The Fear of Writing Everything Down — Turning "My Risk" into "Our Risk"── Turning "My Risk" into "Our Risk"

Is writing down every risk I feel a form of honesty, or insurance to protect myself? The fear of missing something and being blamed for it later is real. That is exactly why I want to face that fear head-on instead of denying it. It was Freud who said anxiety is not an enemy but a signal. This piece is about learning to read that signal.

01In Front of the Send Button — Who Are These Twenty-Three Comments For?

It was a Friday evening. I had finished reviewing a new promotional material, and when I counted my comments from the top, there were twenty-three. The send button sat in the bottom right of the screen. My cursor hovered over it, but my finger would not move. I started reading again from comment number one.

Reading them over, I noticed the comments were not all the same weight. Three or four were genuinely dangerous: the evidence (= the data backing up a claim) was cited beyond the scope of the approval; the way a comparison was presented could mislead. Those I could not cut. But most of the rest were, to be honest, "just in case." This phrasing should pass because there is precedent, but I'll flag it anyway. This figure is probably fine, but the room for interpretation isn't zero, so I'll mention it. A dozen or so comments like that, sitting there wearing the same face as the most important ones.

I know, in my head, that I should cut them. Faced with twenty-three comments, the author may not be able to tell which ones are truly dangerous. An alarm panel with too many warnings is about as useless as one with none. Even so, the cursor stops over one of the "just in case" items, and I move to the next line without deleting it. What if I delete this one, and it becomes a problem later? That thought is what stops my finger.

The anxiety around writing comments takes two forms. One is the anxiety of having something to say and not being able to put it into words. The other is the anxiety that makes me write down even the things I don't need to. This time it's the latter. "Can't write" and "write too much" look like opposites, but don't they grow from the same root? That is the question this time.

One advance notice. This is not a piece about how to get rid of anxiety. As we'll see, anxiety is not a malfunction to be removed but a signal to be read. The problem is not that the anxiety exists. The problem is holding it entirely in my own hands while I keep writing all twenty-three comments.

02Anxiety Is an Alarm — Freud's Signal Theory

"What if I miss this point, the material goes out into the world as is, and later the authorities send an inquiry?" The moment I imagine that, my stomach feels heavy. Anyone who does review work knows this feeling. For a long time I took it as a weakness of mine — a mark of inexperience that would fade as I gained more.

What changed that view for me was the late Freud (= the founder of psychoanalysis, a physician active from the late 19th to the early 20th century). In his 1926 book Inhibitions, Symptoms and Anxiety, Freud overturned his own earlier theory. In his younger years he had thought of anxiety as the residue of repressed desire — a kind of psychic runoff. Later, he restated it: anxiety is a signal that the ego (= the part of the mind that acts as a control tower, negotiating with reality) sounds in advance of danger. This is the signal theory of anxiety (= the idea that anxiety is not the product of a breakdown, but an alarm the mind sounds on its own to announce danger ahead).

This rereading fits the feel of the job well. My stomach gets heavy not because my mind is broken, but because the control tower is issuing a forecast: there may be danger ahead. A fire alarm goes off not because the alarm is faulty but because it detected smoke; the alarm itself is proof the system works. Someone who can feel anxious at the thought of a missed point has a properly functioning circuit for anticipating danger. A person who feels no anxiety in a job with this much responsibility frightens me far more.

But Freud's theory has a sequel. Anxiety as a signal is meant to work in small doses. Detect smoke, sound, and stop once the response begins. That is what a working alarm looks like. Now look at my Friday evening. The alarm started ringing before I wrote the first comment and did not stop after I finished the twenty-third. Comments written under an alarm that never stops become not signals pointing to where the danger is, but filler to quiet the alarm. Those dozen "just in case" comments were not a response to risks in the material. They were a response to my anxiety.

So the first task is neither to hate the alarm nor to ignore it. It is to acknowledge: it is ringing right now. Frightening things are frightening. And given the nature of this work, the thought "missing something could be serious" is a correct thought. Accept that without denying it, and then move to the next question. How do you turn an alarm that never stops back into an alarm that rings when needed? The key is not inside my own mind.

03"Write Everything" May Be a Defense — Defense Mechanisms and Projection

When I went back over the twenty-three comments, there were a few I simply could not cut. They read like this: "This expression is not immediately a problem, but just in case, please consider adding supporting evidence." Rereading them, even I could hear the hedging. If I think it's a problem, I should say so. If I don't, I shouldn't write it. Was this in-between sentence written for the material's sake? Or for my sake, for the day someone asks, "Why didn't you point this out?"

Freud proposed, and his daughter Anna Freud organized, the concept of defense mechanisms (= workings of the mind that operate unconsciously to protect us from anxiety). People cannot carry unbearable anxiety as it is. So the mind, without our noticing, processes it: forgetting, rationalizing, blaming something else. None of this is done on purpose. That is exactly why it is hard to see in yourself.

