As I was walking into work this morning, thoughts were rattling around in my head. And as I sit here writing, I was tempted to write something to the effect of "I was thinking about...", but I can't say that "I" was directing my thoughts in any particular direction. Here it is appropriate to use passive phrases such as "were rattling around," because the things that were being thought were arising spontaneously without some conscious aspect of myself choosing the subject matter or even the content of what arose.
And what was rattling around was related to my most recent post called Anomie vs depression. In that, I posit that there is descriptive language that better portrays the phenomena I see in my clinical practice every single day than does the diagnostic language of depression. Diagnoses are simply particular kinds of descriptions that are officially sanctioned. And I recall the story in the post of the ways in which certain kinds of phenomena were grabbed by the DSM nosologists of the 1970s and came to exist under the diagnostic rubric of depression.
What "I"—the more directed conscious aspect of myself—realized as those thoughts rattled around on my walk this morning is that I put forward the language of anomie as a replacement for depression, but I didn't spend much time talking about the phenomenology—the interior lived experience—of anomie. And further—insert gasp here—I didn't apply my every ready adhd lens to the discussion. As I will demonstrate, anomie and adhd are intimately linked.
To recap, anomie is a descriptor of the way people experience times in which there is social upheaval characterized by uncertainty, normlessness, and alienation of people to each other, themselves, and their environments. My hypothesis is that during these times, the informational processing burdens placed on each person in these communities is characterized by this pervasive sense of uncertainty is much more substantial than people who live in more stable/traditional communities. And it is precisely this burden that produces the phenomena that I and every other Counsellor working today sees in their office every day. I roughly categorize these into first order problems, such as insomnia, fatigue, fogginess, chronic pain, emotional dysregulation, restlessness, hopelessness, and groundlessness. And then all the other issues, such as alcohol, cannabis, shopping, gambling, etc., I call second order problems and are designed—but ultimately fail—to address the first order problems.
We are living in a time that is characterized by social upheaval and uncertainty. Durkheim's work on anomie dates from the late 19th century, which was characterized by great migrations internationally and intra-nationally from rural environments to urban. Perhaps we could call that uncertainty social: that is, the manner in which people should treat each other, relate to each other, from the standpoints of race and sex and class. But today... I would call our current sense of uncertainty existential. We still have all the same uncertainties of the 19th century—those never really got resolved—but now add to that the spectre of nuclear annihilation and environmental collapse. Our contemporary uncertainty is whether our biosphere will continue to support life in the way it has since the beginning of human history. Now that... is proper uncertainty.
But the question for me is how the lack of social clarity and environmental uncertainty effects the physiologies of the people who spend time with me therapeutically? How does it produce those first and second order problems enumerated above? What is the relation to adhd? And... what can be done to combat or live with it?
First, a pointed question: which is heavier, wearing a 25kg backpack and having to walk around with it all day every day or not knowing if you and the people in your life are going to be safe—in whatever way you want to conceptualize "safe"—on a day-to-day basis? The reason I pose this question is that clients who struggle with the first and second order problems I named above regularly use the language of heaviness, feeling weighted down, burdened, or most recently a client talked about their feeling of walking around with a yoke.
For me, I make no distinction between carrying around a burden that has a verifiable weight, like a heavy backpack, or a psychic burden. Both require the expenditure of energetic or metabolic resources. Both require the use of ATP (adenosine triphosphate), which is the primary source of energy in your cells. It gets used by the cells in muscles, and it gets used by cells in your brain and nervous system. This means that it makes no difference whether your burden is measured in weight or worry. All the ways in which we shoulder our responsibilities and burdens cost the metabolisms of the people who shoulder them.
The key function of your brain is to keep your body safe. And the main way your brain does this is through prediction. Lisa Feldman Barrett claims this in no uncertain terms:
Prediction is such a fundamental activity of the human brain that some scientists consider it the brain’s primary mode of operation. Lisa Feldman Barrett, How Emotions are Made, p. 60)
And this is precisely where the relationship of uncertainty and normlessness meet the first and second order problems that I see in session: lack of certainty in one's present produces the requirement for much more intensive thinking/projecting/simulating potential futures. The degree to which one experiences uncertainty is directly related to the amount of ATP required to simulate all the possible futures in which your brain projects you could land. Remember, prediction is considered to be the "brain's primary mode of operation," and, as such, it consumes the most resources.
Please note: much of this—the great majority—is non-conscious processing. Just as I introduced this post with a little riff on how thoughts and feelings spontaneously arose for me on my walk into work, the work of prediction in which your brain engages is not consciously directed. You feel anxious about the future. This is a passive process. You don't direct your thinking and emotions towards a future problem and then direct your body to experience anxiety. Anxiety happens to you. Or maybe... it might be more accurate to say that anxiety is constitutive of your you-ness in that moment.
The central point here is that the uncertainty of one's environment is directly related to the resources your body uses to simulate, project, and predict the future. And the more uncertainty there is in the environment, the greater the processing burden. Think about it from the 18th century farming family I imagined in the previous post: these were people who were born into a farming environment as were the many generations who preceded them. Men, women, and children knew their roles, and they knew they would remain farmers as would their children. There is not much of a future to predict, and while from our contemporary vantage we might see that as terribly constrained and perhaps even sad, it is the case that those people spent very little in thinking about how things would go. It was a hard life, but it was extremely predictable. Those people spent the majority of their ATP on carrying heavy physical burdens than they did psychic ones.
