Ask HN: Struggling with poor memory and executive function. What to do? | Hacker News Reader

Ask HN: Struggling with poor memory and executive function. What to do?

162 pointsregainmemory127 comments

In my late 30s and have always struggled to effectively build a career, network, life. Has only occurred to me that this may due to what seems to be a deficiency in my memory. I've had a wealth of experiences, both good and bad, but few have found their way into my mental models of how the world works, and so I keep making the same mistakes or am unable to effectively navigate my way to a specific goal.

From learning new topics & skills, to learning how to network, to learning the dynamics of how an organization and how to navigate various relationships, to making well-reasoned and effective decisions, my mind often feels like mush, totally blinded to the realities of the world. I feel I've been stuck both cognitively and emotionally at a late-teen stage. Poor emotional regulation, difficulties with thinking in nuanced details, constantly flying at 1000 feet.

The older I get with no improvement, the more it feels my goals keep drifting farther away. I want to get fit, I want to read more, I want to develop skills, I want to build relationships, I want to be an entrepreneur. These are things many of my colleagues have been working towards for years. It feels like I just wasn't given the playbook, and worse, am incapable of piecing one together.

Have any of you dealt with this? Any advice? Are there coaches that can help?

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Let's assume that you have followed the advice to check if your health is fine, and it is (or you have found ways to improve it).

On a high level, what's going on in your life may not be considered the best by some "social standards", but it's not necessarily "bad".

You can start by checking if your desires are in line with the standards, or if you would rather have a more "unconventional" way of being, accept it, and try to find ways to work and relate to people from there.

The next part is that a lot of what you see as the problems are skills and you can learn them.

* Emotional regulation is a skill, it has to be learned and practiced.

* Concentration is a skill; some meditation practices are a way to develop it.

* Thinking is a skill; "real" thinking can be difficult and uncomfortable, especially at first.

* Building coherent models of reality is an advanced skill and requires thinking, modeling, verification, self-reflection, and other skills.

* Being a successful entrepreneur is a very advanced skill, requiring all of the above and much more.

Next, you can define your skill learning priorities and decide for which skills you can use some help from professionals and which skills you can train yourself.

If you do your work and come back to the same topic in a year, you will have more experience and better understanding. Identify what you're missing and keep going. Eventually you will be in the much better state.

Good luck!

What are you referring to with "'real' thinking can be difficult at first"?

Have you considered professional therapy from a licensed professional (whatever that might be in your region)? Not because that's the only way to improve your life, but because you specifically mentioned a "deficiency in memory", relationships, and emotional regulation – all traditional fields for such therapists to work in, and they often partner with psychologists who can diagnose underlying medical conditions and prescribe medication if necessary.

There might be some combination of drugs and therapies that could help some or all of those conditions. It doesn't work for everyone, but if you have never tried the mainstream approach, it might be worth a shot.

If you can start to see small improvements in some of those areas, then you can build other practices on top of them and keep improving those skills.

There are also many alternative modalities (doctors of naturopathic medicine, for example) with different approaches, if you prefer. You can try multiple providers/modalities until you find one that works for you, if you can afford it.

Best of luck to you! 40 here, and my life's also a mess, but I have no neurological/biological excuses lol, just my own personal failures. Hopefully you'll find some helpful approaches once you start looking.

> "...you specifically mentioned a "deficiency in memory", relationships, and emotional regulation – all traditional fields for such therapists to work in..."

I support the recommendation of seeing a mental health professional, and wanted to emphasize that the scientific literature suggests a moderate to strong link amongst the symptoms you mentioned (citations below). I selected articles that reference ADHD and Cluster B personality disorders because they very broadly map onto the symptoms you're describing; I'm by no means making a diagnosis, but only trying to provide additional insight.

From the abstract of a journal article regarding the link between emotion dysregulation and ADHD [1]:

> "Emotion dysregulation, a major contributor to impairment throughout life, is common in ADHD and may arise from deficits in orienting toward and processing emotional stimuli, implicating dysfunction within the prefrontal cortical network. Understanding the nature of the overlap between emotional dysregulation and ADHD can stimulate novel treatment approaches."

From the abstract of a journal article regarding the link between emotion dysregulation and Cluster B personality disorders [2]:

> "Individuals suffering from personality disorders, particularly borderline personality disorder, often evidence substantial problems in regulating and managing their emotions...The newly developed brief General Emotion Dysregulation Measure (GEDM) has shown good reliability and validity with a clinical sample of 100 individuals diagnosed with Cluster B personality disorders."

I am not a licensed clinician but have considerable experience in clinical psychology research, so if anyone has any questions, please feel free to reach out. But to be clear, I am offering academic views; a licensed clinician offers medical views.

[1]: https://psychiatryonline.org/doi/full/10.1176/appi.ajp.2013....

[2]: https://www.journals.uchicago.edu/doi/abs/10.5243/jsswr.2010...

Thank you for the info on General Emotion Dysregulation Measure (GEDM). It's both helpful and insightful.

I'm going to turn 50 in less than a month. Up until very recently, I had undiagnosed CPTSD and ADHD.

Trauma disorders, not to put too fine a point on it, fuck up your memory something fierce. CPTSD in particular can cause emotional flashbacks, where you're not audiovisually experiencing the prior trauma, but your brain is playing back the emotions. Thus, the emotional dysregulation.

I would strongly echo other people's comments here about therapy, a big benefit to me. I've always seen it as something with no stigma - you are just adding tools to your mental toolbelt. There is a good book by Pete Walker on complex PTSD; it may be worth a buy to see if it sounds familiar to you.

I also would suggest to you this: one of the best slogans I've ever heard is that we don't see other people's films, we see their highlight reels. You may have 100 different places you want to go. You may think everyone is going to each of their 100 different places.

But be kind to yourself. Believe it or not, it's not just an emotionally kind idea, it's a good one from a productivity viewpoint. If you're attacking yourself, you're putting yourself into fight-flight mode, and that redirects a lot of blood flow towards the more reactionary, less cognitive parts of your brain. Higher-order thinking is actually easier when you are not attacking yourself.

Hope this is helpful.

Second and third all the advice to talk to a therapist and/or an MD.

Beyond that, though, three things that have been Big in helping me build my mental capacity (and they’re all deeply stereotypical, but):

1. Sleep - more than anything else, consistently getting 8+hrs of sleep improves my cognition and consequently my productivity and my mood. I spend a lot of effort on sleep hygiene (dim red light and no screens at night, bright light or sun in the morning), but a couple days of good sleep are irreplaceable.

2. Related to 1, cut booze. Mostly because it ruins effective sleep, but also because it’s a depressant and a stand-in for all the other stuff I’m trying to improve for myself. Less booze, better sleep, better mood, better health, repeat.

3. Exercise - I can’t do cardio for shit, but I started doing strength training a while back and love it. It’s a great mood booster - physiologically, you’re basically doing a nervous system reset when picking up a sufficiently heavy thing. It also helps me sleep better, reduces a bunch of weird aches and pains, and makes me feel like a badass.

Again, go see a professional - my therapist’s how I learned all the above - but in the meantime, those three things have been enormous to improving my mood, capacity, and productivity.

I would add:

4. Water. Make sure you're hydrated.

5. Diet. Ensure you have a sufficient intake of all important nutrients and try to eat a diet that isn't too carb/sugar heavy (this doesn't need to be taken to extremes).

Diet's super important, but I feel like it's such a giant friggin' thing in our society that it's hard to put that at the top of the list. I subscribe to the "make a change that feels tractable, live with it for a bit, do it again, repeat" method for personal improvement, and I feel like if I'd tried to tackle diet first, I would never have gotten started.

Agree with the water, though - I've always got a big water bottle next to my desk.

Agree. A good first step is to learn about how food chemistry, and how your body processes it.

I lived my whole life with barely an understanding of the macronutrients, wrapped in popular wisdom: eat enough fiber, protein is good for you, be careful with carbs, sugar is bad (but you can't avoid it).

I also casually dabbled with some fashion diets, experimented with apps for counting calories, and grew up with plenty of wrong and harmful advice (fruit juice is healthy, honey & cereal as a healthy breakfast, etc). Nothing really stuck.

I never understood why sugar is bad, or what's the difference between fiber and carbs (aren't they both plants?), what happens in your body when you eat carbs, or what the heck are calories anyway?

It was only when I read more about how your body processes food and the impact on your glucose levels that things started to click for me. I also got a CGM, and started seeing the direct correlation of the spikes and crashes with mood, cravings, motivation, post-lunch slump, headaches, energy levels.

