Uncertainty Isn’t the Problem; It’s a Paradox that Promotes Possibility: Three Strategies from Critical Disability Studies for Reframing the Unknown

Uncertainty and disability are simultaneously well-studied and enigmatic conditions in medicine. Yet while uncertainty and disability have individually received significant attention, little mind has been paid to how they interact. Common assumptions and biases underscore the frequently negative view of both conditions. However, overemphasis on reducing and eliminating uncertainty has negatively impacted physicians beholden to a culture that venerates certainty. At the same time, medicine's focus on fixing and curing disability, which is founded on ableist practices and policies, has led to deleterious patient health outcomes. If what is required for equitable, person-centered care is a greater tolerance of uncertainty, then we might derive wider benefits from approaches with demonstrated efficacy in dismantling ableist logic. For this reason, we employ the social model of disability to formulate three interrelated strategies for reframing uncertainty as a source of possibility in clinical encounters and life more broadly. The first strategy entails reappraising mental models that have contributed to structural barriers. Applying Paul Han's framework for tolerance to pervasive sources of bias, we argue that reappraisal inhibits certainty preference from erasing the subjectivities that invigorate our collective wisdom and grant significance to our lived experiences. The second strategy involves reexamining ways of knowing that have controlled ways of being. By applying a critical lens to the labels and categories indispensable to contemporary knowledge systems, we illustrate how an ethics of uncertainty can help us realize the principles of epistemic justice. The third strategy involves replacing the "un-choosing of disability" as described by the disabled poet and activist Eli Clare with the reclaiming of uncertainty. This approach reveals how creating a medical culture that fosters meaning and purpose can positively influence the relational aspects of care. Collectively, these strategies form the foundation of a praxis necessary to foster tolerance of uncertainty and bodily variability throughout medicine. We conclude by demonstrating how leaning into the discomfort inherent to paradoxes can transform uncertainty from a limiting factor to a liberating force for epistemic justice.