in: Behavior, Character, Podcast

• Last updated: March 4, 2022

Podcast #757: How to Achieve Cognitive Dominance

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 gained 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, as well as the author of Cognitive Dominance: A Brain Surgeon’s Quest to Out-Think Fear. Today on the show, Mark and I discuss how fear manifests itself in a range from mild discomfort to full-blown paralysis, and how you can get a handle on it by developing cognitive dominance. Mark then unpacks what cognitive dominance is, and how it involves being able to overcome our visceral reaction to unexpected events, and respond to elements outside our control with poise and composure. We then talk about how to gain that kind of composure by breaking things down into objects (things that exist independently of us, with features everyone can agree on) and subjects (things that are specific to you, and encompass the sphere within which you can personally act). Mark walks us through how the objective and subjective can form an x- and y-axis, and how you can map the things that happen to you into the four quadrants they form in order to figure out how to respond. We end our conversation with how to deal with known unknowns by making a two-column list of who you do and don’t want to be, and focusing on the former.

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Brett McKay: Brett McKay here, and welcome to another edition of The Art of Manliness podcast. And when it comes to high stakes endeavors, few are as fraught as brain surgery. One fall smooth and you can forever alter someone’s life. That’s why my guest has spent his life saying 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 as well as the author of Cognitive Dominance, A Brain Surgeon’s Quest to Out-Think Fear. Today on the show, Mark and I discuss how fear manifests itself in a range from mild discomfort to full-blown paralysis and how you get a handle on it by developing cognitive dominance.

Mark then unpacks what cognitive dominance is and how it involves being able to overcome our visceral reaction to unexpected events and respond to elements outside our control with poise and composure. We then talk about how to gain that kind of composure by breaking things down into objects, sort of things that exist independently of us with features everyone can agree on, and subjects, things that are specific to you and encompass this fear within which you can personally act. Mark walks us through how the objective and subjective conform at X and Y axes, and how you can map the things that happen to you into the four quadrants they form in order to figure out how to respond. We end our conversation with how to deal with the known unknowns in life by making a two-column list of who you do and don’t wanna be, and focusing on the former. After show’s over, check out our show notes at

Alright, Dr. Mark McLaughlin, welcome to the show.

Mark McLaughlin: It’s my pleasure to be here. Thanks, Brett.

Brett McKay: So you are a neurosurgeon, a brain surgeon, and you’re also an author, you wrote a book called Cognitive Dominance. And in this book, you explore extreme fear and how to overcome it. So how did a neurosurgeon end up exploring the topic of extreme fear?

Mark McLaughlin: Well, I think we all have episodes in our life of extreme fear, and I guess each of us perceive it and experience it in a different way. For me, I think it came as I was a young neurosurgeon, because I care a lot about my patients, and that’s something 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, certainly when you’re in the operating room and you’re in dangerous situations, and so it’s a very hard thing to balance. I think, obviously, caring a lot makes a great doctor, but it can also get in the way of you making important decisions and dealing with emergency situations. So for me, that’s kind of where it started. I 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?” And 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.

Brett McKay: Well, yeah, you call this paralyzing, like thinking about being freaked out, you call it the “fear of freak out” and you kind of break down what are the elements of the fear of freak out. For you what are those elements when you… You know you’re about to do a surgery that’s a real big deal. For you, it was doing surgery on kids, that’s the thing that kind of triggered it. So what are those elements of the fear of freak out?

Mark McLaughlin: So, 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 of freak out. That’s when… It’s some form of the fight or flight response, so it’s important for you to be able to identify that in your own… In anyone’s behaviors. For me it was, “Why do I keep trying to not think about this problem or put it off or distract myself from thinking about the problem that’s really bothering me?” Because once I start really putting my efforts towards what’s bothering me, and I think it through, my anxiety level goes down. So that’s the thing you need to focus on before you get to the fear of freak of out.

