Change or Die

The Three Keys to Change at Work and in Life

Alan Deutschman

• Publisher: Harper Business
• Year: 2009
• Print ISBN: 9780061373671
• eBook ISBN: 9780061843556
• Topic: Psychology
• Subtopic: Business Strategy
• Index: Psychology

PART ONE

Change 101

IF THEY CAN CHANGE, SO CAN YOU

Case Studies: Heart Patients, Criminals, and Workers

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 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 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

Frames

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. I found this when none of my friends could remember that my wife, Susan, and I were spending two years living in Roanoke, Virginia—a small city in a remote part of the Appalachian mountains. I told everyone that we were moving there so Susan could study for her master’s degree at Hollins University, a small women’s college that had a very reputable graduate program in her field of creative writing. My friends, whom I had first met when we were in college together or during the fifteen years I lived in San Francisco and Manhattan, had never heard of Roanoke or Hollins. During those two years they frequently called and asked how we liked living in Charlottesville (which is one hundred miles away from Roanoke) and how Susan liked it there at the University of Virginia. They didn’t believe that “people like us” went to graduate school in Virginia unless it was at the University of Virginia, which they knew about because of its top-ranked programs in business, medicine, and law. They had a particular vision of how the world worked, and it told them that people who had gone to Ivy League colleges and lived in major global cities only moved to provincial towns to enroll at top law, medical, or business schools. No matter how many times I repeated “Roanoke” and “Hollins,” their brains transformed the data into “Charlottesville” and “University of Virginia.”

“Concepts are not things that can be changed just by someone telling us a fact,” says Lakoff, who’s a professor of cognitive science and linguistics. “We may be presented with facts, but for us to make sense of them, they have to fit what is already in the synapses of the brain. Otherwise, facts go in and then they go right back out. They are not heard, or they are not accepted as facts, or they mystify us: Why would anyone have said that? Then we label the fact as irrational, crazy, or stupid.”

The other reason I began this chapter with Dick Cheney’s 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 “scientific medicine.”

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, who’ve often relied on magic, faith, or plants. In the scientific age, our healers have been physicians, and they’ve 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 “Western” medicine. Only in recent years, with the rise of “alternative” 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 they’re negligent for refusing to take their children to doctors.

Throughout our lives we’ve 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 older—the group that relies the most on doctors—it found that 93 percent of them trust their physicians.

Given this background, let’s take another look at the case of patients with severe heart disease. Let’s say, for the sake of illustration, that you’re one of them. For many years, decades even, you tried repeatedly to live healthier but your efforts have failed, and now you’re suffering from awful pain. In the lingo of psychologists, you’re “demoralized,” meaning that you’re 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 you’re powerless and the doctors are all-powerful. It casts you as helpless, and the doctors as heroic. You’re 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 there’s 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 artery—that’s astonishing. Removing a vein from your leg and stitching it near your heart so the blood can bypass the blocked passage—that’s 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 “statin” pill that can reduce your cholesterol and lower your risk of having a heart attack. Magical! Even though you’re accustomed to the spectacular achievements of science and technology, you’re awestruck by these demonstrations of power.

After performing the miracle surgeries and prescribing the miracle drugs, the doctors remind you: By the way, now you’ve got to start living in a healthier way. Even though the doctors are doing their duty by mouthing these words, they don’t really believe that you can change. They know about the studies saying there’s a 90 percent probability you won’t change. They’ve seen this firsthand in the hundreds or thousands of patients they’ve treated over the course of their careers. It’s very difficult to inspire a belief in others that you don’t 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, what’s more persuasive: their words or their actions? The surgery and the drugs convey the message that you really don’t have to change. They were invented because you can’t or won’t change. (And you know it’s true. In your gut you believe that you can’t change your lifestyle.) The insurance company paid so much for the operations, and will pay for expensive medications that you’ll need to take for the rest of your life, because you can’t 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 they’re not magical healers. They can relieve symptoms—chest pain in the case of heart patient—but they usually don’t “cure” 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 they’ll cure us. After the doctors have taken their heroic efforts with heart surgery, then you’re no longer in pain, so you feel as if you’re cured.

The doctors are tra...

Table of contents

• Cover
• Title Page
• Contents
• Introduction
• Part One
• Part Two
• Conclusion
• Frequently Asked Questions (FAQ)
• Sources
• Acknowledgments
• Searchable Terms
• About the Author
• Other Books by Alan Deutschman
• Credits
• Copyright
• About the Publisher