The science of having no answers
Ninety-Five Percent.
On Having No Answers, and What That Does to a Body.
Almost everything in the universe is made of something nobody has identified. Physics treats that as a frontier and funds it. The same sentence, said about a woman's symptoms, gets her sent home. This post is about both, because they turn out to be the same sentence with different consequences.
Start with the number, because it is the most underappreciated fact in science and almost nobody who hears it reacts the way they should.
Add up everything in the universe that is made of the kind of matter you are made of. Atoms. Protons, neutrons, electrons. Stars, planets, gas clouds, people, the entire contents of every telescope image you have ever seen.
That is about five percent of what is out there. [1]
The remaining ninety-five percent is divided between two things named after the fact that we cannot see them. Dark matter, which has mass and does not interact with light. Dark energy, which is making the expansion of the universe accelerate and has no accepted explanation at all. The names are not descriptions. They are placeholders, and they have been placeholders for decades.
This is the current best-tested model of the universe. It works extremely well. It is also mostly a description of two things nobody can identify.
I find this steadying rather than disturbing, and I have been trying to work out why. Part of it is that physics is comfortable saying it. The unknown fraction is written into the standard model, given a symbol, measured to several decimal places and handed to the next generation as work to do. Not knowing is the job.
And then you take the same sentence, we do not know what is causing this, into a consulting room with a woman in it, and it stops being a frontier. It becomes a verdict about her.
The Inventory
Everything there is, by fraction, according to the best-fitting model. Tap a band.
Fractions from the Planck 2018 cosmological parameters. These are the values that best fit the data under the standard model, not direct measurements of substances anyone has isolated. [1][2]
There is a second kind of not knowing in cosmology and it is better than the first, because it is sharper.
Two good methods for measuring how fast the universe is expanding give different answers, and both keep getting more precise. One method reads the cosmic microwave background, the light left over from the early universe, and infers the expansion rate from the model. The other measures distances to nearby galaxies directly, using Cepheid variable stars and supernovae as rungs on a ladder.
Adam Riess and colleagues published the direct measurement at a precision of roughly one kilometre per second per megaparsec, and reported that the disagreement with the value inferred from the cosmic microwave background sits at around five standard deviations. [2] Five sigma is the threshold particle physics uses to declare a discovery. Here it is the threshold at which two ways of measuring the same quantity are definitively failing to agree.
What makes this good rather than embarrassing. Nobody can currently explain it away. For years the reasonable position was that one measurement had an unfound systematic error. Both have been checked repeatedly, by different groups, with different instruments, and the gap has widened rather than closed. So either something is wrong with one of the measurement chains in a way that a lot of clever people have failed to find, or the standard model of cosmology is incomplete in a way that would be genuinely important.
Hold on to the structure of that, because it is the transferable part. A well-specified unknown, with two competing measurements, clear criteria for what would settle it, and no pressure on anyone to pretend otherwise. That is what a good unanswered question looks like.
Now the other half, which is what all of this does to a nervous system.
Two Routes Out of the Same Sentence
I do not know. Switch between what that state becomes.
The same epistemic state, routed two ways. Note the sample sizes on the awe side before you build anything on them. [3][4][5][6][7][8]
The psychology here is genuinely interesting and it is also the section where I have to be most careful, because awe research is popular in exactly the way that produces overclaiming.
The construct is reasonably well defined. Dacher Keltner's group characterises awe as the response to something vast that does not fit your existing mental structures, which forces those structures to update. The vastness can be physical, like a mountain or a night sky, or conceptual, like a very large number or a very long timescale.
Jennifer Stellar and colleagues measured seven positive emotions and looked at their relationship with interleukin-6, an inflammatory cytokine. After correcting for multiple comparisons, only awe remained a significant predictor of lower IL-6, both as a dispositional trait and as recent daily experience. [3]
That result is cited constantly. Here is what is usually left out. The two studies had 94 and 105 participants, all undergraduates. The design is cross-sectional, and the authors say directly that their work cannot address causality, noting that inflammation can reduce positive affect just as readily as the reverse. [3]
So: a real, well-conducted, small study with an honest limitations section, which has been repeated in the wellness world as though awe lowers inflammation. It might. Nobody has shown it.
