The Certainty Myth: How to be resilient when the world keeps changing

Prologue

If there is one thing I see in my clinical practice more than any other, it is uncertainty.

I have seen uncertainty show up in a million ways — in the ways that humans behave, or the ways that diseases and our bodies betray us. I have seen it in human relationships and in systems, and when the rules don’t work the way they are meant to. The very nature of the work I have done over the last decade or so, as a psychologist for cancer patients and their loved ones, has shown me over and over again that the world that we live in is unpredictable. Things are hard for people, and there is an indiscriminate way in which hard things are dished out.

And this has changed the way that I am in the world. It means that I don’t take things for granted — I do what needs to be done now, because we don’t know when things might change.

I have a good sense of what is important. In the thousands of people I have met, young or old, not one person has ever said to me at the end of their life that they wished they had worked more or that they had more money. Never. And if they speak of regrets, it is about not doing what mattered or not showing up for the people who needed them.

I see uncertainty for what it is: a living, breathing and present thing that we can’t escape.

But somehow, naively, I have had it in my head that, because I know about it, uncertainty would never catch me by surprise and that somehow I would be immune to the effects of it. But man, was I wrong.

Thankfully, it hasn’t shown up for me very often. Or when it has, it has been in small, manageable ways. But in the past few years that has changed. I have had a couple of personal situations that were heavily laden with an unknowing.

And then 2020 came along.

Initially, I was one of the people who underplayed the impact of all the pandemic stuff. I was almost jovial about it. I had just come back from a lovely trip with my mother to visit my sister who was living overseas, and it seemed to me at the time that it was incredibly ridiculous that something could change our world so fundamentally.

But then, suddenly, it was more present than I had imagined, and along with it came a bunch of emotions that were unexpected and unfamiliar.

I am someone who is very chilled — not much phases me, and I tend to just go with whatever is happening. I am lucky that my brain doesn’t go to anxiety easily, and I am quick to forget things that feel difficult for a time.

In small steps, and largely without me noticing at the time, I changed. I was watching the news, and noticed my brain preoccupied with thoughts about the future and trying to anticipate what was going to happen. I was grasping for information in any way I thought would make it make sense, and then finding that the more information I had, the worse the gnawing feeling in my abdomen would be. I was eating chocolate before nine most mornings, to distract myself from the increasing workload and managing the impact of other people’s uncertainty, while trying to contain my own.

I was waking exhausted as soon as the sun rose, and the first thing I would do was look at my phone. Looking to see what had happened in the US overnight — how much money had been shed from the markets, how many new cases, how many dead. I felt an anxiety inside my chest that wasn’t familiar, which was almost as scary as the uncertainty of the situation.

Each of these things in themselves doesn’t seem like much, but the accumulation was significant, like a million little raindrops filling up a bucket. I hadn’t really clocked this, until one day my partner innocently asked if we should start driving to work rather than catching the train. We were walking along the quiet back streets near where we live, and it was a completely appropriate request. Except that, inexplicably, I found myself crying on the street, the overwhelm of this small decision spilling out. And in that moment, no matter where I looked, nothing made any sense.

Knowing, it seems, isn’t the same as understanding — in a real, visceral sense — what something means. But at least I knew what it was. All of these emotions were my brain trying to help me.

I knew then that to be able to manage whatever happened next, I needed to work out what to do with myself. And I had to do a better job of it. From the outside looking in, I don’t think anyone saw any of this — whenever I spoke to people, they were getting the same picture as they had before. But I could recognize the limited longevity in this — I needed to take my own advice, and learn how to tolerate the uncertainty.

I realized that, just like the conversations I have with my patients, I had to work out how to make space for it — and it was hard. It was hard to not watch the news, or to watch the markets in the red. It was hard not to reach for the chocolate when I felt uncomfortable, and it was hard to contain my own worry when other people were seeking support.

I know that I am not isolated in this, and I am pretty certain there are millions of people worldwide who have had these emotions or versions of them turning up in ways that were unfamiliar. And many of them would have done the exact same things I did — information seeking, distraction, trying to gain back control — and some would have done others.

This book isn’t about the pandemic, but it is about managing what happens when unexpected things turn up.

And it seems these unexpected things turn up all the time. Sometimes in small ways, and sometimes in things that are bigger than us.

Introduction

Don’t worry about the future; or worry, but know that worrying is as effective as trying to solve an algebra equation by chewing bubble-gum.

—Mary Schmich

The quote above appeared in an article in the Chicago Tribune, as part of an imagined commencement speech. From what I’ve seen in my professional life, it’s true: worrying about the future is indeed ineffective. But the writer, journalist Mary Schmich, also added: ‘The real troubles in your life are apt to be things that never crossed your worried mind; the kind that blindside you at 4 p.m. on some idle Tuesday.’ And that, too, is true.

Over the last decade or so, people have been coming to talk with me about the problems in their lives. In the setting I work in this usually takes the form of anxiety or worry, but occasionally it can be depression, and sometimes it’s about how they interact with other people (or usually, to be more accurate, it’s about how people interact with them). And on the surface this seems completely reasonable. These things are hard and problematic, and make being in the world difficult. And pretty much everyone I meet wants these things gone and out of their lives forever.

But when people arrive for a session we don’t talk about fixing. Instead, most of my sessions start with a version of ‘This thing that you are feeling — we aren’t going to get rid of it, and it isn’t fixable’. You might assume that, at that time, most people would get up and walk out. Why else would you go to see someone but to fix something or to make it better? But the thing about where they are — usually with cancer in their lives — is that they understand that the anxiety, sadness, anger, despair or distress that is showing up isn’t the driver. It’s just the thing we see.