Extreme physical labour produces fatigue and exhaustion. This is uncontroversial. Extreme cognitive and emotional labour produce the same. The difference is that physical labour is bounded by one's relationship to the thing one labours on or with. The psychic labour of prediction can be 24/7... because for some, that labour can extend into the time when we require sleep and rest. The kinds of issues I see in my clients are precisely the result of their incapacity to stop the psychic labour of prediction.
The first order issues I see in session are all the result of a lack of metabolic resources. It's worth noting that I am working and writing in Vancouver, and those who live here know of the burden of simply making enough money to live. Vancouver has become one of the most expensive cities to live in the world, and the hours people need to labour to pay their mortgages and rents is an extra resource expenditure on top of the uncertainty and normlessness I have been describing.
Let's do a quick recap:
- It's the brain's main purpose to keep one's organism—one's body—safe.
- The main way it does this is by anticipating/projecting/simulating potential futures.
- The greater the degree of uncertainty in a person's world, the greater the metabolic resources necessary to anticipate/project/simulate potential futures.
- Each person's physiology is unique, but all human physiologies can be overwhelmed by the informational processing requirements associated with uncertainty and normlessness.
- The first order issues—insomnia, fatigue, fogginess, chronic pain, emotional dysregulation, restlessness, hopelessness, and groundlessness—are produced as a result of the incapacity of person to shoulder the burden of their futural processing requirements.
- Second order issues are strategies used by people to overcome their first order issues.
- Those who struggle with second order issues must also attend to their first order struggles.
Let's look at the first order issues: they all point to metabolic insufficiencies. By that, I simply mean that the phenomena I am calling first order issues are all manifestations of some sort of organic energy deficit. Two of them—fatigue and fogginess—are explained in the most straightforward fashion: fatigue and fogginess are simply a deficit of resources to run your body. And as I sit here writing, it strikes me that fatigue and fogginess are, in fact, the aspects of the same phenomena. After all, it is difficult to think of a scenario where one is physically fatigued but cognitively sharp. And it is hard to think of a scenario where one is cognitively foggy and physically energetic. And this is as it should be, because though we might like to leave some space for something called "mind," there is no distinction between brain and body. It's all just body.
So... fatigue—which now includes fogginess—is a lack of resources to start physiological processes in motion. That seems straightforward. But the rest of these first order issues do not represent the incapacity to start processes but the requisite resources to stop of cap or inhibit processes already in motion. I won't go over all of these, but let's just take a couple as examples.
We generally think of insomnia as the inability to get or to stay sleep. But in the context of this metabolic resource analysis, insomnia isn't the inability to sleep but the inability to not stay awake. That may strike the reader as either very odd or a semantic distinction. Here's why it's an important difference: getting to sleep and staying asleep take energy. Or to put it another way, there are significant energy requirements to remaining still. This is one of the most common complaints that I hear from clients. It generally goes something like this:
As I mentioned, getting to sleep and maintaining sleep cost metabolic resources, and when exhausted... those resources are not available. This gets us back to the idea that insomnia isn't the inability to sleep but the lack of metabolic resources necessary to stop or cap or govern or inhibit your futural projections. And in an environment where there is a lack of rules or norms or laws, the need to engage in simulation/projection/prediction increases. In an environment where there is an absence of certainty, there will necessarily be a surfeit of anticipation.
The exact same explanation holds for the first order struggles such as emotional dysregulation or restlessness. Emotional dysregulation is not a surplus of emotion but a deficit of the resources to remain regulated. Restlessness isn't a surplus of movement. It is the lack of resources needed to remain still—just as in our sleep example.
In the end, there are only two basic ways of treating these sorts of first order issues that rise out of an environment characterized by uncertainty and normlessness: to find more metabolic resources or to find ways of existing in the world in a more energy efficient way.
The first is certainly the more attractive solution. In finding more resources, it means you don't need to make any changes, i.e. just add some hotter burning or more efficient fuels and continue. This is the reason why caffeine is the most widely used psychoactive substance in human history: it is what I might call a brute force attempt to shore up one's energy supplies to combat the first order issues mentioned above. And, of course, caffeine does work very well. But as we all know, caffeine has its limits. And abusing caffeine—which isn't really an abuse of caffeine but an abuse of one's physiology by pushing it past it capacities with caffeine—simply returns us to those first order issues of insomnia and fatigue and fogginess and emotional dysregulation at a slightly later date. In the end... no single body can stand up to the processing requirements of infinite possibilities.
If adding increasing amounts of fuel isn't a long term strategy, then... I guess we're stuck with finding ways of living in the world that require fewer resources. And unlike the brute force style of caffeine that is so attractive but ultimately fails in the face of ever greater energy requirements, living in the world in a way that requires fewer resources does require change. These changes I refer to as practices of inhibition.
Let me end there on a bit of a psychotherapeutic cliffhanger. In my next post, I will describe these practices of inhibition and get to—finally!—how anomie and its metabolic requirements produce the phenomena we call adhd.
