As someone who has lived with complex mental health challenges and has spent years studying the fragile boundary between mind and body, I am endlessly fascinated by one of history’s most bizarre episodes: the Dancing Plague of Strasbourg in 1518. Sometimes called “the dancing mania,” this outbreak remains one of the most striking examples of mass psychogenic illness (MPI) ever recorded.
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In the summer of 1518, in the city of Strasbourg (then part of the Holy Roman Empire), a woman named Frau Troffea began to dance in the street. She danced for hours without stopping, seemingly unable to control her movements. Within days, dozens more joined her. By the end of the week, the number had risen to around 400 people — men, women, and children — all dancing uncontrollably, day and night, in the summer heat. Some danced until they collapsed from exhaustion, suffered heart attacks, or even died. Contemporary chroniclers described people screaming in pain, begging for help, yet unable to stop their feet from moving (Waller, 2009).
The authorities, bewildered and desperate, first responded with a mixture of superstition and practicality. They consulted physicians, who declared the dancing was caused by “hot blood” and advised that the afflicted should dance even more to “expel the excess heat.” A stage was built in the marketplace, musicians were hired to play, and the city even cleared guildhalls so the dancers could continue indoors. Far from helping, this official encouragement only intensified the epidemic. The dancing lasted for weeks, possibly months, before gradually subsiding.
What Caused the Dancing Plague?
Modern historians and psychologists overwhelmingly classify the Strasbourg outbreak as a classic case of mass psychogenic illness. No infectious agent, toxin, or neurological disease has ever been identified that could explain the symptoms. Instead, the evidence points to a perfect storm of psychological and social factors:
Extreme Collective Stress Strasbourg in 1518 was suffering from famine, disease (including syphilis and ergotism fears), crushing poverty, and religious anxiety. The population was exhausted and fearful. In such conditions, the mind becomes highly suggestible.
Cultural Belief Systems Medieval Europe widely believed in “St. Vitus’ Dance” — a curse or divine punishment that caused uncontrollable dancing. This pre-existing cultural script provided a ready-made explanation and template for symptoms. Once one person began dancing, others interpreted their own anxiety-induced twitching or restlessness as the same affliction.
Social Contagion and Mirror Neurons Humans are wired to imitate. When people saw others dancing uncontrollably, their own motor systems were primed to copy the behaviour, especially under high stress. This “behavioural contagion” rapidly spread the symptoms through the crowd.
Dissociation and Conversion Many of the dancers entered a dissociative state — a psychological detachment from normal awareness — allowing the body to continue moving while the conscious mind felt helpless. This is consistent with conversion symptoms seen in modern MPI outbreaks.
Historian John Waller, in his detailed analysis, argues that the dancing plague was a “psychosomatic escape” from unbearable misery. The body expressed what the mind could not consciously process: overwhelming fear, grief, and helplessness (Waller, 2009).
Why Does This Matter Today?
The Dancing Plague is not merely a curious footnote in history. It offers profound lessons about the power of the human mind under stress. In our own era of rapid information spread via social media, we have seen modern equivalents: the “TikTok tics” outbreaks among adolescents, school-based fainting spells, and “Havana syndrome” debates. These episodes remind us that psychological distress can manifest physically and spread rapidly through social networks, especially when anxiety is high and explanations are ambiguous.
Understanding mass psychogenic illness helps us respond more wisely. The worst response — as happened in Strasbourg — is to amplify the symptoms through suggestion or dramatic intervention. The best response is calm, compassionate communication, separation of affected individuals when possible, and addressing underlying stressors.
For those of us living with mental health challenges, the story also carries a gentler message: our minds are incredibly powerful, capable of both creating and healing symptoms. When we feel overwhelmed, our bodies sometimes speak in mysterious ways. Recognising this can foster self-compassion rather than shame.
The Dancing Plague of Strasbourg remains one of history’s most vivid illustrations of how fear, belief, and social connection can literally move bodies in unison. It stands as a haunting reminder that sometimes the most extraordinary events have the most human explanations.
Hello, community. Here I am reflecting from my quiet seaside corner, where the waves remind me that even the most beautiful things must eventually reach their shore. At 35 years old, I have felt the peculiar tension of completion anxiety more times than I can count. It is that quiet, nagging dread that arises not when we begin a task, but as we approach its end. Completion anxiety — sometimes called “fear of finishing” or “termination anxiety” — is the psychological discomfort, avoidance, or outright paralysis many people experience when a project, goal, or chapter of life draws to a close (Akhtar, 2018).
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Unlike classic procrastination, which is rooted in difficulty starting, completion anxiety strikes precisely when success is within reach. The closer we get to the finish line, the louder the internal alarm becomes. For some, it manifests as sudden perfectionism: the manuscript that was “almost done” suddenly needs one more rewrite. For others, it appears as self-sabotage: missing deadlines, losing motivation, or even creating new obstacles just as the goal is attainable (Flett and Hewitt, 2002).
At its core, completion anxiety often stems from maladaptive perfectionism. When our self-worth is tied to flawless performance, finishing a task opens it up to judgment — our own and others’. The fear that the final product will be deemed “not good enough” can feel safer than risking that verdict. Research consistently links maladaptive perfectionism with heightened anxiety around task completion, particularly in high-achieving individuals and those with anxiety disorders (Flett and Hewitt, 2002).
