Episode #1 - What We Don't Know... about Mentally Surviving and Supporting during COVID with Mark Goulston
Xander Schultz: [00:00:00] All right. Dr Goulston, super appreciative of you taking the time.
You worked in suicide prevention for a long time as a psychiatrist, and you were famously successful in doing so. During this time where people are incredibly stressed out who should we be worrying about the most? Who should we be checking in with?
Mark Goulston: [00:00:50] A friend of mine had a great phrase. She says, "we always guard our calendar". When we have an appointment or we have something on our calendar of what exercise, if it's on our calendar, we do it.
So what I would say is I would calendar an hour a day and that hour you start with your closest circle and since things are changing, you communicate with them, in the way you do, whether it's text or email, and what you say is "Just checking to see if you're okay?". That's a different statement than saying "How are you doing?". Because when you say, "How are you doing" it almost is similar to those kind of empty or ways we greet people. "Hey, how you doing?" "Oh, I'm good. How are you?"
Xander Schultz: [00:01:32] "Just checking in to see if you're okay... "
Mark Goulston: [00:01:34] Yeah, "just checking in to see if you're okay". But when you schedule that hour to check them with people, I would make a list, especially make a list about the people you're most worried about because frequently those are the people we're scared to call and it hangs over us.
And I know this is tough, but if you get into this routine, put down three or four people that you're most concerned about and contact them first in that hour. Because otherwise what will happen is it will just be lingering, eating away at you.
Part of my understanding and my observation about people becoming suicidal is when they feel. Well, I pulled despair and I break that into D.E.S.-P.A.I.R. and that means when they feel unpaired with a reason to live. And so when people feel hope-less, help-less, power-less, use-less, worth-less, it can all combine to be point-less. And also when people choose suicide, they're pairing with a way to relieve that pain.
And also something we talked about earlier, because I have a large passion for neuroscience and how we can help us calm ourselves down by understanding what's going on in our body, our brain and our mind and something we've spoken about and something I speak about frequently, is that when we're under great stress, there's a chemical in our body called cortisol. And a lot of people know that cortisol is the stress hormone. It's something that our adrenal glands secrete that basically signals our body get ready cause, the crap's going to hit the fan any moment.
Now what happens is that cortisol triggers the survival part of our brain, and there's a part of our brain called the amygdala. Some people have heard of something called the amygdala hijack. So when the cortisol goes high, it triggers our amygdala actually shunt blood into our lower survival brain, our fight, flight, freeze, brain, reptile, brain, and away from our being able to think.
And here's the thing, there's another hormone. Called oxytocin. That's the bonding hormone. That's what enables mothers to bond their screaming infants and go without sleep for three or four days and not yell at them. And so oxytocin counteracts high cortisol. And the way we increase oxytocin is by connecting to people, feeling to feeling, which brings me back to intervening with suicidal people.
And one of the techniques that I've used over the years is something that I call interventional empathy, and it's a way of actually going into a dark night of the soul and keeping people company there until they start to cry with relief. Yeah. Sometimes when someone understands us in an unsolicited way, they catch me not in a good place and they say "Are you okay?" Sometimes kindness makes us cheer up because we feel a connection and that connection is oxytocin and that oxytocin tends to lower. Cortisol tends to deactivate our amygdala and our blood flow goes to our upper brain.
And I've come up with a, what I'm now calling nine words because I was just on a podcast and we added one. So here are nine words that you might want to use with people we've seen in a bad place, but the nine words are anxious, depressed, afraid, frustrated, angry, shamed, alone, lonely tired. Now, there can be other words. A couple of people added other words like "I feel nothing".
What was interesting is when you get people to attach an accurate word to how they're feeling, it lowers a amygdala activations. It actually calms you down. It was interesting when we did this live stream, we actually had some participants on the call and at the end of it we listed the nine words and we had people in the chat room, just write the words they were feeling in Zander. You could feel that as each person just typed in the word and the chat room, you could feel almost a collective exhale.
Xander Schultz: [00:05:57] Do you think there's something almost positive about how shared this trauma is in almost this historically unique way?
Mark Goulston: [00:06:04] Totally. I agree with you. I think there is a chance to collectively come together. Is there a way to extend human kindness, the human kind beyond this crisis as opposed to humankind wanting back to excitement too. A distraction.
Xander Schultz: [00:06:21] It's funny, you know, the older I get, the more I find cliches to be true, and I was just neglecting them for a long, for a long period of time in my, you know, naivety that somehow I was going to craft all the answers that we need. But it sounds like just empathy in this moment, empathy always, and empathy, especially in this moment is just so important.
When I reached out to you and asked what you thought people should know that could help them get through this tumultuous period during this crisis, you immediately talked about Russell Bishop's five steps, and so I thought that would be great to share with folks.
Can you walk us through Russell Bishop's five steps?
