I keep going through the same thought processes without resolution

I don't think I am experiencing rumination because I'm not thinking about things I am especially worried about. Instead it seems that these things are tendentially problems that involve uncertainty and complexity.

It's as if my brain has difficulty being spontaneous and wants to analyse the problem to come up with a solution. It analyzes and searches for solutions, has difficulty concluding the search, then becomes tired and unable to make any progress. I then give up and decide to think about it the next day, but the next day it's as if a good portion of the memory containing the progress has been wiped and I have to redo much of the work. The end result is an often absurd inability to get things done. It can take me months to make a decision to see a dentist, buy something for my bike, buy train tickets, make up my mind about many things.

If I haven't made up my mind, I can't act. Or it feels that way. I'm not always so inhibited, but often.

I believed this was executive dysfunction, but I've been told that I have no executive dysfunction, at least on the particular test performed.

 

It's executive dysfunction caused by an issue in the limbic loop - basal ganglia, ACC and so on. These regions are responsible for the fluidity of thought and dysfunction there would cause those kind of symptoms. For some reason, nobody has ever thought to investigate this particular aspect instead of looking at viruses and T cells for the 200th time.

 

Do you have literature on this? Are there specific tests?

 

I don't, it's been years since I looked and have no energy to go and get it - as for tests, an example is the whole brain MRS Dr. Younger did - the biggest abnormality there was the cho/cr ratio in ACC. I did this test myself and it was replicated (in my case my abnormality was more pronounced than younger's patients, probably due to my severity)

Younger said elevated cho/cr is a marker of inflammation, but in reality it could be many other things. For example, if the basal ganglia wasn't working properly (for any reason), the ACC would have to go on overdrive to compensate and that could be reflected in abnormalities found in that region.

There are probably many tests that could be used to investigate this, but it's likely that they have to be tailored to find this problem. PET, qEEG, fMRI, evoked potentials and so on. I'm too sick to study so I had to give up on this and can't go in the details.

 

I just had the same issue. I was unable to comprehend my old code or hold multiple if-conditions in my head. The upshot was that it took several days to fix a DB bug which would've taken only a few hours normally.

It's a memory issue, not executive one. If you can't hold enough data in your cache memory, you will have difficulty comprehending, analyzing and deciding. You have to keep going back to the source and fetch, and by the time you fetch one piece, the other slips off your brain. So you keep repeating, get lost in the process, and give up. Then you repeat the same process the next day. Same problem pops up when cooking. Normally, I can juggle multiple burners at the same time. When I'm struggling though, I get lost and end up staring at the fridge or the cutting board.

 

It would be the same for me if I didn't put things in my diary as soon as I think of them. I schedule them for a random date in the future; if it's something that needs an appointment to be made first, I remind myself to make one on that day. Then I get a reminder popping up on my screen in the morning, and it nags at me till I do it.

I find (slightly surprisingly) that I usually do the things. They may get postponed for a day or so if something else has gone in the diary in the meantime, or if they involve going out and I'm just too tired, but they get done.

I adopted the system because I realised I had a block on decision-making. But if I diary things as if the decision has already been made, and regard them in the same way as the non-negotiable dates I had in my work diary, I just do them without the need for a thought- or decision-making process. It sounds a bit weird, but it works for me.

 

yes i experience this in a way i never did when well, or when i was more moderate, it has gotten worse i became more severe.

The only way i found to mitigate it a bit is to write it down, to spill the thoughts out into a big notebook. I start sections for each topic & leave several pages ( i got kind of used to how many pages the topic is likely to take, some are 4 page issues some 10, some a new notebook), and then i just kind of mentally spill, i dont try to make any sense of anything at that state its just a written record of the thoughts regardless of how much sense they make just recording all the processing/the experience.

That way, nothing is lost. I also have a sticky pad by my bed. That way whenever i think about the issue, regardless of what the thought is, i jot it down & put it in a special section of my bedside drawer. Then when I'm able i gather the notes & the book & i can see it all there together.
So although it takes a little more energy to jot stuff down at the time i'm thinking it, i find its outweighed by the benefit - which is that although i keep forgetting what i thought about, I can quickly look & when i see it written there i think 'ah yes i remember that now', so in effect i am starting not from square 1 again, but slightly further forward, which despite having to perhaps look at it & collate it several times, eventually it leads to resolution, because each time i am looking at the thoughts and the process from the previous days rather than starting from the beginning again.