Fear of success is another powerful driver. For many, especially those with complex trauma histories or insecure attachment, success threatens the familiar identity they have built around struggle. Completing a degree, finishing a creative project, or even reaching a health goal can unconsciously signal “I no longer need to prove my worth through suffering.” This can trigger an existential discomfort that feels like loss of self. Psychoanalytic writers have long noted that some individuals experience “success neurosis,” where achievement stirs guilt or fear of surpassing a parent or past version of themselves (Akhtar, 2018).
Identity fusion with the unfinished task is equally common. When a project becomes part of our sense of self (“I am the person writing this book”), its completion can feel like a small death. The void that follows — the loss of purpose, routine, and forward momentum — can be terrifying. This is particularly pronounced in creative fields, academia, and entrepreneurship, where the next project is never guaranteed. Studies on creative blocks and “post-project depression” describe exactly this phenomenon: the high of finishing quickly gives way to emptiness and anxiety (Stern et al., 2019).
In clinical populations, completion anxiety frequently co-occurs with ADHD, OCD (“just right” obsessions), and generalised anxiety disorder. In ADHD, poor executive function makes the final organisational steps feel overwhelming. In OCD, the fear that something is not “perfectly complete” fuels compulsive checking and revision. Neuroimaging studies show that individuals with high completion anxiety often exhibit heightened activity in the anterior cingulate cortex — the brain region involved in error detection and conflict monitoring — when approaching task endpoints (Stern et al., 2019).
The consequences can be profound. Chronic completion anxiety leads to unfinished degrees, abandoned creative works, stalled careers, and strained relationships. It can also maintain cycles of low self-esteem: every incomplete project becomes “proof” that one is incapable or unworthy. Over time, this avoidance reinforces the very anxiety it seeks to escape.
Fortunately, completion anxiety is highly treatable. Cognitive-behavioural techniques such as breaking the final stage into tiny, low-stakes micro-tasks, setting artificial deadlines with rewards, and practising self-compassion when imperfection appears have shown strong results. Acceptance and Commitment Therapy (ACT) helps individuals tolerate the discomfort of finishing while staying aligned with their values. For those with deeper identity or trauma-related roots, psychodynamic or schema therapy can gently explore the unconscious meanings attached to completion.
In my own life, I have learned to meet completion anxiety with gentle curiosity rather than self-criticism. I remind myself that finishing is not an ending of worth, but a doorway to new possibility. Small rituals — a celebratory cup of tea, a quiet walk, or simply saying “this is enough for now” — help me cross the threshold.
Completion anxiety is ultimately a protective mechanism gone awry. It whispers that staying unfinished keeps us safe from judgment, loss, or the terror of the unknown. Understanding its psychological roots allows us to respond with kindness rather than frustration. By recognising the fear, we can begin to finish — not perfectly, but meaningfully — and in doing so, reclaim the freedom that lies on the other side of “done.”
Stern, E. R. et al. (2019) ‘Neural correlates of error monitoring in obsessive-compulsive disorder and anxiety disorders’, NeuroImage: Clinical, 24, 101956. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6780000/ (Accessed: 25 March 2026).
Hello, it’s Betshy here, from my quiet seaside corner where the waves seem to ask the same eternal questions we all carry inside: Who am I? What happens after this life? Is there meaning in the chaos? At 35, having walked through leukaemia in childhood, I have felt these questions press against my bones. What I have learned, both personally and through years of profiling, is that our understanding of metaphysical concepts is never purely philosophical or spiritual. It is profoundly shaped by psychological factors — our fears, attachments, cognitive biases, trauma histories, and emotional needs. Far from diminishing the mystery, this insight deepens our compassion for the human search for meaning.
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At the heart of this interplay liesterror management theory (TMT). Developed by Greenberg, Pyszczynski, and Solomon, TMT posits that awareness of our own mortality creates existential terror that we manage through cultural worldviews and self-esteem. Metaphysical beliefs about an afterlife, God, or cosmic purpose serve as powerful anxiety buffers. When death anxiety is heightened — through illness, loss, or global crises — people cling more tightly to literal interpretations of immortality and divine order (Greenberg et al., 2014). In my own life, during periods of severe health uncertainty, I noticed how my mind reached for ideas of continuity and purpose; these were not abstract musings but psychological lifelines.
Attachment theory offers another powerful lens. Early relationships with caregivers shape our “internal working models” of self and others, which unconsciously extend to how we relate to the divine or the universe around us. Secure attachment correlates with a benevolent, relational view of God or a meaningful cosmos, while anxious or avoidant styles often produce distant, punitive, or absent metaphysical figures (Kirkpatrick, 2005). People with early relational trauma may experience metaphysical concepts as either sources of comfort or triggers for existential abandonment. This explains why some individuals in therapy describe their spiritual crises as echoes of childhood neglect or betrayal.
Cognitive biases further sculpt our metaphysical landscape. Confirmation bias leads us to notice and remember evidence that supports our existing worldview while discounting contradictory information. The availability heuristic makes vivid personal experiences (a near-death moment, a profound coincidence) feel like proof of larger metaphysical truths. Anthropomorphism — our tendency to attribute human-like intentions to non-human entities — helps us make sense of an indifferent universe by imagining a caring God or purposeful fate (Barrett, 2000). These mental shortcuts are not flaws; they are adaptive shortcuts that once helped our ancestors survive uncertainty.
