I have been thinking lately about uncertainty.
Not the uncertainty of markets or weather or whether a flight will be delayed, but the much more intimate uncertainty that enters our lives when something important is beyond our control. A diagnosis we don’t yet understand. A relationship whose future we cannot predict. A child whose choices we cannot make for them. The aging of our bodies. The possibility of loss. The knowledge that, eventually, we will die.
I have several patients who seem to struggle less with the thing that is happening than with not knowing what will happen next. When there is an unanswered question, the mind begins working. It creates explanations, predicts outcomes, searches for patterns, and sometimes constructs an entire future from very little information. I don’t think this is necessarily a flaw in human psychology. In many circumstances, it is probably one of the ways we learned to survive.
The question I keep coming back to: what happens when the mind can no longer tolerate the space between what is known and what is not?
That space seems to be where fear, anxiety, and control begin to overlap.
Fear is relatively straightforward. Something is happening, or appears to be happening, and the organism responds. Anxiety is more complicated because it does not require a present threat. It can live entirely in possibility. Something might happen. Something could go wrong. Someone might leave. The test might be abnormal. The symptom might mean something serious.
The mind is remarkably capable of turning possibility into experience.
And then, because uncertainty is uncomfortable, we often try to resolve it before reality has had a chance to reveal itself.
We seek reassurance. We research. We plan. We check. We rehearse conversations. We try to control the people around us. We construct explanations for other people’s behavior. We decide what something means before we actually know what it means.
These behaviors can look very different from one another, but perhaps some of them share the same underlying impulse: I need to know in order to feel safe.
I don’t think that impulse deserves to be judged too quickly.
I was talking with my mother about this recently, and we began discussing the stories we create in our minds to make sense of difficult circumstances. My first instinct was to think about those stories as something that needs to be corrected. We tend to do that in medicine and psychology. We identify the cognitive distortion, the defense mechanism, the maladaptive behavior, and then we try to change it.
My mother complicated the idea by reminding me of my grandmother.
My grandmother lived to be eighty-four, despite a life that, by conventional measures of health, contained an extraordinary number of reasons why she shouldn’t have. She smoked two packs of cigarettes a day from the age of fourteen. She went through rehabilitation twice for alcohol. She lost her son in a plane crash when he was far too young. She spent much of her life as the mining camp caretaker and wife of a hard-rock miner. There was very little about her life that could be described as easy.
And yet she had a particular way of moving through the world. Her internal refrain seemed to be some variation of, “I’m fine. This isn’t going to kill me. Can I go home now? I need a cigarette.”
I could interpret that as denial. Some of it probably was.
But I also wonder whether the story she told herself gave her a place from which to continue living.
It wasn’t necessarily an accurate story. It was a functional one.
That distinction matters.
We often talk about the stories people tell themselves as though the goal of healthy psychology is to replace them with more accurate ones. Sometimes that is exactly what is needed. A person who believes they are worthless may need help discovering that the story is not true. Someone who believes every physical sensation signals catastrophe may need help developing a different relationship with their body.
But not every protective story is pathological.
Some stories provide enough coherence for a person to endure what cannot be changed. Some give us the psychological equivalent of a handrail. They help us move through an experience before we have the capacity to fully understand it.
Perhaps the problem isn’t that we create stories.
Perhaps the problem begins when we can no longer revise them.
There is something here that reminds me of the yogic understanding of the mind. Patañjali describes the mind as continually moving through fluctuations—perceptions, memories, interpretations, projections, identifications. We don’t simply experience reality; we are constantly constructing an understanding of reality.
That construction is necessary. We need a sense of continuity. We need to know who we are and where we stand in the world.
But yoga asks us to develop the capacity to observe the movement without becoming completely identified with it.
That seems particularly relevant to uncertainty.
If I can notice the thought, This is going to go badly, there is at least a small amount of space between the thought and my response to it. I don’t have to prove the thought wrong. I don’t have to replace it with, Everything will be fine. I can simply recognize that my mind is attempting to predict an outcome that has not yet occurred.
That is a very different relationship with fear.
And perhaps it is also a different relationship with control.
I have come to think that control is often less about power than it appears to be. Many controlling behaviors are attempts to create enough predictability to feel safe. If I can get the other person to behave differently, if I can anticipate every possibility, if I can make the right decision, if I can keep everything organized, perhaps the uncertainty will finally settle down.
The difficulty is that control can become self-reinforcing. When controlling behavior temporarily reduces anxiety, the nervous system learns that control is what keeps us safe. We become increasingly dependent on it.
But life keeps producing things we cannot control.
Eventually the strategy meets its limit.
This is one of the places where I think modern medicine has an interesting paradox.
Medicine has become extraordinarily successful at reducing uncertainty. We can see inside the body, measure physiology, sequence genes, identify pathogens, monitor biomarkers, replace organs, intervene surgically, and alter the course of diseases that once would have been fatal. These are extraordinary accomplishments, and I would never want to romanticize a time when we had fewer tools to help people.
But every increase in our ability to control an outcome can also create an expectation that control should be possible.
If we can identify the problem, perhaps we should be able to fix it.
If we cannot fix it, perhaps we have failed.
