re supposedly engaged in.”

Every time a big box gym installs another treadmill with a TV, the fitness industry advances a disengaged lifestyle and a dysfunctional relationship with the body. In this sense, we are definitely part of the problem.

air guitar heroes

At the outset, this distinction between presenteeism and full engagement may seem subtle, but over time it becones immense. Neuroscientist John Medina, author of Brain Rules, makes this point crystal clear when he says “the difference between just showing up and full engagement is the difference between air guitar and actually learning to play the guitar.” You can play air guitar all you want, but it will never make you a musician. For that, you have to engage, sweat, participate and take personal risk, over and over again, for thousands of hours. Merely holding the guitar in your hands will get you nowhere. The analogy is clear: By failing to engage our bodies with depth, substance and authentic participation, we are now creating vast populations of physical air guitarists. It’s no wonder our health is failing.

Woody Allen was wrong

Woody Allen once declared that “Eighty percent of success is showing up.” Coaches and commentators often bring out this quote when they try to motivate people to get past the sticking point of total apathy, hoping to inspire them to get off the couch and actually do something. Obviously, showing up is better than not being there at all, but fundamentally, Woody Allen was completely off the mark. In fact, simply showing up doesn’t get us anywhere near 80% of the way to success. Just showing up for conditioning class or dance, music, job training or any other discipline doesn’t even get us close to learning or high performance. No, we have to get our bodies, our attention and our lives intimately involved in the process. Being present is obviously necessary, but it’s not even close to being sufficient. To revise Allen’s estimate, we might say “Twenty percent of success is showing up. The rest depends on full participation and engagement.”

See also "The Power of Full Engagement" by Jim Loehr and Tony Schwartz