Anticipated Regret for Doing vs. Not Doing

Someone somewhere said that it’s better to regret the things you have done than the things you haven’t—but every thing done is another not done, every glass of wine is a chapter unread, there is no simple dichotomy of action and inaction, there are only the same inescapable mechanisms of value judgement. –From my Autobiography of an Illness, 2004

The most familiar bit of folk wisdom about regret concerns its asymmetry: We regret the things we didn’t do more than the things we did.

Some research findings back this up, suggesting that anticipated inaction regret is more strongly felt than anticipated action regret in the domain of health, and has more reliable associations with behavioural intentions and perhaps health behaviours (Brewer, DeFrank, & Gilkey, 2016).

Anticipated Regret in Anorexia

How does this asymmetry play out in anorexia? I mentioned in the previous part of this series that, for me, illness deadened me to most strong forms of regret that might have encouraged meaningful action. The backdrop to this was, at least in the earlier years of my illness where everything was less congealed into self-evidence, a fun microlevel tapestry of both retrospective and anticipated regret for things both done and undone, sometimes so closely interwoven that one shaded into the other. I remember hiding away an Easter egg to eat in secret in the dead of night, regretfully recalling all the eggs of other years received and hidden away with regret, knowingly repeating the exact same action to store up next year’s regret. I remember feeling paralysed almost weekly by anticipated regret that felt like it would be unavoidable whatever course of action I chose: almost never going out on a Friday night when someone suggested something, knowing that in the morning I’d regret not having gone but would also regret having gone.

It seems strange to me now that all these lose-lose scenarios didn’t lead me sooner to serious efforts to change the rules. Instead, I tried to make sense of it all in my journal with some good old mind/body dualism:

I do wonder whether it’s worth it for my mind to be destroying my body like this, in what are supposed to be the days of its prime. I’ll regret it when the wrinkles start appearing, regret not going out and showing myself off. But my brain can think of better ways of spending its time, and forces the rest to follow suit, that’s the problem. The problem with my anorexia, too, perhaps—brain just too strong for body… (4 February 2002).

I got it spot on with the brevity of youth, but my brain was, of course, just as weak as the rest of me; how could it have been otherwise?

In the Recovery Context

So, how do the dynamics of regretted actions versus inactions shift in the recovery context? It’s a funny one: Regret (anticipated or retrospective) for not having recovered is a kind of macro-frame for all the specifics that not recovering means you haven’t or won’t have done (laughed, adventured, stuffed yourself with everyone else, orgasmed, had inspired thoughts, wept without your eye on the next workout…). But not-having-recovered is also a frame for all the specific things done that will have been wrecked in quite specific ways, whether (as I explored in the previous part of this post) where it changed primarily my own experience, via lack of presence (the friend’s wedding where I couldn’t think about anything except how cold I was) or where it strongly affected someone else’s, too, perhaps through compulsion-driven unkindness (the time I ignored what my brother needed because I prioritized my sacred nighttime meal instead). These are things done or experienced, not undone and unexperienced, but their structure has the flipside built in: Here’s the thing that could have been beautiful, or just kind and ordinary, and instead it was this perverted version that hurts to remember. So they’re still things undone: things that anorexia prevented you from doing in the way you would have wanted.

In regret of failure to recover, then, there’s a high-level amalgam of done and not done, all funneled into “I did not recover” (regret) or “I am scared of regretting that I did not recover” (anticipated regret). In the starkest case, the anticipation stretches to the very furthest horizon: We imagine this illness persisting until our own death. Perhaps we imagine the deathbed review of all the priorities so badly set.

Simple Doesn't Mean Easy

So what’s stopping us? I’ve written elsewhere about the blessed simplicity of what’s involved in getting the recovery process started—and, indeed, in most of what’s required to get it finished: eat lots; rest lots; let yourself get bigger, fatter, stronger, calmer, all the rest. But, of course, simple doesn’t mean easy. One factor that makes it all harder, which leapt out at me when reviewing the research literature on anticipated regret in other health contexts, is that recovering from a restrictive eating disorder doesn’t just mean doing generally agreed-upon “healthy” things to get yourself from ill to healthy.

In the beginning, doctors and therapists will probably agree that you should eat more, as well as perhaps prescribe you tests and supplements and all the other standard accessories of mainstream medical health care. But, even early on, and increasingly as recovery proceeds, if you’re doing it right (i.e., in a way that will work) you’ll probably be doing plenty of things that the mainstream medical establishment frowns on—for the general population but sadly often even for people in precisely your situation. These might include not exercising for ages, or eating lots of refined sugar for ages, or eating according to your hunger beyond BMI x rather than switching to a “maintenance plan.” Actions of these kinds also contradict the majority of media messaging about how to be healthy, yet they are crucial to becoming healthy after a restrictive eating disorder.

The need to defy medical and media orthodoxy changes the stakes relative to other health behaviours studied in relation to anticipated regret. Anticipated regret works as a motivator for action because humans who are trying to make decisions generally attempt to minimize unpleasant feelings. Another unpleasant feeling we try to minimize is self-blame. In general, we anticipate less regret for justifiable decisions, and justifiability is a highly social construct. Thus, people anticipate less regret for an action widely believed to protect health (e.g., getting vaccinated) than for an inaction that the medical establishment consistently condemns (e.g., not getting vaccinated). The balance in the vaccination example would shift, presumably, if one grew up in an anti-vax community, but, in general, “In the context of health behavior, inaction often defies medical authority, thereby leaving the decision maker more vulnerable to self-blame” (Brewer, DeFrank, & Gilkey, 2016).

Eating Disorders Essential Reads

When the Shoe Fits, Wear It: Understanding Body Weight Set Point

Psychological Maintenance Processes of Binge-Eating Disorder

Full recovery from anorexia has the strange status of requiring defiance not only of sociocultural norms but too often also of medical authority. So avoidance of self-blame is harder to enlist as an ally; fighting both one’s own lingering anorexic tendencies and the world’s hysterical obsessions with control of diet, exercise, and body weight that are so well aligned with those anorexic remnants turns recovery into rebellion and requires willingness to risk all kinds of unpleasant feelings including self-blame—often with no one to turn to to reassure us that it’s all going to be all right if only we can hold our nerve and keep going.

These painfully stacked odds add another dimension to our understanding of why outcome measures for standard treatments remain so poor (Troscianko & Leon, 2020). In the face of all this, perhaps the clarity of the knowledge of just how much we’ll regret it if we don’t is one of the only things strong enough to keep us going.

In the final part of this series, I’ll offer some ideas for realizing anticipated regret’s potential and sidestepping some traps.