It has also completely changed my relationship with food. I started eating more, lost weight, and my glucose levels are significantly lower (and, more importantly, I know exactly how to control it). Also have a bit more energy, less cravings, no post-lunch slump.

There's plenty of resources out there, but the three that helped me were [1][2][3], and a Dexcom CGM (but that's totally optional).

[1] https://www.amazon.com/Glucose-Revolution-Life-Changing-Powe...

[2] https://www.amazon.com/Glucose-Goddess-Method-Cutting-Cravin...

[3] https://www.amazon.com/gp/product/B000QUEHNU/

Diet is the easiest thing on that list of 5 things in all first world countries.

It's just that people refuse to engage with a simple diet. All you have to do is start to cook for yourself and it's done, your diet is solved by the required meats, vegetables and carbs you get in a basic home cooked meal two times a day. Even if it's reheated.

I know what you mean, but not strictly true. I cook everything from scratch - the most processed ingredient I use is probably a can of whole tomatoes or occasionally a pack of pasta. I’m a good cook, I think, and it’s easy for me to make our meals, but I do like things to taste good, and I no doubt add more butter, olive oil and cheese to things than is strictly healthy.

No one is going to get fat from adding proper amounts of fats, sugars and salts to their home cooked meals provided they are average in the first place.

Love these 5 items.

Also worth mentioning how deeply they are all inter-related: diet will influence your glucose levels, metabolism and gut health. Metabolism and glucose is directly related to brain function. Exercise helps with sleep, reduce glucose levels, increases dopamine levels. Alcohol impacts REM and deep sleep, and your gut microbiome. The list of inter-relationships goes on and on.

Setting aside time to relax and read an actual book made me feel sharper.

Yeah, I had a ludicrous amount of free time during the pandemic and got to pay more attention to my attention span (heh) - I found when I sat down to read, I’d get about 3 minutes in and my attention span would wander; if I persisted, I’d make it another 15-20min before getting the phone itch again, and if I made it through that I’d get another hour or so of calm reading in.

It really does make a difference for me to read paper, though. It feels more tangible than reading on a device, and something about the feeling of actual progress (as opposed to infinite scrolling) seemed to both help me take in the material and also make the whole thing more satisfying.

Unfortunately I did all 5 of these and still felt severe brain fog and poor short term memory. I can think insanely quickly on things that don't matter or have logical cues. I can't think on things with a string of procedural cues. So even simpler things are harder than complex things if they take more than a few steps.

GYM body is so good and only takes a year in the gym, I love it and it does help get rid of aches and pains.

When you do all 5 well and still feel hindered in some spaces, it really sucks. I assume I'm just extremely lazy but with a huge willpower that turns on and off. I always experienced on/off stages with work, either creativity and leisure flows, or work and engineering flows.

So for sure talk to a professional at that point - if you’ve fixed all the sort of baseline health bullshit we all do to ourselves and still feel like you can’t do the things you want, talk to a doctor or a therapist or psychologist. Two notes - I had a friend with a thyroid issue that manifested in really pretty severe fatigue and brain fog that went undiagnosed because it mostly presented as a mental, not physical, problem. I’d also say what you’re describing sounds a bit like what I hear from friends with ADHD, so that might be another thread to pull.

Everyone has ADHD these days, I don't believe it has any actual boundaries any more. I do get migraines as my only physical sickness, doctors suggest just taking pain killers and that's all. Will see a specialist though, but would rather be naturally not right than clinically unwell for a misdiagnosis.

It has boundaries and good psychiatrists will know what to look for.

Every comment here starts with "see a doctor". What do you lose by trying that since it seems you already tried everything else?

Sure. Most will just diagnose ADHD and autism willy-nilly though, hence the realistic poor boundaries.

I have tried that. I will see a specialist with proper over-the-top tools when I can. But the people I see are renowned for over diagnosing too these days.

There’s a lot of great answers here. See a doctor. But here’s a tip for memory. Accept you can’t remember stuff and stop trying.

Externalize your memory and put it on other people. Here’s what I mean.

My wife calls and asks me to stop at the store and starts telling me a list of a few things she needs me to pickup. I say “Sure I’m happy to help. Can you txt me the list so I don’t forget? I’ll leave it unread to remember to look at it.”

I then read it and mark it unread. Over the next hours before I go to the store the little notification icon will bug me and I’ll go to read it only to realize it’s the grocery list. And then mark it unread. When I leave I’ll go to the store and look at the list while I get things. Then I double check the list and my cart before I checkout. Same with people I work with. “Sure I can send you that report and you shoot me an email so I don’t forget?” I’ll leave that unread or pinned till I do it.

When someone asks me to remind them of something I say “I’d love to but there’s no way I’ll remember to do that.”

I use kanban / trello to organize my work tasks and make notes immediately because I just accept I won’t remember tomorrow.

Once I started doing these things I have way less anxiety about forgetting. I think people rely on remembering stuff way too much. It’s like keeping your money in a pocket with holes in the bottom.

Bonus: remember names by making a big deal about it. “What’s your name?” I then use it several times. And when I forget then I just ask them “What was your name again?” I say the name that comes to mind when I see them “Your name was John right?” If they say “No it’s Steve” then I say “Ah Steve. I was so close!” And we laugh. Honestly they probably don’t remember my name so this whole schtick helps them too.

Seeing a doctor for a referral to see a psych should be step one here.

But man… time blindness? I’ve recently started using an Apple Watch to set reminders, timers, calendar events, and alarms. Game changer!

Some days I can make over 30 reminders for that day alone, and the cool thing about this is that I can’t forget any items because it’s all externalised.

In contrast, keeping your TODO list internalised is like walking to a room for a specific purpose, not remembering what you needed to do when you got there, or worse do something ELSE in that room but because you’ve achieved something you go back to what you were doing before and only a few hours later when you’re in bed you realise you forgot to do something critical

I was in a similar situation. Couldn't keep a consistent job, couldn't keep a long term relationship. Jumped from one thing to another again and again. Struggled with poor emotional regulation (but hid it very well).

I was diagnosed with ADHD in my early 30s and things started to turn around. I've kept up the same job for longer than I ever had before, I'm in a long term relationship and I am better able to handle the general ups and downs of life. Things definitely aren't perfect. I still have to handle forgetfulness, distraction, lack of focus and so on, but getting diagnosed helped me immensely.

Talking to medical professionals of all kinds can only help you. Maybe they find some simple, fixable cause. If they don't, you haven't really lost anything.

Yeah this. Sounded like a specific flavor of ADHD I’ve been lucky enough to build a toolset and team around my ineptness in a bunch of places including memory.

Ironically poster sounds pretty smart and good communicator

Go to a doctor, many different conditions can cause memory issues. HN makes for poor medical advice.

Asking anonymous strangers on the internet that don't have your best interest in mind how to handle your medical problems is a great recipe for success.

On the other hand, asking anybody for help is probably better than asking nobody. I applaud this person’s courage and willingness to reach out.

Maybe not the "best" interest, but the replies seem to have a caring interest and definitely not a conflict-of-interest which is unavoidable with medical professionals.

I didn't see it mentioned so wanted to add that it's possible that ADHD's impact on working memory[1] leads to issues with long term memory[2].

Basically, we struggle with holding stuff in RAM which corrupts writes to disk.

The effect is more prevalent with auditory inputs vs visual ones[3]; learning this helped explain why I find myself more likely to engage with a lecture or meeting while simultaneously doodling[4].

---

[1] https://laconciergepsychologist.com/blog/what-is-working-mem...

[2] https://www.verywellhealth.com/can-adhd-cause-memory-issues-...

[3] https://pubmed.ncbi.nlm.nih.gov/24232170/

[4] https://www.additudemag.com/focus-factors/

From my own personal experience I’d recommend getting your B12 checked. I had similar problems, bloodwork came back with B12 a little low and the doc recommended I supplement it (monthly injections). Helped a ton. Obviously I’m not a doctor and can’t give medical advice, just relaying something that happened to me.

Yes, I have dealt with this and am still dealing with this, and much of it it all came down to early childhood trauma and how I needed to survive situations as a kid. I ended up that I had a pretty extreme amount of dissociation and symptoms of PTSD, and after grappling with literal decades of therapy and many diagnoses I started looking into dissociation, from which things truly clicked into place and finally I had a model to understand how I worked. If you have memory issues, please check in about CPTSD and dissociation - it’s not well known and it’s been life changing for me, and it’s massively undiagnosed compared to people who have them (6% of the population has one).

