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The unbearable uncertainty of being. Is psychiatry the cure?

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Interview with Fredrik Svenaeus


 

Uncertainty is a part of life, perhaps one of the few things we truly have knowledge about. We all must come to terms with the fact that our knowledge is limited. The concept of uncertainty is found within areas such as philosophy, statistics, economics, psychology, and sociology. Generally, it involves predicting future events, interpreting various measurements, and grappling with the unknown within the realm of science.



The problematic nature of uncertainty is tied to our limited understanding of both the future and the past. In philosophy, questions about what it means to exist are studied, along with inquiries into the nature of knowledge and its relation to truth, belief, and justification. What do humans really know, and where does that knowledge come from?

 

The realization of uncertainty as one of life's fundamentals is dealt with both on an individual and group level. We all seek predictors, clues that help us anticipate future outcomes. In the absence of predictors, feelings of discomfort and frustration easily arise. From an evolutionary perspective, this anxiety may be purposeful, contributing to averting danger. However, in many contemporary cases, anxiety takes on maladaptive and dysfunctional expressions.

 

As psychiatrists, we encounter symptoms of uncertainty within the framework of our established diagnoses. The nagging feeling of doubt in individuals with OCD, the anxiety about almost everything that could happen in generalized anxiety disorder, and even in depression, there is uncertainty about life, stemming more from rumination and self-doubt.

 

To gain perspective on the concept of uncertainty, I reached out to Fredrik Svenaeus, a well-known Swedish philosopher and author of several books, who has problematized the concept of illness and what happens in the interaction between doctor and patient. I asked him to elaborate on uncertainty in our time.


Fredrik Svenaeus: "The ability to have direct contact with children is now a requirement, which is why children, even young ones, are equipped with mobile phones. Not instantly being in contact with each other and knowing exactly where the children are is no longer an option. Tolerance for the uncertain has decreased." Image by Unsplash.
Fredrik Svenaeus: "The ability to have direct contact with children is now a requirement, which is why children, even young ones, are equipped with mobile phones. Not instantly being in contact with each other and knowing exactly where the children are is no longer an option. Tolerance for the uncertain has decreased." Image by Unsplash.

"In line with the increased availability of products and services to anticipate risks and plan for the future, which have increased our real security, tolerance for uncertainty paradoxically has decreased. Today, lacking control over existence is not perceived as an option. An example of this can be seen among today's parents. The ability to have direct contact with children is now a requirement, which is why children, even young ones, are equipped with mobile phones. Not instantly being in contact with each other and knowing exactly where the children are is no longer an option. Tolerance for the uncertain has decreased.

 

With new technology, we now have new opportunities to plan our lives. A packed calendar several weeks in advance was not common a couple of decades ago. Today, it has become difficult to find time for spontaneous meetings. The meticulously planned existence gives us an illusion of control, a notion that everything in life can be planned.

 

The demand for control also makes our choices fateful. How does one choose a partner when there are so many more on the dating app? Who knows, maybe the next one is better? Our choices must be deliberate to optimize the outcome. Another example is the choice of studies and profession. How do I find a job that is adequately challenging, secure, stimulating, well-paid, prestigious, and allows for a rich leisure time? We must leave nothing to chance."

 

Total control is, of course, unattainable. When the future becomes uncertain, perhaps due to too many options or external circumstances, anxiety easily arises. We tolerate it in various ways, some with more trust in the unknown. Others develop worry, anxiety, frustration, and sleep difficulties. This often leads to encounters with healthcare, which is quick to respond with solutions. Symptom combinations are put together, and suddenly, a psychiatric diagnosis is formed. With a confirmed diagnosis, paradoxically, a sense of security sets in. The expert names the condition, which suddenly exists. The abstract becomes concrete and something to relate to. Often, there is a treatment available at the pharmacy.


"The demand for control also makes our choices fateful. How does one choose a partner when there are so many more on the dating app? Who knows, maybe the next one is better? Our choices must be deliberate to optimize the outcome."

 

"One might wonder why more psychiatric medications are prescribed today than ever before. Does it mean that psychiatric illness has actually increased? Probably not," says Fredrik Svenaeus. "But the way we express and contextualize uncertainty and mental suffering has found new avenues, and psychiatric diagnoses have become a primary option. Through the diagnosis, one can gain self-knowledge and learn how to organize life. What one's weaknesses and strengths are. Then life also becomes more predictable, and the choices diminish.

 

Even the doctor must deal with the concept of uncertainty. What is the patient suffering from? Is it something that should be treated in a medical sense? It's easy to create diagnoses with today's descriptive diagnostic systems. The patient reports symptoms. The doctor uses diagnostic tools and rating scales. Treatment follows. CBT or medication. Or both. Experiences and symptom combinations are described and treated as if they were real conditions in themselves. A diagnosis should, according to various guidelines, be treated with evidence-based methods. And before we know it, we medicalize expressions of the relentless force that is unbearable uncertainty. Perhaps we should listen more to the patient and find out a bit more about her life and thoughts before making a diagnosis." □



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