“If you try this and hate it, we’ll learn something.”
Sometimes a great plan brings no relief. Many patients come into my practice having read, researched, consulted, and asked thoughtful questions for years. They have tried different diets, bought various supplements, gone to therapy, and seen multiple practitioners. Some things may have helped briefly, then outcomes faded. Other protocols or so-called solutions felt overwhelming and expensive, preventing them from even starting.
We are surrounded by conflicting advice, and each new option carries the burden of dashed hopes, “What if this doesn’t work either?” Over time, choosing starts to feel more challenging than staying uncertain. We want to feel better, but the act of committing to a plan, a practitioner, or a direction feels utterly exhausting.
This is a common experience for patients entering the holistic and natural health space, where treatment plans often involve lifestyle changes. Sometimes, even well-meaning practitioners dismiss it as “noncompliance” or “lack of readiness.” But the issue is rarely a lack of will, motivation or intelligence. Patients in this state are often highly active and engaged in healing. Over time, enough disappointment, overwhelm, or contradictory guidance leads their bodies to expect that effort won’t lead to results. Their system isn’t refusing to heal; it’s protecting them from the emotional cost of choosing and the heavy shame of bearing the responsibility.
When people are actively seeking solutions but repeatedly struggle to initiate or sustain action, the system responsible for authorship is already overburdened. Low agency arises when we feel that authorship of our lives is unsafe, exhausting or futile. Many who struggle with follow-through have lived for years, often since childhood, in environments where choice wasn’t safe.
If you struggle with decision-making and commitment, you may have grown up learning that trying often came at a cost, such as overwhelm, criticism, or collapse.
Over time, your body may have learned to conserve energy by waiting rather than acting. This was never a conscious decision you made, but an intelligent adaptation. In nervous system terms, chronic stress, trauma, illness, or prolonged uncertainty can pull the system into shutdown or freeze states, where initiating action feels heavy, confusing, or risky. You want to change, but struggle to implement change over time.
I’ve seen this pattern many times, often in people with complex histories. A patient might come in carrying a heavy file of childhood trauma. Perhaps they come to me with a history of disordered eating, chronic pain and fatigue, emotional volatility, panic, and depression. They’ve been waiting, sometimes for months, for the “right” referral, the specialist who will finally have the answer. When that appointment arrives, the encounter is brief and decisive. The recommendation may be a strict diet, testing and supplement protocol, or medication. Collaboration is non-existent, follow-ups are sporadic, and the style of care is directive: do this to feel better.
And sometimes, remarkably, it works, at least at first. Symptoms ease within days. Pain lessens and mood lifts; the relief is real. Through my years of practice, sometimes watching this from the outside, I’ve found it disorienting. After many sessions of careful pacing with clients facing many struggles, they seemed miraculously cured by authoritative, sometimes heavy-handed interventions, and I’ve often wondered whether my slower, gentler, collaborative approach was wrong.
But, over time, I came to understand what often unfolds next. Without ongoing support, context, or integration, these intensive plans become unsustainable. For patients with a history of restriction, control, or collapse, the intervention slots perfectly into an old binge-shame-control-restrict-rebel-shame cycle. After a period of deprivation, without nervous system scaffolding and the structure in place to hold these significant changes, patients inevitably slip through the cracks, falling off the plan and spiralling into shame and self-defeat.
Not only does relief disappear, but so does the sense of being held by an authority that had the answer. Disappointment deepens, leading to further collapse, and what remains is paralysis: no clear way to continue, no internal compass for deciding what changes mattered, what helped, or how to adapt.
Healing doesn’t fail because the intervention was wrong, misguided, or useless, but because something essential, something required for healing, was never named or built.
In these moments, agency, or rather the lack of it, becomes visible. Intense, immersive fixes can feel irresistible precisely because they temporarily relieve the burden of authorship. We don’t trust our capacity to steer, decide, or stay with change because our system has never been taught to do so. And so an external structure feels like salvation. We are exhausted, miserable, and in pain and in these states, containers like retreats, protocols, charismatic practitioners, and tightly defined rules offer certainty. And certainty temporarily regulates a system that feels uncertain and chaotic.
