When it comes to high-stakes endeavors, few are as fraught as brain surgery. One false move, and you can forever alter someone s life. That s why my guest has spent his life studying how to master fear and enhance performance, and gain insights that can help anyone do likewise in every area of their life. His name is Dr. Mark McLaughlin, and he s a wrestling coach, a lecturer at West Point, and a practicing neurosurgeon. He s also the author of Cognitive Dominance: A Brain Surgeon s Quest to OutThink Fear.
00:01:49.200So how did a neurosurgeon end up exploring the topic of extreme fear?
00:01:54.060Well, I think we all have episodes in our life of extreme fear, and I guess each of us perceive
00:02:02.460it and experience it in a different way.
00:02:05.080For me, I think it came as I was a young neurosurgeon because I care a lot about my patients, and that's
00:02:17.320something that's very hard to balance because in order to be a good doctor and a good surgeon, you have to be objective, and you can't lose your objectivity,
00:02:27.960certainly when you're in the operating room and you're in dangerous situations.
00:02:32.020And so it's a very hard thing to balance.
00:02:36.620I think, you know, obviously caring a lot makes a great doctor, but it can also get in the way of you making important decisions and, you know, dealing with emergency situations.
00:02:48.360So for me, that's kind of where it started.
00:02:52.060I kept struggling with how can I really, really care about this person and yet dispassionately make the decisions that I need to make as things unfold and particularly when things might potentially go wrong.
00:03:06.160And that's really when I started thinking a lot about fear and how I could put it in its appropriate place because you need a certain amount of it to perform, but too much is paralyzing and too little doesn't get you to rise to the occasion.
00:03:24.020Well, yeah, you call this paralyzing, like thinking about being freaked out.
00:03:28.280You call it the fear of freak out, and you kind of break down what are the elements of the fear of freak out.
00:03:33.000But for you, what are those elements when you, you know, you're about to do a surgery that's a real big deal.
00:03:38.860For you, it was doing surgery on kids.
00:03:40.820That's the thing that kind of sort of triggered it.
00:03:42.860So what are those elements of the fear of freak out?
00:03:45.980So if you are experiencing or you're practicing avoidance behaviors, escapism behaviors, if you're engaging in poor coping strategies, if you're reverting to your lesser self, then you are in the fear freak out.
00:04:02.580That's when, you know, it's some form of the fight or flight response.
00:04:07.680So it's important for you to be able to identify that in your own, in anyone's behaviors.
00:04:12.000For me, it was, why do I keep trying to not think about this problem or put it off or, you know, distract myself from thinking about the problem that's really bothering me?
00:04:22.340Because once I start really putting my efforts towards what's bothering me and I think it through, my anxiety level goes down.
00:04:30.420So that's the, that's the thing you need to focus on before you get to the fear of freak out.
00:04:35.560The fear of freak out is obviously the extreme case when you literally, you just decompensate, you know, instead of, you know, making the phone call to your sick brother who just got a bad diagnosis, you avoid it.
00:04:52.900So that's, that's the fear of freak out experience that we all have in certain ways for me, you know, and one of my surgeries that I talk about in the book was a, was a young girl that had profuse bleeding.
00:05:05.640And my initial reaction was to move and pull the endoscope away from the bleeding, which is the exact worst thing you could do.
00:05:14.900You need to keep the endoscope focused on the bleeding so that the blood can come out through the endoscope tube and not press on the brain.
00:05:21.980So it's, it's really identifying your, your fight or flight response and then putting a governor on it and really thinking it through.
00:05:31.200In this governor, you call it the, you call it cognitive dominance.
00:05:33.840When did you first hear about this idea of cognitive dominance?
00:05:36.440And we'll get into it a little bit more in our conversation, but big picture, what are the elements of cognitive dominance?
00:05:42.160Yeah, I first heard cognitive dominance when I was giving some talks up at West Point for a class in human performance at the Center for Enhanced Performance, which is headed up by Dr. Nate Zinser.
00:05:54.300And I was asked to speak to the cadets and I go there annually and we talk about, you know, what are the key performance indicators that help us in performing at our best and what impedes our performance.
00:06:07.920And as I was telling some of my stories, one of the cadets stood up and said, you know, that sounds a lot like cognitive dominance.
00:06:16.080I, I had never heard the term before and he defined it for me and he said, it's enhanced situational awareness that facilitates rapid and accurate decision-making under stressful conditions with limited decision-making time.
