Dr. Mark Goulston On How A Death and Dying Specialist Confronts His Own Mortality

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…For the first time, I’m allowing people to care for me. I’ve always been the caregiver. It’s been a revelation. When people ask how I’m doing and I open up about my struggles, it creates an intense bond. These raw, honest emotional moments draw people in. When I apologize for getting emotional, most tell me it’s the most genuine and intimate conversation they’ve had in years. Some even express envy at my ability to be so open in ways that they have never been able to. Many, usually hard to reach, have told me to call anytime, an offer that still stands when at times my health might be improving temporarily…

I had the pleasure to talk to Dr. Mark Goulston. Dr. Goulston is an esteemed American psychiatrist, executive coach, and consultant renowned for his association with various Fortune 500 companies, universities, and organizations. He is credited with the development of “Surgical Empathy”, a distinctive process that employs targeted empathy to assist individuals in overcoming internal emotional hurdles, thereby enhancing their overall well-being. He hosts the highly ranked podcast, “My Wakeup Call,” and the weekly radio show, “Hurt Less, Live More,” on UK Health Radio.

Born in Boston, MA, Mark was the son of Irving, a professional who had an impressive career progression at United Liquors, and Ruth, a shop owner and homemaker. Demonstrating early academic prowess, he skipped a grade and graduated ahead of his peers from Newton South High School. His academic journey led him to the University of Vermont, followed by a transfer to the University of California, Berkeley. Afterward, he pursued graduate studies in Zoology at the University of Massachusetts, Amherst and then medical studies at Boston University School of Medicine (BUSM).

Mark’s commitment to mental health was evident early on, as he took a three-month medical student elective at the Menninger Psychiatric Clinic in Topeka, Kansas, focusing on schizophrenia in young men and women farmers. After completing his MD in 1976, he underwent internship at Harbor General Hospital in California and psychiatric residency at UCLA’s Neuropsychiatric Institute. He then spent over two decades as an assistant clinical professor of psychiatry at UCLA.

Professionally, Mark initiated a private practice concentrating on severe areas like suicide and end-of-life matters, even conducting house calls. This experience later paved the way for his roles as a consultant, speaker, trainer, and coach for global companies and organizations. He has been featured in and contributed to various prominent media outlets, and co-hosted radio shows. He has also been involved with organizations such as HealthCorps, American Women Veterans, Heartfelt Leadership, Marshall Goldsmith’s 100 Coaches and is the co-founder of the Deeper Coaching Institute, a Division of On Global Leadership

His passion for education led him to co-develop The Exam Performance Program, an eLearning initiative designed to bolster student performance. Additionally, Mark held pivotal roles in organizations such as China Foundations, Alchemy, and his own venture, the Goulston Group. He has even delved into theater, penning and performing a one-man show entitled, “Steve Jobs Returns,” playing Steve Jobs after he returned to Apple in 1996 up until he introduced the iPhone in 2007 later hosting a weekly podcast titled “Prison Letters with Dr. Mark Goulston’’.

Mark’s international impact was felt when he traveled to Moscow, where his book, “Just Listen”, had its Russian edition titled “I Hear You Through and Through”. This visit culminated in an article in the Russian business publication, RBC, which garnered significant attention. He continued to extend his influence with other ventures including the launch of @wmystglobal, a global initiative to combat societal disconnection, after his TEDx talk, “What Made You Smile Today?”

A notable contribution to the field of mental health was Mark’s involvement in the documentary “Stay Alive: An Intimate Conversation about Suicide Prevention” and “What I Wish My Parents Knew,” where teens talk about their lowest points that the couldn’t talk to their parents about and where he served as an Executive Producer. Furthermore, his book, “Just Listen”, became a significant success, being recognized in multiple countries and forming the foundation for a PBS special.

Throughout his illustrious career, Mark has authored and co-authored several books, each delving into various facets of interpersonal relationships, work dynamics, and mental health. With his dedication and efforts, Dr. Goulston stands as a beacon in the realms of psychiatry, coaching, and consultation.

