Psychiatry 2013: Hometown Hero Mark Goulston, MD


Dr. Mark Goulston is the bestselling author or four books, including “Just Listen”: Discover the Secret to Getting Through to Absolutely Anyone (AMACOM). His expertise includes “getting through” to those in relationships, those holding hostages, even soldiers returning from war with post traumatic stress disorder (PTSD). Goulston has spent his life demonstrating the need to care about others, and he encourages others to do so as well. His work has changed lives across a broad spectrum of society. For this reason, he is a Hometown Hero.

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Mark Goulston honed his skills as a UCLA professor of psychiatry for more than 25 years, an FBI/police hostage negotiation trainer, and a clinical psychiatrist. He is a member of the International Leadership Association and has been a member of the National Association of Corporate Directors and the Worldwide Association of Business Coaches.

He is co-founder of Heartfelt Leadership (Missions: Daring to Care and Go Positive Now) and the Resident Big Brother at Business Women Rising. He serves on the Board of Advisers of American Women Veterans and Dr. Oz’s foundation, Health Corps.

Dr. Goulston was selected as one of the America’s Top Psychiatrists for 2004, 2005, 2009, and 2011 by Consumers’ Research Council of America. He is a contributor to Psychology Today and Harvard Business Review. He lives in Santa Monica, California.

How did your own experience with depression affect your choice of psychiatry as your field of expertise?

After I hit a wall in medical school twice – I dropped out of medical school twice and finished – I knew what it was to feel hopeless, worthless, useless and helpless and then when our Dean of Students stepped in and believed in me when I didn’t, saw a future for me that I didn’t, and stood up for me when I couldn’t, something shifted in me.

It still didn’t crystallize until after I came back following a second non-consecutive leave of absence and I was a third year student on rounds at the Boston VA Hospital. The oncologist and surgeon and the Resident, Intern and Fellow were outside the hospital room of a veteran whom I will call “Mr. Smith.” They were debating what Mr. Smith needed. The oncologist said he needed more chemotherapy, the surgeon said he needed surgery, the fellow said that perhaps more tests were in order. At that point a nurse came over to our group and said, “Didn’t you hear? Mr. Smith jumped from the roof last night and he is in the morgue.” The group went quiet and I thought loudly to myself, “Maybe Mr. Smith needed something else.” I think that may have been the incident that turned the corner for me.

You honed your skills as an FBI hostage-negotiation trainer. In fact, you teach others how to “get through to anyone.” What makes the difference in a hostage survival situation?

If you are in a hostage negotiation situation and you are having a conversation, there is something that if the hostage taker hears it will (or may) cause them to connect with what you are saying or more specifically with how you are understanding them, and let go of the what they intended to do. The key is to get the hostage taker talking and keep them talking.

Without going into detail, one of the key components is to tell the hostage taker something such as: “This is much too important for me to miss even one word that you are saying, so what I heard you say was (repeat slowly exactly their words verbatim). Is that exactly what you said?” What this does is causes the other person to listen to you because you have said that what they said is important and you have asked them to listen to what you say. Listening is a much slower and calmer frame of mind than talking. By causing them to listen, you calm them down.

How can these same techniques/words be applied in everyday life?

There is a continuum in how another person feels when you are listening and talking to, and more importantly, with them. From worst to best, they can feel: presumed upon – judged – figured out – understood – “felt.” The more people feel presumed upon or judged the more they resist, push back and resent you. The more then feel figured out or understood, the more they nod from the neck up in agreement. But the more they “feel felt” by you, the more they will actually lean into it, feel less alone, feel relieved and relax. And the more open, as opposed to resistant, they will be to hearing what you have to say.

During the last decade, many soldiers have returned home from fighting in Iraq and Afghanistan with PTSD. Why do you feel so passionately about this cause?

Because while some of my high school friends were killed in Vietnam and are on the Vietnam War Memorial Wall, I was protesting the war in the 1960s. And while all of my children were safely and comfortably attending very nice universities, some of my friends have had children my children’s age killed in Iraq and Afghanistan. Even though I have had some issues with our going to war, I think it is noble to put yourself in harm’s way for others. And I cannot turn my back on or do nothing for the “all who gave some and the some who gave all” so that we can enjoy freedom.

What have you done that was instrumental in helping these soldiers, our veterans?

It’s been very frustrating. For several years I was partners with Lt. General Marty Steele (USMC retired) and Colonel Tom Tyrrell (USMC retired) trying to get funding for a highly effective transition program that 500+ Marines went through between 2006 and 2008. When the economic collapse hit in 2008, the private funding for that disappeared. After several years of near misses in getting that re-funded by military and governmental agencies who promised to do so, but in the end didn’t fund it, the three of us have gone on to do other things.