With the help of therapists and peers I have been able to figure out how I work and make progress on things I haven’t been able to for much of my life, after dealing with a spate of pretty extreme burnout. There’s no telling what your journey might hold, but I can say with experience that it is possible to figure out what underlies the hangups that have been hamstringing you.

That's oddly reassuring in that I have CPTSD. How has your memory improved? And through what modality – just therapy?

It’s a lot of things, and it takes a while. EDMR, modified IFS, somatic work, massive amounts of internal reflection and relational work have all contributed - it’s not something I could just buy. I remember 80% of my childhood whereas before I only remembered something like 20% (the nicer parts and a few impactful moments). I remember school, I remember real details of being in my 20s including emotional memory, I remember what it was like to teach myself to code. All of this stuff wasn’t accessible until I started learning about structural dissociation.

Also as an FYI, dissociation can greatly reduce the efficacy of so many other treatments if not detected.

See here for a short primer on this: https://www.youtube.com/watch?v=jWRnewwMO2U

Also if it might help, I'd recommend doing a self assessment for dissociation. The MID-60 is the one that I'd recommend over the DES-II, as it gets much closer into real experiences without as much wiggle room.

Has dealing with your PTSD actually improved your memory or has the damage already been done?

Yes. My memories are fragmented and dissociated from each other, especially traumatic ones. Processing the PTSD is literally reconnecting with and processing those memories that were pushed away to protect me.

There are many things that could result in what you're describing. If in USA, you should visit a psych MD to discuss your concerns.

I have experienced similar issues and received medication for [underlying condition], which has helped immensely.

May I ask what condition you had/have and what medication helped?

Regrettably, it's a cocktail of highly interrelated psychiatric issues:

1. cPTSD 2. ADHD 3. Depression 4. (Relatively mild / high-functioning) autism spectrum disorder

Likely combined with aftereffects from mild traumatic brain injury (i.e. a high number of concussions), but this part is largely speculative.

Would not recommend attempting to research your way into a solution without the help of a trained practitioner.

I've been diagnosed with cPTSD, GAD, Depression, and ADHD. Ketamine therapy has helped to grow awareness & understanding but little in the way of behavioral change. I've avoided stimulants thus far as I don't want to resort to that path just yet.

What helped you? Traditional psychotropics? Psychedelics?

In terms of medication, my own personal experience has been:

* Ketamine was life changing (for depression symptoms)

* Stimulants help me a lot. The first time I took adderall, I cried, because I had never experienced such a relaxed state of calm or peace. I haven't been able to get any due to the longstanding shortage, and my quality of life has suffered as a result. Other drugs help me to control my focus, but they don't tend to help my memory or emotional regulation much.

* I also take antidepressants that are slightly helpful.

* Diet, exercise, and sunlight make a huge difference.

Adderall was great at first but literally a week of daily use and I felt like all it was back to normal.

Felt like Im just damaging my physical health for no good reason

How much content do you consume?

I’d say start your day off with absolutely nothing. Just go outside and go for a walk with no phone. No music. No technology. From the moment you wake up, try a one hour walk like this (map out a route that takes about an hour so you don’t need a clock with you). Let your mind fly, then after the hour is up, write down some notes about your thoughts. Try this for a week.

I consume a lot of content as a coping mechanism for what feels like an insurmountable stack of issues with no clear path to addressing them.

Then I think you already know the solution to getting unstuck.

> I've avoided stimulants thus far as I don't want to resort to that path just yet.

I'm interested in knowing why you're reluctant to try stimulants. what you describe in your OP sounds a lot like the symptoms of ADHD and stimulant medication helps many people with the exact symptoms you list with little to no side effects. why leave that on the table?

Mainly cardiac concerns. I tried stimulants for a short stint and my baseline heart rate was noticeably elevated.

Isn't that somewhat of a survivor bias? People with ADHD on stimulants would typically have little to no side-effects because if they had moderate to severe side-effects, then I doubt a medical professional would keep them on stimulants.

I treat my ADHD with stimulants, and I would say there are definitely side-effects, but the side-effects are mostly manageable.

While I do benefit from stimulants, I personally believe the benefits are exaggerated, and apparently the Cochrane Library does not disagree with me:

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...

For ADHD, stimulants like Ritalin have the opposite effect. Your brain goes... quiet. In a really good way. You can focus on what you want to, with ease. If you have a diagnosis don't be afraid of exploring medical treatment. Just be aware that while it does solve the problem of being able to stay focused and on task, it does not solve the problem of figuring out what to focus on. Also some people react differently to different medications. If Ritalin doesn't work, Elvanse or one of the others might work better. It can take some trial and error to figure out.

I want to add, try starting with lowest dose! For me 3.1mg Adzenys or 10mg Vyvanse (both lowest dose possible) have a clearly noticeable and beneficial effect without overriding my core personality and preferred mental tendencies (though this along with a low/moderate dose of NDRI and SSRI)

Do you do caffeine?

There are some nonstimulant medications available, generally less effective. There's a good overview from a medical article published in a seemingly legit journal by seemingly legit authors: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3000197/.

If you don't mind me asking, what was the source of the concussions?

I have a similar profile, along with seizures in childhood that led to repeated head injuries. Cause and effect was always an open question for me.

Please make sure you put in the work before you start taking meds.

I'd like to share a personal story in the hope that it helps you. My brother turned me on to Dr. Amen. We both took his on-line test for ADHD[1] and both tested positive for multiple forms of ADHD. He agreed that my results were much worse.

My brother used that as an immediate excuse to take meds. I instead signed up for his on-line course and lost count of the number of times he said "this practice has been found to be just as effective as medication". I put in the work and it made a major lasting difference in my life. My brother didn't bother with the work, the course, or the recommendations and is still searching for that magic pill or mushroom that will "fix" him.

As an aside, the powerful realization while taking that test is how bad it made me feel. I had flashbacks to all the people I disappointed over the years. It's like every question was "are you also shitty in this way ?". It made me realize: 1) I didn't want to be shitty anymore, 2) with good practices and habits I can fix/mitigate my flaws, 3) and failing meant being dependent on big pharma and doctors who might not have my best intentions.

Please ask yourself sincerely: Have you put in the work ? Do you really care about improving ? Is there a single _simple_ new habit you know would improve your life ? Are you going to start right now working on that one simple habit and writing yourself an email daily/weekly to check your progress ? No one is coming to the rescue. Don't waste your money and a coach's time if you can't even do the bare minimum.

[1] I believe this is the test (I took it 5 years ago) https://theaddquiz.com/

I learned recently the "OHIO method" – Only Handle It Once.

If something is easy to deal with right now, just deal with it immediately.

For me, it's been dishes, trash, and organising (e.g. keys not in the key-bowl; cables not in the cable drawer) where it's helped most. I'd say it's a 30% improvement, which doesn't necessarily sound great, but it's all about things that require almost zero effort.

I'll take a look into your reference soon!

To someone else reading this who thinks they may have ADHD, I really implore you not to waste your time with non pharmacological routes. You can’t wish or think or really want your way out of this. You need a leg up, and it has to come from within yet also without you.

Speaking from experience. Advice like the kind I’m replying to wasted so much of my time. For some reason everyone is an expert on this particular topic. No, the experts are (ignore pop psych shysters also).

> My brother turned me on to Dr. Amen.

Red flag detected.

Dr. Amen is basically the Dr. Oz of ADHD treatment.

https://en.wikipedia.org/wiki/Daniel_Amen#Reception_of_ideas

> "this practice has been found to be just as effective as medication".

No other research supports his conclusions. It's so fascinating that he can use brain-imaging to diagnosis 7 'types of ADHD', when no one else has ever discovered more than three subtypes of ADHD, and no other researchers have even been able to successfully diagnosis any mental disorder via brain imaging.

Let me put it this way, unless you are an exceptional individual, "putting in the work" and overcoming ADHD typically means one thing: You do not have ADHD.

> doctors who might not have my best intentions.

Do you not see the irony in this statement?

Please ask yourself sincerely: Do you truly think you have ADHD because an online test's results? Do you really think people with ADHD do not care about improving? Do you think people with ADHD have not tried habits they know would improve their lives?

Do you understand how many people with ADHD take medication, use behavioral interventions, and still struggle?

> I believe this is the test

That test appears to be crappy lead gen for their online clinic. That's my expert opinion.

FWIW, I don't know if anyone in the world is truly neurotypical, but I am not aware of any suffering of a psychological nature, in my own life.

