From Breakdown to Breakthrough: Tips For Heeding Your Wake-Up Call, with Dr. Mark Goulston | EDB 195

Suicide Prevention expert Dr. Mark Goulston gives tips for overcoming adversity.

(30 minutes) Originally a UCLA professor of psychiatry for over 25 years, and a former FBI and police hostage negotiation trainer, Dr. Mark Goulston’s expertise has been forged and proven in the crucible of real-life, high stakes situations. An influencer who helps influencers become more influential, his unique background has made him an indispensable and sought after resource and change facilitator to Fortune 500 leaders, entrepreneurs and educators across the nation. Dr. Goulston sits down with Dr. Hackie Reitman to discuss his history of suicide prevention, tools he uses for his own struggle with depression, and offers tips on how to take advantage of “wake up calls”.

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Meeting Dr. Mark Goulston

HACKIE REITMAN, M.D. (HR): Hi I’m Dr. Hackie Raymond welcome to another episode of Exploring Different Brains. Today’s a big thrill for me because we’re getting to interview Dr. Mark Goulston, a former classmate of mine who you’re going to hear all of the great things he’s doing and we have a similar hero in mind that you’re going to hear about also. Rather than me butcher the introduction I’m going to let my friend Dr. Mark Goulston introduced himself to our Different Brains audience. Mark welcome.  

MARK GOULSTON, M.D. (MG): Well thank you Hackie I thank you for having me and thank you to your audience for tuning in and how can I hope this will be worth your time maybe give you some inspiration maybe some tips maybe even a little hope because that’s what Hackie and I are both about. My background, Hackie and I attended Boston University School of Medicine, and he was a six-year student which means he got a Bachelor’s degree and a medical degree in 6 years and I was 6 year medical student because I dropped out of medical school twice. I didn’t drop out to see the world, I dropped out because I think I had untreated depression. I mean I did have nice jobs, kind of blue collar jobs that I missed when I dropped out. And so what happened is that I went for a couple years and then maybe you can relate to this, I was highlighting all my books in yellow but I couldn’t hold on to the information. I would read it but I couldn’t hold on to it. So I took a leave of absence for a year and then I came back and my mind was sort of working and then then about after six months that happened all over again. So I asked for another leave of absence because I was passing my courses, and at that time the school wanted me to withdraw which is a nice way of saying they were done with me because they lose money when someone takes time off and I was asking for time off for the second time. Then I met with the head of the school good guy but you know he has to watch the financial status of the school and I met with him which I didn’t remember because I was pretty low. Then I got a call from our mutual hero Dean Lee McNary who we called Mac he had a thick Irish Catholic accent from Boston and he called me and I remember getting on the phone and he said “Mark this is Mac! Mark better come in here get a letter from the dean. Mark. Better get in here.” I didn’t know what it was about and so I went in and he said “Mark read this letter here” It was a letter from the dean Friedman and it said “I’ve met with Mr. Goulston we talked about another career and I’m advising the promotions committee that he be asked to withdraw.” Which because as I said, they were losing money and I can understand that. I was at a low point, I come from a family in which is not unusual where you’re only worth what you do in the world. If you don’t do anything in the world you are not worth anything. So maybe some of you can relate to that.

And so I said what does this mean and Dean McNary said “Mark you’re being kicked out”. I’m trying to recreate at because I’m looking right into that green dot. And when he said that I felt like I’ve been shot I mean I just looked on like that and I’m not a very spiritual person but I remember something was wet on my cheeks and I thought I was bleeding. I looked at my hands like this and it was tears. And it felt like a gunshot wound and I know what that feels like ‘cause I had a perforated colon about 10 years ago and I almost died. And literally just kicked everything out of me. So I want you to imagine us and maybe Hackie you know you knew him better than I did because you stayed around there and I dipped and so he said to me… There I am at a low point thinking and he said “Mark you didn’t screw up ‘cause you’re passing everything but, you are screwed up. But if you got unscrewed up I think the school would one day be glad to give you a second chance.” So I just started to cry… what is he saying? I can’t do anything I’m not worth anything. He said “Mark even if you don’t get I’m screwed up even if you don’t become a doctor even if you don’t do anything the rest your life I’d be proud to know you because you have the streak of goodness and kindness in you that unfortunately we don’t really grade in medical school and you have no idea how much the world needs that- what you have. And you’re not going to know it until you’re 35.” I just couldn’t look at him I was sobbing. Then he said “but you got to make it till 35” and I couldn’t look at him because he was just bathing me and all this kindness. I remember him saying “look at me” pointed his finger, look at me and I looked at him and he said “you deserve to be on this planet and you’re going to let me help you.” Then he set up an appeal with the promotions committee which had all these doctors and him and I had to make my case but I think the promotions committee may have seen something in me that he saw and I got a second leave of absence.