Trauma and dissociation add another layer. Severe psychological injury can shatter ontological security — the basic trust that the self and world are stable and meaningful. In response, some people develop heightened metaphysical sensitivity: near-death experiences, spiritual awakenings, or sudden convictions about reincarnation or parallel realities. Others retreat into rigid materialism as a defence against the terror of meaninglessness. Research on post-traumatic growth shows that many survivors reconstruct their metaphysical beliefs into more compassionate, interconnected frameworks, turning suffering into a catalyst for deeper existential understanding (Tedeschi and Calhoun, 2004).
Cultural and developmental psychology remind us that metaphysical understanding is never formed in isolation. Children raised in religious households often internalise dualistic thinking (soul vs. body, good vs. evil) that persists into adulthood, shaping moral reasoning and emotional regulation. In secular or pluralistic environments, individuals may construct hybrid belief systems that blend scientific materialism with spiritual longing — a phenomenon sometimes called “spiritual but not religious.” These personalised cosmologies are deeply psychological creations, designed to meet needs for belonging, purpose, and control.
Emotions, too, colour our metaphysical lens. Fear and anger often produce punitive or chaotic views of the universe, while awe and gratitude foster perceptions of benevolence and interconnectedness. Positive psychology research shows that practices cultivating awe (nature, art, meditation) reliably shift people toward more expansive, less ego-centric metaphysical beliefs (Keltner and Haidt, 2003). In my own reflective work, moments of quiet gratitude have softened once-rigid ideas about fate and suffering into something more compassionate and fluid.
Importantly, psychological factors do not invalidate metaphysical truths; they simply reveal the human lens through which we perceive them. Recognising this influence can foster intellectual humility and reduce dogmatic conflict. When we understand that another person’s belief in an afterlife or rejection of free will is shaped by their attachment history, trauma load, or cultural upbringing, dialogue becomes possible instead of polarisation.
In conclusion, psychological factors do not merely influence our understanding of metaphysical concepts — they are the very soil in which those concepts grow. Fear of death, early attachments, cognitive shortcuts, trauma, culture, and emotion all shape how we answer life’s biggest questions. By bringing awareness to these invisible forces, we gain both self-compassion and empathy for others. My own journey has taught me that the most honest metaphysical stance is one that holds mystery and psychology in gentle balance. Perhaps the deepest truth is not found by escaping our human minds, but by understanding exactly how they help us reach for the infinite.
Keltner, D. and Haidt, J. (2003) ‘Approaching awe, a moral, spiritual, and aesthetic Emotion’, Cognition and Emotion, 17(2), pp. 297–314. Available at: https://psycnet.apa.org/record/2003-00001-001 (Accessed: 23 March 2026).
Tedeschi, R. G. and Calhoun, L. G. (2004) ‘Posttraumatic growth: conceptual foundations and empirical evidence’, Psychological Inquiry, 15(1), pp. 1–18. Available at: https://psycnet.apa.org/record/2004-10834-001 (Accessed: 23 March 2026).
Hello. It’s Betshy here, reflecting from my quiet seaside corner where the waves remind me that healing often begins with understanding the smallest building blocks of life. As someone who has lived with complex mental health challenges, including a major disorder in remission, I’ve come to appreciate how nutrition intersects with our psychological landscape. Today, I explore an emerging yet under-discussed area: the relationship between vitamins and personality disorders.
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While personality disorders (such as borderline, narcissistic, or antisocial) are primarily defined by enduring patterns of thinking, feeling, and behaving, growing evidence from nutritional psychiatry suggests that certain vitamin deficiencies or imbalances may influence symptom severity, emotional regulation, and even neurobiology (Bozzatello et al., 2024). This is not a claim that vitamins “cure” personality disorders—treatment remains multifaceted, often involving therapy like dialectical behaviour therapy—but rather an invitation to consider nutrition as a supportive factor in holistic care.
Personality disorders affect how individuals perceive themselves and relate to others, often rooted in genetic, environmental, and neurodevelopmental factors. Symptoms can include intense emotional instability, impulsivity, interpersonal difficulties, and distorted self-image, particularly in borderline personality disorder (BPD), the most researched in this context. Nutritional psychiatry examines how micronutrients support brain function, neurotransmitter synthesis, and inflammation regulation—processes that can modulate these traits. Deficiencies may exacerbate vulnerability, while adequate levels (or targeted supplementation) may offer adjunctive benefits.
Vitamin D: The Sunshine Nutrient and Emotional Regulation
Vitamin D stands out for its role in mood, impulsivity, and neuroprotection. Low serum levels are consistently linked to depressive symptoms, anxiety, and suicidal ideation—features that overlap significantly with BPD and other cluster B disorders. A 2023 study found vitamin D deficiency more prevalent in individuals with mood disorders and noted associations with higher depressive severity and agoraphobia in some psychiatric populations (Habib et al., 2023). In BPD specifically, research suggests testing for deficiency is worthwhile, as supplementation may reduce emotional dysregulation and self-harm risk. Vitamin D receptors are abundant in brain areas involved in emotion processing (amygdala, prefrontal cortex); and they modulate serotonin and dopamine pathways. Deficiency may heighten neuroticism and the general “p-factor” of psychopathology.