The fear of freak out is obviously the extreme case when you literally, you just decompensate. Instead of making the phone call to your sick brother who just got a bad diagnosis, you avoid it, you do something else. You don’t do what needs to get done. So that’s the fear of freak out experience that we all have in certain ways. For me, one of my surgeries that I talk about in the book was a young girl that had profuse bleeding, and my initial reaction was to move and pull the endoscope away from the bleeding, which is the exact worst thing you could do. You 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. So it’s really identifying your fight or flight response and then putting a governor on it and really thinking it through.

Brett McKay: And this governor you called it, you call it cognitive dominance. When did you first hear about this idea of cognitive dominance? And we’ll get into it a little bit more in our conversation, but big picture, what are the elements of cognitive dominance?

Mark McLaughlin: Yeah, 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 Zinsser. And I was asked to speak to the cadets, and I go there annually, and we talk about what are the key performance indicators that help us in performing at our best and what impedes our performance. And 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.” 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.”

And 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.” And 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 there are important decisions and you need to chart your course in life. So I thought, “Wow, that’s… I need to know more about this. How do I get this cognitive dominance thing, and what keeps me from being cognitively dominant?” And that’s when I sort of began my search. I had been studying human performance for years, but this really crystallized my thoughts and it helped me start shaping the narrative of my book.

Brett McKay: And a big part of gaining cognitive dominance is understanding fear and our response to fear, and you spend a lot of time in the book going through this and you get into details with it. But like, big picture, what is fear? Like, when you ask people how do you define fear, what sorts of answers do you get? And then how do you define it?

Mark McLaughlin: Let me just take a step back and, you know, a big picture on cognitive dominance first before we go to fear, and that is ’cause it’s intimately related. And really, cognitive dominance boiled down is… It’s poise, it’s keeping your cool, it’s what Rudyard Kipling wrote in the poem If, “Meeting triumph and disaster and treating those two impostors just the same.” So 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 outside of our control. So that leads me more into the fear side of things, so fear is what we experience when something unexpected comes our way. We’re all living in the world, we’re doing our things, we’re trying to achieve the goals that we have set out to achieve, and we have like sort of a map of where we wanna go, and 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, and that’s when 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 full-blown mortification or paralysis of what to do depending on the level of the unexpected event. And 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.

Brett McKay: Well, you make one big distinction, there’s internally dominant fear and externally dominant fear. What’s the difference between the two?

Mark McLaughlin: Internally dominant fear are the demons that we conjure up in our own mind. I love the story that, cave man walks into cave and draws a picture of a tiger and looks at the picture and scares himself and runs out of the cave, and it’s one of those, “Wow, the guy’s a fool, isn’t he?” But 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 could potentially occur? So that’s like an internally dominant fear state that we have to be careful of. And then externally dominant fear states are real threats to us, whether that’s a threat to our job, when a new person comes in and maybe has been given the title that you have, and now you’re looking at a potential competitor, it’s an externally physical threat that you might have when you’re walking down the street and you notice that somebody’s following you. So that’s important to distinguish these types of threats because they trigger different strengths of fear in our brain.

Brett McKay: And then related to this idea of externally and internally dominated fear is you make the case in order to figure out, what is it you’re dealing with, what’s this unexpected thing you’re dealing with, is to make a distinction between object and subject. So this is where you get philosophical, and I think you majored in philosophy…

Mark McLaughlin: I did.

Brett McKay: Before you became a neurosurgeon. So why is the distinct between object and subject important in trying to figure out… Suss out our fear?

Mark McLaughlin: So I learned this from Jordan Peterson, who I was very influenced by his book, Maps of Meaning, and also his subsequent books. And one of the things I learned from his teachings is that, he talks about there 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. And 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 then when we were little kids, all the way till now. That’s how we remember things, it’s through stories. And stories are sort of a… They’re like a mini map of the world, and they teach us ways to act in this world. And 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.”