Yitzi: Mark, thank you so much for joining us. It’s really an honor. Before we dive in, our readers would love to learn about your personal origin story and your background. Can you share with us the story of your childhood and how you grew up?

Mark: I grew up in a middle-class family outside of Boston, Massachusetts. My childhood wasn’t the happiest, possibly because my father was always concerned about whether he could provide for our family. His anxiety often manifested as criticism. He passed away in 1995. Now that I understand his fears and worries, I’ve reframed that criticism as his being anxious and worried, two emotions I have experienced frequently in providing for my family. It also made me curious about the underlying issues in relationships. I often wondered, if we love each other, why are we unhappy?

When I went to medical school, I dropped out twice but eventually finished. I don’t know anyone else who has done that. The first time I left was due to depression and confusion, and the school gave me a year off. During that break, I worked blue-collar jobs, which I still look back on fondly. It was a great experience meeting and serving everyday folks. However, when I returned six months later, my depression returned and was even more intense.

The dean of the school, whose primary concern appeared to be fundraising, met with me. He then sent a letter to the dean of students, who was more concerned about student welfare. From what I understand, the head of the school wanted to expel me, because every time someone took a leave of absence the school would lose matching funds from the government. In other words, whenever a medical student’s place went empty it would cost the school . To his credit, he was also likely concerned about my well-being and didn’t want me to harm myself. That’s why he referred me to the dean of students.

The dean of students showed me the letter from the main dean. It recommended that I consider an alternate career and suggested that I withdraw from the school, even though I was still passing. I felt devastated and asked the dean of students what it all meant. He told me I’d been expelled.

That moment was when I truly understood the power of true, raw and open vulnerability. When he delivered the news, I felt as if I’d been physically struck. It reminded me of the time I nearly died from a perforated colon about two decades ago. Tears streamed down my face, which was an unfamiliar feeling for me, given my background with a Depression-era father who did his best, had his own issues and didn’t show his underlying fears.

The dean then shared with me a trifecta of hope, a message I’ve since shared with my patients for over 35 years, with none of them taking their own lives. He told me, “You didn’t mess up since you’re passing, but you are in a mess. If you sort yourself out, I believe we’d be glad we gave you another shot.” He went on, “Even if you don’t get your act together, even if you never become a doctor or achieve anything significant, I’d be proud to know you.” That was the first pillar of hope — unconditional love, unwavering positive regard and a belief in me. That was a revelation for me.

Trying to make sense of his words, I recalled a poem I’d written during my first leave and sent to him. It was published in the Journal of Geriatric Psychiatry. The poem, titled “Lament for the Old,” focused on my interactions with elderly individuals when I was 25. Considering I’m now 75, it’s intriguing to think back on it.

Seeing my emotional state, the dean shared the second pillar of hope by telling me he saw a future for me that I didn’t see. He pointed at me and said, “But you have to make it to 35,” asserting, “You deserve to be on this planet.”

And then the third aspect of hope was , his saying, “Look at me. You’re going to let me help you.” If he had simply said, “Give me a call if I can help you,” for a variety of reasons, I might not have called him. There’s a good chance I wouldn’t be here today. So, there’s unconditional love and positive regard, a vision of a hopeful future for me, and his advocacy for me against the medical school and the dean when he was just a PhD.

That resonated with me and I internalized it. During my second leave of absence, I went to the Menninger Foundation in Houston, although it used to be in Topeka. Surprisingly, I was able to connect with young schizophrenic men and women from farms. I grew up in a suburb and knew nothing about farms in Topeka. I remember asking attending psychiatrists there if this was legitimate, unlike medical school. They responded, “It’s legitimate, and you might have a gift.” Me, a two-time dropout?

I held onto that thought and decided I’d become a psychiatrist. Even now, psychiatry faces stigma, even within the medical profession. But with this newfound passion, I completed medical school and trained in psychiatry at UCLA. One of my mentors there was a leading figure in suicide prevention, and he would refer suicidal patients to me.