I answered the test questions to the best of my ability, and received a "diagnosis" of an ADHD type (not generally recognized by the medical community), which the clinic's own literature describes as exclusively having symptoms that I explicitly answered Never or Rarely to.

I know they didn't have much to work with, but an honest response would have been more along the lines of "You tabulated 11.3% on our scale of this ADHD type, you're probably not significantly impacted!"

Dr. Amen can sometimes drive folks towards effective treatments, but many of his diagnostic methods are full on quackery. I'm glad he was able to give you some guidance that worked for you, but he has created a lot of harm and a lot of misdiagnoses at great personal inrichment.

Personal story: I have pretty severe ptsd, and was being abused at the time I visited. I had a full brain scan done as an adolescent using his nuclear imaging technique, and the results were that I should take X and Y and Z medication, none of which worked. They promised "a new life" on these, but they did not treat the underlying causes, nor did they screen for them. This is now 25 years later, but he is still pushing the same diagnostic techniques that ignored the underlying reasons for my issues. This was at a cost of some $13,000. I still have the brain scan and the recommendations - they are near-total bullshit.

He is a Dr. Oz style quack who is out for massive personal enrichment, and nobody has been able to replicate any of his own developed techniques because they are not real.

More sources:

https://quackwatch.org/research-projects/amen/

https://rationalwiki.org/wiki/Daniel_Amen

Here's a couple of practical tips.

A very powerful method for remembering facts long term is spaced repetition. There's a go-to app called Anki that makes it easy to get started. A good write up on how it works and why is here: https://gwern.net/spaced-repetition

If you want a neat way to help with more "absent minded" type stuff, just associate whatever you're trying to remember with something unusual in your environment. For example say you're driving home and you want to make sure you stop by the store to get milk on the way. If you wear a watch, flip the watch the other way around on your wrist. Now every time you notice your watch you'll immediately think, "oh yeah the milk." If you don't wear a watch just pick something else in your vicinity and arrange it in an unusual way. Every time you see that object you'll immediately recall the thing you don't want to forget.

Definitely seek the help of a doctor or psychologist and follow their advice, they could help find the root cause. They can often find treatments and strategies that can help.

But on a more practical level, I have found that using a calendar and a notes app (I use Obsidian) has been invaluable for my memory and organisational skills. Also having a daily routine and sticking to it.

There are also habit trackers that help with repetitive tasks if you find routines too difficult.

Hi, i can relate to that due to my adhd related poor executive function, and lack of proper internal structuralisation (both organisational and time or task related)

Have you checked if you have adhd? In any case, it is always a good idea to get a professional help from both a psychologist and a psychiatrist if you can.

On the other hand, i recently start practicing tai-chi, it helps you to center and ground yourself, might not seem like a direct solution to those problems but definetely helps to have a centered and grounded psychological base to look around and yourself. (And i believe complex nature of the moves trains executive functioning)

https://scottjeffrey.com/center-yourself/ https://scottjeffrey.com/how-to-ground-yourself/

Many people struggle with similar issues. Here's what you can do:

See a doctor: Rule out any underlying medical conditions. Seek professional help: Therapists or coaches specializing in executive function and memory can provide personalized strategies. Develop routines and systems: Use calendars, to-do lists, and reminders to stay organized. Break down tasks: Tackle big goals in smaller, manageable steps. Practice mindfulness: Meditation and other mindfulness techniques can improve focus and emotional regulation. Connect with others: Talking to friends, family, or support groups can be helpful. Remember, you're not alone and there's help available. Start with small changes and be patient with yourself.

I can relate, 67yrs of dealing with the same. Have always tried to ensure I have external guidance and pressure, keep me on track and focused. Control your environment to set up for success, good managers and plans, remove distractions. We need others to help focus our power!

But the real suggestion is pick a passion - paint, write, run, write, act.... anything that can motivate you to focus, develop new physical and mental skills, generate lots of dopamine. Mine has always been music, but working on art now. Give your mind and body a different place to go for that part of the day, your brain is learning constantly. Your executive system will thank you.

Considering only the practical advice, and not the medical side, I think that what would help you is to develop a knowledge management system. Journaling to capture tasks, events and learnings you want to remember, and periodic reviews to review, look back, and look ahead.

I discussed my own system here [0].

Personal Knowledge Management helps avoid having to rely on a weak system (your brain), and instead rely on a trusted system.

In it, you can track your goals, vision, plans, progress, lessons learned, and much more.

[0]: https://www.dsebastien.net/overview-of-my-personal-knowledge...

Writing is really the key skill to focus on. I've stopped relying on my memory a long time ago, and have developed systems that help me remember. Write to forget.

I'm going through something similar. I think you need to try doing less, try to reset. Someone said "Think big, start small", this might help you.

I play golf with this older Japanese guy, he has this super cool aura about him and is amazing at golf even though he is a cancer survivor in his late 70s and is getting a bit frail. He would always say to me "soft, soft". It's crazy how much this works.

The fact you're making this post tells me you're pretty ambitious, you want to achieve things...maybe you're just going too hard but not in the right directions?

There's some sound advice in this thread, including the obvious ones: talk to a therapist, psychiatrist, get disciplined, etc. etc. What some people don't get is that for the person on the other side, all these advices are usually a given.

I'm relatively successful in tackling my mental health issues and neurodivergence, have been on therapy, medication constantly for over a decade, but when I'm in a particularly bad shape from a depression or attention deficit, I'll actually drop the very things that have worked in the past, even when I'm perfectly aware they help. It's weird and absolutely irrational.

The only advice I can give you, really, based on this personal experience, is to get a third-party to "coach" you into doing the right stuff. Anybody. It can be family, a friend, anyone. If you already have a therapist, most will be likely happy to do it. All you need is someone to hold you accountable for the stuff you know you need to do. That person will keep tabs on you for a few weeks until you follow all the obvious advice here: find a therapist, a psychiatrist, a gym, quit booze, etc. In worst case scenarios, that person can go ahead and schedule appointments for you.

Once you're in therapy and|or medication and|or good habits for a couple months, you'll get traction to do everything else, and with some luck (finding the right professional, the right drug, the right methods is a trial-and-error) you'll build up some momentum quickly and won't need anyone keeping tabs anymore.

I am desperate for a coach. The therapists I’m currently seeing are not providing actionable advice. We spend most of our sessions introspecting and self-validating, which has run its course.

I’ve been on the hunt for a life coach of sorts who specializes in ADHD. Ideally someone who’s familiar with tech employees & entrepreneurs, but I’m probably chasing a unicorn.

HealthyGamer has coaching program that might be worth checking out [0].

Also might be worth getting evaluated by a psychiatrist if you haven't [1].

[0] https://www.healthygamer.gg/about/coaching

[1] https://www.youtube.com/watch?v=UOLB-4MbrSw

1. have a serious look at your diet. This includes caffeine, meat, processed foods, etc. 2. Sleep Study 3. How much stillness do you have in your life? where you're not scrolling on a site or on your phone? Can you increase the amount of time you have to yourself where you aren't processing any incoming info?

Write more. Find an outlet that makes it worthwhile and just write (e.g. a 1000-word essay on a pet topic). It can be rough getting started, but it forcibly makes you do research and admit what you don't know. That will develop your mind and redevelop your sense of curiosity.

The other tips here are great, specially related to health and emotional balance. Those are on the top of the list.

Apart from that, you must realize that building a company, or learning hard technical skills can be a huge mountain to climb and lead to all kinds of stresses. It's never as easy as it seems.

Maybe try something lighter, something less challenging? You seem like a good writer. Try writing a blog, LinkedIn articles and posts to grow your reach, curating content and stuff like that. Those are all very helpful and valid ways to engage with the developer community and might give you the confidence boost you need to take it to the next step. Who knows? You might grow the business or skills you want from there!

Take a week long vacation to somewhere with minimal allergens. Like an island or a cruise.

Allergens can absolutely cause the symptoms you’re describing, and so if you don’t feel better away from continental allergens, you can at least rule them out.

Go to a hearing aid provider or ENT/audiologist and have your hearing and speech processing evaluated. You may have auditory processing disorder or APD, which often correlates with ADHD and similar disorders.

It can get worse with age, annd the coping mechanisms you’ve developed over the years become a you’ve developed over the years become less effective. It doesn’t often get evaluated.

If you weren’t hyperactive as a kid, you may not have been evaluated for ADHD. Your story sound like friends and loved ones who ended up with adult diagnoses. Explore it - worst case you get it ruled out.

> Are there coaches that can help?

You don't need a coach, you need to learn how to 'exercise', and I don't just mean that physically.

