Let’s say you’ve been working very hard to reach a goal. It could be the goal of going to your college of choice, or saving enough money to buy a house, or to convince another person to spend the rest of their lives with you. Or in my case…to become a brain surgeon.
You’re making progress. You’re almost there. Or maybe you have reached that goal and just want to maintain what you’ve already attained.
And then something unexpected happens that drops you into a dark psychological vortex. Like what happened for me after Anthony, a young boy I operated on whose life was spared, but was left nonverbal, never to be the same.
Things haven’t gone according to your plan. And all of the work you put into the process, all of the late nights, all of the sacrifice you’ve made across every level of your life adds up to…a negative outcome. In fact, the result of all of your hard work is not just a negative outcome; it’s a result you would rank as one of the absolute worst things that has ever happened to you.
The fact torments you because you just didn’t see it coming. And it just doesn’t make any sense. No matter how much you turn it over in your mind, you can’t stop freaking out about it.
You keep asking yourself a slew of impossible questions.
For me, after the Anthony experience, questions like these:
How could I spend tens of thousands of hours of my life preparing and learning a valuable skill and end up maiming a little boy?
How is it that I could do everything according to the “book,” that is correctly and up to the standards of the most advanced healthcare system in the world, and end up with a result that is a fate worse than death? Because, make no mistake, my performance resulted in that little boy’s life turning upside down.
And after what happened with Anthony, how am I supposed to live with myself? How am I supposed to get back in the OR, put the past out of my mind, and perform as if I were unaffected by the deeply traumatic experience?
I operated on Anthony 19 years ago. I performed at my highest level under the highest life/death pressure imaginable. I could not have done anything better. And still, I failed.
Ever since, I’ve been running from the fear of failing another boy or girl like Anthony.
In fact, I quit Pediatric Neurosurgery because of it.
So, the “fear-freak-out” (FFO) problem and I are very close companions.
That’s my big meta-problem.
How can I stop the fear freak out and perform at my highest standard? How can I make sense of things that don’t make sense?
The answer, the solution I’ve discovered with help from everyone close to me, especially my father, is a mental practice, a psycho-technology I call Cognitive Dominance. Admittedly, this phrase is overly serious and rather intimidating, which are two of the reasons I love it so much. The phrase Cognitive Dominance is like wrapping your mind around The Force in Star Wars. It sounds cool, but it’s also cryptic and amorphous. So let’s start with the technical definition of Cognitive Dominance, which has been percolating in military circles for some time now.
Cognitive Dominance: Enhanced situational awareness that facilitates rapid and accurate decision-making under stressful conditions with limited decision-making time.
Let’s unpack it:
1. Enhanced situational awareness: Focusing your attention on unexpected information that arises while you are pursuing some goal.
2. Rapid: Making decisions quickly.
3. Accurate: Making decisions about what to do about unexpected information with the greatest probability of achieving your fundamental goal, that is accurately solving the problem of the unexpected information.
4. Under stressful conditions with limited decision-making time: Acting this way under demanding physical and mental stress.
If Cognitive Dominance represents the ideal way to handle unexpected information, than the technical, military-like definition of “Fear Freak Out” would be:
Fear Freak Out: Compromised situational awareness that delays decision-making, which increases the severity of stressful conditions as time rapidly expires, leading to indecision or poor decisions.
Let’s unpack it:
1. Compromised situational awareness: Focusing your attention on the response (fear) induced by an unexpected event instead of intellectually metabolizing the stimulus.
2. Delays: Slows down decision-making.
3. Increases: Makes the physical and psychological experience of the stress worse.
4. As time rapidly expires: The time to act is slipping away as the stress and negative feeling double down in a negative feedback loop.
In other words, as a performance goal, Cognitive Dominance is the opposite of Fear Freak Out. It’s the goal state for keeping your cool. My take is that Cognitive Dominance is the process by which you achieve what Ernest Hemingway called “grace under pressure.” It’s an evolving discipline to get better and better at quickly performing at the limits of your mental and physical capacity under maximum pressure with the highest probability of success.
Nailing the winning free throw for the NBA championship. Alternatively, successfully landing a plane on the Hudson River after your engines have failed and you’re flying in one of the most densely populated places on Earth. Or not losing your temper as you pile four children under the age of five into their car seats while making sure your cartful of groceries doesn’t careen into the sports car parked next to your minivan as the children wail and scream in protest.
A high bar, indeed, but knowing the location of the top of the Stimulus/Response mountain is extremely useful.
Now all we have to do is pack some supplies and begin the climb up.
Excerpt adapted from “Cognitive Dominance: A Brain Surgeon’s Quest to Out-Think Fear” by Dr. Mark McLaughlin and Shawn Coyne (Copyright Mark McLaughlin and Shawn Coyne, 2019).
Mark McLaughlin, MD, FACS, FAANS, is a practicing board-certified neurosurgeon; a national media commentator; author of the book “Cognitive Dominance: A Brain Surgeon’s Quest to Outthink Fear,” and a keynote speaker. He is the founder of Princeton Brain and Spine Care, where he practices surgery focusing on trigeminal neuralgia and cervical spine surgery. Dr. McLaughlin is also a thought leader in performance enhancement and physician hospital relations.