So the objective part is what are the specific identifiable features that everyone can agree on, whether that’s… There’s a tiger that’s gotten loose at the zoo, that’s a physical, objective threat that everyone is in danger for, as opposed to a subjective threat, which is, let’s say, somebody broke out a peanut butter sandwich in the cafeteria and you happen to have a peanut allergy. That’s something that’s specific for you, that’s something that is related to you. Peanut butter is something that’s dangerous to you but it’s not dangerous to other people. So 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.

Brett McKay: And you face this all the time with your work as a neurosurgeon. You actually walk through, there’s moments where you experience fear and you kinda do this quickly in your head, it’s like, “Okay, what’s the story that I’m telling myself? What do I think is happening?” That’s that subjective part, but then you have to… You actually start talking to people around you and say, “Are you seeing what I’m seeing? Are you all seeing this?” You’re trying to figure out, “Is this thing real that’s happening or is this just a part of… Am I just making this up in my head?”

Mark McLaughlin: That’s exactly right. And that’s part of the IRIS concept that I talk about in the book. So the IRIS concept is a way to bring higher resolution to an unexpected event. And it’s not something I use for everything, but it’s something… It’s one technique that I use, and what it is, is it’s just an acronym for, I being Identify, really see what you’re seeing and define its characteristics, and then Reject your initial… So the second letter is R, Reject your initial impulse, which is usually some type of self-preservation impulse. That’s your, what I talked about in the book as brain 1.0, your fear guardian, your fear detector. And then the third letter is Inventory, so it’s I-R-I. Inventory, which is basically, look around, talk to people. Has anybody else experienced this? Get as many perspectives as possible, because that’s gonna help you solve the problem. And then Stabilize, which is the S in IRIS, and that’s act… Try and buy some time. Act with the lowest possible cost. In medicine, we say that, first, do no harm, so 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, and then lastly, re-evaluate and really try to think laterally, try and come up with alternative solutions to the problem. So that’s one technique that I use to deal with an unexpected event.

Brett McKay: Going back, as you mentioned this idea of brain 1.0, brain 2.0, I wanna explore this idea of fear more to help… ‘Cause I think it was really useful for me to… ‘Cause it helps you, sort of a meta-cognition, it helps you understand what’s going on in your brain so you can start manipulating what you’re thinking about. And you talk about how… What goes on in our brain when we experience fear, and you make this very simplified version of what’s going on, and I guess it’s first you said there’s a brain 1.0 and there’s a brain 2.0 that this unexpected event gets filtered through. So walk us through that process. We’re going through life and we encounter this unexpected event. What’s going on? How do we react to that in our brains?

Mark McLaughlin: Sure, so I took a page out of Daniel Kahneman’s book, Thinking, Fast and Slow. I think that’s a fascinating book, and he talks about how we make quick decisions with one system, system 1.0, and then we make more iterative, careful and deliberate decisions with a system 2.0, and I think that’s a really great model to think about how fear lands in our brain as well. Brain 1.0 is the more primitive part of our brain, the amygdala hippocampal area, the medial temporal region of your brain, which has been ingrained to recognize snakes, and to recognize danger, and height, and being near the edge of a cliff like… And even infants have a fear of heights. So that’s the ingrained encoded system that’s helped us survive for thousands and thousands of years, and it works great for imminent bodily threats, external forces that can harm us, but it doesn’t function well in the operating room, it doesn’t function well in the board room or when you’re in a family crisis.

So 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 and how can this fit in a bigger picture. So the one layer of thinking about this is that there’s the brain 1.0, which is the guardian that’s gonna warn you of bodily threats, but you need to watch out ’cause it can overly turn on your reaction to something that’s gonna be detrimental, and then you need brain 2.0 to think through that and be more iterative and deliberate. And then the other way to think about it also, and I talk about this in the book is we have two hemispheres, and there’s a reason for that.