When these structures disappear or fail to fit our realities of daily life, we’re left holding the responsibility for our health and lives, and without support, it becomes too heavy to carry. The resulting collapse under this weight is a predictable nervous-system response, not failure.
Early in my practice, I felt this tension acutely. I understood, intuitively and philosophically, that patients heal themselves, and that my role was to guide, explain, and support. This is explicit in psychodynamic psychotherapy, where healing comes not from answers, but from understanding oneself in the presence of a steady, attuned other.
I noticed, however, that in medical settings, many patients are understandably impatient with nuance. Patients are dealing with troubling symptoms that demand an answer. In our healthcare system, we are trained to defer our bodies, agency and choice to an authoritarian expert. In this context, I could feel the pull to become that leader: more directive, more convincing, even more “magical.” But, I knew that while this stance might improve short-term compliance, it would undermine the very thing required to heal: agency.
Patients struggling with low agency want to heal but don’t yet trust themselves to carry the process. When patients appear indecisive, demand authority, or continue gathering information, they’re often asking not for more answers but for help tolerating the vulnerability of change. As clinicians, we can misread this (I often have) and respond by adding more plans, complex explanations, and intense structure, thereby unintentionally increasing the load on a system already at capacity.
Many so-called miracle cures follow this arc. They rely on pressure, urgency, restriction, or intensity to push a nervous system into action. For a time, this can feel like a transformation. But without integration, these highs often collapse into more profound shame, fatigue, pain, or shutdown. The lesson isn’t that these experiences are meaningless; in fact, they can teach us a great deal if they’re reflected on and metabolized. The problem is that without support, the learning often never consolidates. We usually view these experiences as something out there that works, but that we failed somehow.
The problem was never the plan, or practitioner; it was the mismatch between the agency the intervention required and the agency the patient had access to at that moment.
In psychology and medicine, several concepts overlap with what I’m describing here, including self-efficacy, locus of control, autonomy, and learned helplessness.
Self-efficacy refers to a person’s belief that they can carry out a specific action. Self-efficacy predicts why confidence is needed for follow-through and why low confidence can trigger avoidance and early abandonment of plans, but agency is not just about beliefs. Low agency is not about a lack of doubt in one’s ability to act, but a system that can not tolerate the act of authorship itself. The problem isn’t confidence or belief, it’s capacity.
Locus of control describes whether someone experiences outcomes as internally or externally determined. In other words, do we believe our actions matter or that outside forces dictate them? An oscillating locus of control can overlap with the pattern of deference to authority, followed by rebellion and collapse when one struggles with agency. Still, it doesn’t account for the emotional or physiological costs of choosing.
In Self-Determination Theory, autonomy is a felt sense that one’s actions are self-endorsed. Research consistently shows that behaviour change is more durable when autonomy is supported rather than coerced. However, Self-Determination Theory assumes a baseline capacity for autonomy. This article points to something that lives upstream of that assumption: with patients whose systems are not yet able to tolerate autonomy without threat.
Learned helplessness comes closer to describing how repeated, uncontrollable stress can reduce action, even in the face of options. Learned helplessness maps well onto chronic illness, long diagnostic odysseys, healthcare trauma, and repeated disappointments over attempts to heal. However, it is often framed as passivity rather than high-effort, high-seeking, low-integration patterns that many chronically ill patients are trapped in.
In the late 1960s, psychologist Martin Seligman and his colleagues ran a series of experiments that came to be known as the Learned Helplessness Studies. In one version, dogs were placed in a situation where they received mild, unavoidable electric shocks. No matter what the dogs did, move, whine, or try to escape, the shocks continued. Later, those same dogs were placed in a new environment where escape was easy: a low barrier they could step over to stop the shock. But the dogs learned that their actions didn’t matter, and so many of them didn’t try. Their agency was extinguished.
In contrast, dogs who had never experienced uncontrollable shocks quickly learned to escape. This experiment has since been ethically criticized and is no longer conducted, but its implications have echoed through psychology, medicine, and trauma theory.