The behavioural work is sturdier, because the manipulations are experimental. Paul Piff and colleagues ran five studies and found that inducing awe produced a diminished sense of self and increased prosocial behaviour. In one of them, participants who spent a minute looking up at a stand of tall eucalyptus trees, rather than at a tall building, were subsequently more helpful and reported less entitlement. [4] Yang Bai and colleagues replicated the small self effect across samples in the United States and China, with cultural variation in how it played out. [5]
Awe is not a nice feeling about a nice view. It is what happens when the world does not fit your model of it, and the model is the thing that gives way.
Melanie Rudd and colleagues found that awe changed how people experienced time, leading them to feel less time-pressured and more willing to give time away. [6] Craig Anderson and colleagues took military veterans and young people from underserved communities on river rafting trips and found that awe experienced during the trip predicted improvements in wellbeing and stress-related symptoms in the days afterwards, more strongly than other positive emotions did. [7]
Put next to the ninety-five percent, this stops being a coincidence. The most reliably studied route from a large unanswered question to something good in a human nervous system runs through awe, and awe requires exactly the thing an unanswered question provides. Something too big for the model you arrived with.
Four Questions Nobody Can Answer
What is actually established, what is genuinely open, and what a bad answer looks like.
A good open question names what would settle it. That is the difference between a frontier and a shrug. [1][2]
In physics, we do not know is a frontier. In a woman's body, it is a diagnosis.
Ninety-five percent of the universe is unidentified and nobody calls cosmology hysterical. The unknown fraction gets a symbol, a budget line, a satellite mission and a generation of graduate students. It is written into the model as an open problem, which is to say: as work.
Now take a woman with pelvic pain to a consulting room. The literature describes delays from symptom onset to an endometriosis diagnosis ranging from four to eleven years, a finding that holds across countries, including ones with universal healthcare. The multicentre study by Nnoaham and colleagues, across ten countries, documented both the delay and the associated loss of quality of life and work productivity. [9]
Those years are not spent waiting for a test to be invented. They are spent being told there is nothing wrong. The unknown, in that room, does not get recorded as an open problem. It gets converted into a statement about the patient.
Diane Hoffmann and Anita Tarzian documented the mechanism in 2001, reviewing the evidence on how women's pain is assessed and treated, and describing a pattern in which women's reports are more readily attributed to emotional causes and less readily treated as requiring investigation. [10] Twenty-five years later the diagnostic delay figures have barely moved.
The category that does the damage is medically unexplained. Read it carefully. It sounds like a description of the state of knowledge, and it functions as a description of the patient. Dark energy is medically unexplained too, in the sense that nobody can account for it. Nobody has ever suggested it is anxious.
Not knowing is not the problem. It is the correct state of affairs for most questions most of the time. The problem is that in one setting not knowing is treated as a property of the field, and in another it is treated as a property of the woman.
Four things to hold lightly
The awe and inflammation finding rests on two small cross-sectional samples of undergraduates, with the authors explicitly stating that direction of causality cannot be addressed. It is a good study that has been badly used. [3]
The cosmological fractions are model-dependent. They are the parameter values that best fit the data assuming the standard cosmological model. If that model is wrong in the way the expansion-rate disagreement hints it might be, the fractions change. I have written them as measurements because that is how they are reported, and they are better described as very well constrained inferences. [1][2]
Awe research shares the replication problems of social psychology generally. The behavioural effects have been replicated across cultures, which is encouraging, but effect sizes in this literature have a history of shrinking under scrutiny and a single striking study should not be load-bearing for anything. [4][5]
And nothing here is a reason to accept not knowing about your own body. The point of the activist section is the opposite: that unexplained should trigger investigation rather than conclude it. If you have symptoms without an answer, the correct response is a better clinician, not equanimity. [9][10]
A good unknown comes with criteria. Physicists can tell you exactly what observation would resolve the expansion-rate disagreement. If someone tells you something is unknown and cannot tell you what would count as finding out, that is usually a sign that nobody is looking.
These are different sentences. The first is about the state of medical knowledge and the second is about you. Noticing the swap as it happens, in real time in a room, is a usable skill, and asking what has been ruled out and what has not is the version of it that gets said out loud.