For me its a glorified version of what i have to do to communicate when i am in PEM & very weak...
So for example if i want to say "Please can you bring me a cup of tea", i take a breath, start speaking but can only get the words "please can you" out, before i completely run out of steam. So a i have to rest a few moments before taking another big breath & mustering the strength to say the rest of the sentence....

But instead of saying, "please can you", taking a rest & then continuing with the rest of the sentence "bring me", take another rest, & then a "cup of tea". My brain just wont have it, & every time i have to pause with exhaustion/weakness, it resets & goes back to the flipping beginning. So i just keep repeating "please can you" over & over again.

Its very frustrating for me (and for carer who is waiting to find out what the hell i want her to do! LOL).

So i discovered if i write it down instead of speaking it, although i still have to stop after the first couple of words as too weak to write, when i go to start again i can see what i already written, & thus am able to then write the rest of the sentence instead of starting at the beginning again. (assuming the sentence isnt too long because then i cant understand what i already written, lol, but i cant deal in complex sentences when i bad anyway, so that rarely comes up.)

Edited to add: once i have finally made a decision, like @Kitty i have to very quick set a reminder, or several on consecutive days/weeks, for me to do the said thing, otherwise it will never happen.
But if its a thing to be done in the future, then at the point that i have scribbled & rambled & eventually come to a decision about something, i set the reminders to do it, but i also (& this is important for me) write down in the notebook at the end of the section in the notebook, about 'house roof' or whatever it is - 'Decided to do X, because _____ & then list the reasons, because i will very likely have forgotten the decision or the reasons for it by the time the reminder goes off. Which can then lead to the whole palava starting again!

 

I think it’s an executive function problem compounded by a lack of memory.
At times I struggle with double-negatives. Luckily I can intellectually understand the issue. At times I get lost in them as they are four things at once - the thing, the negative of the thing, and another thing with the negative of that. I can’t get past the first negative.
With bigger stuff like my PIP application, I could explain what I needed to do and how to go about it, in detail - but I couldn’t actually do it, I needed someone to help.

I have pondered whether there are other groups where people are aware of cognitive difficulties and can research, and explain the difficulties and differences? Usually it’s either the silly language like “brain fog/blonde moment/baby brain/senior moment” or people are busy masking - dementia.

 

All of this exactly for me too. It’s a great feeling of achievement to have ticked something off the list too.

Where difficult but not urgent choices are concerned, I may not be able to make a decision immediately which is not the norm for me so I find it distressing and confusing. I have to remind myself that if I wait a day or a week a solution always reveals itself.

 

Is ruminating a bad thing to do then? I thought rumination was just a synonym for "thinking" but perhaps with a hint of "obsessiveness" as part of it, but perhaps I'm wrong.

I ruminate on events that do worry me but they may have occurred at any point in my life. I might have questions that I can't answer or don't understand about what happened, and because of that I worry that my state of "not understanding" massively increases the risk of such events happening again.

 

Of course short term memory actually technically is part of executive function.
Agree it sounds like a big factor is waiting until there is ‘fit’ between suze/length of short term memory and the particular‘chunk’ of the problem needed to be analysed.

it may be eventually exhaustion and other drains lift enough you get that bit more from your short term memory and speed of being able to sift or whatever the task is. It may be that trying from different angles eventually means the right chunk is there it might be that circumstance changes to make it a different problem ur time becomes more if essence and it’s more obvious how ‘just getting something is better than nothing’ outdoes ‘can only spend the money once’

Difference indeed to someone who works who has times they can’t make and times they can narrowing things down (and if you are at dentist you aren’t in the office) vs predicting your health.

it’s a horrible illness for this very reason - gets you from every angle - the coping strategies snd work around a other disabilities might have often just involve energy or issues popping up elsewhere for us so it’s a slog just thinking through in the absence if us having really good groups of peopl with v similar disability and situation being able to provide reliable reviews and suggestions for everything.

the tropey stuff of ‘we’re tired too’ or peopl comparing having sleepless nights or hectic days from other sources as being the same is so sick for this reason.