You want to run a marathon? You don't just go running as hard and as far as you can, puke, then feel like a failure, and stop trying.

You have to be realistic with yourself and make slow steady improvements in life and understand you're moving towards a goal.

You don't concentrate well? Fine, use pomodoro to force yourself to study for 15 minutes without distracitons and then take breaks.

You're not in shape? Start doing ten pushups in the morning and some air squats.

I'm not a psychiatrist, but this sounds like a classic case of undiagnosed ADHD or less so, perhaps AuDHD. Certainly enough so that it's worth pursuing a diagnosis to either rule that out, or get some answers.

If you aren't able or willing to pursue a potential diagnosis, you can at least check out some of the channels that deal with A(u)DHD lifestyle challenges and coping/productivity methods. Even if you don't fit the bill for a diagnosis, there's enough crossover that you will probably find them very helpful, as you have evident ADHD traits.

In another comment, they mention they have been diagnosed with ADHD.

Ah OK, I did run through the comments before I posted, but I guess that wasn't up yet.

Yeah, this is classic.

If OP is interested I can find some of the channels I've found helpful. They can be a little cringe sometimes (neurodivergence is like thay), but even then, they're often genuinely helpful.

Out and about now but I can link them later.

EDIT: For OP's sake, the first thing you need to accept is that your brain is genuinely different from most people. You can be immensely successful if you adopt the right strategies. But the first step is accepting that no matter how much the advice makes sense, neurotypical advice, at least on its own, will very often _not_ be helpful.

Considering OP says they haven't tried stimulants, I'm guessing they haven't glimpsed what a neurotypical brain feels like. It really is a fundamental difference. Stimulants can get you close to it, but for day-to-day living, you need to explore advice from other neurodivergents primarily.

Do you use twitter? Stop using twitter.

I love this one. The outrage I would feel reading people's extreme tweets (not political necessarily, just hyper argumentative) was addictive for me, and simultaneously kept me wired. I thought it was worth it to keep up on the latest of tech, news, sports, whatever, but cutting it out helped my mind get to a FAR slower pace. It's crazy what fomo can put you through

Assuming you're male, get your testosterone levels checked and consider getting some testosterone replacement therapy. I'd prefer that to SSRIs etc.

I'm 35, I had similar issues. Tested my testosterone, it was at 290 ng/dL. Went on TRT, my tests since starting have been from 650-1050 ng/dL. Night and day difference in energy, focus, emotional regulation.

As a bonus, it helped slightly with body composition and strength.

Glad to hear it helped. People think it's all about muscles, but the mental effects are very significant.

1. Sleep

2. Adderall

3. Write a journal/notes

4. Routine

For what it's worth I know how you feel. I had a bad motorcycle accident that left me in the ICU for a week and for which I had to get surgery to get fixed up. Since I had a history of concussions this one was particularly bad and I had trouble focusing for months. I used to have the kind of memory where I could recite sections of my VIN after entering it twice or thrice, and recite it in entirety if done a few more times. I have degrees in Mathematics and Physics with only one class where I took notes (the one I did the worst in). Now I don't have that memory, and it is comparatively debilitating.

I've compensated by using more to-do lists and notes and it has worked a lot better. The hardest part has been sticking to goals. I forget why I set goals which makes it hard to stick to procedures that achieve them. Fortunately for me, my wife is a substantial support, and because my cognitive skill hasn't declined as much as my memory I still get a lot of things done.

Good luck.

As a supplement to therapy I can recommend neurofeedback. It is a scientifically supported method that basically uses EEG to help you tune up your subconscious stress reactions. Completely noninvasive, used with children too. It has multitude of benefits, including improvement of mental acuity.

I've dealt with much of what you've mentioned, however it is unlikely that there is "one thing" that will fix it.

Having one or more good friends that will bust your balls when needed, eating right, keeping a journal of your successes as well as thoughts and failures, and much more besides will be needed.

What was it for you?

I felt similar things about 1.5 years ago, and I decided to read a lot of books about work and business and write myself a todo manager and gradually build up tooling around it to help myself function effectively.

It is too early for me to tell definitively whether it has helped, but I think it has.

Be prepared for this to be a long process.

Get a sleep apnea machine (i.e. check if you need one). Untreated sleep apnea can cause cognitive damage.

I know someone who was greatly helped by acetyl-L-carnitine in that regard.

Also, do everything you can to be healthy.

Your problems sound rooted in physical and health issues. Try this:

- Cut out carbs. Start with a month of full keto, then dial it in. The goal is a constant energy level, no feeling sleepy or hungry, no brain fog. Intermittent fasting can help, even just skipping breakfast a couple days a week. This is all achievable, and it’s easier than you think. The goal isn’t weight loss, but if you’re overweight, you will slim down.

- Cut out seed oils. The oils themselves are bad, but also they tend to be plentiful in the absolute worst trash foods.

- Get some kind of exercise every day, and not just aerobic. You need some type of upper body strength development.

- Attend to your posture. Get a stand up desk, and stand more than you sit. I’m a fan of Alexander Technique, which teaches good posture and how to avoid poor use of your body. You can find a coach in your area.

- Attend to your breathing. If you’re mouth breathing, train yourself to nose breath. There’s a good book out now called “Breath” by James Nestor.

You should see a psychiatrist

Late 30s, not sure if you’re a drinker but cutting out alcohol helped me.

I've personally found success with magnesium and serotonin reuptake inhibitors. Also if your diet is mainly grain try to get to a large mass of greens.

These were huge for me.

Have you optimized for sleep and exercise?

If you haven't, there's no other drug or behavior that can boost your cognitive abilities without first optimizing those two things.

Hey, I don't have any solutions for you, but wanted to share some camaraderie. I feel exactly this way. In fact, I could have written the post myself.

Ask your doctor today for Intuniv ER!

Seriously, it was a big help and minimal side-effects aside from a bit of aggression, but if you want assertive, you get assertive.

https://executivefunctioningsuccess.com/

You need to first regulate and discipline your everyday Lifestyle;

1) First, regulate your interactions with the environment i.e. limit exposure to everything/everybody which could trigger you, put you in a negative frame of mind etc. A good example is to do a "digital detox" in addition to limiting socialization with negative people. Clean up your room, change some decor etc. The idea is to break those cues in the environment which have been detrimental and replace them with something positive.

2) Next start with your Diet; stop all junk food and eat proper home cooked healthy food. Stop eating before you feel full i.e. satisfied but not completely full.

3) Regulate your Circadian Rhythm by following the six steps given by Dr. Satchin Panda in this talk - https://www.youtube.com/watch?v=fciGNBN0nKM and this talk https://www.youtube.com/watch?v=qOXQgyjRm0I Note especially Intermittent Fasting, Sunlight Exposure in the Morning and Exercise in the Evening.

4) The "Gut" (aka The Second Brain) is now known to play a vital role in our Health both Physical/Mental. Massage all the organs in the gut area everyday by doing two special exercises from Hatha Yoga; "Uddiyana Bandha" (https://en.wikipedia.org/wiki/Bandha_(yoga)#Uddiyana_bandha) and "Nauli Kriya" (https://en.wikipedia.org/wiki/Nauli). Start slow and gentle with these exercises. See Youtube for some demo videos.

5) Your Breath links your Body and Mind (i.e. Psyche) together and hence you need to regulate your breathing. Do the following couple of simple breathing exercises (i.e. "Pranayama" from Hatha Yoga); 4.1) Normal inhalation followed by fast and forceful exhalation with abdomen pulled in, all through the nose; do ten reps 4.2) Do "Nadi Shodana" i.e inhale gently through the left nostril by closing the right nostril and exhale gently through the right nostril by closing the left nostril. Repeat the same but switching sides. This constitutes one set; do ten such sets.

6) Tackle Sleep as if it were a paying job i.e. with discipline and dedication. Satchin Panda's above video already mentions how but to drive the point home, listen to your body and sleep/nap when you feel sleepy/drowsy. Everything else is dispensable but not Sleep.

7) You don't have to go crazy with exercise but should at least be able to take a walk everyday. If you can't go outside walk within your home or building. For better results use a weight vest and/or ankle weights. Since we all spend so much time sitting and staring at a screen do 6.1) Special/extra exercises for Waist/Pelvis/Hamstring/Knee loosening 6.2) Massage your scalp/face/head to balance circulatory function. Everyday exercises should be light which energizes you but not tire you out.