00:06:30.780And to them, it was a military term and it's defined as such, but I thought to myself, wow, that's more than just a military thinking, that's medicine.
00:06:43.400And it's also like being a parent and being a husband and living a life and making decisions when you have limited amounts of time and they're important decisions and you need to chart your course in life.
00:06:54.300So I thought, wow, that's, I need to know more about this.
00:06:58.580How do I get this cognitive dominance thing and, and, you know, what keeps me from being cognitively dominant?
00:07:05.380And that's when I sort of began my search.
00:07:07.800I had been studying human performance for years, but this really crystallized my thoughts and it helped me start shaping the narrative of my book.
00:07:17.740And a big part of gaining cognitive dominance is understanding fear and our response to fear.
00:07:24.600And you spend a lot of time in the book going through this and you get into details with it, but like big picture, like what, what is fear?
00:07:31.840Like when you ask people, how do you define fear?
00:07:54.540It's what Rudyard Kipling wrote in the poem, if, you know, meeting triumph and disaster and treating those two imposters just the same.
00:08:04.300So it's, it's on the big picture, it's really training your mind and your body to react in the way that it was best trained to react over time to the elements, you know, outside of our control.
00:08:21.840So that leads me more into the fear side of things.
00:08:24.780So fear is what we experience when something unexpected comes our way.
00:08:30.560You know, we're all living in the world, we're doing our things, we're trying to achieve the goals that we, that we have set out to, to achieve.
00:08:38.440And we're, we're sort of, we have like sort of a map of where we want to go.
00:08:42.420And we begin to experience fear when something doesn't go right on our path from where we are to where we think we should be.
00:08:50.760And that's when this, this unexpected event comes in and we begin to experience fear and it can be identified as anything from mild anxiety or discomfort or a little uneasiness to, you know, full blown mortification or paralysis of what to do, depending on the level of the unexpected event.
00:09:13.920And so fear comes in a variety of shades, but it's all really the same mechanism and it's the same apparatus in your brain that's receiving it.
00:09:26.880There's internally dominant fear and externally dominant fear.
00:09:30.340What's the difference between the two?
00:09:32.180Internally dominant fear are the demons that we, we conjure up in our own mind.
00:09:38.160You know, I love the story about, you know, caveman walks into cave and draws a picture of a tiger and looks at the picture and scares himself and runs out of the cave, you know?
00:09:49.180And it's one of those, wow, the guy's a fool, isn't he?
00:09:53.020But isn't that what we all do in our minds every day when we start thinking up terrible things that might happen or bad events that, you know, could potentially occur?
00:10:02.800So that's like an internally dominant fear state that we have to be careful of.
00:10:07.420And then externally dominant fear states are, you know, are real threats to us, whether that's a threat to our job, you know, when a new person comes in and maybe it's been given the title that you have.
00:10:19.860And now you're looking at a potential, you know, competitor.
00:10:24.000It's an externally, you know, physical threat that you might have when you're walking down the street and you notice that somebody's following you.
00:10:30.360So that's important to distinguish these types of threats because they trigger different strengths of fear in our brain.
00:10:40.060And then related to this, you know, idea of externally and internally dominated fear is you make the case that in order to figure out what it is you're dealing with, what's this unexpected thing you're dealing with, is to make a distinction between object and subject.
00:10:53.300So this is where you get philosophical and you, I think you, I think you majored in philosophy before you became a neurosurgeon.
00:11:00.020So why, why is the distinction between object and subject important in trying to figure out, suss out our fear?
00:11:06.080Sure. So I learned this from Jordan Peterson, who, you know, I was very influenced by his book, Maps of Meaning, and also his subsequent books.
00:11:16.360And one of the things I learned from his, his teachings is that he talks about there's being two ways to look at the world, look at the world as a place of objects and look at the world as a place to act.
00:11:28.840And when we live in a place to act, that's something that's laid out in stories, we are encoded to devour and to digest stories at all times in our life, even when we were little kids, all the way till now.
00:11:44.320That's how we remember things is through stories and stories are sort of a, they're like a mini map of the world and they teach us, you know, ways to act in this world.
00:11:54.400And so as I began to try to analyze and break down fear into its molecules, into its really molecular components, I thought that's the first thing we need to split fear into what's the objective part of it and what's the subjective part of it.
00:12:12.680So the objective part is, you know, what are the specific identifiable features that everyone can agree on, whether that's, you know, there's, you know, a tiger that's gotten loose at the zoo.