Awe needs vastness that your current model cannot absorb. A night sky away from streetlights. A timescale you cannot intuit. A number like ninety-five percent. The behavioural findings are the sturdier part of this literature, and the manipulations in those studies were often a minute long. [4][6]
The difference between a well-supported open question and a neglected one is usually not difficulty. It is whose question it is. That is true across medicine, and female physiology has been on the wrong side of it long enough that the gap is measurable in years of diagnostic delay. [9]
I went looking for something comforting about uncertainty and found something more useful instead.
The comfort version is available and it is thin. Everything is mysterious, nobody knows anything, relax. That does not survive contact with a woman waiting eleven years for a diagnosis, and it should not.
What the physics actually offers is a demonstration that a field can hold an enormous unanswered question in the centre of its model, name it precisely, measure its edges, and get on with the work, without either pretending to an answer or collapsing into vagueness. Ninety-five percent unknown, written down, funded, taught.
That is a standard, and it is one medicine can be held to. The state of not knowing is fine. It is the only honest state for most questions. What is not fine is the moment it stops being a description of the field and becomes a description of a person.
And the rest of it, the looking up, the deliberate overwhelm, the small self in front of something vast. That has the best evidence of anything in this post for actually changing how a body feels, and it is free, and the studies that found it used about a minute.
The distance between what is unknown about female physiology and what is assumed about women is the gap The Art of Female Health was written across. The chapter on diagnostic delay covers the endometriosis literature in more detail than a post can. nammu.academy/book
References
- Planck Collaboration, Aghanim, N., Akrami, Y., et al. (2020). Planck 2018 results VI: Cosmological parameters. Astronomy & Astrophysics, 641, A6. https://doi.org/10.1051/0004-6361/201833910
- Riess, A. G., Yuan, W., Macri, L. M., et al. (2022). A comprehensive measurement of the local value of the Hubble constant with 1 km/s/Mpc uncertainty from the Hubble Space Telescope and the SH0ES team. The Astrophysical Journal Letters, 934(1), L7. https://doi.org/10.3847/2041-8213/ac5c5b
- Stellar, J. E., John-Henderson, N., Anderson, C. L., Gordon, A. M., McNeil, G. D., & Keltner, D. (2015). Positive affect and markers of inflammation: Discrete positive emotions predict lower levels of inflammatory cytokines. Emotion, 15(2), 129–133. https://doi.org/10.1037/emo0000033
- Piff, P. K., Dietze, P., Feinberg, M., Stancato, D. M., & Keltner, D. (2015). Awe, the small self, and prosocial behavior. Journal of Personality and Social Psychology, 108(6), 883–899. https://doi.org/10.1037/pspi0000018
- Bai, Y., Maruskin, L. A., Chen, S., et al. (2017). Awe, the diminished self, and collective engagement: Universals and cultural variations in the small self. Journal of Personality and Social Psychology, 113(2), 185–209. https://doi.org/10.1037/pspa0000087
- Rudd, M., Vohs, K. D., & Aaker, J. (2012). Awe expands people’s perception of time, alters decision making, and enhances well-being. Psychological Science, 23(10), 1130–1136. https://doi.org/10.1177/0956797612438731
- Anderson, C. L., Monroy, M., & Keltner, D. (2018). Awe in nature heals: Evidence from military veterans, at-risk youth, and college students. Emotion, 18(8), 1195–1202. https://doi.org/10.1037/emo0000442
- Carleton, R. N. (2016). Into the unknown: A review and synthesis of contemporary models involving uncertainty. Journal of Anxiety Disorders, 39, 30–43. https://doi.org/10.1016/j.janxdis.2016.02.007
- Nnoaham, K. E., Hummelshoj, L., Webster, P., et al. (2011). Impact of endometriosis on quality of life and work productivity: A multicenter study across ten countries. Fertility and Sterility, 96(2), 366–373.e8. https://doi.org/10.1016/j.fertnstert.2011.05.090
- Hoffmann, D. E., & Tarzian, A. J. (2001). The girl who cried pain: A bias against women in the treatment of pain. Journal of Law, Medicine & Ethics, 29(1), 13–27. https://doi.org/10.1111/j.1748-720X.2001.tb00037.x