Etiology of Belief–behavior Systems and Hierarchies


Mihal Emberton, MD, MPH, MS1

Perm J 2021;25:20.269
E-pub: 03/03/2021

Editor’s note: Please also see: Learning in Humans versus Hierarchies and Unconscious Bias Is a Human Condition


Introduction: In order to understand the well documented patterns of mental health, human learning, human behavior, and the mechanics of hierarchies such as academic institutions, political systems, and business organizations, one must discover the rules and pathways that cause those patterns. My Belief-Behavior Systems archetype is the first of its kind to reconcile the theories and insights from social sciences, political science, psychiatry, and evolutionary biology into a unifying paradigm which explains how socialization and human interactions evolved into the patterns we recognize today. More importantly is that this new contribution to our understanding of human behavior within hierarchies provides the key insights to guide the restoration and repair of our dysfunctional hierarchies which, unfortunately, all too often oppress, manipulate and exploit our humanity.


This manuscript is the third in a 3-part series that began with “Learning in Humans Versus Hierarchies,” followed by “Unconscious Bias Is a Human Condition, published in The Permanente Journal.”


It is generally understood that, once born, the first goal of life is survival. To survive, individuals must secure sustenance (food and water), protection from the elements (shelter and clothing), and safety (protection from threats to life). And to solve the problem of survival, individuals must allocate their resources for learning, time, assets, labor, and knowledge in such a way as to solve the problem of survival.

Societies form to combine the resources of time, assets, labor, and knowledge to secure survival more easily.1-3 The combination of these resources leads to a reorganization of those resources, also known as division of labor, which allows for the development of expertise to solve focused social survival problems more effectively. With the division of labor also comes the development of hierarchies, creating supervisors to solve the new problems created by the combination of resources and the division of labor.

An ideal or true hierarchy forms when the people doing the work (laborers or subordinates) select a supervisor to oversee the division of labor and allocation of resources. Evolutionary biologists call this process prestige strategy and note that the selection of an individual to act as the supervisor results from admiration and voluntary deference.4 More specifically, the group tends to elevate a person to a position of power who maintains a democratic belief–behavior system that allows for enhanced problem solving and values each person’s intellectual currency as a resource for learning. This also describes a true democracy and social justice.5

Although many evolutionary biologists believe the second goal of life is to pass on one’s genes through reproduction, also known as highest fitness,6 there have been well-recognized limitations to this theory. Martin Nowak, PhD, Professor of Mathematics and Biology at Harvard University and Director of the Program for Evolutionary Dynamics, recognized that the evolutionary theory of survival for the purpose of reproduction cannot be explained by the evolution of social cooperation because cooperation often leads to decreased reproductive fitness.7 In addition, Hudson Kern Reeve, Professor of Neurobiology and Behavior at Cornell University, and Paul Sherman, PhD, Professor Emeritus of Neurobiology and Behavior at Cornell University, also recognized the incomplete nature of the theory of survival in order to reproduce because this theory conflicts with behaviors such as “recreational sex, incest avoidance, cigarette and alcohol use, adoption, and abortion.”8

Although some scientists might argue that behaviors such as cooperation or recreational sex are merely outliers, my framework for belief–behavior systems,5 on the other hand, addresses these known limitations of the theory that we survive in order to pass on our genes, by providing inclusive understanding about the evolutionary benefit of cooperation, recreational sex, adoption, and abortion as behaviors that improve individual survival and quality of life (physical comfort, intellectual growth, and emotional fulfillment). The same resources used to solve the problem of survival—time, assets, labor, and knowledge—are also needed and used to secure quality of life. And hierarchies also have the capacity to help us improve our quality of life in addition to improving survival.

In summary, the evolution of cooperation improves survival by better solving the problems of securing sustenance, acquiring protection from the elements and safety, as well as improving quality of life by improving physical comforts, emotional fulfillment, and intellectual development. Therefore, there is an evolutionary benefit for cooperation, the development of hierarchies, and thus development of belief–behavior systems to navigate cooperation and hierarchies.