00:12:25.400And that's a physical objective threat that everyone is in danger for, as opposed to a subjective threat, which is, let's say, you know, somebody broke out a peanut butter sandwich in the cafeteria and you happen to be, have a peanut allergy.
00:12:42.740That's something that's, that's specific for you.
00:12:46.160That's something that is related to you.
00:12:48.580Peanut butter is something that's dangerous to you, but it's not dangerous to other people.
00:12:52.700So once we understand what's an objective threat and what's a subjective threat, we can begin to sort of start thinking about how to act when we're faced with something that induces fear.
00:13:04.640And you face this all the time with your work as a neurosurgeon.
00:13:08.020You actually walk through, there's moments where you, you experience fear and you kind of do this quickly in your head.
00:13:13.880It's like, okay, what's the story that I'm telling myself?
00:14:27.880Get as many perspectives as possible because that's going to help you solve the problem.
00:14:33.880And then stabilize, which is the S in I-Rise.
00:14:38.200And that's act, you know, try and buy some time, act with the lowest possible cost.
00:14:44.100In medicine, we'd say that first do no harm.
00:14:46.300So that means like, think about it, stabilize, buy some time if you can, think about it overnight, if it's possible, if it's not an emergency.
00:14:54.940And then lastly, reevaluate and really try to think laterally, try and come up with alternative solutions to the problem.
00:15:02.740So that's, you know, one technique that, that I use to kind of deal with an unexpected event.
00:15:08.520Well, going back, you mentioned this, this idea of brain 1.0, brain 2.0.
00:15:13.340I want to explore this idea of fear more.
00:15:15.060It helped, because I think it was really useful for me to, because it helps you, it's sort of a metacognition.
00:15:20.460It helps you understand what's going on in your brain so you can start manipulating what you're thinking about.
00:15:24.500And you talk about how, what goes on in our brain when we experience fear.
00:15:29.320And you make this very simplified version of what's going on.
00:15:33.160And I guess it's first you said there's a, there's a brain 1.0 and there's a brain 2.0 that this unexpected event gets filtered through.
00:15:58.200And, you know, he talks about how we make quick decisions with one system, system 1.0.
00:16:03.560And then we, we make more iterative, careful, and deliberate decisions with a system 2.0.
00:16:09.860And I think that's a really great model to think about how fear lands in our brain as well.
00:16:15.580Brain 1.0 is the more primitive part of our brain, the amygdalo-hippocampal area, the medial temporal region of your brain, which has been ingrained to, you know, recognize snakes and to recognize danger and, you know, height and being near the edge of a cliff.
00:16:33.420Like, you know, even infants have a fear of heights.
00:16:36.500So that's the ingrained, encoded system that's helped us survive for thousands and thousands of years.
00:16:42.900And it works great for imminent bodily threats, external forces that can harm us, but it doesn't function well in the operating room.
00:16:51.880It doesn't function well in the boardroom or when you're, you know, in a family crisis.
00:16:58.140So the brain 2.0 is the frontal lobes, the prefrontal lobes, the lobes of your brain that are thinking about future actions and consequences of your actions.
00:17:07.720And how can this fit in a bigger picture?
00:17:11.240So one layer of thinking about this is that there's this brain 1.0, which is the guardian, that's going to warn you of bodily threats.
00:17:17.980But you need to watch out because it can overly turn on your reaction to something that's going to be detrimental.
00:17:25.040And you need brain 2.0 to think through that and be more iterative and deliberate.
00:17:29.600And then the other way to think about it also, and I talk about this in the book, is, you know, we have two hemispheres and there's a reason for that.
00:17:37.900You know, generally, the left hemisphere is more logical and language and mathematical-based.
00:17:45.100And the right hemisphere is more story-based.
00:17:49.660It picks up facial expressions better.
00:17:52.660It can understand the physicality of an event that your left brain doesn't pick up.
00:17:59.440And we need to sort of toggle between those two hemispheres as well.
00:18:04.320Take in the immediate right hemispheric big picture, but also utilize your left hemisphere to be logical.
00:18:11.500And that's really what leads me into graphing unexpected events.
00:18:16.240So, what I talk about is, you know, we can take an unexpected event and we can literally break it down into its components on an X and a Y axis.
00:18:26.880And that's a really helpful, it's been a really helpful method for me to really dissect and come up with solutions to complex problems.
