The science of starting over
How your brain processes major life changes—and why that keeps you stuck
We’ve all got that friend. The one who’s decisive as hell in part of his life—but couldn’t choose a salad dressing if that life depended on it.
What’s going on?
Let’s talk about it, because not only is it a fascinating peek under the hoods of our brains, but it also exposes one of the subtle ways our brains keep us stuck in the status quo.
I met Ravi on the ski slopes. It was one of those chance encounters you have with strangers on the lift. We were both surgeons, so, obviously, we started trading war stories.
If you’ve never heard one of these conversations, consider yourself lucky. They almost always become a game of oneupsmanship, each of us telling increasingly shocking war stories, trying to cow the other into submission with the maggots we’ve taken out of people’s noses or the leeches that we’ve pulled off patients and dropped in alcohol so that they’d explode (yes, this really happens).
I’d saved my best for last. This wasn’t my first rodeo. For sure the lady who used her, um, diarrhea to help slide herself out of her hospital bed would be the worst thing either of us heard.
Reader, it was not.
Ravi had me beat with a story so grotesque that every person I’ve told it to since has plugged their ears before it was over.
You know those maggots? Those leeches? They did not prepared me for what Ravi told me.
But.
His story isn’t the point of this post. (Also, it’s so grotesque, I’m not reproducing it here. Sorry…)
The point of this post is what happened next in our conversation.
After a few runs together, our stories moved from purulence to personal. In his early fifties, Ravi had been a surgeon for a couple of decades by that point.
And he was over it.
Done.
The thing is, he had zero idea if what he was feeling was just burnout, stagnation, a midlife crisis, or just a bad workday.
And the more he talked, the more confused he became. As we commiserated about the state of American medicine over a hot chocolate in the ski lodge, he’d bounce between, “It’s just me,” and “It’s time for me to open a bookstore.”
Here was a man who had to make split-second decisions in the operating room, someone whose experiences still haunt me ten years after I first heard them.
And yet he couldn’t, for the life of him, make perhaps the most important decision in his life. Should he stay or should he go? Was he stuck in burnout or was there a way out?
Ravi is not alone.
Decisions are harder when you’re stressed
I’ll admit, it doesn’t take fancy scientific research to prove to anyone who’s ever been a teenager to know that stress makes our decisions harder.
But still. The science is pretty cool. See, stress causes our bodies to produce and release glucocorticoids (like cortisol, the “stress hormone.”) And that leads to a literal rewiring of your brain.
In a 2012 article in the journal Cell, Sousa and Almeida wrote: “Research in both humans and animal models has begun to identify morphological correlates of these functional changes. These include dendritic and synaptic reorganization, glial remodeling, and altered cell fate in cortical and subcortical structures.”
In non-Cell language, that means: Stress hormones change the brain’s structure by causing the neurons to rewire their connections, by altering how the brain’s supporting cells work, and by—quite literally—making some cells in the decision-making parts of the brain die faster.
Sousa and Almeida continue: “Stress induces a ‘disconnection syndrome’ whereby the transmission and integration of information that [is] critical for orchestrating appropriate physiological and behavioral responses are perturbed.”
Essentially, chronic stress leads to changes in our brain’s neural network, which, in turn leads to us not being able to connect the various bits of information that we need to process under uncertainty.
It makes sense, then, that when we’re stressed we’ve got increasingly limited decision-making capabilities.
Expected and unexpected uncertainty
In addition to burnout and stress literally changing the architecture of our brains, big decisions like the one Ravi faced suffer from two types of uncertainty: “expected uncertainty” and “unexpected uncertainty.”
Let me explain what I mean.
Let’s say you’re trying to decide whether to take your umbrella with you when you leave the house tomorrow morning. The weather forecast tells you there’s a 40% chance of rain.
Your brain approaches that uncertainty in two different ways.
First, there’s the “expected” uncertainty. A 40% chance of rain means that, on 40% of the days that look exactly today, it’ll rain.
(Technically, it means that if you ran 1000 weather forecasts with initial conditions identical to today’s, 400 of them would show rain, and 600 of them wouldn’t).
That uncertainty is expected. You don’t know if it’ll rain today, but you know that, over the last 1000 days that looked like today, it rained on 400 of them. Easy, simple, measurable. Expected uncertainty.
But then there’s unexpected uncertainty. To continue (clumsily) with the weather example: climate change is a thing, and climate change has led to much less stable weather patterns.