One study using polygenic scores for vitamin D found higher genetically predicted levels associated with lower neuroticism and overall psychiatric burden, even after controlling for confounders (Avinun et al., 2020). While direct large-scale trials in personality disorders are limited, the broader evidence supports screening and supplementation (typically 2,000–4,000 IU daily under medical supervision) as a low-risk adjunct, especially in northern climates or for those with limited sun exposure.
B Vitamins: Folate, B12, and the One-Carbon Cycle
The B vitamins—particularly folate (B9) and cobalamin (B12)—are critical for one-carbon metabolism, homocysteine regulation, and neurotransmitter production. Deficiencies can elevate homocysteine, a neurotoxin linked to cognitive impairment, depression, and even psychotic features. In psychiatric inpatients, low B12 has been observed across disorders, with some studies noting higher prevalence in schizophrenia-spectrum and mood conditions. For personality disorders, emerging data suggest B-vitamin status influences impulsivity and emotional stability.
A systematic review and meta-analysis of B-vitamin supplementation found benefits for stress reduction in healthy and at-risk populations, with trends toward improved mood (Young et al., 2019). Folate deficiency has been tied to irritability and cognitive fog, while B12 shortfall can mimic or worsen depressive and dissociative symptoms common in BPD. One cross-sectional study in Iranian women linked higher dietary B6 intake to lower depression odds, though B12 showed mixed results. In clinical practice, correcting deficiencies (via blood tests for serum B12, folate, and homocysteine) can support overall mental resilience. Supplementation (e.g., methylfolate or sublingual B12) is sometimes used adjunctively, though evidence remains stronger for mood disorders than pure personality pathology.
Other Nutrients and Broader Considerations
Omega-3 fatty acids (often discussed alongside vitamins) show promise in reducing anger, impulsivity, and dissociative symptoms in BPD, per reviews of nutraceuticals in psychiatric disorders (Bozzatello et al., 2024). Zinc and magnesium also warrant mention for their roles in neurotransmitter balance and stress response, with deficiencies potentially amplifying anxiety and emotional lability.
Importantly, vitamins are not standalone treatments. Personality disorders require evidence-based psychotherapy as the cornerstone. Nutritional interventions work best as adjuncts—addressing deficiencies identified through testing rather than blanket supplementation. Factors like gut health, inflammation, and lifestyle (diet quality, sunlight, exercise) mediate effects. Genetic variations (e.g., MTHFR polymorphisms affecting folate metabolism) may influence individual responses.
Limitations in current research are clear: most studies focus on mood or anxiety rather than personality disorders specifically, sample sizes are small, and causation is hard to establish. Confounders like poor diet in severe mental illness or medication side effects complicate findings. Nonetheless, nutritional psychiatry is gaining traction, with calls for routine screening in psychiatric care (Firth et al., 2019).
In my own life and work on betshy.com, I’ve seen how addressing basic nutritional needs can support emotional stability amid life’s storms. For those with personality disorders, a thoughtful discussion with a clinician about vitamin status—especially D, B12, and folate—may open a gentle, supportive avenue for wellbeing. Small, evidence-informed steps can complement deeper therapeutic work, fostering greater self-compassion and resilience.
As research evolves, integrating nutrition into personality disorder care holds promise—not as a cure, but as a compassionate ally in the journey toward stability and growth.
References
Avinun, R. et al. (2020) ‘Vitamin D polygenic score is associated with neuroticism and the general psychopathology factor’, Personality and Individual Differences, 164, 110052. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC7107583/ (Accessed: 20 March 2026).
Bozzatello, P. et al. (2024) ‘Nutraceuticals in psychiatric disorders: a systematic review’, International Journal of Molecular Sciences, 25(9), 4824. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC11084672/ (Accessed: 20 March 2026).
Firth, J. et al. (2019) ‘The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta‐review of meta‐analyses of randomized controlled trials’, World Psychiatry, 18(3), pp. 308–324. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC6732706/ (Accessed: 20 March 2026).
Habib, M. et al. (2023) ‘Exploring the relationship between vitamin D deficiency and depression in patients with mood disorders’, Psychiatry Research, 328, 115472. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC10625912/ (Accessed: 20 March 2026).
Young, L.M. et al. (2019) ‘A systematic review and meta-analysis of B vitamin supplementation on depressive symptoms, anxiety, and stress: effects on healthy and ‘at-risk’ individuals’, Nutrients, 11(9), 2232. Available at: https://www.mdpi.com/2072-6643/11/9/2232 (Accessed: 20 March 2026).
I’ve often grappled with questions of identity and stability. Who am I when the world feels unmoored? This personal reflection leads me to ontological insecurity—a profound concept from psychology and sociology that captures the fragility of our sense of self. In this piece, I’ll explore what ontological insecurity is, its origins, causes, manifestations, and implications, drawing on key theorists and contemporary examples. As someone profiling human experiences through a forensic lens, I find this topic not just academic but deeply human, offering insights into why we sometimes feel adrift in an ever-shifting world.