Although there are benefits of forming a hierarchy, such as improved ability to solve survival and quality-of-life problems, the creation of a hierarchy at the same time creates a power differential in relation to the allocation and control of the resources for learning. In a hierarchy, the supervisor generally gains control over the collective resources of time, assets, and labor to solve both the focused social survival/quality-of-life problems as well as the problems created by the division of labor (hierarchy), whereas the subordinates only generally retain control over their own knowledge and expertise.5

When the supervisors in a hierarchy are functioning in their democratic belief–behavior systems, they not only value the knowledge and expertise of subordinates as intellectual currency to solve organizational problems, but also they allocate the resources for learning in such a way as to drive organizational innovation and growth. However, the creation of a hierarchy, a power differential, also comes with a very fundamental flaw: it incubates the unconscious bias, the knowledge or experience gap, of the supervisor.9 When supervisors toggle into their autocratic belief–behavior system, they unconsciously overlook the fact that the subordinates’ knowledge, insights, and experience are a resource for learning, the intellectual currency needed to solve organizational problems, and thus misallocate resources to drive conformity and status quo. The moment supervisors unconsciously believe they have nothing to learn from their subordinates is the moment they close themselves off to discovery.5

Even though an autocratic supervisor’s intention is to protect the common good of the hierarchy, he or she behaves in such a way as to protect the hierarchy at the expense of subordinate engagement in problem solving, suppressing subordinates’ intellect. When an idea challenges autocratic supervisors’ unconscious knowledge gap, they feel vulnerable and threated by the new idea, attack and blame subordinates for making them feel bad, and engage in coercive interactions.5 This then forces subordinates to respond in 1 of 2 ways (Figure 1).

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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

If subordinates want to protect their place in the hierarchy for individual survival/quality of life, they will use a disengagement belief–behavior system, aligning with autocratic supervisors to make the autocratic supervisors feel good about their knowledge or experience gaps, while acknowledging this will also maintain the organizational status quo. The other alternative is for subordinates to use a resistance belief–behavior system, challenging supervisors on their knowledge or performance gap in an attempt to drive learning for the benefit of the hierarchy, and thus benefitting the subordinates who rely on the hierarchy. The resistance strategy, however, is risky, because often autocratic supervisors view confrontation as insurgency and put more energy into coercing subordinates to submit to their imperfect solution.10


When subordinates suffer coercion and conformity from autocratic supervisors, the subordinates, justifiably, feel oppressed and replaceable,5 and show signs of depression and anxiety. The fact that 7.1% of adults—17.3 million people—in the US reported symptoms of severe depression in 2017,11 and 19.1% of adults—an estimated 46.5 million people—reported symptoms of anxiety,12 does not mean that 1 in 4 US adults has dysfunctional brain chemistry, but rather that the hierarchies in which we work and live are often themselves dysfunctional. The World Health Organization emphasizes this fact in their recognition and definition of “burnout” as an occupational phenomenon.13 In addition, our understanding about adverse childhood experiences14 and trauma-informed care15 highlight our burgeoning realization that dysfunctional hierarchies have a negative effect on subordinates.

A very public incidence of the negative effects of an autocratic hierarchy occurred earlier this year when US Navy Captain Brett Crozier was forced to engage his resistance belief–behavior system to highlight the autocracy, the knowledge gap of his hierarchy, to save his crew from a coronavirus outbreak on his ship.16 If Captain Crozier’s supervisor truly valued Crozier’s knowledge, insights, and experience, the supervisor would have used Crozier’s intellectual currency to help solve the problem of the coronavirus outbreak on the ship. Instead, Crozier had to work outside the chain of command to challenge his hierarchy to validate and act upon his insights. And as a result, the autocratic hierarchy felt vulnerable and threatened; it attacked and blamed Crozier as an insurgent, and engaged in coercive behaviors to end Crozier’s career.17 Alternatively, Crozier could have chosen to safeguard his career by using his disengagement belief–behavior system, letting his hierarchy keep its knowledge gap regarding the severity of the coronavirus outbreak on his ship and maintaining the organizational status quo, but this would have placed the health and safety of his crew at risk for the benefit of his individual survival in the hierarchy.

