A Psychiatrist's Secret To Handling Anxiety In The Face Of Uncertainty

Psychiatrist By Amy Bloch, M.D.
Psychiatrist
Amy Bloch, M.D., has been practicing child, adolescent, and adult psychiatry for 23 years. She received her B.A. from Dartmouth College and her M.D. from Yale University School of Medicine, and she completed her psychiatric residency training at The Payne Whitney Clinic, New York-Presbyterian/Weill Cornell Medical Center.

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Uncertainty causes anxiety because the brain wants answers, wants knowledge. But in her newly released book The Power of Heart, psychiatrist Amy Bloch, M.D., says the secret to mitigating that anxiety is to shift the focus from your brain to your heart. In this excerpt, she explains why the heart is much more capable of sitting with "I don't know."

A Friday afternoon voicemail informed Priya her mammogram results were back and that the doctor would like to discuss them with her, but by the time she picked up the message, the doctor's office was closed until Monday. Facing a loooooooong weekend, Priya called me, insisting she couldn't stand the uncertainty of not knowing what the doctor wanted to tell her.

Jean was laid off four months ago, and he still hadn't found work and had no clue how he was going to pay his rent if something didn't turn up soon.

Beth and her partner had been trying to get pregnant for 14 months and were heading into yet another round of IVF. It was all she could talk about in our sessions. The not knowing if she'd be able to have the family she long dreamed of was unbearable, she said.

What these disparate patients have in common was the reliance on brain to deal with their problems. And the experience of brain being absolutely undone by not knowing. For each, it was coming to the point where they felt they could not rely on brain to be productive at all.

They all rightly counted on brain to maximize their chances of achieving their wished-for outcomes, using brain to assess their strengths and weaknesses, plot their strategies, keep up with the medical follow-up visits, polishing their résumés and their interviewing skills, researching best protocols and nonmedical ways to support their success. But brain could not do a thing about the inevitable uncertainty of their situations.

The other thing these patients ultimately shared was the discovery that heart is completely capable in the midst of uncertainty.

Heart is comfortable not knowing. And so, when they learned how to shift into heart, were they.

While brain charges headlong into solving everything and closing the case, heart holds space for being in uncertainty without rushing into knowing of any kind.

What heart does that is so powerful in uncertainty is create space. While brain charges headlong into solving everything and closing the case, heart holds space for being in uncertainty without rushing into knowing of any kind. Heart creates space between something happening and us settling on a definitive analysis of what it means. In this way, heart allows us to be in the truth of not knowing, which is: We do not know.

Priya managed her distress through the weekend by reminding herself that she was in a situation of not knowing—she simply didn't know what the doctor's report was: good, bad, or indifferent—and telling herself that whatever it was, she would deal with it when she found out. Just as she had dealt when she was first diagnosed with breast cancer, she had to admit. This follow-up scan was another step in the journey she had, in fact, been coping with.

Jean worked to create space in his life for uncertainty to indicate possibility rather than anything dire. The shift to heart led him, ultimately, to deciding to go out on his own rather than hold out for another corporate job.

Beth learned to remind herself she could not, in fact, see the future, and she didn't know what the outcome of this round of IVF would be any more than she had the previous times. Furthermore, she didn't really know what her family experience would be if it never did include this potential new family member—or if the success of the procedure would match her dream, either. Not knowing wasn't just limited to a positive or negative result on a pregnancy test—it also applied to the infinite possibilities of either outcome. She realized she knew what she preferred now but also that she knew nothing about the broader implications for her life. Heart makes space for the future being a mystery with infinite possibilities while brain jumps to conclusions, most of the time envisioning the worst possible outcome. While waiting for the results of this trial, Beth replaced her old spikes of panic from envisioning another "failure" (brain's) with a new attitude: This time is entirely new, neither good nor bad, just not yet known.

When faced with uncertainty, what we need to do, as these patients did, is access heart. If brain is already too exhausted to deal, you can rely on heart to see you through. Better still, when brain is burned out, or threatening to burn out, you can call on heart rather than waiting for heart to happen. Even better is going from strength to strength: Once you know how to intentionally access heart, you can combine heart's power with brain's. I think uncertainty will always be a difficult experience for us humans, but accessing heart and its capacity to create space for "This is new" eases the pain.

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Heart knows a thing or two about uncertainty.

Drawing on heart in tandem with brain is crucial because heart harbors some deep truths that brain can't easily access. Brain is great for solving for X when there is an X to discover and great for developing a perfectly reasonable plan for reaching your goal. Brain will work tirelessly to get to a definite answer or set a tight plan. But answers are not always available, the certainty of a specific outcome is not possible, some things are unknowable, and that's when we need to tap into what heart knows.

What the heart knows that brain doesn't.

Heart knows we don't know...and that's OK.

To heart, uncertainty is just uncertainty. Answers aren't available, even though you want them, and that's all uncertainty is. In heart, we do not have to have answers, not right now, and maybe not ever. Maybe we can't know and will never know. Or maybe we will know when we know. Until then, not knowing is OK. That's the message of heart, as Emily summarized: Wow, that's new.

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Heart knows we don't know what anything will ultimately mean.

The truth is, we don't know, can't know, if this or that occurrence is "bad" or "good" until we see how things play out. We don't know right now what something will ultimately mean. And that's OK, too!

Put another way, just because we don't know what's happening/what's going to happen doesn't mean it is bad. Doesn't mean it is good either, of course. It just means we don't know, at least not yet.

Heart knows you are capable in uncertainty.

You've been practicing a long time, actually, and heart knows it. You've done plenty of unknown before, and you'll do it again. Heart knows you have handled everything up until this point, so you will handle this, too, whatever this is.

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Heart knows there can be calm in chaos.

Because we don't know, because not knowing is OK, because we don't have access to the ultimate meaning of anything until it unfolds, and because you are capable, heart knows there is calm to be had, even in chaotic situations. In heart, it is clear that we do not need to resolve uncertainty to feel better. We just have to understand it as uncertainty—and that's all. That's the outcome of a deep heart truth: In the present, the future is neutral. (As far as we know.) That's the place to stand in the middle of the storm.

From The Power of Heart by Amy Bloch. Copyright © 2019 by the author and reprinted by permission of St. Martin's Publishing Group.

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