Decision fatigue can take a hike
Here’s how we balance choice and peace of mind.
Welcome to Solicited Advice, our weekly column that celebrates the helpfulness in health. Because in a world where strangers at the grocery store love to tell you that a specific brand of magnesium will indeed “cure” what ails you (it probably won’t, so sorry), we’re all about passing on our lived experience in a way that makes your life a little better. Are we experts? Nah, not really. But we’re great listeners who have perfected the art of pillow screaming. Let’s get into it!
Is it just me or is decision-making so much harder when you live with chronic health conditions? I constantly feel exhausted by it, even when the decisions are “simple.” I welcome any and all tips!
Ash: I like to say “my executive is not functioning” when I’m having a particularly bad day for decision-making to reference the cause: executive dysfunction. It’s something that can be fairly common for neurodivergent folks, as well as folks living with mental illness. Decision-making is incredibly exhausting, and most days it stands in the way of getting enough food in me because I feel frozen in indecision. My advice really comes from a place of, well, it worked once or twice which is better than none at all (read as: I’m not an expert, but a few things have thawed me before!):
Turning over the reins to someone else when they are able to take it on. For some, decision-making isn’t that hard. If the decision won’t cause undue burden, pass it on!
Using a randomizer to select a decision for you. Just put together your list of options and let the randomizer make the choice. P.S. There’s something coming to all subscribers later this week if you like this idea!
Plan decisions in advance when you’re in the right headspace for it. Maybe you get the mental clarity to meal prep so you don’t have to think about lunch for the whole week. Perhaps you only buy one of a thing so you have no choice but to pick that when indecision strikes.
Ultimately, hack your brain however you need to. We’re going to have to make decisions our entire life, so find what works best to motivate your brain into having the best outcome for you!
Kat: Hi, I’m waving to you from my perpetually-unable-to-decide treehouse, which is built on instability, a caffeine drip, and a prayer! Have I stood in the frozen foods section before, unable to make a choice about which dumplings I want to buy because of my searing joint pain, and then just abandoned my cart altogether? Yes. Do I put off big life decisions because I can’t even comprehend what I’d need to know in order to make an informed choice and then my anxious brain whispers that I’m not “qualified” to make such a decision? 1000%. Hell, even on bad nausea days or during heightened brain fog episodes, the singular act of choosing which shirt to wear can knock me off-kilter. But our lives are full of decisions, some that are a joy to make (like choosing taco toppings!) and others that drain you (like finding a new cardiologist). I think it’s important to remember that fatigue can set in much faster for people who live with health conditions because we have to make so many more choices, both big and small, in the course of a single day.
Here are some examples of decisions that able-bodied people don’t even have to entertain:
1. Is my migraine attack bad enough to take my abortive medication?
2. If I run errands today, will I still be able to clean the house tomorrow?
3. Are the side effects of a specific treatment worth the risk?
4. Which mobility device would serve my needs best today?
5. Am I safe to disclose my diagnosis to my employer?
I bring those specific questions up because it can be really easy for us to should our way into internalized ableism. I should be able to be busy all weekend. I should be able to function without a nap. I fall into that mental trap all of the time and actively let it guide me off course. I make decisions based on what non-disabled bodies can do — and that hurts me in the end, the very person who I was trying to protect! It took me many years to realize this, so I’ll pass it along in case it’s helpful: When we talk about spoons or a limited energy supply, we often apply it to physical tasks or acts (e.g., brushing teeth, driving to the store, going on a walk). But there are mental spoons too, and decision-making actively spends that energy if we’re not careful.
And I don’t know about you, but when I’m barely hanging on physically, it’s easier for me to make rash decisions. To combat that, I try to save up batches of decisions for days when I feel clear-headed. If I do have to make a decision of some kind within a short window, I try and check in with myself a few times before making it — no matter what my initial reaction or emotion was. That quick checks and balances I set for myself has saved me from making a decision I’d regret more times than not, like that time I wanted to hastily quit a previous job when I had a debilitating kidney infection and the patience of a gnat (true story 😬). Wishing you a no-decision day when you need it.