Mark Goulston: [00:06:58] Yeah. Russell Bishop has a book called "Work Arounds That Work". And Russell's a very smart guy, and that's what I like about the five steps is they're like Lego blocks, so they fit together.
So the first step is he calls it own it. And that means, accept that the coronavirus crisis is real. It's not a bad dream, it's happening. It's something topping to all of us. So we all have to deal with it.
The second step is, he calls it outcome, meaning, given that that first thing happened, the coronavirus crisis has happened. What's the best outcome near term outcome? And I think it's clear that the best near term outcome is to try to reduce the spread of it. Hopefully, if we can prevent as many deaths as possible, slow it down, flatten the curve, whatever you want to call it, health care resources can catch up and treat it. And so that our brave Valliant healthcare workers on the front lines can deal with it. And so that's the best near term outcome.
And the third step is you called control. What is something that's under your control that you don't need other people's permission to do? And three of the main things are what we're told every day. Wash your hands, social distance, and third now, stay at home. Those things we can all do. There's other things we can also do that are under our control when we're staying at home. We can come up with ways to interact with our family. We can come up with games to play. We can learn new skills. I've heard that all the Ivy league schools, for instance, have put up, I may be wrong, 450 free courses.
Xander Schultz: [00:08:44] That's incredible.
Mark Goulston: [00:08:45] It is incredible. And you can learn all kinds of things and, and so that's under your control. You don't even have to pay for it. So think of what's under your control and do that.
The fourth step is he calls influence. So when something's not under your control, you have to influence other people to act to get that near term outcome. So, for instance, what's happening with our leaders in namely president Trump, governor Cuomo, whether you like his politics or not, he has stepped up. And then the experts, Dr. Fauci and Dr. Burke, I think is her name. They've stepped up. And so they're trying to influence the country to really do these things that can slow down the rate of spreads.
So they are trying hard to influence us. They can't control us. There's still parts of America where people are not keeping a social distance in many places where they're throwing caution to the wind and it's going to come back to bite them. And so what can you influence? And then how do you get those people to do it?
And the fifth thing Russell talks about is you cause it your response dash ability response ability. What is your ability to respond? What are you going to do with regard to those first four things? And I think that these five steps, I just think they're great in the way they fit together.
Xander Schultz: [00:10:02] When you talked about influence in Russell Bishop's five steps, a lot of people really struggled with that. Right. That they were having a hard time influencing their partner to get on the same page with them or their parents. There's a lot of articles going around about how millennials were having a hard time convincing their parents to take precautionary measures and protect themselves during this.
Mark Goulston: [00:10:20] There's a, and millennials will like this, there's actually a hack when you're having an issue with another person who you're trying to influence, and that hack is this. If you can - try this in terms of your partner - if you could pause and ask yourself, "what's it like for the other person right now?" Just pause and be curious. What's it like for the other person right now, what you'll discover is you can't be curious about another person's state of mind or feelings and be venting at them at the same time.
I remember years ago when my wife, uh, you know, we were having a little bit of an argument. Yeah. And it was picking up speed. And I remember, uh, there was an exchange and ask myself, "what's it like for her right now?"
And so instead of reloading to throw something at her, I paused and I said, um, "you don't like where this is going, do you?"
she says, "No, I can't stand it when this happens."
I said, "I can't stand it either. You don't like where this is going anymore than I do, do you".
She's says "No, no. I can't stand it when we get into these things"
And I said, "you have any idea how we can keep us from going there?
And she smiled and then she said "No, but you're doing good."
Xander Schultz: [00:11:44] Control and what's under your control was, I think the hardest for me and a lot of folks that aren't used to being vulnerable
It really wasn't until the last couple of days where I started to turn more inward, started thinking about doing things like this podcast with you, that I started seeing light again at the end of the tunnel.
Mark Goulston: [00:12:01] Well maybe the hour, the scheduled hours to reach out to people will satisfy what I'm about to say. If you can think of "What can I do or what can I get done every day, that helps someone else." And one of the reasons that can help you is, I can tell you that over the years when I was a practicing psychotherapist, more than a few people who were depressed and anxious, when you drilled down, would say "maybe I don't deserve to be happy because way, way down deep. I don't care about anyone but myself. I'm just self-absorbed. Even if I do things on the surface, you know, I do things on the surface because I can, I have money, I can write a check, but down deep, I'm not sure I really care about anyone other than myself".
And one of the things I used to do is I would give some of my patients a box of healthy treats. And I'd say "when you pass homeless people and you're afraid to give them money because of, you know, they use it on drugs or alcohol , go over to them, introduce yourself, ask them their name - you know, homeless people have names and they actually talk. And then after you do that, give them a healthy treat and say "Here - hope this helps a little bit. Now take care of yourself" and then report back to that every day.
And the majority of patients who did that, they came back and they say, guy, I feel less depressed. It's because every day they felt, you know, "I was doing something other than just being focused on myself. I was making the world better."
