Something is off. The appointment happened, or the test was ordered, or the symptom has been there long enough that it can no longer be explained away. No one has said anything definitive yet — or something was said that raised more questions than it answered. The mind is running, and the running isn't proportionate to any specific thing that has been confirmed, because nothing has been confirmed. The fear does not wait for certainty to arrive.
That particular condition — the space of not knowing — is its own kind of suffering, and it tends to be underestimated.
The nervous system does not require a clear diagnosis to activate a threat response. Ambiguity, in many ways, is harder for it to process than bad news. Bad news at least arrives. Uncertainty stays open — and the mind, under an open threat, keeps scanning. Cortisol rises. Heart rate climbs. The field of attention narrows. Sleep becomes a place where unresolved thoughts go when there's nowhere else for them to be.
The body is doing its job; the problem is that the job is designed for short-duration threats with clear resolutions. Medical uncertainty doesn't resolve on a timeline the nervous system can work with. When the stress response doesn't quiet — when there is no sprint, no escape, no clear moment when the threat is past — the same physiology that is meant to protect begins to work against what the body needs to do.
Sustained psychological stress affects immune function, inflammatory processes, and the body's capacity for self-regulation — and the research on this is not subtle. The mind's relationship to a health scare already belongs to the medical picture, whether the clinical encounter makes room for it or not.
There is a particular fear that lives in not knowing where things are heading. It is different from the fear that arrives after a diagnosis, and in some ways harder to hold. After a diagnosis, there is at least a name, a path, a set of things to do. In the space before clarity — the waiting room of the medical process — there is none of that. There is only the question, and the mind's repeated attempts to answer it with information it doesn't have.
What the mind tends to do with unanswered questions is answer them anyway, usually at the worst end of the available range. The scan hasn't come back yet, but the mind is already somewhere past it. The symptoms haven't been explained, but the explanations the mind has generated are thorough and detailed. This is not a failure of reason — it is reason running without adequate data, filling the gap with what it fears most. The waiting for results, for clarity, for the next appointment, is not passive. It produces its own particular form of exhaustion.
Jon Kabat-Zinn developed mindfulness-based stress reduction — now used in hospitals and medical centers across the country — specifically for people navigating chronic illness, pain, and medical uncertainty. What he observed was that most of the suffering happening around the medical situation was happening in a future that hadn't arrived — and that curing anything was beside the point. The present moment — today, this appointment, the ordinary difficulty of what is actually happening right now — is survivable in a way the catastrophized future usually is not.
The return to present-moment attention takes the health scare seriously and adds nothing to it. The mind, left to its own devices under threat, will race to worst-case scenarios with a fluency that feels like realism and often is not. Cognitive reframing runs alongside this: examining the assumptions underneath the catastrophic projection, checking whether the worst case the mind has constructed is actually the most likely one. But it requires enough steadiness to look at the thought rather than simply being inside it.
There is something that tends not to get named during the period of medical uncertainty: it involves loss even before anything is confirmed. The body that moved through the world without question — the one that could be trusted to behave predictably — is already changed in some sense. The uncomplicated relationship to health shifted the moment something felt wrong enough to warrant attention. Even if results come back clear, the person who sat with that fear for two weeks is not quite the same as the one who first noticed something was off.
When a diagnosis does arrive, that loss deepens and takes on a shape. Whatever certainty existed about the body, its cooperation, its predictable behavior, no longer holds in quite the same way. That is a grief, and it is worth treating as one rather than moving past it quickly in the direction of action and information-gathering.
Acceptance, in the mindfulness sense, means being with what is — the not-knowing, the diagnosis if one has come, the uncertainty about what follows — without the additional suffering of fighting the fact of the situation. Resignation waits; acceptance is the earlier move.
What most people find, in the weeks of a health scare or after a diagnosis, is that the interior experience becomes carefully managed. At home, there is the partner who cannot be frightened further. Friends respond with their own health stories or too much research or forced reassurance. At work, composure is simply expected. The actual fear — the particular quality of it at three in the morning, the images that arrive uninvited, the things that cannot be said without making them more real — tends to find no room.
Therapy offers something the personal conversations cannot, particularly during the period before things are clear. There is no clear narrative yet, nothing to organize the telling around — and that makes the experience harder to bring to people who need something coherent to respond to. A conversation genuinely outside the personal circle holds the ambiguity without requiring a resolution. What becomes possible there is saying what cannot be said at home — without managing how it lands, without holding someone else's fear alongside one's own.
The city adds its own layer. New York asks for competence and forward movement even when the interior life is in upheaval. The pace that usually feels like momentum can become, in the weeks of not knowing, something that simply keeps a person from sitting still with what has actually happened.
I work with adults throughout New York — in Manhattan, Brooklyn, and across the city — via telehealth. Prospective clients are welcome to reach out at jonathanwalsh@hushmail.com or to request a complimentary 15-minute consultation through this site.
Frequently Asked Questions about Mindfulness-Based Therapy
What is mindfulness-based therapy?
Mindfulness-based therapy draws on practices of present-moment attention to help people develop a different relationship to difficult thoughts and feelings. Rather than trying to eliminate distress, it works on changing how distress is experienced and responded to — particularly useful when the source of distress is something that cannot be immediately resolved.
Can therapy help before I even have a diagnosis?
The period of not knowing — waiting for results, sitting with unexplained symptoms, living with medical uncertainty — is often when the psychological weight is heaviest. Therapy during this period isn't contingent on having a clear situation to work with. The fear and unease that come with not knowing where things are heading are reason enough.
Does stress actually affect medical outcomes?
The research on psychoneuroimmunology is clear that sustained psychological stress is not neutral to immune function, inflammation, or the body's regulatory systems. Mindfulness-based approaches were developed partly in response to this — as a way of addressing the psychological dimension of illness as part of the medical picture, not separate from it.
Why see a therapist rather than just talk to people I'm close to?
The people closest to you have their own fear about what's happening, their own responses to manage, and their own need for you to be okay. When there is no clear narrative yet — when the situation is still unresolved — that makes the personal conversations even harder. A therapist offers a space where there is nothing to perform, no one else's anxiety to contain, and the full difficulty of not knowing can be said out loud.
Jonathan Walsh, LMHC, LCMHC, LPC is a licensed therapist offering mindfulness-based therapy via telehealth in New York and several other states. He is a member of the New England Center for Existential Therapy and has completed core training at the Institute for Existential-Psychoanalytic Therapy. Learn more about Jonathan.