8) The above together should have put your Body/Mind in a equilibrium state where you feel alert/calm and energetic. Now you work on your focus/concentration by reading/studying something from a book (no phone/music/videos and no other distractions). Pick anything you find interesting (trivial/simple/complex/whatever) be it fiction/non-fiction; you are training your mind to focus on one thing for an extended period of time (at least 1 hr). If you don't like to read then do some other activity (eg. crossword/puzzles/whatever) but again fully focused for at least an hour. The idea is to have the mind fully occupied (aka mindfulness) with no other thoughts/distractions.

Persist with the above discipline and you will definitely see some real benefits.

I'm a fan of most of this advice here. Also, as someone with ADHD, I'd also add to this advice some concrete suggestions that have been very helpful for me.

Regarding Point 1 & 4) As someone who's a been following the health podcast space of researchers, I've been finding that exercise, nutrition, and sleep are the foundations that are critical to feeling one's best. However, like all things, the devil's in the details and finding a protocol that's sustainable, affordable, and palatale is pretty key to being compliant and feeling one's best.

Personally, my goals nutritionally has been to just "feel better." I noticed very early on in life, that almost any meal I consumed would lead me to falling asleep and being unfunctional for 2-3 hours in a state of brain fog. No amount of caffiene and such could really snap me out of it. So I went to the doctor and got prescriptions for stimulants, but they mostly have diminishing returns and have other downsides. And my whole life, I've always had a slight bit of fatigue, a bit of ADHD, a bit of narcolepsy, so I feel like there's so much more on the table that I could engage in, but have failed to really get at. So I've found that really getting my diet in order has been key. Now that I've embarked on on a multi-year journey of nutrition and fitness, I'm finding that I have a ton more energy to engage, a lot more focus (still hard, but much easier) and I have a lot more mental stamina than I used to have.

I've given my protocol to several friends, and not one person hasn't felt better on it so far, even if they didn't integrate the exercise portion. I've also read numerous change-your-life-by-doctor-foo books and they generally all come to the same conclusion: the body is a chemical reaction machine and it needs the right set of molecules (either via gthe gut microbiome (bacteria) or synthesis or nutrition) to function at its best. And at the core of everything health, optimizing mitochondrial function is at the heart of all things health, for just about every curable/manageable ailment and chronic health condition out there. Food, as personal and opinionated as it is, is one of the core tenets for functioning well. And in that context, it becomes obvious that reducing or eliminating the bad, while increasing the good is the key to many improvements.

On the food front, it's too difficult and not practical to really cut out everything, but I do agree with cutting out most "ultraprocessed" food. (ie chips, soda). Since getting healthier, I find that my body can tolerate junk food far better than it ever has been able to. So much so that, if I go on vacation with friends and binge on junk food for a week, I'm fine. Over time, I noticed that my tolerance for the "bad" stuff grew more and more. For OP, I'm sure on your journey, you'll experience similarly.

What I find that most people have difficulty with is getting enough of the good stuff. Most of the compiled research out there recommends some form of eat lots of whole foods, lots of color, lots of variety, and I've found that getting enough in quantity and variety is tough.

In an ideal world, look towards getting 2-3 cups of color, 2-3 cups of greens, and 2-3 cups of sulfur per day. This is easiest done with a smoothie and drinking whole foods. Then my daily food intake becomes about getting healthy enough amounts of calories of proteins, carbs, and fats. Generally, a target of around 50-75% of 1g per lb for protein gets most people to a solid target for muscle building and retention. Then most folks can mix/match how much in carbs and fats they want to target. For most, what that balance is, doesn't really matter, unless one has a higher propensity for diabetes and should keep their carbohydrate targets relatively low. I've found that the best way to address all my micro-nutritional needs is to make batches of smoothies 1-2x/week and consume them on the go.

My smoothie concoction is as follows: 3x batches in a 64oz Vitamix (don't bother with the smaller vitamix and cheaper blender alternatives. They aren't powerful enough). This fills 6x 28oz blender bottles, and I look towards drinking 2x bottles/day, usually for breakfast and a mid-day snack.

Smoothie mix: 24 oz colorful grape tomatoes (color), 16 oz carrots (color), 3-4 heaping cups frozen blueberries (color), 12oz brocolli (sulfur), 16oz greens mix (greens: spinach, chard, kale), 3x apples, water.

On the supplement front, most people don't get enough sun (vitamin D) and Omega 3's (fish/algae), so I supplement about 5000IUs of D, 1-2g each of DHA & EPA for the antioxidant effects. Lastly, I think which is super critical, mitochondrial health is important (especially cuz my family has a history of diabetes) So I also add about 200-300mg of Ubiquinol (Coq10 in reduced form), B1 as Benfotiamine (dosing per label) and 5g of creatine for its mitochondrial benefits. For most of the general public, I would say this addresses most of the deficiencies that exist in the standard american diet. It addresses comments like, "80% of the US population is vitamin D deficient, omega3 deficient, etc"

Regarding Point 6) Research has also shown that doing something like 10x body weight squats around once every 45-60 minutes while sitting down also has incredible benefits, even if one isn't able to make it out for a walk. Just wanted to point out that there are many alternatives to movements and many benefits don't necessarily need to be super strenuous.

Good luck OP!

Nice.

What i was conveying was a comprehensive outline framework to think about "Health" which i define as "a emergent attribute" of the relationship between "the adaptive living organism" (i.e. Us) and "the dynamic and ever-changing environment we are embedded in" (i.e. everything else). It is Complex Systems Science and hence one should treat it holistically based on the specific context and not narrowly as Just-Exercise/Just-Diet/Just-Medicine etc. This is what people are missing when it comes to Health/Fitness etc. We have empirical experience from traditional systems eg. Yoga/Ayurveda/Siddha/Qigong/Acupuncture/etc. which we need to reconcile with Modern Sciences of Physiology/Genetics/Epigenetics/Neuroscience/etc. A lot of researchers have been working on this but for some reason it is not mainstream, possibly due to the cultural baggage surrounding the traditional systems. I have been studying the traditional systems listed above (plus martial arts) along with modern science for a while now and find it always enlightening to map between them and apply both of them in a holistic manner in pursuit of "Good Health".

Supplement properly. Vitamin D, Omega fish oils, a solid multivitamin, plenty of protein and hydrate. Start there.

Lots of procrastination? Could you be seeking cheap dopamine hits that rob you of your time?

also struggled with this my whole life, would love to see some suggestions that don't involve doctors for people who live in countries without access to that kind of healthcare.

Review your nutrition. What does it like now?

May I recommend How To ADHD? It's a YouTube channel (now book, too!) by someone who IS NOT a licensed doctor (it is fact-checked by someone who is though) but she does have ADHD and has a ton of recommendations, tips, et cetera. It's really helpful. There are also tons of online communities for ADHD.

And as for 'coaches', I'd recommend therapy (CBT in particular is good for people with ADHD - speaking from experience.)

Edit: Oh, you do have ADHD, guess I can remove all the 'you should see if you have ADHD' bits.

you are stuck; over analyzing your life. I mean it's not bad to be self aware of what is wrong with you. but the point is "what's next?". yes you know all this about yourself. what are you going to do do about it?

don't try very hard because you'll probably fail. 0.01% percent improvement every day is enough. read one page, walk 100 meters, ... you get the idea.

never victimize yourself. it's a self fulfilling prophecy.

your problem is that you are unable to fix your problem. if the solution can not come from yourself why not seeking help from others?

> I want to get fit Hit up the gym

> I want to read more Hit up a place of books

> I want to develop skills Choose books that skill you up

> I want to build relationships Consistently reach out to people

> I want to be an entrepreneur You're in good company.

> It feels like I just wasn't given the playbook, and worse, am incapable of piecing one together. Have any of you dealt with this? Any advice? Are there coaches that can help? You're capable. Don't tell yourself you're not. Go and form a plan for yourself, you know yourself best and you don't need anyone else. Be confident.

Get a sleep study.

anki?

Hi, OP, this one seems right up my alley.

What you describe is very much how my life was for most of it. There were other complicating factors in my case, but what you describe was part of it. I have significant executive dysfunction by default, enough so that it nearly killed me in the distant past. And while those struggles are by no means gone or trivial (I am in fact writing this post partly to procrastinate on my work!), they are not things that constantly cripple me anymore.

I'm the founder of my own company that, while it may or may not succeed, at least exists under fairly challenging conditions. I don't feel constantly crippled and scared about my ability to handle basic personal growth. I've lost 135 pounds in the last two years. None of these things were possible in the very recent past. So I feel comfortable saying that I have at least somewhat figured out how to overcome some of my innate tendencies.