Health professionals, especially when thinking about people’s mental health, usually aim the treatment at what the person sitting in front of them says is the problem. So, if someone tells their doctor they are anxious, then it would make sense to treat anxiety. And there are heaps and heaps of treatments for this — everything from medication to therapy to meditation (and a bunch of other things way too numerous to mention). Some of these things will work for one person and not for another, and if the treatment doesn’t ‘fix the problem’ then the person will likely try something else.

But I want us to take a step back and think about this differently.

All the things we treat — anxiety, depression or other things that turn up — are just symptoms of something much bigger. In the same way that, if we have a problem with our knee it swells and pain shows up to tell us we have injured it, these psychological symptoms turn up to tell you that you are struggling with something.

We don’t need an X-ray to see it, though. I can guess that most of the time that thing is uncertainty.

It might be you have never thought about uncertainty before. You might have not noticed it at all — but you have probably noticed what happens when it turns up in your world. Most of the time when uncertainty turns up in our lives, we are scared and terrified even of what might happen next. But there are times when, in the face of what would appear the most complex of uncertainties, the world makes sense in a way that doesn’t make sense.

You are going to meet lots of people and hear their stories as we move through the book. I tell these stories because they are important, but also to help us navigate the complexity of uncertainty. We often can make sense of things better when we see them happening in other people.

I wonder if I know what you are thinking: ‘Those stories won’t be relevant to me’. And you might be right, but rather than focusing on the ways you are similar or different, I ask that you connect with the emotions in the stories. The outcome isn’t really the bit that is important; it is much more about the way uncertainty drives how we think and feel, and how we make sense of the world that we are in.

There are a million reasons why you might have picked up this book. It could be that you have been struggling with anxiety or uncertainty all your life and you want a solution to make it stop. It might have been that you heard about it from someone else, or the book shop had a display. It may be that since the pandemic began, you are looking for certainty anywhere you can get it. Or it may be that the cover was just enticing enough.

In lots of ways, it doesn’t matter what the driver was. But if you have kept reading, I am going to assume there is something in the way we are talking about managing uncertainty, anxiety and other discomforts that appear in our lives that is making you feel it would be helpful for you to understand better. Perhaps you are imagining this book will have the solutions to make this anxiety disappear or at least be less problematic.

Anxiety is usually the first of the symptoms of uncertainty to turn up. It is usually the signpost to tell us there might be a broken bone somewhere in the midst. Sometimes, it won’t be obvious right away what that bone is, but when anxiety turns up it is usually a helpful guide for us to understand better.

It might seem strange to pair uncertainty and anxiety together — but in my experience they are strongly linked. And hopefully as you work through the book their link will become obvious to you.

In the last couple of years, the world has been forced to deal with uncertainty in a way that it hasn’t for a long time. But, as humans, uncertainty is always with us — it’s just that we don’t like it. It messes with the way our brains like to make sense of things. We prefer black or white, good or bad, alive or dead.

Anxiety is the opposite side of the same coin. We fight incredibly hard to live lives where no anxiety turns up. But the very nature of our lives is that anxiety will turn up. In fact, almost every day of our lives some kind of anxiety will turn up at some stage.

You know that expression about not thinking about a pink elephant? The more you try not to think about it, the more images of a pink elephant flood into your brain. Well, that’s the same as telling anxiety and uncertainty to not turn up. Trying to not make them turn up is likely to mean that that big, fat, pink elephant is stretched out all over the couch and has its trunk resting on your table lamp. But we can learn to manage them (or teach the elephant to go outside when we want it to).

About the book

The book is in three parts. The first part, ‘The Set-up’, is about getting to know uncertainty and identifying the ways it turns up in our worlds. As a part of this, we explore what the relationship between anxiety and uncertainty is, to set the scene for the following sections. Part 2, ‘The Lessons’, is a series of lessons. These are things I have learnt over the years from my patients about uncertainty. Part 3, ‘Uncertainty in Different Guises’, is about the ways uncertainty appears for all of us, and applying what we have spent the rest of the book talking about!

Most of the people you meet in the book are composites of several people, to make sure that I am protecting those who have shared very vulnerable moments with me. Some of the details have been changed but the purpose of the stories remains.

Uncertainty and death

You might have noticed that death has already come up a few times. It might have made you uncomfortable or it might have piqued your curiosity. There are a couple of reasons why it is turning up:

•Death provides us with the ultimate uncertainty. Underneath most of the worries about uncertainty and our intolerance of it is fear of death. We, as humans, always have a tricky relationship with it. Many of the things we do to manage uncertainty are really about trying to control what happens to us next and put some structure around what might happen next.

•Many of the examples are around the ideas of mortality . This is partly because this is the work I do almost every day of the week. Even if people aren’t going to die from their diseases, the threat of death and the uncertainty around it turns up consistently in almost all our sessions. This isn’t about being morbid; it’s about connecting with what happens for people at the pointy end of things, and hopefully as you read it will help you connect with the concepts we are talking about. I personally haven’t had brushes with my own mortality, but an awareness of the presence of it has been a helpful steward in my life.

•It happens to all of us . As much as we don’t want to think about it, death is there and present in all that we do, but it’s only when uncertainty turns up that we tune into it (or in some cases work really hard to avoid it).

These aren’t things to be fearful of, and I encourage you to approach them with curiosity and openness as we explore further. Hopefully, by the end of the book you will understand what I mean.

This book doesn’t aim to fix uncertainty (or even the anxiety that turns up with it). By the end, it’s likely you will still have things that are uncertain or things you are worried and anxious about. Even more so, it isn’t going to teach you about controlling these things so that you are able to push them aside and out of the way.

Instead, the book is based on a therapy style called Acceptance and Commitment Therapy (ACT). The general gist of ACT involves changing the frame of how we think