Communion Of Dreams

Decisions, decisions . . .
August 22, 2011, 11:55 am
Filed under: Alzheimer's, Health, Hospice, NYT, Science

There was an item making the rounds last week that I found pretty interesting. It was about the phenomenon of ‘decision fatigue’ where the process of exercising willpower to make decisions wears you out, and after a certain point you start making bad decisions until you take a break and give your brain a chance to recharge with rest, food, and a change of pace. You can find the full article here, and here is a good passage which sums up the research:

Decision fatigue helps explain why ordinarily sensible people get angry at colleagues and families, splurge on clothes, buy junk food at the supermarket and can’t resist the dealer’s offer to rustproof their new car. No matter how rational and high-minded you try to be, you can’t make decision after decision without paying a biological price. It’s different from ordinary physical fatigue — you’re not consciously aware of being tired — but you’re low on mental energy. The more choices you make throughout the day, the harder each one becomes for your brain, and eventually it looks for shortcuts, usually in either of two very different ways. One shortcut is to become reckless: to act impulsively instead of expending the energy to first think through the consequences. (Sure, tweet that photo! What could go wrong?) The other shortcut is the ultimate energy saver: do nothing. Instead of agonizing over decisions, avoid any choice. Ducking a decision often creates bigger problems in the long run, but for the moment, it eases the mental strain.

I think we’ve all probably experienced some form of this, and the long article goes into plenty of examples such as shopping, making the ‘decision’ to resist temptation (whether food or leisure or sex), having to go through and make judgments about difficult matters of fact, and so forth. I know that it is one of the reasons why I found editing Her Final Year so damned exhausting – fine distinctions between word choices and phrasing combined with the emotional content of the material meant that I could only effectively work on the book for 45 minutes or an hour a day.

And I think that there’s a connection to Alzheimer’s that this research clearly explains: the phenomenon of “sundowning“. Here’s a passage from Her Final Year, from an entry of mine titled “When does this plane land?” originally written 9/3/07:

There’s a phenomenon familiar to those who deal with Alzheimer’s. It’s called “sundowning”. There are a lot of theories about why it happens, my own pet one is that someone with this disease works damned hard all day long to try and make sense of the world around them (which is scrambled to their perceptions and understanding), and by late in the afternoon or early evening, they’re just worn out. You know how you feel at the end of a long day at work? Same thing.

And interestingly, that passage comes from the chapter October: Hospice or placement? which deals with the incredibly difficult decision of what to do with a loved one when you’ve reached a crisis point. A decision that any care-provider has to make in the face of years of exhaustion. A decision which they will probably second-guess for the rest of their lives.

Jim Downey

(Cross posted from the Her Final Year blog.)

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