Everything that follows is just my own personal observations. They're the "view from the inside" of how I feel about it. I'm not an academic expert on mental health, but what experts can give you from the outside I can give you from the inside. I also strongly recommend considering medication if you've never tried it (it was life-changing for me despite the fact that it only worked for a short time), but I can't help you with that one.

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So, let's start with an observation:

> I feel I've been stuck both cognitively and emotionally at a late-teen stage...constantly flying at 1000 feet.

"Constantly flying at 1000 feet" sounds like inattentiveness. You mention elsewhere you have an ADHD diagnosis, and it's worth thinking about paying attention to your life in the same framing that you think about paying attention to anything else. If it's hard for you to focus on school or relationships or other things, why WOULDN'T it be hard to focus on your own life?

As I wrote that paragraph, I was eating my breakfast, and I realized I hadn't been paying attention to the food I was putting into my mouth. I was trying to do several things at once. I consciously stopped writing and took a slow, deliberate bite to try and refocus my attention on my current situation.

And when you struggle to pay attention to your experiences, of course you struggle to learn from them or recall them. It's no different from struggling in an English class because your eyes keep skipping over paragraphs without really digesting them, or struggling in a math class because you couldn't sit down to memorize a few formulae. (I didn't personally struggle with these things, but that's because they interest me. Anything that didn't was borderline impossible.) Or to use a more abstract analogy, it's like trying to read a blurry whiteboard from far away - your experiences are dulled, softened, greyed out, by the fact that you can't fully experience them in the first place. More precisely, that you don't fully experience them in the first place by default.

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> The older I get with no improvement, the more it feels my goals keep drifting farther away. I want to get fit, I want to read more, I want to develop skills, I want to build relationships, I want to be an entrepreneur.

I currently do three of these things: I'm maintaining a diet after massive weight loss (328 lbs -> 196 as of my last measurement), I've developed many, MANY skills in recent years and in recent months particularly, and I am the solo founder of an early-stage startup. I don't do the other two: rarely read and I have few relationships. But I have to often remind myself that getting even this far is actually a pretty extraordinary achievement. Most people could not do what I do, and even I couldn't have done it in the very recent past. (I'm not even sure I can do it NOW, but I can at least take a reasonable stab at it.)

So the first piece of advice I'd give you is to stop thinking of these things as easy in the abstract. Being an everyday functional human being is already very hard. Losing weight ALONE was a major challenge for me. Growing in my career ALONE was a major challenge for me. And that's normal.

Most people have vices they will never overcome. That's not a horrible failing on their part. It's just the nature of being a human being at all. If you've got a job, a few close friends, keep your home in order, and are basically happy with your daily life, you're doing better than the vast majority of people! EVERYONE has the equivalent of those leftovers in the back of the fridge that you'll totally get to any day now.

All that being said, there's nothing wrong with wanting to do better than the average and to be more than you are. So how can you do that?

Well, for one, your goals are (a) scattered, (b) big, (c) vague, and (d) have ill-defined success criteria. And that's a recipe for killing motivation, even in neurotypical people:

- Because they're scattered, your efforts to get started get distributed across all of them. Rather than roll one boulder up a hill, you're trying to roll five boulders up five hills simultaneously.

- Because they're big, they seem insurmountable and difficult. And the difficulty of a task tilts your motivation towards inaction. "Start a company" was a gigantic impossible task for me six months ago. But "figure out what I think we should sell and get a working website up" was more manageable.

- Because they're vague, it's even harder to connect with concrete actions. You already have trouble focusing on something. But right now you're trying to focus on something that shifts and changes and morphs every time you look at it.

- Because they have ill-defined success criteria, you can't connect with the potential rewards of the action. Note the way you phrase it: you want to "be an entrepreneur", not "found a company". You want to "get fit", not "BE fit". Your thoughts are focused on the task and the challenges of it, not on the rewards at the end. That's a key problem with executive function, which we'll get to more in a moment.

Note that I am not saying "you're doing it wrong" or "you're screwing up and it's your fault you're not acting". This advice is more akin to "you're trying to build muscle but there's no protein in your diet". Your motivation, which is weak by default, is not being fueled with the things that it needs to have in order to work.

That isn't a personal or moral failing on your part. It's a problem with your environment (which I will argue includes your existing thought patterns that you're not consciously enforcing), not with "you", and it's fixable as an environmental problem without you being any less you.

(continued in a comment, this post is too long for HN)

(continued from top-level comment)

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[from a comment]

> I've been diagnosed with cPTSD, GAD, Depression, and ADHD.

Depression adds to what we were just talking about.

See, one of the key symptoms of depression - or more specifically of major depressive disorder, which is what you're talking about - is that it warps perception. Not to the point of actual delusion, but in a way that works more like mild colorblindness. It's not that you can never see anything positive, it's that in the absence of very strong signal, you'll default to more negative interpretations (in the same way that a mildly colorblind person CAN tell the difference between red and green, but often needs clear contrast and cue to do so).

This was something I fundamentally misunderstood about depression. During my worst years, when someone told me I was depressed, I'd get upset with them. Of course I am! Everything's terrible and unfixable and I'm a horrible human being! Why wouldn't I be depressed?

I didn't understand it until I was on an antidepressant for the first time. (Or rather, after it started working a few weeks in.) For the first time I could remember, I could operate without the constant screaming voice of negativity and pressure towards negative interpretations of everything that, until then, I thought was just "me". But medicated me wasn't not-me. It was just me without a voice that, today, I don't really think of as part of "me". I think of it as a chronic illness I have to manage.

At the end of the last section, I talked about the idea that your thought processes don't focus on the rewards of your actions. What I'd suggest is that that's because, right now, you can't feel them at all. The power of a reward comes from (a) intensity, (b) certainty, (c) proximity, and (d) what I'll call "salience":

- An intense reward is the difference between "making a million dollars" and "getting $20". Obviously, bigger rewards help more.

- A certain reward means the degree to which you think the action will result in the reward. Video games are often appealing because they set up an artificial environment in which certain rewards are always available, for example: if you finish this quest, you WILL get a +6 sword of orc slaying.

- A proximate reward means you don't have to wait too much. The classic marshmallow test is an example of this. I would argue that what it is testing was the innate tendency the study subjects had to discount future rewards, which is a classic symptom of executive dysfunction. And that's because...

- A salient reward is one you can "feel", not just know exists. The more you can feel the reward NOW, the more you can connect the reward to the task, the more the task itself feels inextricable from its reward, the more the task itself takes on the rewarding color. But if you, like me, suffer from executive dysfunction, this is very hard to do!

Depression hurts a, b, and d. It dampens intensity almost by definition - a lack of pleasure from otherwise-pleasurable activities is a key symptom of depression. It lowers certainty because it will underestimate your chances of success (and when you struggle with executive function, there's a vicious cycle of "I won't succeed so why even try?"). And it cripples salience because it fills your consciousness with negative immediate problems and leaves little room for visualizing and enjoying future rewards.

Again, this is not YOU doing something wrong. This is an illness you have that is making things that are easier for others harder for you. It's not impossible to overcome, it just requires more deliberateness.

My advice is this: one, you may or may not be in a position to try to push yourself to do better right now. Depending on your life situation, you may need to rest and work on building a better immediate environment (both externally in your living spaces and internally in your mental landscape first. But once you are ready, pick ONE thing, focus on THAT, and figure out WHAT IT IS YOU WANT from that thing.

To use my recent weight loss as an example, I started losing weight shortly after a chair broke under me. It felt horrible. I felt humiliated by how my body was. That HURT. It provided immediate emotional salience to my weight. And so, when I got a little momentum a few months later, I had the emotional leverage to start dieting and exercising more.

I developed hard rules (exercise by climbing a nearby hill to X height every other day, 2000 calorie hard cap) that gave me a success criterion, where I could feel good as long as I'd done those rules. The task I needed to do was not "lose weight". It was "manage to follow these two rules today". And then tomorrow-me would follow them tomorrow, and the next-day-me would follow them the next day. 784 days later, I'm still following them, because there's an immediate salience to stopping: the second I stop, I won't get it back, and that will hurt IMMEDIATELY. I'll feel terrible if I stop.

I don't diet because I'm motivated, I diet because stopping dieting would hurt more than dieting does. And that's how motivation usually works. I'm going to go do my work after this post because I'll feel immediately terrible if I don't, not because it means I'll get paid for getting someone a job in a month.