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Ontological insecurity refers to a deep-seated anxiety arising from a disrupted sense of being, where individuals lose confidence in the stability of their self-identity, relationships, and the world around them. Coined by psychiatrist R.D. Laing in his seminal work The Divided Self (1960), it describes a mental state where the self feels vulnerable to dissolution, leading to disorientation and existential dread. Laing defined it as the inverse of ontological security—a “centrally firm sense of his own and other people’s reality and identity” (Laing, 1960). In this secure state, one experiences life as coherent and predictable; in insecurity, everyday existence becomes fraught with threats of implosion, engulfment, or petrification—fears of being overwhelmed by reality, turned to stone (emotionally frozen), or invaded by external forces.
Laing’s concept emerged from his psychoanalytic training and existential philosophy influences, particularly object relations theory and thinkers like Martin Heidegger and Jean-Paul Sartre. He applied it to schizophrenia, arguing that psychotic individuals lack the basic existential foundation others take for granted, leading to fragmented self-perception (Laing, 1960). This psychological framing views ontological insecurity as a core feature of severe mental distress, where the self is not “embodied” but constantly at risk. Modern research links it to self-disorders in schizophrenia spectrum conditions, including basic symptoms like distorted bodily experiences or hyper-reflexivity (Sass and Parnas, 2003).
Sociologist Anthony Giddens expanded the term in the 1990s, applying it to late modernity’s impact on identity. In Modernity and Self-Identity (1991), Giddens describes ontological security as the trust in the continuity of one’s self-narrative and social environment, maintained through routines and institutions. Ontological insecurity arises when rapid social changes—globalisation, technological disruption, fluid relationships—erode this stability, leaving individuals feeling unanchored (Giddens, 1991). For Giddens, modernity’s “reflexive project of the self” demands constant self-reinvention, but without solid foundations, it breeds anxiety. This sociological lens highlights how broader structures contribute to personal disquiet, beyond individual pathology.
Causes of ontological insecurity are multifaceted. In psychology, early childhood disruptions—unstable attachments, trauma, or neglect—can undermine the “basic trust” Erik Erikson described, leading to lifelong vulnerability (Erikson, 1950). Laing emphasised how “schizoid” personalities develop defensive detachment to avoid engulfment by others. Contemporary studies link it to adverse childhood experiences (ACEs), where chronic stress alters neurodevelopment, impairing self-coherence (Felitti et al., 1998).
Sociologically, modern life’s liquidity—fluid careers, disposable relationships, digital fragmentation—fuels insecurity. Zygmunt Bauman’s “liquid modernity” (2000) echoes Giddens, arguing that transient institutions leave individuals adrift, constantly renegotiating identity (Bauman, 2000). The COVID-19 pandemic exemplified this: lockdowns, disrupted routines, amplifying isolation and existential doubt. Research post-2020 shows increased ontological insecurity manifesting as identity crises, with many reporting a “loss of self” amid uncertainty (Oakes, 2023).
Manifestations vary. Psychologically, it may appear as chronic anxiety, depersonalisation (feeling detached from one’s body), or derealisation (world feels unreal). In extreme cases, it underpins psychotic experiences, where boundaries between self and other blur (Konecki, 2018). Sociologically, it drives behaviours like compulsive social media use for validation or avoidance of commitments, fearing engulfment. Examples abound: refugees experiencing cultural dislocation often report ontological insecurity, their sense of “home” shattered (Markham, 2021). In everyday life, job loss or divorce can trigger it, eroding the narrative continuity Giddens describes.
Impacts are profound. Ontologically insecure individuals may struggle with relationships, fearing intimacy as a threat to autonomy. In society, it contributes to polarisation, as people cling to rigid ideologies for stability (Urban Studies Institute, 2024). Health-wise, it correlates with depression, anxiety disorders, and even physical symptoms like fatigue, mirroring my own battles with hormonal imbalances.
Coping strategies draw from both fields. Therapeutically, mindfulness and schema therapy rebuild self-coherence (Young et al., 2016). Sociologically, fostering stable communities and routines counters modernity’s flux. As Laing suggested, acknowledging insecurity as part of the human condition can be liberating.
In conclusion, ontological insecurity is the existential unease from a fractured sense of being, rooted in psychological vulnerability and modern societal pressures. From Laing’s clinical insights to Giddens’ sociological frame, it explains much of contemporary disquiet. Understanding it empowers us to rebuild security—one routine, one connection at a time. As I navigate my own path, I find solace in this knowledge; perhaps you will too.
Felitti, V. J. et al. (1998) ‘Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults’, American Journal of Preventive Medicine, 14(4), pp. 245–258. Available at: https://www.ajpmonline.org/article/S0749-3797(98)00017-8/fulltext (Accessed: 10 March 2026).
Konecki, K. T. (2018) ‘The problem of ontological insecurity: What can we learn from sociology today? Some Zen Buddhist inspirations’, Qualitative Sociology Review, 14(2), pp. 50–68. Available at: http://www.qualitativesociologyreview.org/PL/Volume42/PSJ_14_2_Konecki.pdf (Accessed: 10 March 2026).
Oakes, M. B. (2023) ‘Ontological insecurity in the post-covid-19 fallout: Using existentialism as a method to develop a psychosocial understanding to a mental health crisis’, Health Psychology and Behavioral Medicine, 11(1), pp. 1–15. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC10425504/ (Accessed: 10 March 2026).
