Tolerance of Uncertainty

To start off, for any fellow nerds that may read this. I’m sorry to disappoint, this is not a comprehensive review article on the psychological concept of intolerance of uncertainty (let’s get the acronym out of the way, IoU). However, happily, it is definitely related. From what I understand, IoU represents a tendency to react negatively to events that are unpredictable or uncertain. If anyone remembers the game Crocodile Dentist (by far my favourite reptilian-based dental boardgame), you may be able to conjure the mental representation of IoU to the forefront of your mind. Some of us may just dive in, where others may sit and agonise.

The brain is my favourite organ (for those that need to know- 2: Liver, 3: Pancreas, 4: Heart, 5: [CENSORED FOR REASONS OF CAREER PROGRESSION]). It is the ultimate Holmesian entity. From the day you are born, it is absorbing every last essence of data to make predictions about how to engage with life. Life is incredibly uncertain. On a minute-by-minute basis, your brain will be making erroneous decisions and having to correct itself for next time. For example, I just reached for the word erroneous and found the word erogenous (likely in part due to my 5th favourite organ). When dealing with real-life, you are dealing with a far more complex environment. I feel qualified as a psychologist to say that human-beings represent the apex of this complexity. We are hard to read, but we are also hard to interact with sometimes. If you analyse it, any of your standard weeks will be a long chain of uncertainty, being tackled by your best predictions, and often being rebuffed or incorrect. It is easy to see why being vulnerable to handling uncertainty would be disadvantageous. In fact, intolerance to uncertainty has been linked to generalised anxiety disorder, panic, OCD and social anxiety. All in all, it’s not tremendously surprising really.

However, feeding into the theme of uncertainty. Why am I mentioning any of this? Because, for me, a career in research and academia at present needs to be understood as an enormous challenge in tolerating uncertainty. I’m getting more and more requests to speak to young potential scientists about a career in research, and despite my ‘cup-half-full’ mentality, it feels unreasonable to hide this fact from them. A few of them, I’m told, are even reading this. Over the past 6 months, I’ve been contemplating whether to stay in research at all. This is despite it being, to-date, the best and most enjoyable job I have ever had. It doesn’t even take much truth be told. Manuscripts perennially in need of improvement before submission, grants being pulled (sometimes a day before the interview), unreasonable reviewers, but ultimately, two core concepts. Uncertainty as to whether I am actually going to have a job in 6 months and uncertainty as to whether I am good enough. Importantly, these are characteristics shared at some point by every single scientist I know (except the narcissists, but let’s leave them to one side for now).

BUT, I have a belief that morose and pitiful narratives are overplayed these days. I wouldn’t like to put my name to something needlessly defeatist. The key concept within IoU for me is tolerance. It’s something that can make you more resilient than you’d ever think possible. Sometimes you’ll be ahead, sometimes you’ll be behind. Some results are going to be worst than you expected, but sometimes you’ll get it spot on. It’s a little like the weather, sometimes your BBQ will be a washout and you can’t help it, but sometimes, you’ll get that perfect day. This week, alongside a co-investigator, I was awarded my first ever grant to continue my studies into presurgical assessments for those undergoing knee surgery across the next 3 years. The aim being to identify those who are most vulnerable, raise a red flag, and give them the support they need before undergoing unnecessary surgery that will only make things worse. Two days after this grant, a long agonised but important paper on pain during hysteroscopy (watch this space for a synopsis post) was accepted at the British Journal of Anaesthesia. All of a sudden, the washout BBQ is actually becoming brighter!

I never really know what these blog posts are, or who they are useful for. Once lockdown has lifted, I hope to start infusing more science and dissemination into the themes. But during these rather odd times, I’m noticing the mental health and morale of my colleagues and friends dipping with every passing month (while making it clear that I am no different to them in this regard!). The core messages are: for those in research and academia, know that you will be forced to tolerate a great deal of uncertainty throughout your career, and you are not failing when it becomes intolerable. Just like the weather, the grey, wet and dull days cannot by definition last forever. Keep attentive to your own mental health, and do not be afraid to ask for help or to take a break. If you are in your early career, reach out to mentors and fellow ECRs. We’re all feeling like imposters, and we all note that literally everyone appears to be more intelligent than we are. When you’ve had enough, reached your limit, and find it’s no longer giving you any enjoyment, don’t be afraid to move on and try something else. You’re not a failure, you’ve just made a very difficult decision for the benefit of your own future. That seems like a success to me!

“In the face of uncertainty, there is nothing wrong with hope”. Dunno who said it, but I like it! Now, if you’ll excuse me, I’m going to go celebrate a good week with a rousing game of Crocodile Dentist.

2 thoughts on “Tolerance of Uncertainty”

  1. “Two days after this grant, a long agonised but important paper on pain during hysteroscopy (watch this space for a synopsis post) was accepted at the British Journal of Anaesthesia. All of a sudden, the washout BBQ is actually becoming brighter!”

    THANK YOU – on behalf of the 1,000+ women who reported their hideous outpatient hysteroscopy pain to the survey run by the Campaign Against Painful Hysteroscopy.

    And THANK YOU from future gynae surgical patients who you’ll have helped get access to REAL, professional anaesthesia, and not just ‘distraction technique’.

    1. Hi Katharine,

      Only happy to be able to hopefully help to a serious problem for so many women. Thank you for all your help and education along the way, you’re a credit to your campaign!

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