Generally, the left hemisphere is more logical and language and mathematical-based, and the right hemisphere is more story-based, it’s more big picture, it can… It picks up facial expressions better, it can understand the physicality of an event that your left brain doesn’t pick up. And we need to sort of toggle between those two hemispheres as well, take in the immediate right hemispheric big picture, but also utilize your left hemisphere to be logical. And that’s really what leads me into graphing and unexpected events. So what I talk about is we can take an unexpected event and we can literally break it down into its components on an X and a Y axes, and 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. So basically your job in an X and a Y axes, and the X-axis is kind of like your left brain. It’s also the objective part of your brain, so that’s how we deal with the world as a place of objects, the X-axis. And the Y-axis, that’s more your right brain, that’s more of how to act in the world, so that’s the subjective component of your world. And if you can think about the world and these unexpected events in those two axes, you 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.

Brett McKay: Okay, I wanna get into these quadrants, but before, I just wanna recap. So brain 1.0 is that initial response that we have to an unexpected event, and usually that’s the fight or flight response.

Mark McLaughlin: Correct.

Brett McKay: And then brain 2.0 needs to come in and override… Kind of step in and say, “Well, do you really need to do what you… What that initial response you wanna do?” So I guess, going back to that example you talked about, you had that surgery on that girl, she had a lot of bleeding in her brain, that you had a 1.0… Brain 1.0 response was, “I gotta pull this thing out because I gotta protect myself, I gotta… I want this to stop.” Brain 2.0, I guess it was actually a mentor, said, “No, don’t do that, ’cause that’s gonna make things even worse.”

Mark McLaughlin: I didn’t have my brain 2.0 at that point in my training [chuckle], that’s what mentors and teachers help us with. And that’s exactly right, he said, “Don’t move an inch, Mark. Stay exactly where you are, because as long as that blood is coming through this endoscope and out her head, nothing is going to be damaged and all we need to do is keep transfusing her. If you take that scope out of her head, the blood is going to build up and press on her brain stem and she’s going to die very quickly.”

Brett McKay: We’re gonna take a quick break for a word from our sponsors. And now back to the show. And I guess one challenge of modern life is our brain 1.0 responds to, we’ll call them subjective or internally dominant fears the same way as it would to externally dominant fears, so it’s like our brain responds to the fear of social status defeat, because someone didn’t, I don’t know, like something on Instagram, the same way it would respond to seeing a snake. Is that… Would that be correct?

Mark McLaughlin: I’m really glad you mentioned that, ’cause this is a really important and timely feature to think about, and that’s exactly correct. And that’s really where we all are subject to that. No matter how many times I try to adopt the stoic philosophy of just focusing on myself, my character and my virtue, a nasty email comes across or a patient complaint comes in and I’m hurt by it, or I’m upset by it, and I have to reach back into my mind and talk to myself out of that and say, “Listen, you know what? Did you do your best? Yes, I did my best. Did everything work out the way it was supposed to? No. Sometimes you can do everything right and some things still go wrong. And that’s the job you chose, now own it.”

And similarly, I think that, as you say, the social rejection with 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 train brain 2.0 to become stronger, to provide the input to suppress that brain 1.0, “Oh my gosh, I’m a failure. Oh my gosh, none of my patients like me. Oh my gosh, I’m a social outcast.” So the first step is recognizing it, knowing about that inner critic that’s gonna come out, and then figuring out a way to gradually train… You can literally rewire your brain by thinking different thoughts, by reading different philosophies. I’m a big fan of the stoic philosophy, and I’m a Ryan Holiday fan, I read The Daily Stoic every day, and I think 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. So I’m glad you brought that up.

Brett McKay: Okay, so brain 1.0 feels this fear, brain 2.0 needs to come in and say, “Okay, wait a minute. That initial response you have, probably not the right one.” And so the next phase that you recommend doing is again putting… Sort of mapping this experience, this unexpected event in one of these four quadrants that we’ve just talked about, this X-Y axes. So what are these four quadrants? I mean, what are their characteristics and… Yeah, walk us through that.