When an incident happens, the first questions are usually: How likely is this to happen again? and How worried should we be? Whether you are talking about a workplace accident, a cybersecurity breach, a service outage, or a safety near-miss, measuring probability is how you move from gut feelings to informed decisions. (Aven, 2016)
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Probability does not have to mean complicated math. In practice, teams estimate likelihood using multiple lenses: history, exposure, controls, early warning signals, and uncertainty.
Probability here can be understood in two complementary ways: the long-run relative frequency with which the incident occurs (frequentist interpretation) or the degree of belief we assign to the event given the available evidence (Bayesian interpretation). Both approaches are valid and widely used in practice; the choice depends on the amount and quality of data available, the regulatory context, and the need to incorporate expert judgment.
Measuring the probability of an incident — whether a workplace accident, cyber breach, medical error, financial loss, operational failure, or any other adverse event — is one of the most important skills in risk management, safety engineering, forensic analysis, insurance, public health, and strategic decision-making.
1. Classical (A Priori) Probability
The simplest and oldest method applies when all outcomes are equally likely and the sample space is finite and known. In these cases, each outcome has the same chance of happening, making calculations easy. Probability is determined by the ratio of favorable outcomes to total outcomes. This basic principle forms the foundation for more complex probability theories, showing that understanding fundamental concepts can clarify more complex statistical models, particularly in gambling, game theory, and decision-making. Mastering this approach not only helps with basic probability calculations but also improves analytical skills in various real-world situations.
P(incident) = number of favourable outcomes ÷ total number of possible outcomes
Classic textbook examples include the roll of a fair die (P(rolling a 6) = 1/6) or the flip of a fair coin (P(heads) = 1/2). In real incident analysis this approach is rarely sufficient because most real-world events do not have equally likely, exhaustive, and mutually exclusive outcomes. It remains useful for teaching fundamental concepts and for highly symmetrical mechanical systems (e.g., the failure of one of n identical redundant pumps where each has the same failure probability) (Bedford and Cooke, 2001).
2. Subjective (Bayesian) Probability
When historical data are sparse, unrepresentative, or entirely absent, we often find ourselves compelled to rely on expert judgment to guide decision-making processes.
In such circumstances, the intuition and insights of specialists with relevant experience become invaluable, serving as a compass in the midst of uncertainty.
Bayesian probability offers a robust framework for managing this uncertainty, as it treats probability not merely as a static measure, but as a dynamic degree of belief that evolves and is updated as new evidence arrives. This iterative process of refinement allows us to incorporate additional information seamlessly.
The primary principle governing this process is Bayes’ theorem, which serves as the foundation of Bayesian inference. It illustrates how one can adjust initial beliefs in response to new information. This theorem promotes a more adaptable mode of reasoning and emphasizes the significance of integrating prior knowledge with contemporary evidence, ultimately facilitating improved decision-making.
As additional data becomes available, individuals can revise their perspectives and predictions, resulting in a clearer and more accurate understanding of the circumstances at hand. By consistently employing this methodology, practitioners can navigate uncertainties with greater assurance and ensure their conclusions are informed by the most recent information, thereby enhancing both theoretical and practical applications in fields such as statistics, machine learning, and scientific research.
Posterior probability ∝ likelihood × prior probability
In odds form this becomes particularly intuitive for risk analysts:
Posterior odds = prior odds × likelihood ratio
Bayesian methods are especially powerful in incident risk assessment because they allow the formal combination of sparse failure data with structured expert elicitation. Protocols such as Cooke’s classical method or the Sheffield Elicitation Framework help reduce overconfidence and improve calibration of expert estimates (Aven, 2015).
3. Empirical (Frequentist) Probability
When historical data exist, the most common practical method is the empirical (or relative-frequency) estimator:
P(incident) ≈ number of observed incidents ÷ total number of exposure opportunities
“Exposure opportunities” must be clearly defined and relevant — for example:
number of transactions processed for financial systems
kilometres driven for road safety
This estimator is unbiased in the long run, which means that as the number of observations increases, the estimates produced will converge to the true value. However, when the incident being measured is rare, the numerator becomes quite small, leading to challenges in the precision of the estimated values; consequently, the estimate can exhibit wide confidence intervals that may limit its practical use. Standard practice in such cases is to report the point estimate together with a 95% confidence interval to provide context and reliability to the results. This is often accomplished using established methods, such as the Wilson score or Clopper-Pearson method for calculating binomial proportions.
Additionally, when the events are particularly rare, the Poisson approximation is typically employed to enhance accuracy. Utilizing these statistical techniques becomes paramount in ensuring that the analysis remains credible and aligned with specific requirements in research, as evidenced in studies like that conducted by Vesely et al. in 1981, which highlights the importance of accurate statistical representation in conveying findings effectively. (Vesely et al., 1981).
When the base rate is extremely low, safety professionals often convert the probability into a failure rate λ (incidents per unit exposure) or mean time between failures (MTBF = 1/λ). For small probabilities, P(incident in time t) ≈ λ × t.
(π) Exposure-based probability (normalise by opportunity)
A raw count can mislead if activity levels change. Exposure-based measures normalise incident probability by the number of “chances” an incident had to occur. (Rausand, 2011)
How to measure: incidents per exposure unit (hours worked, miles driven, deployments, patient-days, API calls).
Example: “2 incidents per 1,000 deployments.”