(continued in one more comment)

(thread 3/3, continued from previous comment)

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> I am desperate for a coach. The therapists I’m currently seeing are not providing actionable advice. We spend most of our sessions introspecting and self-validating, which has run its course.

Given that you've got some form of ASD - so do I - it's possible you're misinterpreting the advice they're trying to give you.

I got frustrated with my therapists because I felt like they were trying to tell me I was "wrong". That there was something wrong with my logic. What I didn't understand is that they were trying to show me that there was something wrong with the INPUTS TO my logic. In the same way that it's not "illogical" to be colorblind, it's not "illogical" to be depressed - but it will feed factually inaccurate estimates into your consciousness in a way that can result in distorted behavior.

Imagine a thermostat that works perfectly, but whose temperature sensor is set 10 degrees too high. The AC will always be on, even though the thermostat is working perfectly! It's correctly interpreting incorrect inputs.

You're the thermostat. And because you can ONLY see the world through those distorted inputs, it's hard to see that they're distorted at all. They just look like the world.

What therapists are good for - or at least what they were good for for me - was helping to point out patterns of behavior and teach me about the repeating cycles in my own life. They could point out that my judgements one week differed from my judgements another week because one session had been in a particularly bad depressive episode and another had been during one of my rare breaths of air. (My particular depression takes the form of something more akin to a baseline-lowered bipolar II; I get occasional mild hypomanic episodes but it's usually just getting back to baseline-ish health.)

They could also help me understand my emotions as things somewhat distinct from myself. And just like inattentive ADHD might make it hard to focus on your own life, emotional processing problems from ASD can make it hard for us to understand our OWN emotions, too. We can't always read ourselves any better than we can read other people. Insofar as we're not naturally talented at emotional processing, we need help to understand ourselves. Or we at least need a lot of hard work at it.

As a concrete example, something I always hated was advice to "practice self-care". How the hell was I supposed to practice self care? I already wasn't doing anything, I was already eating like Jabba the Hutt, I was already playing video games all day! How was I supposed to go any easier on that than I was?

But from my current understanding, I can explain it a little better.

Remember how I've been framing all of this as a sort of environmental barrier? Well, self-care means "devote your energy towards environmental improvement and towards replenishing the emotional energy you're expending trying to overcome that environment".

For example, for me, self-care is not not cleaning up my room. It is, in fact, cleaning up my room. Why? Because a cluttered environment is distressing and distracting for me. It creates an environmental barrier that worsens my mental health. And as a result, it adds a tax to everything else I do. I'm paying "interest" every day I don't clean my room, so cleaning it is like paying down credit-card debt for someone in financial trouble. It's a way to stop the rate at which things backslide.

Or for me, self-care is not playing video games all day every day. Because what that often is for me is avoiding things that are distressing me. They're still there, they're still distressing me, I'm just not focused on them (so they can never become salient enough to act). Instead, I have to take care of those things that bother me, THEN go play video games to let my brain wander the way it wants to after burning some of that energy.

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The broad point I want to make here is this: you are trying to make big, sweeping changes to your life. You can't actually do that. What you can do is make small improvements that start to tilt your life in the right direction. And then down the line, you'll have more tools to make other small improvements. It's a process of building momentum, not a thing you do all at once. You cannot "change your life". You can take one small action that will eventually lead to a chain that will, almost imperceptibly, change your life eventually. That's true even for neurotypical people, but it's especially true for you and me, buried as we are in multiple layers of emotional and motivational processing problems.

You CAN beat it. You just can't beat ALL of it TODAY. And you are NOT a bad or broken person for struggling. You're just a human being trying to do something very hard.

Search for a partner who kicks you in the ass.

And if your memory problems do not have genetic or other physiological causes, do physical exercises and try diets. If a keto-like diet does not work, try a carbo rich one.

Lions mane mushroom is effective for boosting cognition.

Practice meditation.

Stop striving to hit other people's targets. Find what makes you you.

I've heard of lasting negative effects from Lion's Mane. I wouldn't blindly take it without assessing risks. /r/LionsManeRecovery

Interesting. I get ads on TikTok for a drink with Lion's Mane in it:

https://www.drinkbrez.com/

And I recently bought protein bars (from an ad on TikTok) which turned out to have Lion's Mane:

https://www.eatiqbar.com/products/chocolate-mint-chip

A. Therapy, but only go to a therapist with objective and practical plans for results, even if that may take a few sessions. Any therapist that just offers vague solutions is leading you on. Do not trust therapists that solely affirm you and never challenge you to change your behavior. Everyone has room for improvement; so it’s not worth paying $100+ a session to learn that you are perfectly fine.

B. Remove strong dopamine stimulants from your life (if any) at least for a little while. Dopamine is powerful, but desensitizing. Your brain likes a balance of ups and downs - extreme ups cause everything else to be perceptually lower. This perceived lower outlook often then increases the very need for the thing creating the high, causing a vicious cycle. Alcohol and Porn are the big ones where, anecdotally, you can notice significant changes in your outlook after a month of fully abstaining. Other people may need to cut back or remove Video Games and excess Food for a while. What is important though is that dopamine is dopamine, your brain can get it from many places, so be careful to remove and not replace.

C. Consider your spiritual life. I’m personally Catholic, and will always strongly recommend and beg that you begin investigating that (as I’m showing my bias here); but if you are not at peace with God (or even whatever you honor), it will mentally eat at you. Dante’s Inferno may have demons consuming humans in Hell - but the mental anguish from a guilty conscience will eat at you in this life.

D. When you know there’s nothing seriously wrong with you (therapy); have your mind mentally balanced (removing strong stimulants); and believe yourself to be in a spiritually good place (no nagging conscience); efforts to exert your will or follow guides to becoming more ordered and focused will, in my opinion, have a much higher likelihood of success as the serious boulders in the road will have been removed.

I like your list.

I think you can replace religion in C with mindfulness / meditation. There are community aspects to organized religion but, at least in the US right now, those carry some (a lot of?) negatives that might not be helpful. But an open mind and curiosity about the mystery of life can prove useful without the structure of organized religion.

I firmly believe in what you would call my organized religion; but I’ll give you some food for thought on why I’m not sold on your vision.

The biggest problem, or negative, with unorganized religion or meditation is what I would call the excessive focus on oneself. What is good is what feels right to me as good; what is bad is what feels right to me as bad. This is very subjective and can easily go down a rabbit hole where your religion, is ultimately, your own ability to rationalize your own actions and perspectives. Meditation can also easily backfire into an exercise in forcing your conscience to conform to what you mentally want to believe, regardless of whether it is true.

I am not saying that “organized religion” does not have serious downsides - I believe that any objectively false religion will have enormous consequences. However, I think that almost all of them do recognize one fundamental principle: Good, and Evil, are external properties of us, and our own feelings or preferences or desires or inclinations, have no bearing on whether an action is objectively Good or Evil. It takes an external force (e.g. God) to define what it is, so that we may understand and conform to it - otherwise, we are God.

In a sense, everyone believes in a God. Everyone believes that somebody defines good and evil. Either it’s an external force to which we must logically conform, or it’s ourselves. This is also why people of extraordinary evil (Hitler, Mao, Stalin) are also worth critically examining - after all, the God they worshiped in themselves did not condemn their actions. Why is your personal God better than theirs?

Please, take a Philosophy 101 class. You may be surprised to find your pet ideas about everyone having a god (defined in a way that is effectively meaningless) has been considered and long since moved past.

This would have been taught as Philosophy 101 before Christ was even born, as even the Greek and Roman religions understood that good and evil are objective concepts defined by something. And they must be defined by something, or rape and cannibalism are not crimes. After all, animals do it all the time, it’s only natural. Thus, what is natural, is not necessarily how we ought to act.

Also, what a hilariously weak comeback that doesn’t address anything I said. On that note, I’ll take over 2400+ years of philosophy before I take a modern philosopher sharing the news about his brilliant new idol. Don’t let the novelty fallacy blind you to the fact that even you have an idol - the idol that ironically claims we’ve moved past idols.

> only go to a therapist with objective and practical plans for results, even if that may take a few sessions. Any therapist that just offers vague solutions is leading you on.

No, therapy is also a place to practice relating, eg vocalizing emotions, setting boundaries, or mending ruptures. Therapy is, after all, also a relationship.

"Vague" solutions are, of course, "no true scotsman," but yes, therapists should be able to offer concrete, actionable coping tools--explain them to you, and help you process your attempt to put them into practice.

I don't see a reason, however, to see a therapist who finds fault with me that I don't, myself, consider a problem. Let my friends and relations stage the interventions if need be. ;)

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