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Wars, climate disasters, pandemics, spiralling costs - it’s perhaps no wonder stress is also on the rise. But it does not have to become unbearable, Dr Tom Mulholland, who once contemplated suicide and now champions healthy thinking, tells Bruce Munro.
Talking with Dr Tom Mulholland about stress is getting stressful - before the interview even begins.
The room booked for the face-to-face video interview with the renowned doctor and healthy thinking proponent is occupied when it should be vacant. It is a television studio, and the ‘‘recording’’ light outside the main door is glowing bright, forbidding entry.
By now, Dr Mulholland will be in an online netherworld, waiting to be let in to the call, wondering what is going on.
Pacing in the corridor outside, feelings of concern, frustration and helplessness rise with each second and minute that ticks by.
Ten minutes late, the studio is vacated, the patient doctor is admitted, apologies are given and recording begins.
Kia ora, I’m Bruce Munro. And with me is Dr Tom Mulholland who has been an emergency department doctor, a GP and an honorary lecturer in psychological medicine. Dr Mulholland believes healthy thinking can transform people’s lives.
Welcome Tom. For the past eight years you been travelling around New Zealand in an old Chevrolet ambulance. Can you describe the event that made you decide you needed to become the ambulance at the top of the cliff, rather than at the bottom.
Sure, it was a busy Friday night at Auckland Hospital in the emergency department, and I had just seen another person come in with a preventable death - a 50-year-old man who had sudden onset of a blinding headache and a brain bleed. I had to go and talk to the family and say he’s not likely to make it.
I saw three of those a night. I had 28 years of doing that - seeing people dying prematurely of all sorts of things, including self-harm. I thought, ‘‘I really need to get out and start talking in communities and workplaces about mental health, social health and physical health’’.
What have you done since you decided to go on the road, and what impact has it had?
I funded it myself to begin with. Then I became the first ambassador for Farmstrong and the Mental Health Foundation. I did a series of 50 workshops for farmers on stress and resilience ... Then I did a contract funded by the Ministry of Health, going around 10 communities around New Zealand looking at long-term conditions like type 2 diabetes, high blood pressure and physical aspects of that.
So, I’ve been around the country eight times ... and done hundreds and hundreds of community presentations.
We’ve tested over 10,000 people nationwide and helped them improve their physical, mental and social health.
You have lived in Dunedin. In the late 1980s, you graduated from medical school at the University of Otago. And you will be back in Dunedin soon, as guest speaker at a Life Matters, Suicide Prevention Trust event at the Dunedin Public Art Gallery, on Thursday, August 11. The topic of your talk is ‘‘Healthy Thinking Can Change Your Life’’. Can you tell me about yourself as a young doctor. What role did healthy, or unhealthy, thinking play in your life at that time?
I had a great time at Otago University in the mid-’80s ... But when I graduated as a doctor and I’d been working for a few years, I started a [medical] internet company and had 20 staff working for me and was working huge hours, both clinically and also running a start-up.
I thought I was on top of the world and then my marriage fell apart.
Your whole life changes from being this high-performing, first-class honours degree student who, if you want to get anything you just work harder and harder and you get there, right? But no matter how hard I worked, I didn’t get there.
So I ended up losing my marriage, losing my job, losing the company. I had two little kids who were 4 or 5 at the time - they’re now in their late 20s.
I got to a really dark place ... I had owned my own general practice and was treating people for depression. But it got to the point where I couldn’t go out of the house. I thought I’d failed ... and it got to the point where I had a plan to take my life.
But that’s what got me to discover healthy thinking. I reflected on when I was at the medical school ... and I wrote a paper ‘‘Is suicide predictable or preventable?’’. And I looked at all the suicides in Canterbury between 1977 and 1987 that had been seen by the crisis team.
What haunted me and still haunts me is that I interviewed a young guy who was 16 or 17. I said, ‘‘Was there any warning that your dad was going to take his own life?’’. And he said, ‘‘No. We knew he was in pain, we knew he was suffering, but there was no warning. But when he took his own life he didn’t take his pain away, he just gave it to us’’.