 

I echo that problems in short term or working memory impact on decision making, that is problems holding the necessary information in awareness all at once. Although not exactly the same this is related to the memory need to dial a phone number, for example my digit span has drop from the normal 7+ to four or five and when in PEM it can drop to one or two. So now I can not just read a number and dial it, at my worst I have to put my finger on each number in turn and dial one number at a time. Related to this is my problems reading. I am fine with a single paragraph, but struggle to follow any thing that requires information from one paragraph to another. This makes reading books almost impossible, I used to read three or four books a week, both fact and fiction, whereas I now average less that one a year. Reading Brian Hughes book took me well over a year, having to re read most sections multiple times.

I suspect also related are my problems with novelty. I can now order my groceries on line, though not without some missing things out or occasional random things appearing in my shopping, but I struggle with on line ordering via unfamiliar sites. This also extends to motor acts: I am fine most days walking without a stick at home or in the garden even on rough ground, but need a walking stick, as much to focus my attention as anything when out and about even over relatively smooth ground.

I suspect this might best be characterised as reduce band width or channel width.

I don’t know if this is related but I have problems with larger organisation of information. For example here I deal with new posts or threads that appear on the front page, but struggle navigating the site as a whole to find specific things.

 

Thanks for adding that. I agree that often I'm not just trying to figure out how to do something, but how to do it with least stress and expenses, which complicates the analysis.

 

This also sounds very relevant. I think I might have both a problem with being slow in analysing complex issues and forgetting the progress made so far.

I did a test that supposedly measures one aspect of executive function. I believe it was the Stroop test. I passed with no errors. Yet I have much more difficulty with these issues than normal people.

On the other hand a cognitive test of increasingly complexity showed that my performance slows down with increasing complexity (more than is normal).

If this is a memory problem then it might be possible to mitigate it by taking notes and summarizing the important information. Then one can look at it and fit it all into working memory at once. If this helps, then it's presumably more a memory issue.

 

I have an avversion to beginning tasks where the amount of work and effort required for completion is unknown. This is probably because a person with high fatigueability and susceptibility to PEM hates ending up in the middle of a task with massive fatigue, stress, PEM and perhaps some outside pressure to continue, and then being forced to quit and adding the disappointment of failure to the physical symptoms.

Therefore the desire to analyse the problem thoroughly and plan carefully. With a good undersanding of what is required, what might go wrong and what needs to be done in case something goes wrong, I can feel more confident that it will all be manageable in terms of fatigue and PEM, and that I won't have to make spontaneous decisions under pressure and while exhausted.

 

I had a good example today of why postponing things to a random future date helps make decisions. The calendar ordered me to find and order some smart winter boots.

I have a good quality pair already. They look like big chunky ski boots but are much lighter, they have a hidden zip so I don't need to lace them, and as the price was reduced from over £200 to £55, they were a bargain as well. The only drawback is that if I wear them for a long time, my toes feel bruised and sore.

Replacing footwear is ridiculously daunting. My feet are different shapes, but as it's stressful trying to get a big powerchair into cramped shoe shops, I usually order online. I inevitably find some of them don't fit, and have to organise returning them in time to get a refund. Boots are the worst—harder to find a comfy pair than with shoes, they're expensive, and the return postage really adds up if I have to send back several pairs.

BUT ... in the meantime, I was going out one freezing day and dug out an old pair of sports socks to keep my feet warm. Wearing them made me realise my ski boots bruise my toes because they're a bit big and my feet move around inside them. The thick socks got rid of the problem, so instead of sorting out new boots, today's task is to order a couple more pairs of padded sports socks.

Thorny tasks involving multiple decisions do have a habit of sorting themselves out if I postpone them. Quite often, by the time the date for action dawns I've realised it's not as much of a priority as I thought, or I can sort the problem another way.



ETA: for anyone who struggles with this, isn't too picky, and doesn't need 'nice' boots, I strongly recommend secondhand army boots. Even though they're still in good nick, somebody's already done the hard work of wearing them in for you and they last for years.

I wear them for wildlife surveys, where they come in useful if I have to get out of the wheelie to wade through patches of deep mud (the chair gets bogged down with my weight in it). I replaced some secondhand Goretex-lined boots last year that had been doing sterling service since the early 1990s; the first pair I ordered turned out to be really comfy because they'd already been worn. They're high-spec boots that would have been expensive new, but they were only £33.

 

It’s one more ME paradox

Think about what you need to do/don’t overthink and use all your energy
Don’t overdo it/don’t do nothing