And what I did in the second leave of absence I went to a place called the Menninger Foundation which is a big psychiatric Institute Institution in Topeka, Kansas it’s now I think in Houston, Texas but it was really well known and I went there because I wanted to get away from the East Coast where I grew up Boston and I didn’t want to go to the West Coast where I went to college during some of the hippie days, I just wanted to get away. And so I went to this place called the Menninger foundation big psychiatric Institution and… and I was able to relate to schizophrenic Farm boys. I don’t relate to farming. We’d just go on long walks on the grounds of Topeka State Hospital and it was weird it was weird ‘cause I remember I asked the psychiatrist there “is this legitimate?” and he said “what?” I said “you know I’m just so walking around this is not like medical school, I’m just walking around and going on walks with these schizophrenic farm boys and farm girls and people in it’s not like anything I’ve ever done in medical school” and I remember they said “No it’s legitimate. Psychiatry is legitimate you have a knack” I never knew I had a knack.

So I knew in the back my mind just finish medical school which I did and then I went to UCLA and I trained in Psychiatry there. But because Mac, I think saved my life I became a suicide expert for 25 years and I just did with my patients what Mac did with me. I saw the goodness in them. Didn’t matter to me that they couldn’t do anything. Saw they were worth believing. I saw they were worth valuing. I saw that they were worth loving. Maybe something about that work because none of them killed themselves in 25 years. So now I’m trying to take that to the world but the world is too rushed. Because the world has to check boxes and the world has to fill up protocols and but I’m still trying to get my message out of there. I hope that was okay Hackie because I had no idea what I just said.  

HR: Well you said it eloquently and you’re making me cry a little bit with memories of our hero Doctor McNary who went to bed for those of us who are having a tough time at different times. And giving people their self-esteem – it’s one of the greatest things you can do for them. To make them realize that they are worthy. Tell us about wake up calls.  

MG: So wake up calls is so I have a podcast and I interviewed you and it’s called My Wake-Up Call you can find it on iTunes or wherever you get your podcast on, and I interview influencers Hackie is an influencer and he’s going to say she’s I’m not an influencer I’m a former boxer doing, come on you’re an influencer. I identify influencers who I think have the power to change the world and I do everything I can to help them do that. And so I’ve interview Larry King CNN a guy named Norman Lear who changed television he did some TV shows come All in the Family, The Jeffersons and other people. CEO. I interviewed the CEO of IDO a big design company I interviewed a woman named Esther Wojcicki – how’s this for high achievers: she has two daughters one of them is the CEO I believe of Netflix and the other one is the CEO of 23andMe. Two daughters – little underachievers there. And in many other people, and they’re very personal interviews kind of like what we’re having. It’s a conversation people open up and I do it because what I love to do one day is do some Summit where I just bring all my guests together and say you’re going to love each other just listen to others podcasts, but you know that would be way in the future.  

Wakeup Calls

HR: What do you think is the biggest advice you can give somebody to heed their wake up call?  

MG: Well wake up calls generally are not pleasant they’re uninvited. I’ll tell you what’s going on in your brain what happens, and I would love you to weigh and although I’m too kind of the psychiatrist you know neuroscientist person. I think what causes a wakeup call is if you can think of your brain being in three parts functionally. An upper thinking brain, a middle emotional brain, and a lower fight or flight brain the human the mammalian and the reptile brain. And if you can think that when they’re lined up with what you’re doing in life you have a goal and it’s all lined up you feel great. Sometimes when it’s really going well if you get into something that we call flow but then what happens if suddenly that goal you’re going towards is ripped away and it never comes back. It’s kind of like that goal is like the bracelet holding your brain together and when you whip away that bracelet all those three parts your brain wanna fall apart and it is scary you get anxious you get panicky. There’s even words – “I’m losing my mind” “I’m coming unglued”, “I’m freaked” “out of sorts”.