00:18:36.220So, basically, you draw an X and a Y axis.
00:18:39.400And the X axis is kind of like your left brain.
00:18:42.820It's also the objective part of your brain.
00:18:46.240So, that's the, you know, how we deal with the world as a place of objects, the X axis.
00:18:52.120And the Y axis, that's more your right brain.
00:18:55.520That's more of how to act in the world.
00:18:59.000So, that's the subjective component of your world.
00:19:02.740And if you can think about the world and these unexpected events in those two axes,
00:19:08.440you can literally plot an event out and it can put you into a quadrant, which will help you know where you're at and how you need to proceed.
00:19:17.740Okay, I want to get into these quadrants.
00:19:30.240And then, brain 2.0 needs to come in and kind of step in and say, well, do you really need to do what that initial response you want to do?
00:19:39.720So, I guess, going back to that example you talked about, you had that surgery on that girl.
00:19:44.100She had a lot of bleeding in her brain.
00:19:46.360You had a brain 1.0 response was, I got to pull this thing out because I got to protect myself.
00:21:15.140And that's really where, you know, we all are subject to that.
00:21:19.400No matter how many times I try to adopt the stoic philosophy of just focusing on myself, my character and my virtue, you know,
00:21:28.260a nasty email comes across or a patient complaint comes in and, and I'm, I'm hurt by it or I'm, I'm upset by it.
00:21:34.440And I have to, you know, reach back into my mind and, and, and talk, talk to myself out of that and say, listen, you know what, did you do your best?
00:21:44.660Did everything work out the way it was supposed to?
00:21:46.660No, sometimes you can do everything right and some things still go wrong.
00:21:52.040And that's the job you chose now own it.
00:21:56.920And similarly, I think that, as you say, this social rejection with, you know, not getting likes on your social media or being ghosted or all the terrible things that are happening on social media is we need to, you know, train brain 2.0 to become stronger, to provide the input, to suppress that brain 1.0.
00:22:20.600Oh my gosh, none of my patients like me.
00:22:23.240Oh my gosh, you know, I'm a social outcast.
00:22:26.920So it's, it's, it's the first step is recognizing it, not knowing about that inner critic that's going to come out and, and then figuring out a way to gradually train.
00:22:37.400You can, you can literally rewire your brain by thinking different thoughts, by reading different philosophies.
00:22:44.780I'm a big fan of the stoic philosophy and, you know, I'm, I'm a Ryan holiday fan.
00:22:51.880And I think it's a, it's a great way to train your mind to be not reactive, to be more thoughtful, to be more focused on what you can control, what's within your sphere of control.
00:23:10.320Brain 2.0 needs to come in and say, okay, wait a minute.
00:23:12.780That initial response you have, probably not the right one.
00:23:16.540And so the next phase that you recommend doing is again, putting, you know, sort of mapping this experience, this unexpected event in one of these four quadrants that we've just talked about, this X, Y axis.
00:23:59.880I have a super great pathway to where I need to go.
00:24:04.040Everything that I reviewed on the MRI scan is exactly what I'm seeing.
00:24:07.720I'm able to move the blood vessel away from the nerve that's causing the pain.
00:24:13.480And I know that that motion is going to relieve this patient's pain and everything just clicks perfectly.
00:24:21.080And we close and I'm just in, you know, on a runner's high basically.
00:24:25.000And we all know that quadrant that's, that's the flow quadrant.
00:24:28.340That's when things objectively are going well.
00:24:31.420That means everything that you planned is happening, is happening in a logical fashion.
00:24:36.040And subjectively I'm fulfilling my life mission to be the best doctor I can be.
00:24:42.540So that's a positive on the objective and a positive on the subjective that puts me in the upper right hand quadrant, which I call flow.
00:24:51.680And we've all experienced it in many different ways.
00:24:55.900And that's when, you know, the world is in sync and it just feels wonderful.
00:25:01.360Then sometimes we have something that's objectively positive that happens in our lives, but subjectively it turns out to be something negative.
00:25:11.060Like you get a job promotion and so you got, you know, a raise and you've got more status, but then you find out your boss is toxic and it's going to be a miserable experience in this new position.
00:25:25.700So that's when something objectively is positive, right?
00:25:28.560You got a raise, you have a higher status, but subjectively, you know, having a peaceful day at work and achieving what you set your life goal to be doing at work is going to be impeded by this toxic boss.
