“If you try this and hate it, we’ll learn something.”
Sometimes a great plan brings no relief. Many patients come into my practice after years of reading, researching, consulting, and asking thoughtful questions. They have tried different diets, bought various supplements, gone to therapy, and seen multiple practitioners. Some things may have helped briefly, but the results faded. Other protocols or so-called solutions felt overwhelming and expensive, so they never even started.
In other words, they’ve sought help but haven’t found it, but it’s not necessarily because no one has tried.
Sometimes it’s because change is hard and daunting. Change requires pacing that respects capacity, and that can be hard to tease out when making a plan.
Most of us experience this at some point: we want change, we know how to change, yet we can’t take or sustain the action. It leaves us feeling frustrated, confused, and ashamed.
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 becomes harder than staying uncertain. We want to feel better, but committing to a plan, a practitioner, or a direction feels utterly exhausting.
This is common for patients entering the holistic and natural health space, where treatment plans often require 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. You never consciously decided this, but it was 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 it over time.
I’ve seen this pattern many times, often with people who have 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. One of my patients was recommended a restrictive anti-inflammatory diet for their lifelong mental health struggles. She had no input and received no follow-up. She was told to follow the diet to feel better, and she did, for a while.
She noticed her symptoms ease within days. Pain lessened, and mood lifted. I remember finding this disorienting at first, because after many sessions of careful, collaborative pacing with her and other clients, I would only find them miraculously cured by authoritative, sometimes heavy-handed interventions, and I’ve often wondered whether my slower, gentler, collaborative approach was wrong.
But without ongoing support, context, or integration, these intensive, authoritarian plans become unsustainable, and I’ve watched them unravel.
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 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 stalls because something essential, something required for change, was never named or built.
When we’re handed down a treatment plan from on high, it erases the very agency required to do the healing work.
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 daily realities, we’re left holding 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.
Nuance, however, can be annoying. When you’re dealing with symptoms, you want an answer. I get it. Our healthcare system also trains us to defer our bodies, agency and choice to an expert.
As a healthcare practitioner, I often feel the pull to become that all-knowing benevolent dictator of health: leading, directing, convincing, and bestowing the “magic” of authority.
This stance sometimes works—my Nonna quit smoking because her doctor told her flat out she would “die” if she didn’t—but it often favours short-term compliance and fear rather than true agency-building.
Those who struggle with agency want to heal but don’t yet trust themselves to do so. They may appear indecisive, constantly questioning, or researching. It is hard to tolerate the vulnerability of change when you’re not used to referencing yourself as the compass.
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.
So-called miracle cures tap into this. They rely on pressure, urgency, restriction and intensity that can sometimes push the nervous system into action. It can create a temporary feeling of transformation or relief. But because they lack proper integration (what part worked, how did you feel, what did you do or observe in making this change?), these highs often collapse, and shame, fatigue, and shutdown set in.
These experiences aren’t meaningless. In fact, they can teach us a great deal if we reflect on them and metabolize them into self-knowledge. The problem is, we often leave them aside as stories of failure rather than consolidating them into valuable information. This consolidation sometimes requires the right support.
I’ve met many patients who’ve tried many things and regard those attempts as failures, with the true “cure” still existing somewhere outside themselves. They just need to find it.
But most often, the problem isn’t that these tools didn’t work; it’s a mismatch between the agency they needed and the agency the patient had access to in that moment.
In psychology and medicine, several concepts describe agency as I’m using it 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. Confidence and self-belief can predict whether someone follows through on plans. But agency isn’t just about believing you can act. It has more to do with capacity, the nervous system’s ability to tolerate authorship.
Locus of control describes whether someone experiences outcomes as internally or externally determined. In other words, do we believe our actions matter, or do we believe 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. But locus of control doesn’t explain the emotional cost 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, everyone has different baseline levels of autonomy. Many have been taught that exercising autonomy carries some kind of threat.
Learned helplessness more closely describes how repeated, uncontrollable stress can reduce action, even when options are available. Learned helplessness maps well onto chronic illness, long diagnostic odysseys, healthcare trauma, and repeated disappointments over attempts to heal. However, people often frame it as passivity rather than the high-effort, high-seeking, low-integration patterns many chronically ill patients are trapped in.
In the late 1960s, psychologist Martin Seligman and his colleagues ran a series of experiments 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, moved, whined, or tried to escape, the shocks continued.
Later, researchers placed those same dogs in a new environment where escape was easy: a low barrier they could step over to stop the shock. But the dogs learned their actions didn’t matter, and many of them stopped trying. 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.
Learned helplessness helps us understand that when past efforts don’t change outcomes, we learn to stop trying. If trying hasn’t helped before, the nervous system adapts.
Like learned helplessness, agency is a nervous-system state, 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.
I’ve met many patients whose nervous systems have collapsed in this way. Many arrive depleted, foggy, and frustrated by their inability to initiate or sustain change. They desperately want to feel better, so they keep seeking answers.
As a clinician, I sometimes feel pressure to find the one thing, the right supplement, the proper test, the correct explanation, that would finally ease all their symptoms and bring the long-awaited relief. Sometimes that treatment exists, or we get lucky, and an intervention helps significantly.
