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Eating Disorders

The Gap Between Insight and Action

An introduction to knowing and not doing.

Key points

  • Knowing what to do and not doing it is common in human life in general, and particularly persistent and damaging in eating disorders.
  • The prevalence of this split state can be partially accounted for by the simple evolutionary imperative, “If you’re alive, change nothing."
  • The difference between change and no change always comes down to the collective effects of many tiny probability weightings.

How is it that you can know exactly what to do and yet still not do it?

Years can slip by in this state of knowing and not doing. Decades can. Lifetimes can.

Eating disorders are particularly good at getting this split state to last a long time, partly because their true cost/benefit structure can take a long time to become clear. Then, by the time it is clear, you’ve often embedded yourself so deeply that the way out may seem unimaginably hard, or just imaginable. I explored and offered some remedies for the strange and frustrating persistence of this characteristically anorexic state in my 2015 post, “Recovery From Anorexia: How and Why to Start.”

But knowing and not doing isn’t exclusive to eating disorders or other forms of illness and recovery. It’s a state humans often dwell in on other macro levels, e.g. in the form of career or relationship stagnation, as well as at the everyday micro level of clearing out those drawers or uninstalling Instagram. Humans are great at deferring things—and the amount of insight we have into why we shouldn’t doesn’t often seem to make a lot of difference.

The insight/action gap—a specific variant on the general category of procrastination—might seem like a grand mystery about human nature: How could it be that creatures like us could so often know so much and do so very little? But if you want a grand answer, you probably don’t have to go much beyond the simple evolutionary pressure that says: I’m alive, it’s all good, change nothing.

Changing things costs resources, and any use of resources could turn out to be a waste. Minds get easily sucked into hyperactive patterns of imagining possible actions, and that hyperactivity tendency exists because it can be helpful for keeping us alive, especially when it involves mind reading to determine the possible actions other people (e.g. mates, competitors) might be about to take. But stopping before actual action is a useful default imperative in a context where resources are few and survival is precarious.

Obviously, that’s not us now. Excess resource availability at the individual level arguably now causes more problems than scarcity in post-industrial societies, and mortality isn’t mostly the problem, misery is. So it makes sense that this prior long-evolved “change nothing” wouldn’t be serving us very well anymore.

So what about less grand answers? I think the micro-answer, or rather the aggregate of them, is really the point here. In general, action or no action comes down to finely weighted probabilities.

Let’s come back to recovery from an eating disorder. You have years’ worth of accumulated insight. Maybe the insights have been multiplied and refined by therapy. And maybe you’ve made recovery attempts in the past. Maybe they’ve almost worked. Just think of the millions of micro-weightings that have contributed, over the years, to helping inaction win out, even just infinitesimally, over recovery actions.

If you consider any of your recovery efforts followed by the relapses that came after, the near-miss structure can often be particularly clear. Think of all the little or not-so-little things that contributed: things like precisely how open you’d been with your partner about what you needed right then, exactly how much your children seemed to be noticing your disordered behaviours, how much you liked or didn’t like the food you were eating, how long you’d gone without weighing yourself before you couldn’t help yourself, how long that trip was you took at the critical time, or less detectable details like precisely how much grey matter your brain had lost through starvation (for a great post on this, see Chris Sandel’s blog), precisely how much metabolic damping had or hadn’t happened or been reversed yet… If just enough of these thousand details had been just enough different, that effort would have been the one that worked.

I often think about the second recovery effort I made. The first time, as a teenager, had been the typical flailing-around of a teenager who was scared but really had no idea what the stakes were. But by age 20, I knew what anorexia was doing to me and had already done to me. I’d been living in Germany for a few months, and living meant more or less just subsisting. My parents treated me to a 21st birthday ski trip and brought the weighing scales, and we were all scared by how low my weight had dropped. Again. (I recounted that vacation and its consequences in Part 2 of my series, “History of Anorexia While Skiing.") We made a plan, including frequent visits from England on their part, and it felt like something that was more like mine, not just something I agreed to because I had to. And I followed it. I started buying cereal bars and mini pizzas and real bread and cream cheese and eating them. I took it seriously. It started working. I met a guy, and he seemed to get it, and we ate ice cream together while I practised being romantic in a second language.

And then I moved to Geneva for the summer, so my French would get some year-abroad input as well as my German. And it all unraveled, pretty much from day one. I was staying with relatives and reverted to old habits almost immediately, creeping around and boiling cabbage in the middle of the night. I wondered so often in the dark years that followed, what would have happened if for once I’d not done the conscientious thing and just stayed in Dresden, had a summer there with Robert, and kept eating those pizzas? Would I have been well again in time for my final undergrad year? Would my 20s have been mostly anorexia-free?

Who knows. This 40-year-old recovered me certainly doesn’t, though she still asks the question now and then. The details were what they were: the way my father’s stepsister and I got on (or didn’t), the way she did day-long fasts at the full and new moons, the amount of coursework I was pointlessly trying to do while I was away, the fact that I wasn’t earning anything and felt anxious about spending my savings, probably even the proximity of my bedroom to the kitchen and how hot it was in Europe that summer of 2003.

And I can’t blame ignorance: I knew exactly what I was doing when I started making that expensive fruit gateau or fig ice cream something I ate in bed alone after making cereal my main course; when I reduced my bread ration by 50g; when I felt the guilt and the bloating after a larger lunch than usual and let them be reasons not to repeat it; when I said no to invitations to go out and do things with people in the mornings so I could sleep in, so I could stay up late eating on my own… I did kid myself, in inconsistent ways, that all of these things mattered less than part of me knew they did, but the basic structure of knowing what to do and not doing it was in place throughout. And a year later, I was still journaling about “the gulf between reasonably clear rational insight and the inability to translate it into change” rather than doing anything about it.

So, there was no magic to any of this, and no mystery about it at the time, really. There were just all the crucial prosaic everyday details that feed into answering the question: Does this set of dysfunctional habits get dislodged now, or does it survive another month, year, or decade?

For me, it would be another six years before anything changed. For you, it may not yet have been so long, or it may have been much longer.

In the next two instalments of this post, as a way of expanding on that “How and why to start” post of seven years ago, I’ll offer you eight structural reasons why the insight/action gap comes into being. And, to stave off the irony of trying to merely understand the insight/action gap better, for each I’ll also give a suggestion for how to actually bridge it. Read on here.

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