I realized I needed to pass on the trifecta of hope I’d been given. I learned to deeply look into people’s eyes. I noticed when I was just checking boxes , some of those struggling would feel I wasn’t genuinely there for them. So, I learned to truly connect, listening emotionally into their eyes and diving deep into their despair. I prioritized their needs over strict protocols and paperwork. This mentor also had me make house calls to help terminally ill patients find peace at the end of their lives. Some were affluent and influential, but many faced personal turmoil. One, publicly adored for his humor, told me, “I’ve had all the love money can buy, and that’s only what it’s worth. What I thought mattered doesn’t, and what I dismissed does matter. I’ve run out of time to fix that.”

Yitzi: Can you tell us a bit about your career as a psychiatrist?

Mark: I’ve always been keenly observant, noticing the underlying issues that many overlook. For instance, I specialized in suicide prevention for many years, and thankfully, none of my patients took their own lives during that period. A core belief of mine is the importance of keeping things “deep and simple” rather than “shallow and complex.” When I encountered suicidal patients, I realized they were in such a state because they couldn’t escape their immense psychological suffering and hurt. Imagine enduring a physical condition, like kidney stones, that’s so painful you’d rather die. That’s how these patients felt mentally.

My approach was to alleviate some of that hurt and suffering they couldn’t live with, turning it into pain they could live with. Also when people transition from unendurable suffering to tolerable pain, hope begins to emerge. I would figuratively accompany them during their darkest moments, ensuring they didn’t feel isolated. When they realized someone was there with them helping them to “feel felt” and safe, they often expressed their suffering through tears and could let some of it go.

I’ve given many talks on suicide prevention. While factors like depression, job loss, or the breakdown of a marriage can contribute to suicidal tendencies, many people experience these issues without becoming suicidal. However, I found that most suicidal individuals feel a profound sense of despair. If you break down the word “despair” into Des-pair, it represents feeling unpaired with reasons to live: hopelessness, helplessness, powerlessness, uselessness, meaninglessness, purposelessness. But by pairing with them in their despair, making them feel understood and less alone, it often brought them back from the brink.

Yitzi: Can you share what you are working on now?

Mark: Now, facing my own mortality, I’ve listened and learned for 50 years, and mostly kept my insights to myself because my patients were more interested in lessening their hurt and suffering than insight. My death and dying mentor wrote about “The Good Death.” I meet most of his criteria except perhaps living to 90; I’m currently 75. My health prognosis isn’t great due to my age, and I might need a bone marrow transplant. My hope is for minimal pain and suffering. I don’t want to burden my family. Thankfully, my children are self-sufficient, and I cherish seeing my grandchildren. I’m also ensuring the projects I creatively lead can continue without me. I love mentoring and am particularly invested in a few individuals and I’m also committed to launching them into their future — maybe that could include you Yitzi. I’m now sharing my experiences in youtube videos titled “I’m Dying to Tell You.”

For the first time, I’m allowing people to care for me. I’ve always been the caregiver. It’s been a revelation. When people ask how I’m doing and I open up about my struggles, it creates an intense bond. These raw, honest emotional moments draw people in. When I apologize for getting emotional, most tell me it’s the most genuine and intimate conversation they’ve had in years. Some even express envy at my ability to be so open in ways that they have never been able to. Many, usually hard to reach, have told me to call anytime, an offer that still stands when at times my health might be improving temporarily.

Yitzi: You mentioned that you are facing the possibility of dying. Would you like to share the story behind that

Mark: I was diagnosed with lymphoma about two and a half years ago, and that really shook me. I heard the words that none of us want to hear from our doctor: “I’d like to run a few more tests.” A CAT scan led to a PET scan, which revealed stage three lymphoma both above and below the diaphragm. That news was hard to digest. However, many people live with lymphoma for years. My original oncologist wasn’t sure how long I’d had it and advised waiting to treat it until symptoms manifested. I agreed, but then I developed an anemia that was resistant to treatment, including very costly injections. Thankfully, Medicare was a great help. Later, a bone marrow biopsy showed I had 10% monoblasts. To put it in perspective, 20% monoblast indicates acute myeloid leukemia, while under 5% is normal. I was diagnosed with high-risk myelodysplastic syndrome (MDS). Without treatment, the prognosis ranged from five months to a potential maximum of four years. A bone marrow transplant is the definitive treatment and could cure the illness. However, my hematologist was straightforward and said 20% of people my age die from the procedure, and there’s a 50% survival rate three years after it.