What that means is that even the 40% uncertainty is itself uncertain. In other words, even the analysis that told us it rains on 400 of the 1000 days that look like today—even that uncertainty itself is…uncertain. That sudden change in reliability is “unexpected uncertainty.”
It’s uncertainty all the way down.
Uncertainty all the way down. (Image credit: Sam Hollingsworth)
Using a super cool statistical model, two researchers named Yu and Dayan demonstrated that our brains employ two different neurotransmitters to deal with the two different types of uncertainty: acetylcholine and norepinephrine.
Acetylcholine—the “rest and digest” neurotransmitter of the parasympathetic nervous system—deals with expected uncertainty. Meanwhile, norepinephrine—the “fight or flight” neurotransmitter of the sympathetic nervous system—is employed in processing unexpected uncertainty.
To put it differently: we’re just fine with expected uncertainty—but unexpected uncertainty freaks us right out.
Which brings me back to Ravi and the ski slopes.
On top of the backdrop of already altered decision-making due to the stress of his burnout, considering a major career shift would open Ravi up to both expected and unexpected uncertainty.
On the expected side, Ravi would have to face:
The learning curve of a new job. That’s pretty expected. A learning curve is always there. Ravi couldn’t predict exactly how long it would take to get up to speed at a new place, but he knows for sure that an adjustment period is coming. What the learning curve looks like is uncertain—but it’s very expected.
Building a new professional network. Whether he moves to a new hospital, to a new city, or to a new field altogether, Ravi would have to build a new professional network. Again, he can’t know exactly how long that would take, but it’s a normal part of relocation.
If he decides to change industries, he’ll know that some of his skills will transfer—and some won’t. The exact adaptation process he’d face is uncertain, but he can expect that there will be one.
And then there’s the fight-or-flight–inducing unexpected uncertainty, like, say:
A global pandemic suddenly making his entire industry shift to remote work, completely changing how business is conducted.
An unexpected technological breakthrough (like ChatGPT) that suddenly changes the fundamental nature of certain jobs or makes some roles potentially obsolete.
If he stays in medicine: a major shift in provider payouts, insurance recertification, the election of a new president who shuts down the NIH.
The first set? Predictable, dealable-with. Parasympathetic nervous system.
The second set? Completely anxiety inducing.
Ravi can plan for the known unknowns, even if he can’t predict their exact impact. On the other hand, there’s no way to predict the existence, magnitude, or direction of fundamental changes that would force him to completely recalibrate his understanding of his career and how it fits into the landscape.
And that’s terrifying. To which our brain responds, as we talked about last week, by… doing nothing.
But all hope is not lost.
The upside of stress
There’s an upside of stress (side note: Kelly McGonigal’s book of the same name is excellent). The brain’s stress response—even the rewiring we talked about above—can be modulated through active training.
From programs teaching kids the skills needed for effective emotional regulation, to cognitive-behavioral therapy to compassion meditation—each of these has been shown not only to make people feel different, but to induce changes in the structure, function, or plasticity of the brain—and sometimes all three.
So, if you’re facing a big decision, be kind to yourself. Create the psychological safety you need to allow that powerful parasympathetic system to kick back on.
This means deliberately managing your exposure to uncertainty.
Think of it like strengthening a muscle. If you don’t challenge a muscle, it won’t grow. But if you challenge it too much, it snaps.
This might mean breaking down your big decision into smaller experiments. If it’s a career decision, that might look like conducting informational interviews before committing to a new field, or taking on freelance projects while maintaining your current role.
There’s no way to make the uncertainty of a big decision go away. Any decision—every decision—is made under uncertainty. If it weren’t uncertain, it wouldn’t be a decision.
But what you can do is notice how your body responds—because that’s a window into how your brain is responding—and then be intentional about creating the safety you need to move forward anyway.
As always, the goal is never perfect decisions — they don’t exist. The goal is good decisions.
→ Want more weekly content about making the hard decisions with confidence and clarity? Join my mailing list!
→ Ready to transform this insight into action? Get my free guide, “The Anatomy of a Good Decision,” where I break down the exact framework that helped me navigate my transition from surgery to decision science.
→ Are you a medical provider struggling with exhaustion, burnout, and indecision about how to craft a purposeful career? Check out my free 20-minute webinar on the Solving for Why Navigation System here.