When we repeatedly encounter situations in which effort doesn’t change outcomes, we stop initiating action altogether. Seen through this lens, what we often call “lack of motivation,” “self-sabotage,” or “giving up,” can instead be understood as a learned nervous-system adaptation: why try, if trying hasn’t helped before?
Similar to learned helplessness, low agency is a state of the nervous system, not a personality trait. It often shows up alongside chronic fatigue, metabolic dysfunction that doesn’t respond to lifestyle change, health anxiety, autoimmune illness, and depression. Patients arrive depleted and foggy, frustrated by their inability to initiate or sustain change. They desperately want to feel better, so they ask for testing, supplements, diagnoses, and explanations. On the surface, they’re asking for energy. Underneath, they’re often asking for amelioration from the burden of choosing and carrying their lives. Their systems have been in collapse long enough that surrender feels like the only imaginable intervention.
Suggestions that require sustained action, like regular meals, movement, and supplement consistency, can feel intolerable because they demand a level of authorship the system doesn’t yet have access to.
As a clinician, I felt this as pressure to find the one thing: the right supplement, the proper test, the correct explanation that would finally ease all symptoms. Sometimes that treatment exists. More often, cases are complex and rooted in long-standing patterns that shift only with steady, consistent inputs: changes that require feeling the body change and tolerating what that change brings.
For years, I focused on insulin resistance and metabolic dysfunction as key root causes of hormonal, cognitive, and mood symptoms. Often, this framing was correct. When the labs finally provided a coherent explanation, it felt like a solace for both of us: now we know what to do. I’d suggest a small set of actions, such as movement, nutritional guidance, a supplement, and sending patients off with hope.
Sometimes they improved, then abandoned the plan for something more extreme or restrictive that actually worsened the problem. Frequently, the issue wasn’t the plan. It was that the body was changing faster than the nervous system could metabolize the responsibility of maintaining that change.
Anxiety often reflects this same struggle with authorship. Many patients are highly vigilant: researching, anticipating side effects, seeking reassurance, listening to podcasts, tracking opinions. On the surface, they look engaged. But the engagement is often in the service of control rather than action. The moment a concrete choice is made, like starting a supplement, stopping a food, or setting a boundary, anxiety spikes, and the system retreats into analysis.
Depression, particularly with states of shutdown, involves a profound loss of agency, a loss of the felt sense that actions matter.
In chronic illness, where one feels betrayed by their body, low agency can appear as endless consultation without integration. Patients might move from practitioner to practitioner, accumulating opinions, tests, and plans that never consolidate. Each new expert destabilizes the last, but choosing one path means letting others go, and that loss can feel threatening. Authoritarian care can worsen this by overriding agency through pressure or shame.
Low agency can also show up as over-identification with external authority. Some defer completely to doctors, diets, and ideologies, only to rebel or collapse when asked to sustain the change. Rather than defiance, this reflects confusion about where the self ends and the other begins, often rooted in early experiences in which separation and autonomy were shamed, forbidden, or unsafe.
In practice, this can look like repeated requests for plans that are never used. Meal plans sit untouched. Supplement lists are partially followed, altered, and questioned. The plan becomes a symbolic container for hope rather than a tool for change.
Trauma is often at the center of this pattern. Trauma isn’t only about what happened to us, but what happened to our agency. When initiative was punished, ignored, or exploited, the body learned to stay still. In adulthood, this can look like indecision or endless seeking without consistent action. Beneath it is an intelligent truth: staying small once kept me safe.
Agency can be grown, however, in small, meaningful and survivable steps. It doesn’t come from overhauling your life, but from choosing one thing and staying with it long enough to feel the consequences and survive them emotionally. Agency isn’t a trait that you have or don’t have; it’s a capacity that can be rebuilt.
Consider the smallest action you could take that could be repeated without resentment or collapse. Maybe it’s laughably simple. Eating protein at breakfast, taking your iron supplement consistently, walking for 10 minutes after dinner, or not responding immediately to a triggering email. These are not trivial actions; they are repetitions of agency. Like each rep of a bicep curl, each one is an opportunity for the nervous system to learn: I chose this; something happened, and I survived it. That learning is what builds capacity.
