The implantable cardioverter defibrillator is a device
placed under the
skin, near the heart. It delivers an electric shock to the
heart when a dangerous abnormal rhythm is detected. As you
might suspect, it hurts when this shock occurs (doctors call it a “short-duration
nociceptive stimulation“). Also as you
might expect, it can create a great deal of anxiety.
Persons with ICDs are liable to be shocked at any time, with no warning
There’s an evidence-based review of the subject that is openly
available at Current Psychiatry Online. They review the
problem, and various proposed approaches. The authors
recommend cognitive-behavioral therapy as a proven approach to the
management of such anxiety.
therapy (CBT) often
is used to identify
and correct maladaptive or irrational beliefs about ICDs and shocks and
to eliminate avoidance behaviors that serve as negative reinforcement.
CBT typically begins with psychoeducation about the ICD to help
patients realize their thoughts about the device might be irrational.
Strategies include keeping a daily log of ICD-related thoughts and
cognitive re-structuring. Exposure therapy can help patients re-engage
in activities they have been avoiding because of irrational fears.
study found that ICD patients who received CBT that included
psychoeducation, stress management, addressing distorted cognitions and
avoidance behavior, and resuming work and social activities had less
depression and anxiety and better overall adjustment than those who did
not get CBT, whether or not their ICD had ever delivered a shock.14
Smith et al15
demonstrated the effectiveness of CBT in patients with ICDs who suffer
from panic disorder with agoraphobia and depression.
The Heart Rhythm Society has an article online about ICDs.
In it, they point out that Dick
Cheney has an ICD. The article is illustrated with
what is the only known photo of Cheney actually smiling.
I suppose the point of the article is to try to help people with ICDs
feel better. The photos we are accustomed to seeing would
hardly promote that theme. This got me pondering, what would
it be like to be such a powerful man, yet be subject to the random
infliction of pain?
This is speculative, of course. Just as Cheney cannot really
imagine what it would be like to be humanistically oriented, I cannot
really imagine what it would be like to be incapable of humanistic
It has been alleged that Dick
Cheney feels no pain. The author of the article I
linked to happens to think that it is good to feel no pain.
Perhaps that is so, if one happens to be in the business of paying
mercenaries a billion dollars to take something that belongs
to someone else. If you think it is your job to apply The
Shock Doctrine so that you and your cronies can get more
oilfield contracts, but it means that thousands of other people’s kids
will die in the process, perhaps you should be the sort who does not
I would bet, though, that Cheney does feel pain. He just does
not experience it the way normal people do. He experiences it
as an insult, not as a nociceptive stimulation.
He does not fear it; he resents it.
He resents it because it is beneath him. He does
not fear those who cause him pain, he resents them. He does
not flee them, he dehumanizes them.
Some people think that is good. In fact, about 18%
of the adult population likes people like that. Others
these personality traits. Some can describe them better than
interview with Kurt Vonnegut
(HT: Fried Green Tomatoes):
My feeling from talking to
readers and friends is
that many people are beginning to despair. Do you think that
we’ve lost reason to hope?
I myself feel that our country, for whose Constitution I fought in a
just war, might as well have been invaded by Martians and body
snatchers. Sometimes I wish it had been. What has happened, though, is
that it has been taken over by means of the sleaziest, low-comedy,
Keystone Cops-style coup d’etat imaginable. And those now in
charge of the federal government are upper-crust C-students who know no
history or geography, plus not-so-closeted white supremacists, aka
“Christians,” and plus, most frighteningly,
personalities, or “PPs.”
To say somebody is a PP is to make a perfectly respectable medical
diagnosis, like saying he or she has appendicitis or
foot. The classic medical text on PPs is The
Mask of Sanity
[PDF — link added] by Dr. Hervey Cleckley. Read it! PPs are
presentable, they know full well the suffering their actions may cause
others, but they do not care. They cannot care because they are nuts.
They have a screw loose!
It is not ethical for a physician to diagnose someone who is not their
patient, so I won’t do that. I will, however, in the interest
ethics, call Dick Cheney a PP.
One thing about PPs is that they are very resistant to change.
One reason is that part of their personality structure is
self-reinforcing. The more they are hurt, the more resentful
become. The more resentful they become, the more they abuse
people. The more they abuse other people, the more other
hurt them. It is, literally, a vicious cycle.
Do I think Cheney needs therapy? Sure, so long as I don’t
be the one doing it. Doing psychotherapy with Dick Cheney
be like doing massage therapy with a porcupine.
So what is it like for Dick Cheney to have an ICD? It is an
occasional reminder that he is human, like everyone else, and that has
got to be very. annoying.