Autocratic dysfunction is not only observed in the military, but also it is observed in our other hierarchies. Historically, as many American businesses began to procure profits at the expense of subordinates, a national movement to advocate for and protect America’s subordinate workers from the antisocial behaviors of their hierarchies began with the establishment of the American Federation of Labor in 1886,18 followed by the establishment of the US Department of Labor in 1913,19 and continued with the enactment of additional policies to protect the survival and quality of life of subordinate workers.20 These movements and policies, however, have not been enough to correct the autocratic dysfunction of many of our hierarchies. The current Teachers’ Union contract in San Francisco, for example, highlights that the knowledge, insights, and experiences of teachers must not be interpreted as insurgency and must rather be valued and protected, when it states the following:

“The District and the Union agree that academic freedom [the right and responsibility to study, investigate, present, interpret, and discuss all the relevant facts and ideas in the field of his or her professional competence] is essential to the fulfillment of the purposes of the San Francisco Unified School District, and they acknowledge that fundamental need to protect teachers from unreasonable censorship or restraint which might interfere with their obligation to pursue truth in the performance of their jobs with the District.”21

In addition to oppressing subordinates and driving organizational conformity and status quo, autocratic supervisors tend to promote further autocracy within a hierarchy. When supervisors are in their autocratic mind-set, subordinates who make them feel good about their knowledge gaps are subordinates who use their disengagement belief–behavior systems, and thus those subordinates are more likely to be promoted than subordinates who try to drive change through their resistance belief–behavior system. Subordinates who use their disengagement belief–behavior systems to survive within the hierarchy do not gain much experience in how to facilitate or participate in learning processes, so that when they are promoted to supervisor, they often do not have the understanding or skills to toggle into their democratic belief–behavior system. Without the knowledge, experience, and skills for facilitating learning processes, disengaged subordinates-turned-supervisors tend to mirror the autocracy that got them promoted in the first place, creating a hierarchy of autocratically minded supervisors. Unfortunately, autocracy breeds autocracy.


Autocracy, the fundamental flaw of hierarchies, is also what makes hierarchies vulnerable to additional dysfunction. Once a hierarchy toggles into autocracy, it harbors a culture of suffocation and status quo for the subordinates, which impacts subordinates’ survival and quality of life negatively, creating subordinate disenfranchisement. Once a hierarchy has created a significant level of disenfranchisement, it becomes susceptible to manipulative–exploitive belief–behavior systems (Figure 2).

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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

When a disengagement belief–behavior system (collaborative interactions with conformity process) is no longer used to survive supervisors’ autocratic belief–behavior system, but rather is used to harness the power from the disenfranchised for individual survival/quality of life at the expense of the hierarchy, it becomes a manipulative belief–behavior system that describes, for example, cults and fascism. A demagogue, recognizing when an autocratic political system has created disenfranchised constituents, aligns with the disenfranchised around that truth, telling them that if they give the demagogue power, the demagogue will right the policy wrongs that oppress them. UK Conservative Party Advisor Dominic Cumming’s “Take back control” slogan around the UK’s 2016 Brexit referendum,22 and Donald Trump’s “Drain the swamp,23” are classic and recent examples of this pattern of alignment. The demagogue, however, cannot right the policy wrongs, because it was the existence of the disenfranchised in the first place that allowed the demagogue to gain power, and thus the demagogue must maintain the status quo to maintain disenfranchisement to maintain his or her power.

This is also where the development of false hierarchies and manipulative collaboration comes into play. In order for the demagogue to try to relieve the sense of oppression that the disenfranchised are experiencing, the demagogue invents a false hierarchy, telling the disenfranchised that it is okay for them to oppress another group because this “other group” is truly at the bottom of the social hierarchy and is the reason for their disenfranchisement (eg, sexism, racism, agism, xenophobia, etc) in the first place.

Such a demagogue, who harnesses the power of the disenfranchised for individual gain at the expense of the hierarchy, may also toggle toward the resistance belief–behavior side of the axis—coercive interactions to drive a learning process—that becomes an exploitive belief–behavior system when it is used to gain resources and power at the expense of the disenfranchised, and, thus, at the sociopolitical level, describes slavery, imprisonment, and war.

