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Life is an uncertain project

 

In this unpredictable world the only factors we can control 100% are our own attitudes and behaviour. Nobody can deny us to think or do whatever we want. One advice Ingvard Wilhelmsen gives his patients, is to choose attitudes which will help them reach their goals in life. It is normal to want to be in control, but he suggests that we all stick to factors that are controllable, our own attitudes and behaviour.



Twenty-four years ago I wrote a book called “Life is an uncertain project” (ref. 1). It was true then, it is true today, and it will always be. To accept this is potentially liberating and in my opinion necessary in order to live the life we want to live. The covid-19 pandemic was a universal chance to accept life’s uncertainty, but even before and after the pandemic everything can happen to everybody anytime.


Most things in life are uncontrollable


Based on my experience with running a small clinic for hypochondriacs for 28 years, it is crucial that therapists treating anxiety disorders focus on life’s uncertainty early in treatment (ref. 2). All anxiety disorders are an attempt to control factors which are uncontrollable, like death, the future, what people think of us etc. In this unpredictable world the only factors we can control 100% are our own attitudes and behaviour. Nobody can deny us to think or do whatever we want. One advice I give my patients is to choose attitudes which will help them reach their goals in life. It is normal to want to be in control, but I suggest that we stick to factors that are controllable; our own attitudes and behaviour.


The past and the future


If we look at our past as a book, nothing in that book can be changed. But it is open. We can flip through it, and we remember some of the experiences we have had. We do not remember facts, but interpreted experiences, often loaded with visions and emotions. When witnesses report an accident, they usually don’t lie, but two people can report the same incident completely different. Memories can be manipulated and contaminated (ref. 3). We cannot change The Past, but we can decide how we relate to it and what we focus on. If we spend time ruminating about our failures, unfair treatment etc., we tend to feel depressed and bitter. Another diagnosis is PTSD, Post Traumatic Stress Disorder, experienced by people who have had terrifying experiences like rape, war, accidents, or have been witnessing extremely brutal events. Strong bodily symptoms and emotions can be triggered by a smell, sounds, places and memories with flash-backs to the event.


We can also look at The Future as a book. That one is not yet written, not a single word. It is empty. It is also closed, locked. We cannot peep and see what is going to happen, it is unpredictable. It is wise to have plans, but knowing that what we plan might be changed completely. Patients with anxiety disorders tend to guess what is going to happen in the future. If the events they predict are negative, like serious disease or an early and painful death, they get very anxious. They do not develop PTSD but what I call PreTSD, not with flash-backs but with flash-forward, with visions of different scary scenarios.


Death


At some point in our life most of us understand and accept that life one day will end. We do not know how and when. Most people with hypochondria try to control death. They accept that one day they will die, but not now. In order to reach their goal, they spend a lot of energy on not dying, and hence less on living. This is a paradox, since their aim is to be here for long. Most normal people have a negative view of death, it is an enemy. If we accept that most things in life are unpredictable it is easier to also accept that we are mortal.


Twenty-four years ago Ingvard Wilhelmsen wrote a book called “Life is an uncertain project”.
Twenty-four years ago Ingvard Wilhelmsen wrote a book called “Life is an uncertain project”.

Subjective physical symptoms


If our goal in life is to not die now, we tend to listen to your body’s signals. Subjective physical symptoms are common, and most of them are transient. As long as we have a body we will notice it, increasing with age. To pay a lot of attention to what is going on in our body is a symptom-creating or symptom-strengthening attitude. We will notice symptoms that would otherwise not bother us. To make things worse, we might interpret them as potentially dangerous, which activates our adrenal glands to produce adrenaline, since the adrenal glands do not check if our interpretations are correct. It is not possible to have anxiety without anxiety symptoms, so palpitations, sweating, nausea, pain and in the long run fatigue, will add to the symptom load, making this a vicious circle. I tell my patients that they cannot choose whether they have a serious somatic disease or not, but they can choose what to believe, until further notice. Even though they will have to make this choice with some doubt, they should not make a doubtful decision. It is 0 og 100; they don’t have 20% cancer or 40% ALS. If the patient is willing to be mortal it is easier to trust the body and the life project can be changed from not to die, to wanting to live life to its fullest.


Thoughts are just thoughts


The problem with catastrophic thoughts is not the thoughts as such, but the fact that the answers lie in the future. They have the formula “Imagine if…”. The patients have to identify these questions and give them less attention. They must rehearse having them without feeding them. Catastrophic thoughts will be strengthened by focusing on them, acting on them, trying to get rid of them by distraction, or acting on them. Avoidance and security behaviour relieves anxiety in the short term, but strengthens it in the long run. Thoughts are just thoughts, events in our mind, often quite uninteresting. What is interesting are events in reality.


Behave as if you mean it


To choose a new attitude towards death and symptoms can be done here and now, and might seem easy. The challenge is to behave as if we mean it! Then it is no longer theory, but very challenging. The moment a person avoids avoidance and stops security behaviour, the anxiety will transiently increase. This is called behavioural experiments or exposure. It is scary to exercise hard or to stop checking your pulse if you for a long time have not trusted your heart, but if you choose to trust it, you must put this new attitude into action. The experience that you don’t die, you did not loose control, gives a feeling of mastery. This kind of anxiety is expanding your room of freedom, while the old anxiety restricted your life. After a while the anxiety subsides and you are free to life the life you want. □


References by request


  1. Ingvard Wilhelmsen “Livet er et usikkert prosjekt” Pax Forlag A/S, Oslo. ISBN 978-82-530-3609-0.

  2. Kari-Elise Frøystad Veddegjærde, Børge Sivertsen, Jens Christoffer Skogen, Otto Robert Frans Smith and Ingvard Wilhelmsen. Long-term effect of cognitive-behavioural therapy in patients with Hypochondriacal Disorder. British Journal of Psychiatry Open 2020, 6, e42, 1-7. doi:10.1192/bjo.2020.22

  3. Speaking of Psychology: How memory can be manipulated, with Elizabeth Loftus, PhD https://www.apa.org/news/podcasts/speaking-of-psychology/memory-manipulated

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