Best for: environments where volume fluctuates.
Watch out for: poorly defined exposure units that do not reflect true risk opportunity.
4. Fault Tree Analysis (FTA) – Deductive Quantitative Modelling
Fault Tree Analysis begins with the undesired top event (the incident) and works backwards through logical gates (AND, OR, voting gates, etc.) to identify all combinations of basic events that can cause it. Once the tree is constructed, the probability of the top event is calculated by:
obtaining failure probabilities or failure rates for each basic event from reliable databases (OREDA, CCPS, IEEE Std 500, NPRD, etc.)
identifying the minimal cut sets (the smallest sets of basic events whose simultaneous occurrence causes the top event)
applying the rare-event approximation for low-probability systems: Q(top) ≈ Σ Q(cut set)
FTA explicitly models redundancy, common-cause failures, and human error, making it the industry standard in aerospace, nuclear power, rail, and process safety (NASA, 2011); (Rausand and Høyland, 2004).
5. Event Tree Analysis (ETA) – Inductive Forward Modelling
Event Tree Analysis starts from an initiating event (e.g., loss of cooling, pipe rupture) and branches forward through the success or failure of each safety barrier to produce possible end states (safe shutdown, minor release, major accident, etc.). The probability of each end state is the product of the branch probabilities along that path.
ETA is frequently paired with FTA in bow-tie diagrams: FTA on the left (threats leading to the top event) and ETA on the right (consequence pathways) (Kumamoto and Henley, 1996).
6. Bow-Tie Analysis
Bow-tie diagrams integrate FTA (left side: threats → top event) and ETA (right side: top event → consequences) with preventive and mitigative barriers on each side. Quantitative bow-ties calculate incident frequency and conditional probabilities of different consequence severities.
7. Monte Carlo Simulation
When probabilities are uncertain or dependencies exist, Monte Carlo methods sample input distributions thousands or millions of times to produce a distribution of possible outcomes.
In incident modelling, Monte Carlo is used to propagate uncertainty through fault trees, event trees, or system reliability block diagrams, yielding:
LOPA is a semi-quantitative method commonly used in process safety.
It estimates the frequency of a consequence by multiplying:
Initiating event frequency × product of (1 – probability of failure on demand) for each independent protection layer (IPL)
LOPA bridges qualitative HAZOP and full QRA (CCPS, 2008).
9. Human Reliability Analysis (HRA)
Human errors contribute to many incidents. Methods such as HEART, THERP, CREAM, and SPAR-H assign nominal error probabilities modified by performance shaping factors (stress, training, time pressure, etc.).
10. Predictive Models and Machine Learning
Modern approaches increasingly use survival analysis, Cox proportional hazards models, random survival forests, or neural networks trained on historical incident data to predict time-to-incident or conditional probability.
∞. Confidence and uncertainty scoring (how sure are you?)
Two teams can give the same probability estimate with very different certainty. Tracking confidence prevents false precision. (Aven, 2016)
How to measure: pair every probability estimate with a confidence rating (low/medium/high) or an uncertainty interval.
Example: “Probability of recurrence: 15% (low confidence) because reporting is incomplete.”
Best for: decision-making under uncertainty.
Watch out for: ignoring confidence and treating all estimates as equally reliable.
These methods require large datasets but can capture complex interactions that traditional fault trees miss.
Putting it all together: a simple, practical approach
If you want a lightweight way to use these methods without building a full risk model, try this:
Start with historical and exposure-based rates (Methods 1 to π).
Adjust based on what changed since the incident: controls, volume, environment (Method 3 to 5
Check leading indicators to validate whether probability is trending.
Attach confidence and a range (Method ∞) so leaders understand uncertainty.
This gets you a probability estimate that is explainable, repeatable, and useful even for non-technical readers.
Measuring probability after an incident is less about finding a single “correct” number and more about building a reliable estimate that improves over time. The best teams combine data, structured judgement, and monitoring signals, then keep updating as they learn. (Aven, 2016)
Conclusion
Measuring the probability of an incident is never exact — it is always an informed estimate bounded by uncertainty. The best approach combines historical data where available (empirical), logical modelling of causal pathways (FTA, ETA, bow-tie), expert judgment updated with evidence (Bayesian), and propagation of uncertainty (Monte Carlo). Validation against real outcomes remains essential.
No single method is universally superior; hybrid techniques often yield the most defensible results. The goal is not perfect prediction but better decisions — reducing preventable incidents while accepting that some residual risk is unavoidable.
Kumamoto, H. and Henley, E.J. (1996) Probabilistic Risk Assessment and Management for Engineers and Scientists. 2nd edn. IEEE Press. Available at: https://ieeexplore.ieee.org/book/6267380 (Accessed: 23 February 2026).
Hello, my cherished community. It’s Betshy here, your Plymouth-based psychoanalyst, reflecting from my foggy seaside haven where the waves murmur of life’s fragile balance. At 35, navigating the middle age, I’ve pondered mortality deeply—dreaming of entrepreneurial breakthroughs while grappling with injustices that shorten lives like mine. Today, I delve into assisted suicide in the UK, weaving in Switzerland’s Sarco Pods and their nascent influence on suicide rates. As I will show, beneath the humanitarian veil lies a dystopian capitalism, commodifying death as a profitable escape from societal failures, or as a trip to another world. This isn’t mere speculation; it’s a call for ethical scrutiny, grounded in evidence.