Jess: About 12 hours ago, I was planning to abstain from answering this week’s question because my brain was too foggy. So that’s my first tip — be willing to let things go — which is actually what I’ve done with a lot of my daily decision-making. Here are a few of the ways I’ve done that:
Minimized clothing options. I’m not someone who finds fashion rewarding or fun or a creative outlet. For most of my life, choosing what to wear every day led to me sitting in a pile of clothes on the floor in tears. It was bad for my emotional and mental state, constantly made me late, and I never felt good in what I ended up wearing. I tried all the tips, like setting things out the night before, but inevitably I wouldn’t like how it looked or felt in the morning, and would need to find something else anyway. Now, when I find something that is comfortable and I can put it on and feel both comfortable enough to do nothing and put together enough to leave the house — I buy it in multiples, and only in my comfort color (black). This is possible in part because I don’t buy high-ticket items, and I’ve built it up over time. I don’t buy special pieces in multiples, but I do generally stick to black.
Minimized shoe and accessory options. I used to love buying shoes and purses and accessories, but then I was drowning in options (and broke). Now, I have two pairs of canvas sneakers, a pair of flats, a pair of boots, a couple pairs of flip flops, and my house slippers. Admittedly, it got a lot easier to do this when I stopped being able to wear heels, Vans, and Converse 😭, but it also got easier when I fell in love with Barefoot Shoes — just not the ones with the individual toes cuz that’s a sensory nightmare. I also pared down my purses, bags, and all other accessories.
Minimal personal care items. If you’ve spent any time on TikTok or most other social media sites, you’ve probably been bombarded with 50-step skincare and hair and blah blah blah routines. ThanksIHateIt. I find products that work for me, I figure out the bare minimum routine with those products, and I use those products until they’re gone. I don’t have to decide which serum to use or which face mask or whatever — I just have to do the thing (and then repeat).
A few other things I do to try and automate decision-making as much as possible:
My partner and I add items to a shared cart on Instacart as we think of things. Once every week or two, we place the order and go pick it up. Which leads to my next thing…
I generally batch my schedule because context-switching can burn out my executive function really quickly. If I’m going to pick up groceries, I’m also going to go check my PO Box, make any returns, etc. If I have a dentist appointment, I probably also have a doctor appointment or I’m also picking up groceries. So on and so forth. I try not to leave the house for just one thing unless absolutely necessary because it requires a different function of my brain and my energy is pretty much done for the day when I get home. Then when I look at my plan for the day, it’s “OK, today is errands and appointments” or “Today is meetings” instead of context-switching all day.
This can be a tough one: I say no instead of maybe. A lot of us are socialized to say “maybe” to avoid uncomfortable interactions, but then we have to make a damn decision and then we have to follow up about the decision and honestly? Life’s too short. I only say “maybe” when I genuinely mean it.
While I go through phases with food, I generally have the same thing for breakfast and lunch every day. That’s usually a protein shake for breakfast, and currently it’s buttered, gluten-free toast for lunch because I’ve been dealing with some personal stuff that’s made it difficult to eat. I’ve also done a lot of work around my internalized ableism and shame when it comes to food, which frees up a lot of mental bandwidth. “Fed is best” isn’t just for babies!
We refill the gas tank when it hits half a tank, we purchase replacements when we open the last of something (as opposed to when we use the last of something), we keep the thermostat steady, and I set recurring reminders for routine things like changing the air filter, replacing tooth brushes, and changing my contacts so my brain doesn’t have to use its precious energy on remembering.
At the end of the day, the fewer regular decisions I have to make, the better. I could go on and on about minimizing those daily decisions — which also happens to be better for the environment! — but I think you catch the drift.
If you want to try something similar, I recommend you start by looking at the things you have to do more than once and the things that cause you the most angst, and then changing things one at a time. It’s a bit of trial and error to figure out what works, but it really has helped me.
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For big decisions, I love the DBT framework for writing out pros and cons. The way it's different then other methods I've seen is that it involves writing the pros and cons for both sides, i.e. the pros of "yes", the cons of "yes", the pros of "no" and the cons of "no". It's usually written in a grid, with the two pros on the left and the two cons on the right. While the boxes that are diagonal to each other usually have similar ideas, sometimes other points come up that I wouldn't have thought of if I just wrote the pros and cons for one side of the decision.
I usually give myself one day of writing up the pros and cons and then go back and highlight which point or points are most salient to me. I then usually write out any other points, like things that can remove cons or things like that.
For me, having it laid out neatly on paper helps me make the decision and stick with it, instead of keeping on going back and redeciding...
I also moved to a mostly all black wardrobe (with some charcoal and burgundy in the mix). It also makes laundry much easier…it’s always pre-sorted!
These are some great tips, thanks for sharing!