Xander Schultz: [00:13:27] I would be remiss if I let you go before I give you an opportunity to talk to, maybe people who are at their lowest. So when they think about Russell Bishop's Five Steps and they think about the best outcome, you know, these are people and we have lots of them, unfortunately now in this country that have lost their job. Have lost their income. That have, you know, zero or negative in their bank account and are staring at, you know, a government that is either slow to act or is having trouble acting. We're not at necessarily a high point politically in this country. And so they might be nervous about if help is ever coming or how it's going to come.
What would you say to people who are having even trouble seeing the light at the end of the tunnel, even using Russell Bishop's five steps - to those people who are really, really struggling at this moment.
Mark Goulston: [00:14:10] I'll tell you something we all have control over. We have hope. Internet. Many people don't, unfortunately, but you can reach out to the internet.
You can go to Google and find any particular group that's concerned with anything. Out of work / furlowed / terminated. Reach out to them.
Now, a lot of people say, I don't want to share other people's problems, but what happens is. As you reach out to them and as you even just read what other people are going through and you share what you're going through, you create, again, this massive oxytocin thing.
I'm the suicides specialist, and a year ago on Twitter, and I have over 500,000 Twitter followers, but I've permanently pinned at the top of my Twitter feed @MarkGoulston, I say "Do you know of anyone in your community who died by suicide?" And almost everyone does. And it has 2.7 million impressions. And the number of comments is huge. And people are just listing and listing all the people they know who have killed themselves. And it is, you might think, "how depressing". Well, the point is, if I'm going in your family. Well, if you made an attempt, you're suddenly part of a fraternity or sorority that you never wanted to be a part of. And so I can see how some people who just want to stay away from it, but I can tell you it's say that tween has saved lives because people reach out.
Xander Schultz: [00:15:40] I've definitely found that. Sure. You're familiar a little bit with, you know, my own past trauma. I have a hard time sometimes explaining the gratitude I have for the lived experience of having my father murdered.
I'm not grateful my father was murdered. I'm still struggling to find the words, but that shared trauma has allowed me to connect with so many people, people who didn't necessarily have my exact type of trauma too, but it's really helped me be a better person and a better bridge and a better connector and comforter for so many. So I've certainly found that to be true.
And I'm lucky in some ways that because our loss was so public, it was kind of a forcing mechanism in terms of people know to come to me. And talk to me about what they're going through just because it was so public, what I went through. And vice versa. People knew to reach out to me to help me through that time as well.
And so I'm both grateful for that attribute of the loss and for the public profile of it in so many ways.
Mark Goulston: [00:16:41] I know I can understand. And so what I hope our listeners will get from this is the natural response is to want to withdrawal. And I think we have to resist that. And the reason for that is when we withdraw, we become prey to our own imaginations.
Like I'm a, I'm an introvert. My natural response is to shy away from things. And here's a bit of humor - I'm a founding member of the dread going, but glad I went club.
Meaning, it's like "Why did I say yes? Why do I have to do this." And then I just say to myself, "Just Go!". And I think a lot of introverts have that problem, but in this age now, the Coronavirus Crisis, I think there's a collective decide almost freeze in place.
And again, we guard our calendars. Put that hour in your calendar and just try for week. And if you listened to this interview, try it for a week and come back to it and share your comments. Once you've discovered any surprises and you can even complain, it made me feel worse. We'll listen to anything, but just put that on your calendar and do it.
Xander Schultz: [00:17:53] Well, super appreciative for your time today, Mark, and, and sharing that wisdom.
I really hope it's, it's helpful for a lot of people. I know it will be for me. Before you go, what are you most excited about in your world? What are you up to that you're, you're fired up about and how can we participate?
Mark Goulston: [00:18:09] Well, well, I guess what I'm fired up about is, you know, for many years I've had, at least in America, I've had what the world needed, but I didn't want.
Yeah. My book "Just Listen" has done very well. And I've spoken in overseas and they seem to be more open to listening overseas in the metal here.
Xander Schultz: [00:18:32] We're all influencers over here. We're all output,
Mark Goulston: [00:18:36] All output. You're right.
And so what's happened is the world is realizing that they don't just need to connect with each other. They have to. Because if we, because if we pull away from each other and we're praying to our imagination, we're just going to feel worse. So, I guess what I'm excited about is that the world is starting to discover that connecting with each other really matters, may be civilization saving and you know, and may actually be as, or more, valuable than what you have and what you're doing.
Xander Schultz: [00:19:14] Well that that certainly is making me feel better, and I think a lot of us have that hope that, that somehow through this shared experience and through this forcing mechanism, that's for so many of us to stop in our tracks. We're going to meditate on this collectively and, and come out with some better systems and some better processes both internally, and, you know, as, as societies"
Mark. So great to hear from you, man. Love you, bro. Stay safe out there.
Mark Goulston: [00:19:42] Love you too
Xander Schultz: [00:20:00] Alright, take care