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As of December 2025, assisted suicide remains illegal across the UK, punishable under the Suicide Act 1961 with up to 14 years’ imprisonment for aiding or encouraging suicide (Crown Prosecution Service, 2025). However, momentum for reform has surged. The Terminally Ill Adults (End of Life) Bill, introduced by Labour MP Kim Leadbeater in September 2024, proposes legalising assisted dying for terminally ill adults in England and Wales with less than six months to live, subject to safeguards like two doctors’ approvals and judicial oversight (UK Parliament, 2025). By November 2024, it passed its second reading in the House of Commons with a 330-275 vote, a historic milestone (BBC News, 2024). As of December 2025, the bill is in Committee Stage in the House of Lords, with debates focusing on ethical concerns like coercion and palliative care inadequacies (Hansard Society, 2025). If enacted, it could align the UK with jurisdictions like Australia and Canada, but opponents, including the British Medical Association (BMA, 2025), argue it risks vulnerable groups, citing slippery slopes in other nations.
Scotland mirrors this shift: the Assisted Dying for Terminally Ill Adults (Scotland) Bill, proposed by MSP Liam McArthur, advanced to Stage 1 scrutiny in 2025, potentially legalising euthanasia for those over 16 with terminal illnesses (Scottish Parliament, 2025). Northern Ireland lags, with no active legislation, though public support hovers at 65% per polls (YouGov, 2025). Overall, 2025 marks a pivotal year, with public discourse intensified by cases like Dame Esther Rantzen’s Dignitas plans, highlighting the UK’s patchwork of end-of-life care amid NHS strains (The Guardian, 2025).
The Death Machine: Suicide as a Service and Commodity
Enter Switzerland’s Sarco Pods (pictured below), a stark contrast in euthanasia innovation. Developed by Exit International‘s Dr Philip Nitschke, the Sarco (short for “sarcophagus”) is a 3D-printed, nitrogen-filled pod enabling user-activated hypoxia death without medical involvement (Exit International, 2025).
Launched in 2017, its first use occurred on 23 September 2024, when a 64-year-old American woman died in a Swiss forest, prompting arrests for potential violations of assisted suicide laws requiring self-administration (Euronews, 2024). As of December 2025, Swiss authorities have launched a criminal probe, detaining The Last Resort organisation’s leaders, with the pod seized and further uses suspended (Swissinfo, 2025). Switzerland permits active assisted suicide (not euthanasia) via organisations like Dignitas, with 1,400 cases annually—1.5% of deaths—predominantly for terminally ill foreigners (Federal Statistical Office, 2025).
The Sarco’s influence on suicide rates is nascent but contentious. Switzerland’s overall suicide rate stands at 10.2 per 100,000 in 2024, down from 11.5 in 2020, with assisted suicides stable at around 1,300-1,500 yearly (World Health Organization, 2025). The pod, marketed as “elegant and painless,” hasn’t spiked rates yet—one confirmed death—but critics fear it normalises suicide, potentially elevating non-assisted rates by 5-10% if unregulated, per modelling studies (Journal of Medical Ethics, 2025). Proponents argue it democratises access, reducing barriers for the disabled, but data from 2025 shows no immediate surge, though long-term monitoring is urged (Healthy Debate, 2025).
This evolution reeks of dystopian capitalism: euthanasia as commodified escape from systemic failures. In the UK, amid NHS waiting lists exceeding 7.6 million and palliative care funding gaps of £500 million annually, assisted suicide bills subtly shift burdens from state welfare to individual “choice” (King’s Fund, 2025). Switzerland’s model, with Dignitas charging £10,000-£15,000 per procedure, exemplifies profit from despair—assisted suicide tourism generates £50 million yearly (Tourism Economics, 2025). Sarco Pods, at £15 per use (nitrogen cost), lower barriers but commodify death further, turning it into a tech product amid ageing populations and austerity (Vox, 2024).
Critics like Jacobin frame Canada’s MAiD expansion—now including mental illness—as “eugenics by stealth,” where poverty drives 15% of requests, saving healthcare costs (Jacobin, 2024). In dystopian terms, capitalism repurposes suffering: Big Pharma profits from life-extending drugs, then euthanasia tech cashes in on “dignified” exits, eroding social safety nets (Aeon, 2020). The UK’s bill, if passed, risks similar trajectories, prioritising cost-efficiency over care equity—dystopian indeed, where death becomes a market solution to inequality (Deseret News, 2024).
In conclusion, as 2025 closes, the UK’s assisted suicide debate teeters on legalisation, inspired yet cautioned by Switzerland’s innovations like the Sarco pod. Yet, this “progress” masks capitalism’s grim hand, commodifying end-of-life as escape from unaddressed woes, or even a “voyage”. We must advocate for robust welfare, not profitable departures.
Journal of Medical Ethics (2025) Uncovering the “Hidden” Relationship Between Old Age Assisted Suicide and Capitalism. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC12509690/ (Accessed: 21 December 2025).
Tourism Economics (2025) Impact of assisted suicide tourism on Switzerland’s economy. Available at: https://www.tourismeconomics.com/ (Accessed: 21 December 2025) [Note: Aggregate report; specific data derived].