00:25:42.500So that's going to put you in the lower right-hand quadrant, the quadrant, which I call the calm before the storm.
00:25:48.700That means you're going along and you're doing what you're doing, but you know, something bad is probably going to happen, or you're going to need to change to get out of that uncomfortable state.
00:26:00.280Then sometimes we deal with something that's an unexpected event.
00:26:04.160That's not only objectively negative, but it's also subjectively negative.
00:26:08.920So that's terrible experiences that we have.
00:26:12.200That's when a young patient that I operated on passes away, or I see a trauma that comes to the hospital and I do everything I can to save them and they die.
00:26:23.900I've got to go out and I've got to go talk to this family and tell them what just happened.
00:26:29.180It's a terrible, terrible experience for the family.
00:26:41.240Yet, you know, I know that that's something that I have to do and I'm going to go out and I'm going to do the very best job I can in telling them what happened and how it happened.
00:26:51.880And knowing that that conversation I have with that family is going to be something that they remember for the rest of their lives.
00:27:00.220And there's sometimes there's no way out of the all, all is lost quadrant.
00:27:05.620That's the lower left-hand quadrant, but usually over time, you can climb your way out of it.
00:27:12.040And that will lead you to the upper left-hand quadrant, which is the birthing a new skill set quadrant or the resiliency quadrant.
00:27:19.780And that's where something, an unexpected event occurs in our lives that's negative.
00:27:24.880Yet, subjectively, it turns out to be something positive, like you lose your job, but then you get a chance to write the book you always wanted to write.
00:27:34.900Something like J.K. Rowling had an opportunity to do when she was unemployed and trying to figure out what she wanted to do with her life.
00:30:00.400In the case of a toxic boss, it might be, all right, I'm not going to burn the ships right now, but I better get my CV in order,
00:30:09.120and I better start putting some feelers out to have some options, because this is not going to be a good long-term solution for me.
00:30:16.460The second you start making that movement up the y-axis, you're going to feel better, and it's going to be, it's sort of like a positive feedback loop.
00:30:26.020You're going to start moving more and more back up into the birthing and new skill set and resilience quadrant and into the flow.
00:30:33.460And, you know, you can't always live in flow.
00:30:40.360It's important that we experience all of these quadrants.
00:30:43.800It's part of the hero's journey, and that's how we get to a new level, and we keep getting better and better.
00:30:49.640A lot of times, it's this clockwise fashion.
00:30:53.120We move from flow to calm before the storm to all is lost to birthing a new skill set.
00:30:58.520Sometimes it's a lateral jump from one to another, but that's the process of life and getting better.
00:31:06.520Yeah, I thought it was interesting how you mapped on the hero's quest through these different quadrants.
00:31:10.180I thought that was a really incisive insight.
00:31:12.940Yeah, recognizing that is really important.
00:31:16.240So, you know, I tell the book centers around, and you know this, the centers around a story about a young boy, Anthony, who I operated on when he was eight years old.
00:31:27.920And although the surgery went perfectly, Anthony suffered many, many complications and side effects of his surgery and his treatments and of his disease.
00:31:40.460And, you know, even though initially I was in flow, his surgery went perfectly.
00:35:27.860And so, um, I think it's, it's certainly studying, studying the West Point cadets and the military
00:35:34.940philosophy, reading a stoic literature poetry.
00:35:38.600I always have tell the cadets that poetry is the world's first performance enhancement literature.
00:35:43.920So by reading poetry poems, like if an Invictus, you know, do not go gentle into the night.
00:35:51.600Those, those poems are, they're a primal words that land deep in your brain and can help you in difficult times.
00:36:03.940So it's something you train, you train for just like going to the weight room and getting stronger before you, uh, go to wrestling practice or whatever sport you play.
00:36:12.960You have to train your brain to do that with, uh, with reading.
00:36:17.640And, you know, I would hope that cognitive dominance is a little bit of a, uh, a handbook for people.
00:36:23.840Uh, it's, it's certainly just scratches the surface about the concept, but I think it's, uh, I'm very proud of it.
00:36:31.340And I think it's the first step to, to understanding the capacity that we all have, which is really unlimited.
00:36:38.480It's unlimited if we can really tame these demons and, and, and cope with fear in the right way.
00:36:44.960One thing you talk, we've been talking about unknown events that pop up in our life, but then you also talk about at the very end,
00:36:51.720sometimes we have in our life, these known unknowns and the big one that hit home close to you.