This becomes especially complicated at the end of life. Medicine’s ethical commitment to preserving life is both necessary and deeply human. But the ability to prolong biological life eventually brings us into questions that technology cannot answer for us. More time is not always synonymous with more vitality. Extending life and extending the experience of living well are related, but they are not identical questions.
And beneath those questions is something medicine cannot ultimately remove: uncertainty.
Death is perhaps the clearest example. It is the one outcome in life that is completely certain and yet almost everything about its timing and circumstances is uncertain.
We have become remarkably uncomfortable talking about it.
We hide aging. We often hide dying. We find euphemisms for death. We try to keep suffering private or make it disappear as quickly as possible.
I understand why.
None of us particularly want to sit with suffering.
But I wonder what we lose when we lose the capacity to sit with it together.
That brings me back to Ayurveda.
One of the things I appreciate most about Ayurveda is that it doesn’t begin with the assumption that health means eliminating everything that makes us uncomfortable. It begins with adaptation.
Life is constantly changing. The body changes with age. The seasons change. Digestion changes. Hormones change. Relationships change. Our responsibilities change. Our environments change. We lose things. We gain things. We become different people than we expected to become.
Ayurveda developed as a medicine for a changing world.
The purpose of rhythm, routine, appropriate food, sleep, movement, seasonal living, sensory regulation, and the many other practices of Ayurvedic medicine is not to create a perfectly controlled life. They create conditions in which the organism can adapt to life without being overwhelmed by every change.
This is part of why the concept of Vata is so interesting in this conversation. Vata represents movement, change, variability, space and potential. These are not inherently pathological qualities. They are necessary qualities of life. Without movement there is no creativity, flexibility, circulation, or change.
But when movement exceeds our capacity to contain it, the experience can become fragmentation, anxiety, restlessness and fear.
The answer isn’t to eliminate movement.
It is to develop enough stability to move with it.
This is also where I think our understanding of resilience can become more nuanced. We often describe resilience as the ability to bounce back after adversity. I wonder whether there is an earlier capacity underneath that: the ability to remain present while we don’t yet know what is going to happen.
A resilient person is not necessarily someone who is less afraid.
They may simply have learned, through experience, that fear does not require immediate action.
They can receive difficult news and remain curious.
They can acknowledge uncertainty without immediately constructing a catastrophic future.
They can recognize the impulse to control without assuming that control will make them safe.
They can say, “I don’t know,” and continue participating in their life.
That is a very different kind of health than certainty.
It also changes the way I think about treatment.
In Integrative Ayurvedic Medicine, I don’t want treatment to become another mechanism through which we promise people control over everything that happens to them. Of course we want to identify pathology, address deficiencies, reduce unnecessary inflammation, support metabolism, improve sleep, restore digestion, and treat disease appropriately. Those things matter.
But underneath the intervention is another question: What capacity does this person need to develop in order to meet their life more effectively?
Sometimes that capacity is physiological reserve. Sometimes it is metabolic flexibility. Sometimes it is better sleep. Sometimes it is a more stable daily rhythm. Sometimes it is learning to recognize a nervous system that has been living in anticipation of danger.
Sometimes it is grief.
Sometimes it is the willingness to stop trying to control another person.
Sometimes it is simply the ability to tolerate not knowing.
This is where I think modern medicine and Ayurveda can complement one another beautifully. Medicine gives us increasingly sophisticated ways to intervene in the biological uncertainty of disease. Ayurveda gives us a language for cultivating the person who has to live inside that uncertainty.
Neither should replace the other.
The deeper opportunity is to ask what happens when intervention and capacity are developed together.
Perhaps health is not the state in which uncertainty disappears.
Perhaps health is the capacity to remain responsive within uncertainty.
I’ve started thinking about this as a kind of internal buffer. I used to imagine resilience as creating a buffer around uncertainty, as though we could somehow build enough protection that life couldn’t reach us. I don’t think that is possible.
The buffer is within us.
It is the space between what happens and what we immediately make of what happens. It is physiological reserve, psychological flexibility, relationship, meaning, discernment, and the ability to observe our own minds without being completely governed by them.
We don’t make uncertainty smaller.
We become more capable of inhabiting it.
Maybe that is why I am less interested now in whether people have the “right” story about their lives. I am more interested in whether they can change the story when life asks them to.
My grandmother’s story may have helped her survive one kind of life. Another person may have developed a story that helped them survive a completely different environment. What once protected us can eventually constrain us. What once gave us stability can eventually prevent adaptation.
The work is not necessarily to destroy the story.
It may be to become free enough to revise it.
And perhaps this is also what it means to be alive.
Not to be free from fear, suffering, aging, uncertainty, or death. That would require being free from life itself.
Aliveness may be something quieter: the willingness to remain in relationship with reality even when reality refuses to give us the certainty we want.
To continue loving without guarantees.
To care for the body without believing we can control its entire future.
To make plans while knowing they may change.
To seek treatment without demanding that medicine promise an outcome it cannot promise.
To grieve without needing grief to become productive.
To age without treating aging as evidence of failure.
To know that death is coming without allowing the knowledge of death to prevent us from living.
Perhaps the point of health is not to create a life in which nothing uncertain happens.
Perhaps it is to cultivate the kind of human being who can meet whatever happens with enough steadiness, curiosity, and presence to remain alive to it.
That is a different kind of medicine.
And perhaps it is a different understanding of what it means to live well.