Agency is the nervous system’s bandwidth to make a choice, feel what happens next, and remain intact, emotionally and relationally, through the consequences. Often this means doing less, not more. Complexity can destabilize collapsed systems.
If a plan immediately triggers anxiety, obsession, or the urge to rebel or abandon it, that’s not a moral failure; it’s information. The system is saying, This is too much right now. Plans that are too detailed, too perfect, or too ambitious can actually erode agency by reinforcing the sense that healing is too big to hold.
Time-limited experiments can help. Rather than framing changes as permanent commitments, saying things like, “This is my new diet,” or “This is who I am now,” frame them as experiments with a clear beginning, middle and end. This reduces the existential weight of choice. The nervous system relaxes when it knows there’s an exit: at two, four, or eight weeks. And this makes follow-through more likely.
When agency is fragile, the real task is not optimization. It is learning how to stay with one small choice long enough to experience yourself as the author of it.
A helpful practitioner for rebuilding agency is not the most impressive, directive, or confident one. It’s someone who can tolerate uncertainty without rushing to fill it, who doesn’t escalate complexity when things stall, who respects pacing. Someone who can say, “Let’s try this and see what happens. If you hate it, we can try something else,” and mean it. Someone who doesn’t confuse care with control.
If a practitioner feels all-knowing, rescuing, or possessing secret knowledge, this can feel comforting at first, but often undermines agency over time. It invites outsourcing rather than authorship. On the other hand, you might feel abandoned by a practitioner who offers too many choices and no structure at all.
The sweet spot is containment without domination, and guidance that leaves room for choice. The work of the clinician is not to find the perfect solution but to scaffold agency gently, through simplicity, repetition, containment, and tolerable choice.
Tolerating authorship is often the most challenging part of building agency. Authorship means accepting that outcomes are not fully controllable and that success or failure will belong, at least in part (but never in whole), to you. For many people, this is where shame, grief or fear surface. We might think, if I choose this and it doesn’t work, what does that say about me? About my body? About my capacity to heal? If I feel better, can I sustain it? If I take responsibility, will I be blamed?
Learning to tolerate authorship means staying present with those feelings rather than fleeing into analysis, seeking reassurance, or endlessly choosing. It means practicing saying, internally, I don’t know, but I’m willing to find out by trying something. That is a profound nervous-system shift.
The most challenging part of healing is often not doing something new. It’s staying with it. It’s tolerating the uncertainty, the effort, and the sense that now the outcome depends partly on us. In this realization, there is often grief. On the other side of the grieving process, however, is healing.
Reflection is also part of agency, but it needs to be simple and embodied, asking questions like, Did this feel stabilizing or destabilizing? Did this give me more energy, or did it drain me? Do I feel more resentful or vigilant? Is what I’m feeling a high of healing, a sense of relief, or actual change? These are questions that build interoception, the ability to read internal signals, which is foundational to agency.
Agency is relational; most of us don’t lose it alone, and we don’t rebuild it alone. Safe relationships with a practitioner, therapist, friend, or group provide external regulation that supports internal and self-regulation. The goal is not dependence, but supported autonomy from someone steady enough nearby that you don’t have to outsource your decisions, but don’t feel alone with them either.
It helps to let go of the idea that agency means doing everything yourself. Agency does not mean isolation. It means choosing consciously where you accept support and where you take responsibility. It’s the difference between saying, “Just tell me what I should do,” and asking, “Can you help me think through my options?
When we develop agency, choices become easier, less dramatic, and less charged. Healing stops feeling like a series of make-or-break decisions and becomes a rhythm of choosing, feeling, adjusting, repeating, and creating sustainable change over time.
Healing is not about finding the perfect plan. It’s about building the capacity to stay with yourself while living one.
References:
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Maier, S. F., & Seligman, M. E. (1976). Learned helplessness: Theory and evidence. Journal of Experimental Psychology: General, 105(1), 3–46. https://doi.org/10.1037//0096-3445.105.1.3
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van der Kolk, B. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma (1st ed.). Penguin Books.