Mark McLaughlin: Sure. So if you draw the X-axis and call that objective, and draw the Y-axis and call that subjective, you can… Let’s take an event, let’s say I’m in the operating room like I was the other day, and everything’s clicking. It’s just timing has been good, the anatomy looks really clear, I have a super great pathway to where I need to go. Everything that I reviewed on the MRI scan is exactly what I’m seeing, I’m able to move the blood vessel away from the nerve that’s causing of the pain, and I know that that motion is gonna relieve this patient’s pain and everything just clicks perfectly. And we close, and I’m just on a runner’s high, basically. And we all know that quadrant, that’s the flow quadrant. That’s when things objectively are going well, that means everything that you planned is happening, is happening in a logical fashion, and subjectively, I’m fulfilling my life mission to be the best doctor I can be. So 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, and we’ve all experienced it in many different ways, and it’s when the world is in sync and it just feels wonderful.

Then sometimes we have something that’s objectively positive that happens in our lives, but subjectively, it turns out to be something negative, like you get a job promotion, and so you got a raise and you got more status, but then you find out your boss is toxic, and it’s gonna be a miserable experience in this new position. So that’s when something objectively is positive. You got a raise, you have a higher status, but subjectively, having a peaceful day at work and achieving what you set your life goal to be doing at work is gonna be impeded by this toxic boss, that’s subjectively negative. So that’s gonna put you in the lower right-hand quadrant, the quadrant which I call the calm before the storm. That means you’re going along and you’re doing what you’re doing, but you know something bad is probably gonna happen or you’re gonna need to change to get out of that uncomfortable state. Then sometimes we deal with something that’s an unexpected event that’s not only objectively negative, but it’s also subjectively negative, so that’s terrible experiences that we have. That’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. I’ve gotta go out and I’ve gotta go talk to this family and tell them what just happened.

It’s a terrible, terrible experience for the family, it’s a sad experience for me, and it’s unpleasant in every way, shape or form. It’s gonna hurt. Yet, I know that that’s something that I have to do, and I’m gonna go out and I’m gonna do the very best job I can in telling them what happened and how it happened, and knowing that that conversation I have with that family is gonna be something that they remember for the rest of their lives. So it’s gotta be done perfectly. And sometimes there’s no way out of the all is lost quadrant. That’s the lower left-hand quadrant. But usually over time, you can climb your way out of it, and that will lead you to the upper left-hand quadrant, which is the birthing a new skill set quadrant, or the resiliency quadrant, and that’s where something, an unexpected event occurs in our lives that’s negative, yet, 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. Something like JK Rowling had an opportunity to do when she was unemployed and trying to figure out what she wanted to do with her life, she began writing Harry Potter. So these are things that we all experience as well, and we say, “Yeah, that was not fun, but it turned out to be the best experience I ever had in my life.”

And those are the four quadrants, and what I talk about in the book is that if you have this unexpected event and you have this uneasiness and you’re experiencing fear, if you can map it out to whatever quadrant you’re in, then you can figure out what you need to do next. In the moment you figure out what you need to do next, your anxiety goes down, your fear goes down, and you begin to performing better.

Brett McKay: Well, okay, so what’s the… Are there different responses that you should take, general responses you should take depending on what quadrant you’re in? I guess if you’re in that flow quadrant, it’s just like, “Man, just go with the flow. Don’t disrupt that. Just go with it.” But let’s say you’re in that bottom right quadrant, I guess it’s objectively good, subjectively not good. What should your response be in that situation?

Mark McLaughlin: Exactly. When you’re in flow, don’t ask any questions. Don’t try and break that down, just go with it and enjoy it. And what I say about both of the quadrants in the lower half, in the negative Y, is that sometimes you have to adjust and endure it for a period of time, and you have to wait it out, but usually the first step that you can do is to what I say is climb the Y-axis. ‘Cause if you’re moving on your map from where you are to where you should be, and for me that’s being a better doctor, being a more compassionate doctor, being the best surgeon I can be, that’s the thing I need to do next, that’s the smallest little step that I can do to move up that Y-axis, is what’s gonna bring me out of the negativity zone. So, like I said in the all is lost, that’s gonna be, “Okay, this is a terrible situation. There’s nothing good that can come of this. Okay, I’m going to be the very best, most compassionate, most patient physician that delivers devastating news to a family. And that’s something I can do really well,” and that’s climbing up the Y-axis.