General Steele leads the Office of Military Partnerships at University of South Florida; Colonel Tyrrell has gone on to become Deputy Chief Administrative Officer for the Chicago Public Schools. I have gone on to co-found Heartfelt Leadership, a global community whose mission is Daring to Care by identifying, celebrating, developing, empowering and emboldening heartfelt leaders to come together, support each other and then go back to their regions and change the world.

Regarding veterans, I have developed a protocol for helping them completely recover from combat-related PTSD (including women suffering from military sexual trauma) that I believe will help repair the injuries to the core of these individuals from their inside out. It is built upon neuroscience and neuropsychology. I am currently trying to get this information to the military inasmuch as my view is that treatments which do not get to the core where the trauma goes, are not being as effective as they might be. So far the “not invented here” resistance has kept me out, but I am not giving up.

How are female veterans’ needs different from the men’s needs?

More female veterans have suffered from military sexual trauma than actual combat trauma, but the resistance by the military to address this has been significant. If men feel that being raped is less traumatic than combat wounds, let them be raped by other men and see what wounds that causes them.

The women’s needs and wounds are just as legitimate as those of the men, but the military still has a long way to go to treat them as such.

What more needs to be put in place?

I believe there needs to be a clear and unifying “moon mission” that will supply a universally agreed upon rising tide that will lift all hopes and lessen everyone’s only focusing on their turf, their program, their funding. Here was JFK’s: “I believe that this nation should commit itself to achieving the goal, before this decade is out, of landing a man on the moon and returning him safely to the earth.”

When JFK declared that, it caused people to let go of their petty egos and turf battles to build something historic. Such a mission must be clear, have a date, seem impossible at present but be so compelling and galvanizing that everyone cooperates to make it happen.

I’m no JFK and I would welcome others with better minds than mine to come up with a “moon mission” that we would all want to be part of. To get creative juices going, here’s my shot at it: “I believe that this nation should commit itself to achieving the goal, before this decade is out, that any man or woman who has sacrificed their time and well-being to protect this country, and who is of sound mind, body and will, shall have a seamless path to earning a livelihood upon their return and any man or woman who is not of sound mind or body shall receive the necessary treatments to live the remainder of their life being able to make a contribution and having the dignity that their sacrifices deserve.”

Recently, you’ve founded “Heartfelt Leadership” in an effort to bring more humanity into the workplace. How does psychiatry, your field, fit into this? 

Interestingly I have closed my psychiatric and psychotherapeutic practice after 30+ years to be a passionate advocate for psychosocial rehabilitation. That is because it has been my very good fortune to get to know the services of a mental health program focused on psychosocial rehabilitation called the Life Adjustment Team (LAT). For more than 35 years it has helped to greatly reduce the rate of relapse and re-hospitalizations of patients with severe psychiatric, drug and alcohol problems where the relapse rate within one year of hospitalization is over 80%. LAT has been able to reduce the rate by 80%. Their secret is to treat people where they live as opposed to treating them in offices. Because their relapse prevention rates have been so much higher than mine, I have closed my practice to focus on getting the word out about resources such as LAT. I believe they and other programs that treat people in vivo could greatly reduce many of the problems that veterans face.

Does the United States today have more problems with mental illness than in the past? If so, why? What needs to change?

I believe the United States does have a great deal more problems with mental illness than in the past. I think it’s because people appear more afraid of the mentally ill than in the past. That may be due to the media becoming more and more focused on violent incidents involving someone with a mental illness (“if it bleeds it leads”) and the masses generalizing about that. I also think it is because as a society, we appear to have become much less patient in our dealings with each other and impatience begets agitation even in mentally healthy individuals.

Along with the impatience comes a resistance to trying to understand other people, and feeling misunderstood or presumed upon can also be quite agitating. A part of the secret sauce of the previously mentioned LAT is that they take the time to really listen to and understand their clients (they don’t refer to them as patients) and you can see from the anecdote about hostage negotiation how that can be tremendously calming.

Leaders lead. What would you like to see our leaders doing and not doing to create “Heartfelt Leadership?”

We believe that gratitude inoculates the world against attitude. In our Heartfelt Leadership conferences, rather than giving the steps of leadership, we have leaders share stories of how, where and from whom they learned their values (including daring to care), how those values have helped them succeed, and how they have remained true to those values in the face of people who couldn’t care less. We also have attendees share a story of someone who stood up for them when they couldn’t, stood by them in a crisis and refused to let them fail, stood up to them to push them to do something they didn’t think they were capable of, and stood up to them to stop them from doing something foolish.

After people share these stories, the room is transformed. They then make a commitment to pay forward what was done to them onto someone in their organization and then to report back on the results. They also make a commitment to give a Power Thank You to the person or next of kin of the person they spoke about. This has three parts: 1. Tell them specifically and in detail what they did for them; 2. Acknowledge the effort it took for that person to do that; 3. Tell them what it personally meant to them.

The results have been astonishing.

Find Dr. Mark Goulston online at

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