So the wakeup call is – what I would tell you if you can relate to this, and you watching is a listing this. Is what’s happening is your brain will reorganize around the next reality you face but you don’t think it’ll happen you think you’re just going to plummet. The key and this is the advice that I give people who are going through this when you have obstacles that shake you totally through your mind and your brain to not do anything to make it worse for 72 hours. It’s not an accident in Psychiatry we have a 72-hour hold and what do I mean by that. A lot of times when you feel your brain and mind is coming apart you do desperate things because it’s so awful and you do desperate things that you often have to apologize to others you get drunk, you binge, you scream, you throw things you cut on yourself you all these things are to give you relief but the problem is if you do any of them you know when you come back to your senses you’re actually going to miss a breakthrough because you’re going to be busy apologizing to other people or apologize figuring out how to deal with your guilt and shame about what you did. When I give presentations one of them is how to go from the breakdown to a breakthrough. When I asked people how many of you have breakthroughs in your life most of the audience raised their hand and I say how many of you had breakdowns prior to the Breakthrough and I would have stayed close to 90% of people raise their hand and how many of you and raise your hand if the breakdown was pleasant nobody raises their hand. So what’s happening is that realities taken away and and that’s why I say if for 72 hours you cannot do anything to make it worse. What’ll happen is often a breakthrough will occur to you and it will occur to you because what’s happening is if you don’t do anything desperate your mind and brain reorganizes around what the new reality is. I hope your listeners and viewers can follow that. And so a wake-up call is often you know connected to a breakdown.  


HR: It’s almost the segway though overall to communication – both within yourself and to others. How does communication step into your Calculus?  

MG: Well I’ll tell you if I share an anecdote with you and your listeners and if people are interested I would love to do more of this. I think about 8 months ago I was part of a panel at Hollywood High School. And again this is not a private school so it’s a public school and a lot of disadvantaged kids and it was a mental health program after school. And there were three other panelist, a life coach, therapist and whenever I’m on a panel I say “go to me last because I improvise”, because I’m pretty good at tuning in to connecting with people I think I learned that from Dean McNary connecting with me and me connecting with suicidal people. And so what happened is this was after school I think they went there for the free pizza in the free lunch and the other panelists talked about stress, depression, anxiety and I could see that the students were getting restless this happened in the cafeteria and we’re in four cafeteria chairs, and they’re in front of us. And so when it was my turn I looked at the students and I said I’m going to try something different because I think the other panelists have covered stress, anxiety, depression and what I shared with them; and this is something you can all check out. I said I co-created and moderated the documentary called “Stay Alive: an intimate conversation about suicide prevention” and I interview this fellow Kevin Hines, who jumped off the Golden Gate Bridge and survived he was a CNN hero a couple months ago and if you look up stay alive video you can watch it’s free. And and what I told the teenagers I said I’m going to give you eight words and what I’d like you to do is imagine the worst you can feel right now.

And I’m going to share eight words with you and then I’m going to ask each of you to say the word it most connects to when you’re feeling awful. And so here are the eight words and when I said it I change my tone from the tone I’m using with you now into an inviting kind of tone. I said here are the 8 words: anxious, depressed, frayed, angry, ashamed, alone, lonely, tired. And so one by one I want you to picture this they each said the word and there were some facilitators behind them and afterwards they said it was amazing what happened to all those students, ‘cause he was watching them from their backs he said when they were on the spot to come up with the word they were a little uptight, but then when they said the word it’s like the exhaled alone, frayed. He said it was unbelievable they just got a little uptight being on the spot and then they relaxed because they connected emotionally with that feeling and me and the community. And I asked them how did that feel and they all said it felt great. I said well why? They said I felt less alone, I felt relief I, felt calmer. I said did you judge anyone when they picked a word they are saying things that are kind of tough words and everyone said no no I felt closer to them. And then I gave them homework assignment I said as teenagers there is 4 emotions that you live with excitement, boredom, fear, and anger that’s your life excitement, board, and fear and anger I want you to write 8 words and when you’re trying to reach person one of your friends know who’s stuck, you can say I’m fine and so if your parent listening and you can try this with your teenager young adult that even your spouse and even if someone says that I’m fine but she says yeah I know you’re fine eight words they’re going to say what? Yeah I know you’re fine – 8 words. I’m going to run eight words by you just pick one and then you say the eight words and when I did it with Kevin Hines in the documentary and then I’ve done this with people who are depressed or suicidal and I say pick one I think you know the response.

And this is what Kevin did in the documentary he smiled: “all of them.” He felt relief. So I don’t know if you’re tracking Hackie but it’s a way of going in giving people the word to say and feel with you and then you take it in so they feel less alone when and this is what’s happening inside of their brain. When people are stressed out they have high cortisol, and what happens with high cortisol is it stimulates something in our middle brain called an amygdala and it triggers the amygdala to shoot blood from our lower survival brain and that’s called in an amygdala high jack. And so high stress equals High cortisol equals amygdala hijack equals you can’t think. And what people don’t know when you can check the stuff online, oxytocin which is the bonding hormone it’s what causes mothers to bond on to their infants even when their infant yelling 24/7. And oxytocin is kind of the antidote to high cortisol and so what happened with these kids they felt they remembered an awful time highly stressed out and then they expressed what they felt they were accepted by everybody accepted by me understood. They weren’t lectured they weren’t givens advisor solutions. Their oxytocin went up through the roof their cortisol went down and when and when oxytocin goes up the amygdala calms down and the blood flow goes from our lower brain to our upper brain and so we can think again. And that’s when you can have a conversation with people.  