In the case of a toxic boss, it might be, “Alright, I’m not gonna burn the ships right now, but I better get my CV in order and I better start putting some feelers out to have some options, because this is not gonna be a good long-term solution for me.” The second you start making that movement up the Y-axis, you’re gonna feel better and it’s gonna be sort of like a positive feedback loop. You’re gonna start moving more and more back up into the birthing a new skill set and resilience quadrant and into the flow. And you can’t always live in the flow. Life would be boring. It would be… You’d be unhappy. It’s important that we experience all of these quadrants, it’s part of the hero’s journey, and that’s how we get to a new level and we keep getting better and better. A lot of times, it’s this clockwise fashion, we move from flow to calm before the storm, to all is lost, to birthing a new skill set. Sometimes it’s a lateral jump from one to another, but that’s the process of life and getting better.

Brett McKay: Yeah, I thought it was interesting how you mapped on the hero’s quest through these different quadrants, I thought that was a really incisive insight.

Mark McLaughlin: Yeah. Recognizing that is really important. So, I tell… The book centers around, and you know this, it centers around a story about a young boy, Anthony, who I operated on when he was eight years old, and although the surgery went perfectly, Anthony suffered many, many complications and side effects of his surgery and his treatments and of his disease. And even though initially, I was in flow, his surgery went perfectly, I was so happy about it, I was thrilled, I’m like, “Man, I love being a neurosurgeon,” then he started not doing well, and I started wondering why is he having this complication and that complication, and I was sort of in the calm before the storm, I was kinda like, “Wow, I’m… Here I am, I’m a young neurosurgeon, I trained my whole life for this, eight years in residency, four years in medical school, and I didn’t expect to feel like this. I feel bad, I feel like… Gosh, maybe I could have done something more for him, maybe I could have… Did a better operation or picked up his complications earlier, and I didn’t… I don’t wanna feel like this, this is uncomfortable.” And then I fell from the calm before the storm all the way to the all is lost quadrant.

I basically said, “You know what? You can’t handle operating on kids, this is too much for you. And something you did, maybe you didn’t do as good of an operation as you could have, and that’s why Anthony is not doing well.” And I lived in that all is lost quadrant for a long time. For 15 years I had told myself the story that Anthony was not doing well, and it was my fault in some way, shape or form, and it wasn’t until I started writing this book, and I reconnected with Anthony and found out that he was alive and still doing well, and with his family that I realized, “Oh my gosh, it was a blessing to take care of Anthony, even though you ran away from it and you stopped doing pediatric neurosurgery, and you kinda put him in a place in your life that said that was a failure, you didn’t fail, you actually helped him and kept him part of his family and kept his family intact, and… ”

So I… After 16 years, I went, I rose out of the all is lost and moved into the birthing a new skill set, and then it ultimately just flipped me into realizing, “Wow, what a blessing I have to be a neurosurgeon and to have taken care of Anthony,” and just that revelation, and talking to my editor who said, “Mark, you’re holding yourself to an impossible standard,” and I had never really thought of it that way, kicked me back into flow, kicked me into like, “Oh my gosh, this is such a great privilege. I love what I’m doing, and I get to care for people, what a special job I have.”

Brett McKay: And I imagine that this is… It’s hard to do like, label what’s going on when you’re in the moment of feeling uncertainty or uncertain, so how do you train your brain 2.0 to override brain 1.0 and be like, “Let’s map this thing out.” How do you do that?

