Perspective: The Indifference Point
This morning, I am thinking about loss while I review a new manuscript submission about grief and delay discounting.
Delay discounting is the tendency for people to prefer immediate rewards and devalue future rewards even if the objective gain is greater. Importantly, we can plot a hyperbolic curve showing the mathematical indifference point: an inflection where people stop preferring the smaller, sooner reward. To study the phenomenon in the lab, research participants are usually asked to weigh hypothetical gains and/or losses over time. Usually, the rewards are monetary — would you rather receive $10 today, or $20 in three months? How about $20 next week versus $80 in six months?
How long would you be willing to wait? How great does the reward have to be to make it worth waiting for?
I am a clinical psychological scientist who studies trauma and grief. Temporal discounting is altered in certain psychological disorders. For example, people with prolonged (or “complicated”) grief show steeper discounting – the tendency for rewards to lose value more quickly, compared to peers with a more typical grief trajectory. Many with prolonged grief find it difficult to imagine the future or to access specific details of their past. Without the stable sense of self that we get from autobiographical knowledge, or when the future seems vague or unreliable, it makes perfect sense to take whatever you can get now. In contrast, reward value degrades more slowly over time in people with anorexia nervosa (AN) than in people without eating disorders. In U.S. culture, where consumerism, greed, and instant satisfaction is all too common, delaying gratification is often considered the “adaptive” choice, a virtue of self-control and temperance. But people with AN disallow ourselves reward — of satiety, connection, presence; of not feeling like shit all the time — for so long that our definition of “reward” distorts, and a state of perpetual loss becomes mundane.
But people with AN disallow ourselves reward — of satiety, connection, presence; of not feeling like shit all the time — for so long that our definition of “reward” distorts, and a state of perpetual loss becomes mundane.
In the lab, we simplify scenarios so they become just workable and observable under an experimental setting. Outside of the lab, there is no clear indifference point. Every choice we make means giving something else up — now or later. In my role as a therapist, this is a theme across clients, settings, identities, diagnoses: “There are no ‘wrong choices’,” I say. “We can talk about the options, but at the end of the day, it’s your life and YOU get to decide what matters to you.” I tell my clients, “It doesn’t really matter what you choose; the point is that you can be the one choosing.” From my side of the therapy room, I can’t promise anyone that a risky new choice will pay off, or that a seemingly safe choice will buffer them from pain. There is only an inflection point, where we commit and — act.
2008 is one of my inflection points.
Six months before my second hospitalization for an eating disorder at age 21, I had written in my journal:
There’s a strong possibility that I’ll be spending the summer in treatment again. This is the way it goes; you do inpatient and get out and relapse and do the whole thing again.
I truly never thought I would be that person. (February 4, 2008)
I was right: Eventually, people (again) stopped buying my arguments that I could fix this myself, get out of my business, leave me alone.
When I walked into the hospital for the second time that July, I immediately saw two patients that had been there during my last admission, playing the same Bananagrams on the same dingy carpet of the day room. Same thick sheaf of paper menus with options to circle, same groups, same groggy 5 am weights and vitals, same “bathroom privileges" and blurry shatterproof mirrors, same being granted a few hours out “on pass” and walking a little too much, same earnestly telling our treatment teams that we meant it this time, we were really going to do it right once we got out of here. The same push and pull of the desire to self-destruct in peace versus the desire for care and safety: institutionalization can be a relief when one’s internal world feels profoundly unsafe and out of control. The center for eating disorders only admitted young patients, 14-23 years old, but many of my peers were returning to a “higher level of care” for their second, third, fourth, fifth time.