More often, cases are complex and rooted in long-standing patterns that shift only with steady, consistent inputs.
These changes involve feeling your body shift and tolerating the thoughts, feelings and sensations that accompany it.
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, like movement, nutritional guidance, a supplement, and sending patients off hopeful.
I remember feeling confused when patients would follow the plan, improve, and then abandon it for something more extreme and restrictive that eventually made them feel worse (and from my point of view risked worsening the underlying problem). I thought the issue might have been my plan, but I wasn’t sure what was wrong with it.
I now understand that many of these cases unfolded this way because the patient’s body might have been changing faster than their nervous system could maintain the change. In other words, they were noticing a growing sense of anxiety around being at the helm of their healing, perhaps for the first time in their lives. For a system not accustomed to this kind of authorship, it was profoundly destabilizing.
This anxiety is common. It can show up as vigilance: researching, anticipating side effects, seeking reassurance, listening to podcasts, and tracking opinions. On the surface, it can look like deep engagement in treatment, but often this need for control and certainty blocks the sustained action that actually creates change: picking something and sticking with it.
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.
I don’t mean to sound judgemental when pointing out this pattern. I just mean to point out that sometimes it’s about finding the intervention that makes sense to you and feels manageable to hold. It’s true that slow, sustainable change can be excruciating when you’ve held on so long, waiting for relief.
Depression, particularly with states of shutdown, can be thought of as a learned helplessness condition, in a sense. It often involves a profound loss of agency: nothing matters, and nothing helps. Trying feels exhausting, and shame and failure can feel debilitating.
Chronic illness can strip us of any sense of agency. You may feel like your body has betrayed you. You might have fought for years for a clinician to listen or take your symptoms seriously. This can lead to a quest from practitioner to practitioner, with tests and plans piling up. You’re at the centre of this circle, but you are in pain and depleted. Each new expert opinion might destabilize the last, leaving you feeling foggier on your quest for clarity.
We may overidentify with external authority, deferring to doctors, diets, or ideologies. These blurred lines between self and other keep us from taking in the advice, deciding what fits, what we notice, and what might be working. Instead, we might enter cycles of ideation, rebellion, and collapse. Sometimes this fusion exists because early experiences made autonomy feel unsafe, forbidden, or shamed.
Trauma is often at the center of this pattern. Trauma is the story of what happened to us and what happened to our agency. If we experienced our initiative being punished, ignored, or exploited, we may have learned to shrink, hide, obey, or stay still.
In adulthood, we might struggle with indecision or endless seeking, terrified to act.
Agency isn’t a trait you have or don’t have; it’s a capacity you can rebuild.
Agency grows in small, meaningful, and, importantly, survivable steps. Rather than overhauling your life, riding a wave of anxiety or dopamine and changing everything at once, building agency starts with choosing one thing and staying with it long enough to feel what happens and process that change.
Consider the smallest action you could take and repeat 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.
Like bicep curls, these are agency repetitions; each one gives the nervous system an opportunity 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 choose, feel what happens next, and remain intact, emotionally and relationally, through the consequences. Often this means doing less, not more.
If a plan immediately triggers anxiety, obsession, or the urge to rebel or abandon it, that’s information from your system saying, This is too much right now.
Time-limited experiments can help. Instead of framing changes as permanent commitments, 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. You’re not in charge of solving your whole life today. When your system knows there’s an exit, two, four, or eight weeks from now, it can support relaxation and increase the likelihood of following through.
You don’t want the focus to be optimization, but learning to stay with one small choice long enough to experience yourself as its author: I did this. I chose this. This is what happened. And this is what I felt.
A helpful practitioner for rebuilding agency is one you trust. This is probably someone who listens and works alongside you rather than someone who is highly directive, although you may feel temporarily safer with these types of nervous systems in command. Ultimately, you want a guide who will offer you the wheel while helping you steer.
If a practitioner feels all-knowing, rescuing, or like they have secret knowledge, it can feel comforting at first but often undermines agency by outsourcing it. On the other hand, you might feel abandoned by a practitioner who offers too many choices and no structure at all. You don’t want to feel like you’re driving the ship alone.
The sweet spot is guidance that leaves room for choice. You want a clinician who will help scaffold agency through simplicity, repetition, containment and tolerable choice.
You need someone who listens and displays curiosity and humility.
Tolerating authorship is often the most challenging part of building agency.
Authorship means accepting that you can’t fully control outcomes and that success or failure will belong to you, at least in part (but not in whole).
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, does this mean it’s my fault?
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. This realization often brings grief. On the other side of grieving, however, is healing.
Self-forgiveness is an important aspect of building agency. Can you accept that life is a journey and you’re learning as you go? I believe we’re all doing our best with the tools we have in the moment.
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 healing high, 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. You don’t have to navigate it all alone.
Agency doesn’t mean isolation. Agency means asking for help and deciding what support you need. You’re not looking for someone to tell you what to do, but someone who can share their knowledge and experience and help you think through your options.
When healing work involves agency development, it stops feeling like a series of difficult make-or-break decisions and starts following a rhythm of choosing, feeling, adjusting, repeating, and creating sustainable change over time.
Healing isn’t about finding the perfect plan; it’s about building the capacity to stay with yourself as you follow one.
References:
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