Between moral judgment and randomness: existential anxiety, meaning-making, and the pathway from cognition to health.

Human beings possess a distinctive psychological capacity to anticipate their own mortality and to interpret suffering within broader frameworks of meaning. This capacity gives rise to existential anxiety, particularly in contexts of illness, aging, loss, and uncertainty. While existential anxiety has been widely examined in philosophy and psychology, comparatively less attention has been given to the interpretive frameworks through which individuals explain suffering in clinical settings and to the biological consequences of those interpretations. This conceptual paper introduces the Randomness Intolerance Hypothesis, which proposes that individuals have limited psychological tolerance for interpreting significant life events as random and therefore construct explanatory frameworks that impose moral or cosmic order. Drawing on existential psychology, terror management theory, and the cognitive science of religion, the paper identifies three primary interpretive pathways: randomness, moral causation, and cosmic purpose. These pathways are illustrated through clinical case examples. The paper further proposes a Meaning → Biology → Health pathway, suggesting that meaning-making processes influence emotional states, stress physiology, and long-term health outcomes. Interpretations that reduce perceived threat may support adaptive regulation, whereas those that sustain fear, guilt, or helplessness may contribute to chronic dysregulation. The paper concludes with implications for psychotherapy and future empirical research.