Although the Diagnostic and Statistical Manual of Mental Disorders is an extensive collection of the patterns of mental health signs and symptoms,24 it is far from describing the causes for those patterns. The Diagnostic and Statistical Manual of Mental Disorders, for example, describes the patterns of personality disorders such as histrionic, antisocial, narcissistic, and borderline as maladaptive, creating social disfunction,25 without explaining that it is the drive for individual survival and improved quality of life at the physical or intellectual expense of others, at the expense of the disenfranchised and the hierarchy, that creates the pathological social dysfunction.

Although the development of belief–behavior systems evolved to help us collaborate around improved survival and quality of life, these same belief–behavior systems can also become a social liability. When the behaviors for individual survival and quality of life are used at the expense of others’ survival and quality of life, those belief–behavior systems become pathological or antisocial. Now that the rules and pathways for belief–behavior systems are clear, it is self-evident that a true or ideal hierarchy—made up of democratically minded supervisors—is what protects and harnesses the evolutionary advantage of cooperation, avoiding the creation of disenfranchised subordinates and preventing the dysfunction or corruption from autocratic–manipulative–exploitive belief–behavior systems.


Some evolutionary biologists interpret Darwin’s and Spencer’s theories of evolution as processes that describe the evolution of the mind, rather than the reproduction of genes. Kostas Kampourakis (Biology Faculty at the University of Geneva, and editor of a book series on science) and colleagues discuss Darwin’s theory of natural selection as a “creative process” that favors the accumulation of adaptations.26 John Offer, Professor of Social Theory and Policy at the Institute for Research in Social Sciences and School of Criminology, Politics, and Social Policy at the University of Ulster, UK, describes Spencer’s theory of evolution of individual life and social life as a process of individual adaptations to one’s environment such that one can pass on their acquired characteristics27 to others. One does not “acquire” genes during one’s lifetime, but one does acquire knowledge, insight, and experience, which we do pass on to others—our children, subordinates, peers, and leaders—to improve our social survival and quality of life.

We can think of our evolutionary legacy in our role as parents. As a parent, what is the one thing that you hope or wish for your child or children? Do you wish they can have as many children as possible, starting as early as possible, to pass on their genes in a robust fashion, understanding that this strategy may decrease their individual survival28 and leave them fewer resources to improve their individual quality of life? Or, do you wish for them to be effective thinkers and problem solvers so they can improve their individual survival and quality of life? The idea that we survive to improve our quality of life (physical comforts, emotional fulfillment, and intellectual development) also explains why we can and often do invest in raising children who are not our genetic offspring, because nurturing the development of children often provides emotional fulfillment and intellectual growth to the parent as well. And aren’t we generally content if our children do not have children of their own if that is the quality of life they want and choose? In addition, abortion and recreational sex, for example, also generally improve survival and quality of life and are thus evolutionary adaptations, rather than outliers to the theory that our goal in life is to reproduce our genes.

Although evolutionary biologists Reeve and Sherman try to redefine adaptation as “a phenotypic variant that results in the highest fitness among a specified set of variants in a given environment”8 my work—defining the dichotomies, continua, and evolution of human behavior—reinforces the interpretation of evolutionary theory by Kampourakis and Offer that humans can use a variety of belief–behavior systems (phenotypes and adaptations) to survive and improve their quality of life based on their environment (place in the hierarchy and type of hierarchy). Einstein noted, “A theory is the more impressive the greater the simplicity of it premises, the more different kinds of things it relates and the more extended its area of applicability,”29 which describes my belief–behavior systems archetype accurately. The next step is to use this archetype to refine our educational, business, political, and social hierarchies to become true democracies, not only to improve their function, but to improve the health and well-being of those who live and work within those hierarchies—in essence, to restore and rebuild our humanity.

Disclosure Statement

The author(s) have no conflicts of interest to disclose.


Kathleen Louden, ELS, of Louden Health Communications performed a primary copy edit.

Author Affiliations

1Department of Adult and Family Medicine, The Permanente Medical Group, Oakland, CA

Corresponding Author

Mihal Emberton, MD, MPH, MS (

Author Contributions

The author conceived and designed the analysis, collected and analyzed the data, copyrighted the belief–behavior systems archetype, and wrote the manuscript.


The author did not receive any funding.


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Keywords: burnout, engagement, learning process, organizational culture change, overcoming unconscious bias, successful leadership, teaching collaboration


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