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Change or Die
Case Study: Heart Patients
Richard began smoking when he was a teenager. When he was in his twenties and thirties, he smoked as much as three packs a day. After he suffered a heart attack at the age of thirty-seven, he finally quit the habit—well, at least for a while. He had a second heart attack at forty-three. Following his third heart attack, at forty-seven, he underwent quadruple coronary artery bypass surgery.
Following the operation Richard resumed a lifestyle that worsened his heart condition. He didn't get much exercise. He gained forty pounds. He continued working as a powerful executive, which subjected him to heavy stress and frequent crises. But he was a very lucky man, and his grafts lasted for a dozen years, which was longer than his doctors might have expected. Then, at fifty-nine, Richard was struck by his fourth heart attack. He was rushed to the hospital at four thirty in the morning, and he underwent another operation—this time the surgeons inserted a steel stent to make way for blood to flow through. But the artery clogged up again within three months. Richard felt sharp chest pains, each lasting as long as five minutes. It turned out that the artery was 90 percent blocked. He was taken to the hospital for another medical emergency—"unstable angina"—and surgeons had to redo the procedure. Three months later, his doctors found that he had an irregular heartbeat that could kill him, so they implanted a defibrillator under the skin of his chest—a small electronic device that shocks his heart back to a steady rhythm.
Finally, Richard pursued a healthierlifestyle. It helped that he was a top executive and his organization provided personal chefs who prepared salads for him, doctors who followed him wherever he went, and assistants who hauled his heavy, hulking exercise machine—an "elliptical cross trainer"—onto his private airplane to make sure he could get in his thirty-minute daily workout even when he was traveling around the world, which he often had to do. He was independently wealthy, and he could easily afford to retire to a life of hunting and fishing on his ranch and maybe serving on a few corporate boards. Instead he held onto his job, which had become increasingly stressful. He often responded to the pressure by venting his anger, such as the embarrassing time when he cursed out one of his colleagues in public. When Richard was sixty-three, one of the nation's top cardiologists reviewed his history and said, "It's a testament to medical science that he's alive."
As you may have guessed, Richard's last name is Cheney, he prefers to be called "Dick," and he's worked as the White House chief of staff, secretary of defense, and vice president of the United States.
This chapter is about heart patients and what does—and doesn't—motivate them to change how they live. There are two reasons why I've singled out Cheney from among the sixty-two million Americans who suffer from heart disease. First, I want to talk about how our minds work—how we think about our lives and our world—and politics is a familiar way of introducing a notion that I want to apply to many other topics. That notion is ideology.
Psych Concept #1
As soon as you hear "Dick Cheney"—the name of a controversial political figure in a time of crisis and combat—you probably have a strong gut-level emotional reaction one way or the other. It reflects your "ideology"—the complicated web of entrenched ideas that conditions how you think and feel.
We're guided by ideologies about all kinds of matters, not just politics, and they're vital to understanding change. Instead of "ideology" you can refer to it as a "belief system" or a "conceptual framework" ("frames," for short). Whatever you call them, these are the "mental structures that shape how we view the world" in the words of Berkeley professor George Lakoff. A psychologist would say that our deep-rooted beliefs are part of "the cognitive unconscious." A neuroscientist would say "the long-term concepts that structure how we think are instantiated in the synapses of the brain." A plainer speaker would say that our true beliefs are what we feel deep in our guts, and they're hard to change because they've developed over a lifetime.
That helps to explain why simply providing information doesn't sway how people think and feel. You can give the same facts to liberals and conservatives but people on each side will interpret the facts to support their own beliefs. Look at the varying responses to March of the Penguins, a documentary that shows how father and mother penguins each take turns waddling back and forth across 70 miles of ice to find food while the partner stays home protecting the fertilized egg in 70-degree-below-zero temperatures. Political conservatives loved the film and helped make it a surprise blockbuster. Michael Medved, a conservative radio talk show host, praised the movie because it "passionately affirms traditional norms like monogamy, sacrifice, and child rearing." Rich Lowry, editor of the right-wing National Review, told an audience of young conservatives, "It's an amazing movie. And I have to say, penguins are really the ideal example of monogamy." Other conservatives lauded the film as an emotional case against abortion.
What's interesting is that liberals saw the same movie and thought it was liberal propaganda. When the male and female penguins take turns going out into the greater world and staying home with their progeny—wasn't that an affirmation of progressive ideas about gender roles? Even though the penguins sacrificed to bring new lives into being, they all mated with different partners every year, which suggested a more permissive "serial monogamy" that liberals said clashed with conservative morality.
We take the facts and fit them into the frames we already have. If the facts don't fit, we're likely to challenge whether they're really facts or to dismiss the information and persist somehow in believing what we want to believe . . . .Change or Die. Copyright © by Alan Deutschman. Reprinted by permission of HarperCollins Publishers, Inc. All rights reserved. Available now wherever books are sold.