"Write everything" can be reexamined through this lens. The anxiety of being blamed for a missed point — instead of carrying it directly, I bury it under the number of comments. Each comment I write seems to lighten the anxiety a little. But what is getting lighter is not the risk in the material. It is my anxiety. Is the comment protecting the material, or protecting me? On the page, the two are indistinguishable. Which is why it is dangerous to look at the comment count alone and feel reassured that this was "a thorough review."

Go one step further and you reach projection (= the mind's habit of refusing to recognize an anxiety or flaw as one's own and instead perceiving it as belonging to the other side). When I feel "this material is risky," is the risk really in the material? Or is my own fear of overlooking something simply reflected onto it? Thinking back to those "just in case" comments, I can't shake the sense that their grounds were not in the wording of the material but in my own chest.

To be clear: defense mechanisms are not an illness, and they are not evil. They are ordinary machinery every mind has. Nor do we need to psychoanalyze every review comment one by one. But when you meet a comment you cannot cut, ask just once: "Is this about the material, or about me?" That one question, and several of the twenty-three quietly disappear.

04Where the Irritation at the Author Comes From — Jung's Shadow

Let me be honest. There have been days when I felt irritated at an author: "Why would you even try to get this expression through?" A convenient graph that cherry-picked part of the data. The weaker the evidence, the more confident the phrasing became. My comments that day were a notch harsher than usual. I still believe the substance of my points was correct. But something other than correctness had gotten mixed into the wording.

Jung (= Carl Gustav Jung, a psychologist who stands alongside Freud) left us the idea of the shadow (= the other side of ourselves that we do not want to acknowledge). According to Jung, when a disproportionately strong emotion rises toward another person, that person may be acting as a mirror for our own shadow. What looks like the other person's flaw is, in fact, something that exists in us too — something we refuse to admit.

Hold that ruler up to myself. Chased by deadlines, pressed by a boss, still wanting the numbers to look good — is the author's situation really foreign to me? In weeks when my own review deadlines pile up, I fight the temptation to do at least one comment a little shallowly. The self that wants a shortcut. Because I don't want to admit that self, disproportionate irritation rises at someone who (appears to have) taken a shortcut. The harsh wording that day may have been, at the same time as a critique of the material, a way of insisting "I am not like that."

• A comment with irritation mixed in does not land, even when its content is right. The author reacts first to the tone, goes on the defensive, and the substance becomes an afterthought.
• Conversely, a comment written after noticing the shadow comes out a register quieter. Not "why would you write this," but "a reader will take this expression this way; fix this part and it will pass."
• A quiet wording is not a concession. It keeps the standard of the critique and strips out only the excess heat.

The shadow cannot be erased. Jung himself taught not the elimination of the shadow but living with the knowledge that it exists. All I can do is, in the moment a strong irritation rises, pause one beat and ask: "How much of this heat is actually about my side?" That one beat changes the wording of the comment. And when the wording changes, the relationship with the author changes, and so does the way the material gets fixed. The quality of a review depends not only on how much you know, but on whether you can hold that one beat.

05The Same Material, Different Things Seen — Jung's Theory of Types

Last autumn, a colleague and I reviewed a new oral drug's promotional material in parallel. Same PDF, same package insert (= the drug's official prescribing information), same deadline. When we compared our findings, I was a little shaken. Of the twenty-odd comments, only three overlapped. I had been looking almost entirely at how the graph's vertical axis was cut and at the fact that the comparator in the trial was an older drug. My colleague had been imagining the scene of a doctor explaining to a patient, and kept picking up "could this phrasing be misheard by an elderly patient?" Neither of us was wrong. We were simply looking at completely different places.

My first thought was an anxious one: "Am I the kind of person who overlooks things?" But this phenomenon has had a name for a hundred years. In his 1921 book Psychological Types, Jung argued that the workings of the mind come in patterns. Attention that turns toward the outer world is extraversion; toward the inner world, introversion. And there are four functions (= the mind's toolkit) for taking in information and making judgments. The pair that matters for review work is sensation and intuition. Sensation types pick up the facts and figures in front of them in fine detail. The eye that first notices the trick in a graph's axis is this one. Intuition types see possibilities first — "how will this document be used in the consulting room, and where might it roll from there?" The eye that imagined an elderly patient mishearing was this one. The remaining pair — the thinking type, which judges by logical consistency, and the feeling type, which judges by value and impact on people — I will only name here.

A caution is needed: Jung's typology is not a tool for putting people in boxes like a magazine personality quiz. Jung himself wrote repeatedly that no pure type exists. I want to borrow only one point from the theory: if the patterns of perception and judgment differ, the image of risk that rises from the same material differs too. That I snagged on the graph's axis while my colleague snagged on the patient's ear was not a difference in ability but a difference in type. The eye that sees numbers first and the eye that sees the scene of use first can be stretched somewhat by training, but they cannot be fully exchanged.

