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I know what I need to do but I can sit there unable to do the thing whilst the guilt about not doing the thing takes up all my bandwidth.

Indeed. You can build a system to mitigate most other things, but infinite procastination and the associated guilt is awful.

I live by my calendar. I try to write everything I have to do down. I put my things always in the same place. But procastination...

Meds do help a bit.