Is It Executive Dysfunction or Am I Just Really Tired??

some thoughts on pathologizing our limits

self-portrait of the artist as super fucking tired

I’ve been trying to write this for a week now. I keep opening it up and typing a little, feeling lost in the words, and then closing my laptop and laying down.

Do you ever wake up feeling like you got hit by a bus for no apparent reason? It happens to me kind of a lot. Even after ten hours of sleep, I groan awake, roll over, push myself up, and just sit there on the edge of the bed for a while, feeling the ache in my muscles, thinking about my life choices.

I’ve scaled way back on Doing Things since I became aware that my limits come up faster than most, but still, I run up against the wall of Too Much pretty quickly.

I tried all kinds of work/life configurations for the first 30 years of my life before I finally had to accept that I just need to do most of my work at home, at odd hours, and often, in bed. (I work in bed kind of a lot too — I’m propped up by a couple pillows typing this right now, tbh.)

It’s frustrating! Sometimes I can only do one task, or even half of one task. Sometimes projects take forever, and I feel like I’m just sitting there, watching a movie play in slow motion and I can’t find the remote. Yesterday I couldn’t even think of basic words, to the point that when I tried to ask Gray what temperature to set the oven for dinner, it came out as, “What are…the chicken times?”

I get it. I know what the experience we call “executive dysfunction” is like, and I know how much it can suck. I’m learning to be okay with my slowness more and more all the time, but I would be lying if I told you I’d reached a state of pure self-acceptance and peace about it, or that I never wished I could do more.

Last week we put out Episode 4 of Disorderland (which also took us a really long time, like, over a month!) where we interviewed psych survivor and advocate Maggie Leppert, and I keep thinking about something she said:

This whole idea of like, executive dysfunction? That we’ve been thinking like, oh, if I’m not able to initiate this task, then I have executive dysfunction, instead of being like, maybe this is my body’s signal telling me [that] we’re done for the day. We’re being forced to operate at a productivity capacity that isn’t natural.

Lack of focus, low motivation, forgetfulness, poor follow-through, struggles with self-regulation — so many of the symptoms of executive dysfunction are also the symptoms of exhaustion.

Something like a third of Americans are chronically sleep-deprived, prompting the CDC to declare it an epidemic. Researchers found a decline in sleep time for adolescents over the last 20 years, calling it “The Great Sleep Recession”, and California just passed a law pushing school start times back so kids can sleep more.

If you’re nocturnal like me, it can be worse, because your natural sleep-wake cycle gets interrupted by morning shifts, and then Scientific American blames that on you by calling it “bedtime procrastination”.

Often when I read personal essays about struggling with exec dysfunc, people say stuff like, “I was working a full-time job and also going to school and I just couldn’t concentrate.” Which, you know, makes sense. That’s too much! You must be very tired!

Except, we’ve been taught that isn’t too much, that it’s totally normal and good for a human person to do that much every week, alone, with few or no days off. When we can’t, our minds start to search for The Reason, and capitalists are happy to hand us “executive dysfunction”, a neat little brain-blaming explanation that stops us from asking more questions.

Work takes energy — that’s a basic law of physics, right? When we see the word “work”, we think, trading our time for a wage, but in science, it refers to moving an object across space with external force. It’s a transfer of energy.

Attention, self-control, memory, all of these things we want our brains to do for 8 to 16 hours a day with little rest require a transfer of energy. It’s mental work.

People on the internet like to jump in at this point with their wage-labor definition of work and say, “But you don’t understand, it’s not just work, I can’t do things I want to do!” I don’t really think that makes my point about exhaustion moot, though, because I want to do things I like doing for no pay all the time that I simply do not have the energy to do. And, if we consider the science definition, that is still work!

Today, I want to work on video editing, but when I look at the computer for too long, I start to feel like I’m going to cry. I want to work on my garden — pruning my squash plants and staking the one that fell over, DIYing a shade cloth to protect my sensitive seedlings from the heat wave — but instead, I just go outside and stare at the plants, and then get back into bed.

I want to read a book, but I can’t focus on the words. (Reading is actually a lot of work for the brain, by the way — taking symbols like letters and turning them into words and then extracting meaning from them takes a lot of energy.)

An IG infographic would tell me that this is all executive dysfunction in my brain, but I prefer the more contextual explanation that I am fucking exhausted.

I get it though. There’s no sympathy for the tired. We need to call it something more official, something diagnosable! Otherwise people just scoff and say shit like, “I worked 60 hours last week and set up a dropshipping website for my side hustle.” by which they mean “Suck it up!!!”

We turn to disorder words because we think it will defend us from the bootstrappers. But does it? Something else Maggie said in that interview comes to mind, a line she read in a psych survivor organizing handbook:

"They convinced us that being seen as ill would make us respected, and they lied."

A very large percentage of ADHD content online is just about how disrespected the diagnosis is — how people’s struggles are not taken seriously, how they still get scoffs and eye rolls all the time about their symptoms, and how nobody seems to really get it or care. Medicalization was supposed to make all that go away, but clearly, it didn’t.

Whether you call it exhaustion or dysfunction, the fact is that we don’t respect limitation under capitalism.

Look at how hard it is to get approved for Social Security payments in the US! Only about a third of applications are accepted, and you have to re-certify every 1-6 years, even if your disability is permanent and life-long. (If you ever just want to scream, read an AMA with a social security examiner. Similar horror to going on a landlord message board.)

Beatrice Adler-Bolton wrote about her fight to get SSDI after she fell ill with an extremely rare autoimmune disorder that attacks the optic nerves, taking her vision. It’s very difficult to get approved for SSDI without a lawyer — no lawyers would take her case because her disease is so rare, it wasn’t defined in the documentation that the Social Security Administration uses to determine eligibility.

She was told that her chances were even slimmer because she was still doing freelance work:

I felt trapped in a lose-lose contradiction: I was still working because I needed to continue to have health coverage. I couldn’t stop working because otherwise how would I pay my COBRA bills? My deductible? My monthly co-pays? This is what made me so fucking mad, because you’re faced with impossible choices. You want to say to everyone you encounter, what do you expect me to do? Just die? Go out and try and get sicker? Another SSA agent I spoke to during this years-long process had the brilliant suggestion that I simply “not work” for a few months. How do I feed myself? How do I pay rent? The SSA agent simply replied, “I don’t know.”

Adler-Bolton notes that a lot of people do just die waiting for their approval — almost 110,000 people between 2008 and 2019. We live under a cruel state that casts the sick and dying aside, where disabled people are met with suspicion or scorn, and pushing through illness to work is seen as a virtue.

Why do we think pathologizing our limitations as “executive dysfunction” would afford us any more respect or care in such a terrible culture? Don’t you just want to change that culture instead?