And in my darkest moment - when I was thinking I’d failed my shareholders, my family, my community, failed myself - I thought I can’t transfer the pain I’m suffering to my children.
I thought, I need to work out a plan to fix myself. I decided I needed to change my attitude. I needed to go from being suicidal in my garage to doing stand-up comedy within six weeks.
So, I enrolled to do stand-up. You can’t make this stuff up - the MC that night was Mike King. And he was a different Mike King, over 20 years ago, than he is now. And I started my stand-up career. Then I wrote a book and I started to develop what I call ‘‘healthy thinking’’, and I’ve been teaching it for the last 20 years.
You have been an ED doctor and GP for more than 25 years. You have practised medicine around the world. You have hosted your own media shows, written books, been a professional speaker and a lecturer in psychological medicine. You are also the founder of the Healthy Thinking Institute and developer of a wellbeing app, KYND. It seems that, for you, everything comes down to how we think. Why is our thinking so crucial?
Because thinking is upstream from emotion, right? Figuring that out was the epiphany for me.
This is based on Cognitive Behavioural Therapy, which has been around a long time. If you look at the Stoics, 2000 years ago or more, like Marcus Aurelias, Epictetus, they say ‘‘Life’s not stressful, it’s just our view of it that is’’. And there’s been plenty of other people like Viktor Frankl, of Auschwitz, who have talked about this.
So you have a trigger, an event, say, getting a parking ticket or losing a relationship. That creates thoughts, which then generate emotions, which then generate behaviours, actions, and then consequences or benefits depending on the emotion and the behaviour.
So for me it was, if I want to change how I feel I just change what I think. I hate being miserable, I don’t like feeling stressed, angry, frustrated or disappointed. So, if I want to get rid of those emotions, or reduce them at least, I just change what I think.
So, instead of thinking, ‘‘I’ve failed’’ or ‘‘I’ll never meet anyone again for the rest of my life’’, I change my thoughts to, ‘‘I haven’t met the most amazing person in the world yet’’, and it creates a feeling of excitement. For the past 20 years, I’ve just been practising changing my thinking, and also looking at attitude profiles and patterns of thinking. I’ve collected tens of thousands of data sets on how people think ... It’s just fascinating how people think and how that leads to depression, anxiety, stress.
We live in a world of increasing mental ‘‘dis-ease’’, increasing mental distress. One in five Kiwi adults are diagnosed with a mood or anxiety disorder. There’s a global pandemic; the threat of rampant climate change disaster; international tension over the invasion of Ukraine; we’ve got soaring cost of living, with inflation higher than it’s been for the past three decades. Can we hope to have a sense of wellbeing in times like these?
You can’t control all that at a personal level. I can’t ring up Vladimir Putin and say - although, I’d like to - ‘‘Have you tried some healthy thinking? If you had some healthy thinking, it might save a lot of lives and a lot of money’’. But, you know, he’s angry, he’s frustrated. He’s got perceptions and beliefs about Ukraine and Nato. And I’m sure if he went through a healthy thinking course he’d realise a lot of them are untrue, they’re definitely not worth it and they don’t help him achieve his goals.
Anyway, [all that is going on in the world], it’s pretty hard to control, right? So, the only thing you can control is your thoughts and your reactions to it.
If I’m trying to teach healthy thinking in three short sound bites, it’s a set of tools, which I’m gonna talk more about at the talk.
One of them is a cognitive switch, which, if you look at the brain and how we generate our emotions, it’s about trying to get the signal away from my amygdala, my grumpy unit, my cortisol, which keeps me awake or makes me more at-risk of a workplace accident.
So, instead I think, ‘‘Crisis equals opportunity’’. Whatever crisis it is, it’s an opportunity to help or an opportunity to do something differently. There are so many opportunities in a crisis.
I don’t know how old you are Bruce. But, when I was at school the nuclear threat was the massive thing hanging over us. Russia was going to push the button.
