Remaining in the current moment is a good way to avoid toxic negative thoughts.
When my first son was born 4 years ago, I proudly showed him off to my family.
“It feels strange to love someone so much when I don’t even know who he’s going to become,” I noted.
“But you know who he is right now,” my uncle responded.
I have thought about that comment a lot over the last 4 years. The last 3 have been challenging for me and my wife after I was unexpectedly diagnosed with metastatic kidney cancer when our son was only 1 year old.
Since then, my mind has had a tendency to spiral out of control with dread for what the future holds. I know that despite the incredible advances in cancer care these last few years, metastatic disease remains deadly for most patients. Still, no one can tell me how much time I have left. If I knew that it was a matter of months, I would probably stop working and spend more time someplace warm with the people I love. On the other hand, if I knew for certain that I had years ahead of me, I could more easily make long term investments in my future. Maybe I would apply for that 5year research grant or finally replace my beaten-up car with a new model.
Both of these paths and an infinite number of others are totally feasible, but I cannot know which road I am on. Sometimes the uncertainty in my life has left me with a sense of being emotionally paralyzed. When a decision needs to be made, I have a harder time coming to a conclusion and moving forward than I used to.
The dilemma reminds me of army ants, known for engaging in maladaptive death spirals when they become disoriented.1 These blind insects use pheromones of the ants who came before them to track and follow the colony’s intended path. When a group of ants become separated from the main party, though, the unprepared leader of the trail wanders aimlessly while the others each follow the ant directly in front of them. In this way, thousands of ants can form a gigantic spiraling mass of unproductive marching until eventually they become exhausted and die.
When I was first diagnosed, I regularly found myself caught in the emotional equivalent of an army ant death spiral. My thoughts circled and circled uselessly until I became emotionally drained and exhausted. Over time, though, I have learned skills to help break the spiral. The most meaningful of these techniques I have borrowed from my training as a psychiatrist.
First, I have begun to prioritize only the worry that can lead to change. It is reasonable for me to spend time thinking about the next treatment choice, but less useful, for example, to ruminate about whether the last choice was the right one.
Next, I try to process what it is about the circumstances at the time that is most affecting me. Were there underlying automatic thoughts or cognitive distortions that led me to a place of distress? I often try to write about my experience, both as a way of better understanding it and as a method of connection to all those other individuals out there who are like me. In what I think of as a form of sublimation, I have become dedicated to the cause of patient advocacy and have given my time to worthy patient-oriented initiatives, like the Your Cancer Story program. Being a guide to others, as some longer-term patients have been to me, has given me a sense of value and purpose even through the trials of serious illness.
Finally, when I need to halt an emotional spiral, I deliberately stop trying to determine what the future will bring and redirect my thoughts and actions back to the current moment. I recall what my uncle said to me about my newborn son 4 years ago and realize that there can be enormous value in a moment even if the future remains uncertain.
This approach has indeed led to wonders that I thought had already been lost to the disease. When my wife and I first got married, for example, we used to talk about having 2 children. At the time I was diagnosed, we would speak in hypothetical terms about some point in the future when I might be rid of the disease and be healthy enough to have another child. Last year I underwent multiple treatments and surgeries, and we began to give up hope. Still, we went forward together, controlling only what we could, and in 2020 we welcomed our second little boy the world. I do not know what he will be like when he is older, but I know what he is like right now; like his brother before him, he is truly a wonder.
I am well aware that the future is uncertain. That has been intensely true for me these last few years, but I have come to acknowledge that it is also a universal phenomenon. Our patients certainly struggle with the unknowns in their lives, and not even the best prognosticators among us can know exactly what lies ahead. Nothing in this life is guaranteed except the moment we are in.
While I never would have wished to come upon these lessons by way of my current path, I am thankful for the gifts this journey has given me. I appreciate them now and look forward to discovering the unforeseen value in whatever comes next.
Dr Stern is the director of psychiatry at Beth Israel Deaconess Medical Center’s Berenson-Allen Center for Noninvasive Brain Stimulation, and an assistant professor of psychiatry at Harvard Medical School.
1. Ant mill. Wikipedia. Accessed January 19, 2021. https://en.wikipedia.org/wiki/Ant_mill