Anxiety and Uncertainty

What is behind person's anxiety? A simple question to be sure. Yet, depending on what level one seeks to address this question, our answers can become increasingly varied. We treat anxiety confidently, whether with therapy or medication. We often understand the situational factors behind a specific bout of anxiety, and we all agree that some people are more prone to anxiety than others. But for all our knowledge, do we really understand the deepest causes of anxiety?

I see many patients with anxiety, and each case is unique. Their anxiety manifests in different ways - sweaty palms, feelings of uncertainty, difficulty sleeping or consistent daydreaming about topics that worry them. The supposed "cause" behind these underlying conditions also varies - difficulty in a relationship or feeling insecure at work or "future fright" - worrying what one's future holds. I have often asked myself: if we scratch the surface even further, is there a singular, unifying cause of anxiety? Before we go on, I should say this: I am inherently suspicious of unifying theories. They feel elegant to the author, but rarely mimic the complexities of the real world. Nevertheless, I believe there are some things about anxiety that seem elemental and unifying in their origin- namely, the role of uncertainty. I would like to spend the next several blogs talking about the relationship between uncertainty and anxiety.

Hardship and Uncertainty

As humans, we are equipped to handle hardship or bad news. Whether it is the death of a loved one or being rejected outright by a partner, we have what it takes to handle adversity. It may not be easy; it may even be an extremely bitter pill to swallow, but as a species, we can do it. We are built to work through hardship. But there is one catch to our fortitude: namely, that our adversity has clarity.

What we are unable to handle well as a species is uncertainty. Uncertainty bedevils and needles us all the time. "Maybe my boss doesn't like me...he is always looking dour when he sees me...will I be fired?" "What if person x doesn't like me, then is my career over?" Or "what will the future hold for me if I have no plan?" Or, "what if the pain in my thigh is something medically very serious?" In other words, pound for pound it is sometimes easier to handle clear bad news than the uncertainty that precedes the bad news.

Recall your youth. Being rejected by someone with whom you were romantically interested was difficult and bitter, but ultimately digestible. In contrast, knowing that you are going to be rejected can leave you up at night and unable to concentrate during the day. I recall a fellow classmate in high school. He was accepted to two of the nations top Ivy League Schools. He was a relaxed, happy guy until he had this good fortune. He believed that there was a "correct" answer regarding which school he should go to - only he did not have enough "data" to make a choice. In other words, his good fortune introduced stark uncertainty into his life and this led to intense anxiety for the three months he had before making a decision.