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 habitâwell, 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 didnât 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 operationâthis 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 emergencyââunstable anginaââand 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 chestâa small electronic device that shocks his heart back to a steady rhythm.
Finally, Richard pursued a healthier lifestyle. 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 machineâan âelliptical cross trainerââonto 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 nationâs top cardiologists reviewed his history and said, âItâs a testament to medical science that heâs alive.â
As you may have guessed, Richardâs last name is Cheney, he prefers to be called âDick,â and heâs 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 doesâand doesnâtâmotivate them to change how they live. There are two reasons why Iâve singled out Cheney from among the sixty-two million Americans who suffer from heart disease. First, I want to talk about how our minds workâhow we think about our lives and our worldâand 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
Frames
The other reason I began this chapter with Dick Cheneyâs medical history was to show that when it comes to how we think and feel about health, the vast majority of us share the same belief system as he does. In politics we might be liberals or conservatives, Democrats or Republicans, left-wingers or right-wingers, with shadings and subtleties, of course. But nearly all of us have a deep conviction about the awesome power of science and technology, and that includes a strong belief in âscientific medicine.â
From the breakthroughs of earlier eras (antibiotics, X-rays, open-heart surgery) to the marvels of recent years (antidepressants, DNA testing, fMRI brain scans), scientific medicine has repeatedly startled us with its capabilities. Some of your earliest childhood memories probably involve your parents taking you to doctors, who made you feel better, and those experiences influenced your lasting gut-level emotions and beliefs. Every society in recorded history has had a class of healers, whoâve often relied on magic, faith, or plants. In the scientific age, our healers have been physicians, and theyâve relied on expensive technology and pharmaceuticals.
Scientific medicine so nearly monopolized the health business that it became known in the United States and other Western nations simply as âWesternâ medicine. Only in recent years, with the rise of âalternativeâ medicine, have many people even realized that there are other ways to think about healing. Still, most of us feel suspicious about or even outright condemn people who shun Western medicine, such as Christian Scientists, and think theyâre negligent for refusing to take their children to doctors.
Throughout our lives weâve had extraordinary admiration and respect for physicians and made them into an elite class in our societies. For the past twenty-two years an independent firm called MORI has conducted a poll in Britain, and every year the poll has found that medicine is the most trusted profession. In the 2005 survey of more than two thousand people ages fifteen and older, 91 percent said they trusted doctors to tell the truth, which put physicians ahead of everyone else:
| Physicians | 91% |
| Teachers | 88% |
| Professors | 77% |
| Judges | 76% |
| Priests and other clergy | 73% |
| Scientists | 70% |
| Television news anchors | 63% |
| The police | 58% |
| The ordinary person in the street | 56% |
| Pollsters | 50% |
| Civil servants | 44% |
| Trade union officials | 37% |
| Business leaders | 24% |
| Politicians and government ministers | 20% |
| Journalists | 16% |
When the Harris Poll company conducted a similar survey among Americans, who are markedly less trustful than the British, 77 percent said they trusted doctors to tell the truth, ranking doctors second only to teachers at 80 percent. When Harris focused on Americans who are fifty-five and olderâthe group that relies the most on doctorsâit found that 93 percent of them trust their physicians.
Given this background, letâs take another look at the case of patients with severe heart disease. Letâs say, for the sake of illustration, that youâre one of them. For many years, decades even, you tried repeatedly to live healthier but your efforts have failed, and now youâre suffering from awful pain. In the lingo of psychologists, youâre âdemoralized,â meaning that youâre overwhelmed by feelings of hopelessness and powerlessness. You need to seek out other people who can inspire new hope. People with the power to relieve your pain and heal you: doctors.
From the very start, every aspect of the healing process reinforces the belief that youâre powerless and the doctors are all-powerful. It casts you as helpless, and the doctors as heroic. Youâre entirely passive, while doctors are active.
You start as a supplicant. You make a pilgrimage to a sacred healing place, a complex of massive buildings connected to a prestigious university, a center of knowledge. You wait to meet with the elite class of healers, who are set apart by their special attire. Their offices are lined with framed diplomas attesting to the exceptional skills they developed through many years of arduous education, testing, and apprenticeship. While you believe thereâs nothing you can do to help yourself, the doctors inspire your belief and expectation that they will heal you. The surgeries they perform are amazing. Implanting a piece of plastic to prop open your arteryâthatâs astonishing. Removing a vein from your leg and stitching it near your heart so the blood can bypass the blocked passageâthatâs stunning. After the operation you no longer feel the terrible pain and you can climb stairs again and play tennis. Miraculous! Then they prescribe a âstatinâ pill that can reduce your cholesterol and lower your risk of having a heart attack. Magical! Even though youâre accustomed to the spectacular achievements of science and technology, youâre awestruck by these demonstrations of power.
After performing the miracle surgeries and prescribing the miracle drugs, the doctors remind you: By the way, now youâve got to start living in a healthier way. Even though the doctors are doing their duty by mouthing these words, they donât really believe that you can change. They know about the studies saying thereâs a 90 percent probability you wonât change. Theyâve seen this firsthand in the hundreds or thousands of patients theyâve treated over the course of their careers. Itâs very difficult to inspire a belief in others that you donât believe yourself. Their lack of conviction, betrayed by the look in their eyes or the tone of their voices or their body language, takes away from the impact of their words. Besides, whatâs more persuasive: their words or their actions? The surgery and the drugs convey the message that you really donât have to change. They were invented because you canât or wonât change. (And you know itâs true. In your gut you believe that you canât change your lifestyle.) The insurance company paid so much for the operations, and will pay for expensive medications that youâll need to take for the rest of your life, because you canât change. Besides, if you had the power to heal yourself, then why did you go through the trauma of having your chest sliced open and sewn back together again?
Doctors know that theyâre not magical healers. They can relieve symptomsâchest pain in the case of heart patientâbut they usually donât âcureâ people of disease. However, our mythology about medicine (our belief system) casts doctors as potent healers and we expect them to heal us. We believe theyâll cure us. After the doctors have taken their heroic efforts with heart surgery, then youâre no longer in pain, so you feel as if youâre cured.
The doctors are tra...