Whatever comes next, whether it’s bird flu or whatever ... if each individual just learns to control their thinking, control your emotions, control your behaviour, that’s all you can do. So, focus on what you can control, not on what you can’t control.
Can you tell us a bit more about what will help people achieve mental health in times of stress?
The first thing you’ve got to do is feel the emotion, to take away the trigger, whatever that is.
Let’s take something relatively benign, like you get a parking ticket and that creates stress. The first step is to figure out what you’re thinking. The thought happens so quick we often don’t notice it; we just feel really angry, or really disappointed or frustrated or stressed. Then you might blame it on your partner who made you late, then you blame it on the parking warden. And then you blame it on everything else.
So, the first step is to go ‘‘What am I thinking?’’. And let’s face it, most of us will think ‘‘It’s not fair’’, right? So, 90% of the thoughts that make us feel bad aren’t true, and they’re not worth it - because you might kick the car or walk out in front of a car, because you’re so angry, because your prefrontal cortex shuts down and you lose what’s called situational awareness - and they don’t help you achieve your goal.
So, the first step is to figure out what you’re feeling, and then what you’re thinking and then work out whether these thoughts are what’s called rational thought (that’s a healthy anxiety) or an unhealthy anxiety. It’s like, you were late for this [interview], and I was getting anxious ... You get all these thoughts flooding through your mind. And if I had focused on, ‘‘They don’t really value my time, and I’ve got stuff to do’’, then you start to get irritated and agitated. But if I go, ‘‘My anxiety is more around whether I’m in the wrong Zoom meeting or I’ve got the wrong day or something’’ ... Once I can control that, then I can control my reaction. But often, the thought goes to the emotion and we fly off the handle and we do something we probably shouldn’t. So, yeah, work out what you’re thinking.
Also, in healthy thinking we look at attitude profiles, such as the fortune teller, which is catastrophising. You can say to people who are catastrophising, ‘‘You’ve made up these all things that are going to happen, but they haven’t happened, right?’’.
They need to reframe it.
So, if you’re struggling at the moment, financially, and you’ve got some bills that you can’t pay, or whatever, go and get some professional advice, rather than going round and round in your own head. Go and see an accountant, go and see a financial planner, talk to the tax department ... because we often try to solve those problems ourselves and we can’t and then in our heads we think ‘‘That’s it, it’s done’’, but it’s not.
By reframing it and going and talking about it, [often people discover] ‘‘I haven’t lost my house, I haven’t lost my job, I haven’t lost my farm, I haven’t lost my relationship’’.
Thanks for your time and thoughts, Tom. Lastly, what motivates you to keep going with your work promoting healthy thinking?
I dedicated my first book to a guy from Dunedin who was in my class. We were at med school together and we used to go skiing at Treble Cone. He took his own life. The number of people who take their own life when there were other options just really motivates me.
And anecdotally, people say things like, ‘‘That talk you gave in what seemed like a shitty cow shed in the middle of nowhere about mental health actually made a massive difference and probably saved my life’’. That’s what motivates me to to keep going.
Where to get help:
Need to Talk? Free call or text 1737 any time to speak to a trained counsellor, for any reason.
Lifeline: 0800 543 354 or text HELP to 4357
Suicide Crisis Helpline: 0508 828 865 / 0508 TAUTOKO (24/7). For people who may be thinking about suicide, or those who are concerned about family or friends.
Depression Helpline: 0800 111 757 (24/7) or text 4202
Youthline: 0800 376 633 (24/7) or free text 234 (8am-12am), or email firstname.lastname@example.org
What’s Up: online chat (3pm-10pm) or 0800 WHATSUP / 0800 9428 787 helpline (12pm-10pm weekdays, 3pm-11pm weekends)
Rural Support Trust Helpline: 0800 787 254
Healthline: 0800 611 116
Rainbow Youth: (09) 376 4155
If it is an emergency and you feel like you or someone else is at risk, call 111.