09.29.06

Uncertainty - stressor #1

Posted in Medicine at 10:10 am by PuneTalks

- A lump in the breast is detected in the course of a routine screening examination. The doctor suggests a test to rule out the possibility of cancer. You immediately start a train of negative images. The body does not distinguish between an image and reality and so your body reacts to the negative images with a pounding heart, quickened breathing and a sweaty brow!

A young girl is admitted to hospital with pneumonia. The doctor starts what he feels is the appropriate treatment but her response is unsatisfactory. He orders more tests to find the reason for this sluggish response and is alarmed by the results- she has deteriorated instead of improving. He is wracked by self-doubt. Has he missed something? Should he have treated it differently? Is he competent to deal with the problem?

Life is full of uncertainties. The only absolute certainties in life are death- and change. Why is uncertainty stressful? It is because we have a personal stake in the outcome of any event. If cricket (the game of glorious uncertainties) evokes stress, it does so because you are participating as a player (your pride and place in the team are at stake), you have bet on the game (your money is at stake) or you are a hard-core nationalist (your country’s pride is at stake). If you can remain detached from these concerns, you could enjoy the game and remain stress-free.

What makes the uncertainties of a Hitchcock movie or an O’ Henry novel so enjoyable whereas the outcome of a pathological test, illness, job interview or examination can be so stressful? The “thrillers” are fiction and although they can have you biting your nails in anticipation and have adrenaline surging through your veins, you have no personal stake in the outcome- just an impersonal curiosity. Whereas the “real-life” issues affect you personally and the stress-provoking part seems to be the expectation/possibility of an adverse outcome.

Showing concern is a manifestation of empathy. Concern is transformed into worry when negative images or thoughts regarding outcome are entertained. The various “what-ifs” are all negative images of future possibilities- What if I fail? What if the test result shows the lump is malignant? What if I lose my job? It is when concern turns to worry that the stress-response is evoked. Most worries are fears about what might happen. We let the past colour our present moments and agonize about the future.

What role does uncertainty play in provoking the stress response?

When faced with a situation that is perceived as a threat, the body’s adaptive mechanisms are activated for coping and the process ends with “fight or flight”. However, when there is an element of uncertainty added, the body is kept in a state of constant semi-arousal and this puts an extreme burden on the body’s adaptive resources and resistance systems.

Recent research into this ” uncertainty factor” in stress suggests that we may be able to reduce the effects of stressful events in our lives by learning to distinguish between undesirable events that we have no control over (and hence should not feel responsible for) and those events which we can influence (and feel responsible for)- should we choose to do so.

It must be said in its defense that all worry is not bad. It may, in fact, spur you on to take action rather than sit back. The increased alertness that comes with being aroused may help you focus on the problem at hand.

Coping with uncertainty

As far as a doctor is concerned, concern for his patients’ well-being is not only understandable- it is expected of him. However, at times, in an attempt to “play god”, he forgets that there are situations that are beyond his control (eg a person’s own will to live, the fact that certain bugs are resistant to multiple drugs, the possibility that innate immunity is so low that even the best and most appropriate medications do not help). He needs to be objective in his assessment when things don’t seem to go as expected/planned. Moreover, a common human failing is that we tend to be impatient to see results. Healing is slow but certain- the same as a bud blooming into a flower. You cannot make a bud bloom faster by hitting it with a hammer! If we fail to see results immediately, we start getting restless and start entertaining negative thoughts. That can set off a series of actions that can spell disaster.

A balanced person is one who acts on problems within his power to control and does not waste time worrying about those that are not.

Those people who do not act even when the problems are within their control are prone to illnesses related to immune deficiency- their bodies also believe that they are helpless and just give up putting up a defense, saying “its hopeless”. Then there are those who believe that nothing is beyond their control and then agonize over problems that they can never solve. Such people get frustrated and tend to suffer from stomach ulcers, heart disease and hypertension.

How do we prevent this?

Shift focus: There is a saying that goes something like this:

Yesterday is gone; tomorrow isn’t here yet; so what is there to worry about?

By shifting focus- away from the fear of past preconceptions and future unknowns (the “what-ifs”)- you are able to concentrate on acting in the present. (eg if the chest pain you have has you worried, get the doctor to carry out some tests to decide whether it is really the heart ailment you suspect it is).

Another way of being in the present moment is to take a break and get some exercise- vigorous exercise helps. Then come back and take a fresh look at the problem- you may be able to see it in a different light.

Know your limitations and work to the best of your abilities to effect change, if at all change is possible.

Accept

Learn to recognize situations over which you exert no control (eg if you have an important appointment and get delayed due to traffic, don’t blame yourself or get angry).

Share your concerns (talk to a friend/colleague.): tell someone what’s troubling you- get the problem out into the open. Or, put your worries through a reality test- ask yourself whether your worries are supported by facts.

Visualize: visualization is a technique that is often suggested to people with a negative outlook. For those who express their doubts regarding its usefulness, a gentle reminder that their worries (”what-ifs”) are a result of their fertile imaginations is all that is needed! An example of the technique would be as follows: let’s assume that you are afraid of injections. Visualize yourself in the doctors clinic (add as much detail as you can to make it seem real) and then imagine yourself saying to the doctor that you didn’t even feel the prick of the needle!

Or else, try and imagine the worst possible outcome (pain) and imagine yourself coping with it!

For those worries that are best not acted upon, remember the words of the philosopher Reihold Niebuhr:

“Give us the grace to accept with serenity the things that cannot be changed; the courage to change the things that need to be changed, and the wisdom to know the difference.”

Dr Shyam Kagal

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