I felt a sense of calm when I identified what a good death meant to me. I’m fortunate to have a top-notch hematologist at Cedars Sinai Hospital in Los Angeles. I can’t emphasize enough the importance of having a medical team you trust and have confidence in. It took me time and effort to find this level of care, and I trust their decisions implicitly.

Yitzi: You seem so serene and calm. How do you do that when you know that you are facing your mortality?

Mark: What’s also given me peace is understanding and living by my true values. For me, kindness and personal sacrifice are at the top. These are followed by emotional connection, curiosity, being of service, the power of listening, generosity and taking personal responsibility for my actions. I’ve always tried to live in alignment with these values. I’ve witnessed people at the end of their lives regretting that they prioritized money and power over genuine connections. These individuals felt isolated and realized that their wealth couldn’t replace meaningful relationships or inner peace. I’m proud to say I’ve lived in harmony with my values. While I might have regrets about not taking more family trips or the like, my main concern was always their well-being and education. My wife reassured me that she’ll be financially okay, and that brought me great relief.

Knowing what a good death looks like to me and staying true to my values has given me peace. Facing the reality of my mortality, whether it comes sooner or a bit later, is a journey I’m navigating with these principles in mind.

I can remember one distinct time with my dad where I felt a genuine connection. It was a poignant moment when he was struggling with Alzheimer’s. He was having trouble putting on his slippers. When I tried to help, he told me to leave him alone. But after he managed to do it on his own, he looked up at me with such childlike pride, as if to say, “Look what I did.” These personal moments of emotional connection have contributed to my effectiveness as a suicide prevention specialist and also to life well lived.

Yitzi: Can you share a few of the insights you teach in your podcast?

Mark: One of my missions in life is to foster emotional connections among people.

Here’s a recent insight I’ve had: fathers and sons who don’t connect, especially if the father is highly successful. The father doesn’t like feeling awkward because it makes him feel powerless. This frustration often makes the son feel rejected, thinking, “He’s angry at me.” But in reality, it’s the father’s awkwardness and frustration at not knowing how to bridge the gap, leading to superficial or critical conversations. If you’re a parent or a teen or young adult, clarify with each other that in all likelihood your parents are not disappointed in you. They’re worried about you or disappointed for you because they can tell that some of your decisions are not going to fly in the world and they’re preventable. Sadly most teens and young adults feel compelled to learn these lessons on their own. I know I was one of those.

I’ve been working with a few families on this issue. I told a father and son duo I’m helping, “I’m determined to connect the two of you. I know you love each other deep down, but you’re emotional strangers, and it’s causing pain for both of you.”

Another realization I had is about the time I spend with my family. I make it a point to be home between 4 and 5:30 every day because that’s when my two daughters bring over my four grandchildren, all under 4.5 years. I’m not always up to date on the details of their lives, but I rush home just to be with them. Once, feeling left out during a family gathering, I acted out and complained in frustration. It was so pathetic, I only did it once. But I soon realized the importance of being present, not just physically, but emotionally. I now focus on showing my grandchildren utter delight whenever they glance my way. And this principle of “utter delight” can be applied outside the family too. For instance, genuinely thanking a waiter or waitress can make their day. When I meet my mentees, the first thing I do is show them this delight, emphasizing that my love for them is more important than our work together. And Yitsi, you have been an utter delight in taking the time to listen.

Yitzi: Thank you for this profound and delightful interview, Mark. I wish you many more years of good health and success

Dr. Mark Goulston On How A Death and Dying Specialist Confronts His Own Mortality was originally published in Authority Magazine on Medium, where people are continuing the conversation by highlighting and responding to this story.