HR: And you can’t get any of that alone.  

Dr. Goulston’s Stress Response Toolkit

MG: That’s right. In fact I showed Hackie earlier and I’m going to show all of you now is that I often give trainings on how to relieve stress and it’s interesting when I finished med school. Took six years and I wasn’t a writer and I was a medical student doctor and when I made it through after 6 years and I can’t and I can’t take you over to my little bookshelf here. I took out a little crappy Journal I didn’t know I was going to keep a journal and this is my first entry when I finally graduated. I wrote down I can’t believe I got through. They have graduated a crazy person and if you look at this that was 1976 this is an old picture this is volume 248 I have 45000 Pages.  

HR: Wow and there’s our Hero Dr. William F McNary too.  

MG: And this is a stress response toolkit. So what happens is if you’re going through something upsetting picture a hero it could be a book you read it could be living, or deceased, relative it could be anyone it could be your parent, it could be your young child looking up to you trusting you could be anything. But imagine whoever that person is talking you through it and then so when you’re upset those are the steps imagine they’re saying to you, you can do this you put down the day and time of whatever you’re upset about and then you write in what just happened and you read a couple sentences, what did you think? What did you feel? What did it make you want to do? What does it make you want to do that that’s the key part, because that’s your impulse. Your impulse might be what it makes me want to do is just give up, what it makes me want to do is go out and get drunk. And so imagine that person then saying do you breathe what would be a better thing to do? Why that? So this has really helped me because I starting with Dr. McNary I have seven dead mentors and and I am much harder on myself than other people and so I can say I did let Hackie talk at all during this podcast. So I could beat up in myself and I could reach out to Mac because we both knew him and he’d say “Mark Mark Mark there must have been something in there that was kind of useful Mark. So just put sock in it” and then what I do and what Hackie’s doing now is – I just miss the guy. I just think about grateful I am that he saved my life and gave me a direction I might not be here because I just talked to feel how grateful I am to him. I don’t even remember what I was beating myself up about. You can use that too if you’re listening to this, watching this, you can create a stress response Journal. I’d suggest you give it a try.  

HR: What great, great advice. I feel better already I feel better already. I can’t thank you enough for being with us today Mark this is just great. Where can I our audience learn more about you and more about what you’ve spoken about today?  

MG: Well you can find me on LinkedIn… ‘cause what I’m currently doing my latest profile and I might not change it before this goes up. But what I really do is I’m an advisor to Global Influencers. So at this stage of my life I’m reaching out to people, top people top companies and I’m reaching out to them because I think they can change the world and I’m doing my best to make sure they change the world for the better. And so if you go to LinkedIn and you’ll find a whole bunch of stuff. I have a website at m a r k g o u l a t o n .com and I hope you’ll like to check out My Wake-Up Call, that’s the podcast and Hackie’s interview will go up shortly. And and if you do it if you do a Google search on me you’ll find all kinds of other stuff but I don’t even know what’s up there but most of it’s okay.  

HR: And what about the books?  

MG: the books go to I’ll show you a couple. This is the first book I ever wrote called “Get Out of Your Own Way.” It became a best-seller and actually found its way into prisons and jails. So I did a podcast that ended a year ago called “Prison Letters” ‘cause I got I’ve been getting prison letters from inmates who find this book in prison jails for 22 years, and I read the letters – you can still find it Prison Letters with Dr. Mark Goulston – I read their letters and its not a conversation ‘cause they’re in prison, I try to drill down into their mind. Another book I wrote was “Post-Traumatic Stress Disorder for Dummies” so I know a little bit about trauma. But the book that I’m most known for is this one called “Just listen” and I’m humbled by it because it became the top book on Listing in the world. It’s in 23 languages. I’ve spoken in Moscow twice. uH recently a couple months ago with a Nobel Prize winner because I have 4 best sellers in the Russian editions and one of them was “Just Listen.” So that’s more than enough you need to know about me.  

HR: Mark. (Laughs) And we haven’t even scratched the surface. We’re going to have you back very soon… 

MG: I’d like that.  

HR: …because you got a lot more stuff going on. Dr. Mark Goulston, keep up the great work and thank you so much for being here.  

MG: Mac would be proud of both of us. That means a lot.  

HR: It does. Thank you so much  

MG: Thank you.