Although the conception of ikigai into the four pillars is easy to digest, it may be myopic at times. It may constrain ikigai to external validation from others or societal/cultural norms. Per pillars of vocation or profession, Satonofuji was not very good by sumo wrestling standards (i.e., wins, division rank), but he derived ikigai in sumo by the yumitori-shiki. Again, ikigai can only be defined by our own selves and is inherent within. No one can tell you what is “worthwhile” and, thus, if your ikigai doesn’t “fit” into a pillar, that’s perfectly fine. Instead, we should simply recognize, support, and celebrate others’ ikigai, regardless of whether it aligns with others’ or our own. Those that know of Satonofuji’s ikigai come to the tournament, sitting patiently after the matches conclude, to watch the yumitori-shiki. They may not recognize the intricacies of the tradition, but they recognize an individual who has found meaning. They celebrate his sense of ikigai.

Dr. Koo is faculty and an emergency physician at MedStar Washington Hospital Center in Washington, D.C., and St. Mary’s Hospital in Leonardtown, Maryland.

References

1. Nyanchama V. How much do sumo wrestlers make per professional fight? Tuko. Published June 13, 2024. Accessed January 7, 2025.
2. Mogi K. Awakening Your Ikigai: How the Japanese wake up to joy and purpose every day. The Experiment; 2018.
3. García H, Miralles F. Ikigai: The Japanese Secret to a Long and Happy Life. New York, Penguin Books; 2017.
4. Okuzono S, Shiba K, Kim E, et al. Ikigai and subsequent health and wellbeing among Japanese older adults: longitudinal outcome-wide analysis. Lancet Reg Health West Pac. 2022;21:100391.
5. Miyazaki J, Shirai K, Kimura T, et al. Purpose in life (Ikigai) and employment status in relation to cardiovascular mortality: the Japan Collaborative Cohort Study. BMJ Open. 2022;12(10):e059725.
6. Cohen R, Bavishi C, Rozanski A. Purpose in life and its relationship to all-cause mortality and cardiovascular events: a meta-analysis. Psychosom Med. 2016;78(2):122–133.
7. Tang M, Wang D, Guerrien A. A systematic review and meta-analysis on basic psychological need satisfaction, motivation, and well-being in later life: contributions of self-determination theory. Psych J. 2020;9(1):5–33.
8. Hodkinson A, Zhou A, Johnson J, et al. Associations of physician burnout with career engagement and quality of patient care: systematic review and meta-analysis. BMJ. 2022;378:e070442.
9. Sakamoto JT, Lee J, Lu DW, et al. Factors driving burnout and professional fulfillment among emergency medicine residents: A national wellness survey by the Society for Academic Emergency Medicine. AEM Educ Train. 20226(Suppl 1):S5-S12.
10. Lieff SJ. Perspective: The missing link in academic career planning and development: pursuit of meaningful and aligned work. Acad Med. 2009;84(10):1383-1388.