Seen this way, the foundation of the anxiety I had carried since the beginning — "I must write everything" — quietly gives way. "The risk I felt" was only ever a part. It was an image that passed through the lens of my type, not the whole of the risk hidden in the material. The whole extends beyond my field of view, into the territory my colleague's type picks up. If so, then even if I alone inflate my comments to a hundred, I am only multiplying the number of passes with the same eye. The places I cannot see stay unseen.

Here is the turning point of this piece. The shared risk — the risk an organization truly has to eliminate — does not emerge from one person's field of view. Its outline appears only when eyes of different types are set against each other. That day's list of comments, with only three overlaps, was not evidence of my defect. It was evidence that review work should be designed from the start on the premise of multiple eyes. Once I reread it that way, the question changed from "how can I write everything?" to "how do I connect my part to everyone's whole?"

06From "My Risk" to "the Community's Risk" — Adler's Community Feeling

The measuring stick for that connection, I borrow from Adler (an Austrian psychiatrist, 1870–1937). A concept he kept refining until late in life is community feeling (Gemeinschaftsgefühl, = the sense of whether one's actions serve not only oneself but the good of the community as a whole). Since human beings can only live within a community, the worth of an action can be measured by whether it serves that community. It sounds abstract, but translated into a criterion for sorting review comments, it becomes a surprisingly practical tool.

The method is simple. Before sending, question each finished comment like this: "Whose interest — the patient's, the healthcare professional's, the company's — does this point protect, and how?" Comments I can answer aloud stay. Comments where I stumble are, almost always, a line written for my defense — for the self-protective wish not to be told "you missed it." In practice, the line falls like this:

• "The adverse event frequency should also be stated in the body text" → protects the patient's interest in not making a choice against their own good, and the healthcare professional's interest in being able to explain properly. Keep.
• "This expression leaves room to be read as exaggerated advertising (Article 66 of the Pharmaceuticals and Medical Devices Act)" → protects the company from administrative action, and by extension the credibility of the information. Keep.
• "Just in case, please recheck this whole paragraph" → I cannot say whose interest it serves. It is insurance, so I can say "I did point it out" if something happens. Cut.

The backbone of this questioning is the often-cited difference between Freud's position and Adler's. Freud explains behavior from past causes. On that view, my anxiety would be explained as "caused by a past experience of having a missed point flagged." The explanation may well be correct — but the cause lies in the past, and nothing can move it now. Adler, in reverse, explains behavior from its future purpose. He asks, "For what purpose am I writing this comment?" Causes cannot be changed; purposes can be re-chosen here and now. I write insurance comments not because of my past but because I am choosing the purpose of "a self who cannot be blamed." Then I can re-choose the purpose: "protecting patients and healthcare professionals." I bring up this contrast only this once, but it changed how I live with anxiety at the root.

Using community feeling as the measuring stick, the number of comments goes down. At first that is frightening. But every point that remains is one whose "who does this protect" can be stated in a single breath. For the author receiving them, twenty reasoned points move the fixing hand better than a hundred defenses. My risk passes through conscience and becomes everyone's risk. Translation, I suspect, is exactly this kind of work.

07Separate the Tasks, and Still Trust — Encouragement and the Send Button

Friday evening. I look once more at the comment field I have written. Seven items. Still a lot. Rereading them, three were comments where "I just wanted to feel safe": a possible typo, a formatting preference, a just-in-case confirmation. Writing them reduces my anxiety. But from the receiving author's side, it just adds three points with no obligation to fix.

What I recall here is what Adlerian psychology calls the "separation of tasks" (= distinguishing the tasks you take on from the tasks that belong to the other person). My task ends at finding the risk and handing it over in a form that gets through. How the author receives the comment and how they fix it — that is the author's task. When I try to carry that part too, the comments grow long, the tone edges toward command, and the other person's room to think is taken away. Writing everything to bind someone is not review; it is control. And a person who feels controlled will, from then on, fix only what they are told. For the quality of the material, I think that is the most costly outcome of all.

Adlerian psychology has one more idea: "encouragement" (= engaging with someone on the trust that they can solve things themselves). It is neither praise nor instruction. It means handing over words on the premise that "given this reason, you can judge appropriately." So the job of my comments narrows: not to increase the number of points, but to hand over the shared risks — the points where the patient and the company would truly be hurt — briefly, with reasons attached. For the rest, trust the other person's judgment. Trusting is not optimism. It is a deliberate subtraction, made after choosing carefully what to hand over and what not to.

• My task: find the risks. Hand them over briefly, with reasons.
• The author's task: decide how to fix, based on the reasons received.
• Our shared task: that no misunderstanding reaches the patient. This one, we carry together.

I cut the three. To one that remained, I added just two lines on "why this snags" — not the approval criteria, but the actual way a misreading could happen. The comment field got shorter, yet I feel more got through. And so back to the scene at the beginning. In front of the send button, my finger pauses for a moment. The alarm of anxiety is ringing today too. It will not go away. That it does not go away is normal — it took me this one week to understand that. The alarm is not saying "write everything." It is saying "choose what is truly dangerous." I have finally learned to read it that way. I press the button. My risk has become our risk.