Mark McLaughlin: Well, it comes with experience, and failure, and learning from your failure. So it takes time. We’re ingrained to react, and cultivating brain 2.0 is a… That’s an important process that doesn’t… You’re not born with that. You’re born with brain 1.0, you’re not born with brain 2.0. You’re given the apparatus to use it, but you have to train it and create a neural network of cognitive dominance, and you do that by thinking about it. And so I still have events, not exactly like my experience with Anthony, but I still have events that are like that now, and I’m much more resilient to the event because I say to myself, “Hey, this is the job you chose, you’re gonna do some things, and sometimes, even though you do everything right, something terrible is gonna happen. It’s a risky business. You took an oath, follow that oath, and do the very best you can every day, and that’s all you can do.”

And so I think it’s certainly studying, studying the West Point cadets and the military philosophy, reading a stoic literature, poetry. I always tell the cadets that poetry is the world’s first performance enhancement literature. So by reading poetry, poems like If and Invictus, Do not go gentle into the night, those poems are… They’re primal words that land deep in your brain and can help you in difficult times. So it’s something you train. You train for it, just like going to the weight room, and getting stronger before you go to wrestling practice or whatever sport you play, you have to train your brain to do that with reading, and I would hope that Cognitive Dominance is a little bit of a handbook for people. It certainly just scratches the surface about the concept, but I think it’s a… I’m very proud of it, and I think it’s the first step to understanding the capacity that we all have, which is really unlimited. It’s unlimited if we can really tame these demons and cope with fear in the right way.

Brett McKay: One 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, sometimes we have in our life these known unknowns, and the big one that hit home close to you, you experienced this, is death. And this happens to everybody. We all know we’re going to die, everyone will. But we don’t really know, like, I think… Who was it? Someone, Henry Beecher Stowe I think, he called it the great mystery. This is the great mystery. How do you manage those known unknowns?

Mark McLaughlin: I think you focus on your definition of who you are, and I think that’s an important thing everybody needs to do in their life is literally put down on a piece of paper who you are. What are the words that describe who you are? Integrity, partnership, selfless, generous, what do you stand for? And then put that on maybe on the left side of the column, and then on the right side, put down the things that you’ve been in the past that maybe are part of you but you don’t want them to be. There are parts of you that you want to have less of, maybe that’s being selfish, maybe that’s being, I would say, breaking into a zero-sum game, in other words, being jealous, seeing somebody else’s success and feeling like, “Oh wow, that should be my success,” and then I put in my left column, I always put, “Non-zero sum game,” and that means basically anybody that does something doesn’t take away from my potential success, they just inspire me to my success.

So by writing those sorts of things down and what you stand for, I think that the way you focus on dealing with something like death, or death of a loved one, which is what I… How I realized this, when my father was passing away was, “How am I gonna be during this event?” And I just said, “I gotta be a doctor. I gotta… A son, a brother, a husband, I gotta do it all. And I gotta do it the very best I can.” And I think when my dad was close to the end, I had to administer the morphine for him, and that was the hardest thing I could ever do because he was an intellect and a polymath, and I knew that when I started giving him the morphine, his mind was gonna slip away, but I knew that he was suffering, and it had to be done, and I was the best person to do it. So I leaned into it, and I think that’s what you gotta do, you gotta lean into what you define yourself as, and if you do that, I think you’re living a good life.

Brett McKay: Well, Mark, this has been a great conversation. Where can people go to learn more about the book and your work?

Mark McLaughlin: I have a website, There are a number of videos of my talks and YouTubes. I also have a YouTube channel that you can pick up up from the website, and Mark McLaughlin MD Instagram, and obviously the book, I think is a great start to be introduced to cognitive dominance. And I’m planning a second book, and that will sort of dovetail off of this concept and to some of the other concepts related, which is just in the preliminary works now. So mainly the website would be the best way and you can get Cognitive Dominance on Amazon.

Brett McKay: Alright. Well, Dr. Mark McLaughlin, thanks for your time. It’s been a pleasure.

Mark McLaughlin: Thank you, Brett. It’s my honor.

Brett McKay: My guest today was Dr. Mark McLaughlin, he is the author of the book Cognitive Dominance. It’s available on and book stores everywhere. You can find more information about his work at his website, Also check out our show notes at where you find links to resources where you can delve deeper into this topic.

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