For the past several decades, Western spiritual culture has been profoundly shaped by the rebranding of Buddhist contemplative practices (mindfulness, presence, and the exaltation of “the now”). As a psychiatrist, I have witnessed the arrival of this movement inside the consultation room. Patients arrive quoting teachers, apps, and books urging them to stay present, to watch their breath, to release attachment to the future or past. Many have tried, often earnestly and courageously. And yet, a large subset sit before me bewildered and disappointed: “I stayed in the present, but I’m still lost.”
Their suffering doesn’t come from distraction or restlessness alone, it comes from the structure of their lives, from the unsolved dilemmas of responsibility, meaning, mortality, and the sheer uncertainty of being human. For these patients, mindfulness becomes another demand, another performance, another measurement of failure. Sitting still in the middle of a burning house does not extinguish the fire. Over the years, I have become increasingly convinced that an exclusive focus on the present moment (beneficial as it is for regulating the nervous system) does not satisfy the deeper existential anxieties that drive human distress. Humans are future-oriented creatures. We live not only in the immediacy of breath and sensation, but in a story, one that stretches forward and backward, linking us to memory, culture, ancestry, destiny, and death. When we amputate this temporal dimension, we cut off a vital source of meaning.
The tyranny of the present
It has become almost heretical to question the supremacy of the now. But clinically, I have seen what happens when the present moment is treated as the only moment that matters. Patients experiencing unemployment, marital collapse, chronic illness, or existential despair are asked to “just be.” They try, and fail. And each failure deepens shame. If a patient is in the midst of profound grief (or facing the collapse of their life’s scaffolding) “be present” can feel dismissive. It doesn’t honor the magnitude of the crisis. It asks them to emotionally digest anguish that is not yet metabolizable. The present can be unbearable when stripped of context. It can even feel like a trap.
Reclaiming the future as a therapeutic force
What I have found more enduring (psychologically, spiritually, and existentially) is a shift from mindfulness of the present to meaningfulness of the future. Not fantasy, not escapism. But the conscious, disciplined acknowledgment that life is a trajectory, not a snapshot. The human mind needs hope, direction, continuity, and purpose. These are future-facing faculties. Viktor Frankl understood this in the concentration camps; his survival was tied not to breathing techniques but to the vivid mental construction of a future self. Neuroscience now confirms what Frankl intuited: future-thinking activates reward circuits, dampens the amygdala, and strengthens the dopaminergic pathways associated with motivation and resilience. To heal existential anxiety, we must help patients rediscover that they are not static beings trapped in a moment; they are travelers. They are pilgrims. And pilgrims move.
The briefness of life and the clarity it offers
Paradoxically, the antidote to the tyranny of the present is not denial of death but intimacy with it. When we remember that our days are finite, the present is no longer an oppressive container; it becomes a meaningful chapter in a finite story. I have found that patients who contemplate the brevity of life often feel liberated rather than oppressed. The awareness of death softens the urgency of the present and expands perspective. Problems become smaller through the lens of impermanence. The judgment of others loses weight. The anxious need for immediate resolution relaxes. Death awareness re-situates suffering in a broader frame.
A transcendental horizon beyond space and time
Beyond future goals or aspirations lies another layer, what one might call the transcendent future, the horizon of consciousness that extends beyond linear time. Whether one conceives of this as God, the soul, the collective unconscious, or a spiritual dimension, it offers something essential: the assurance that existence is more than the current predicament. I have seen deeply depressed patients experience a quiet shift when they begin to sense (even faintly) that their lives are part of a larger, unfolding reality. Suffering becomes less suffocating when placed in a cosmic context. This is not magical thinking; it is existential enlargement.
A more complete way of being human
Mindfulness has its rightful place; it steadies the mind and anchors the body. But humans are not meant to live only in the present, they are meant to stretch across time. To remember the past. To imagine the future. To engage in the profound spiritual act of hope. A psychology rooted only in presence is incomplete. A psychology infused with past, present, future, and the transcendent is whole. As a physician-psychiatrist, my work increasingly involves helping patients rediscover not the power of the present moment, but the power of the future:
- The future self they can grow into
- The future meaning their experiences will hold
- The future possibilities they cannot yet see
- And the ultimate future that transcends the limits of mortality
Existential anxiety is not solved by narrowing consciousness to the present. It is softened by widening the lens of existence. In that widening, patients begin to breathe again, not just from the diaphragm, but from the soul.
Farid Sabet-Sharghi is a psychiatrist.
