Essays by Vivek Jayadeva, MD
Insights
Writing about psychiatry, psychotherapy, medication, and the conditions shaping how people think, feel, and live.
These essays examine clinical questions that do not always fit neatly into a diagnosis or a brief prescription encounter.
Editorial focus
Questions that deserve more time
Psychiatric symptoms rarely occur in isolation. Medication response, sleep, stress, relationships, physical health, technology use, and the demands of daily life may all affect what a person experiences and what treatment is likely to help.
The writing here explores those intersections without presenting a single prescribed way to live or reducing every difficulty to a medical diagnosis.
The purpose is to make psychiatric thinking more understandable while preserving the complexity of the person being considered.
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The Insights archive remains available as a professional and educational resource independent of current clinical availability.
Sattva Psychiatry is not currently accepting new patients. The practice is not maintaining a waiting list or providing an estimated reopening date.
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Essays and clinical reflections
Browse current writing from Sattva Psychiatry.
Practice availability: Sattva Psychiatry is not currently accepting new patients or maintaining a waiting list.
Educational use: These essays provide general information and do not constitute medical advice, establish a physician-patient relationship, or replace individual evaluation.
Why Multitasking Can Worsen Attention and Mental Fatigue
Multitasking feels efficient because it creates the sensation of movement. Messages get answered, tabs stay open, small items get touched, and the day appears full. What often goes unnoticed is that this kind of fullness can come at the cost of continuity.
The mind is usually not doing many things well at once. It is repeatedly leaving one task before it has fully become organized thought.
Most so-called multitasking is really rapid task-switching, and switching has a cost. Each shift requires the mind to disengage, reorient, recover context, and rebuild working memory around a new target. Those costs may seem small in isolation, but repeated often enough, they can shape the quality of the whole day: thinner concentration, more mental fatigue, more irritability, and more unfinished cognitive residue.
This matters clinically because the problem is not only reduced productivity. Repeated fragmentation can affect the texture of experience itself. A person who lives in constant switching may lose the feeling of sequence. Thoughts stay shorter. Emotions become easier to react from and harder to reflect on. Even rest may become less restorative because the mind has been trained toward interruption so often that it struggles to remain with one thing long enough to settle.
This is one reason many people feel mentally crowded even when they are not doing objectively extreme amounts of work. The crowding comes not only from workload, but from the number of open loops. Attention gets divided into partial starts, partial returns, and partial completions. Life becomes full of re-entry costs.
A careful psychiatric evaluation may be useful when distractibility, mental fatigue, irritability, avoidance, or difficulty completing tasks become persistent and hard to explain. These symptoms can reflect ADHD, anxiety, depression, sleep disruption, burnout, medication effects, workload strain, or the cumulative effects of chronic interruption. The right treatment depends on understanding which pattern is actually present.
The answer is not perfection or rigidity. It is to rebuild conditions under which continuity becomes possible again: fewer open channels, fewer parallel demands, more monotasking, more deliberate batching, and more protected time for deeper work. The mind generally works better when it is allowed to arrive somewhere before being asked to leave again.
A practical starting point is to pick one recurring part of the day and protect it from switching. One task, one window, one purpose, for a set period of time. The goal is not maximum output. It is to retrain the mind’s ability to stay.
“What multitasking erodes first is not efficiency, but continuity.”
References
- Monsell S. Task switching. Trends in Cognitive Sciences. 2003;7(3):134–140.
- Leroy S. Why is it so hard to do my work? The challenge of attention residue when switching between work tasks. Organizational Behavior and Human Decision Processes. 2009;109(2):168–181.
- Miller EK, Buschman TJ. Cortical circuits for the control of attention. Current Opinion in Neurobiology. 2013;23(2):216–222.
Why Willpower Is the Wrong Frame for Many Mental Health Problems
People often talk about willpower as though it were a fixed personal trait: something a person either has or lacks. Clinically, self-control is usually more state-dependent than that. It changes with sleep, stress, emotional load, overstimulation, hunger, substance use, conflict, and the number of decisions a person has already had to make.
This is part of what makes decision fatigue so misleading. By the end of a demanding day, people may interpret mental drift as laziness, weakness, or lack of discipline. But sometimes the simpler explanation is that the capacity for deliberate choice has been worn down.
When regulatory capacity is lower, the mind starts looking for relief. It may become more impulsive, more avoidant, more reactive, or more likely to default to whatever is easiest, most familiar, or most immediately rewarding. This can affect eating, spending, procrastination, bedtime routines, irritability, medication adherence, and follow-through on important tasks.
This matters in psychiatric evaluation because many people are trying to make their hardest decisions precisely when their capacity is lowest: after a long workday, after conflict, during sleep deprivation, while overstimulated, or in the middle of anxiety or low mood. In that state, even small choices can feel heavier. Judgment narrows. Patience drops. Planning may be replaced by urgency, avoidance, or postponement.
The lesson is not that people are powerless. The lesson is that good decision-making depends partly on conditions. If anxiety, depression, ADHD, insomnia, chronic stress, or burnout are present, the problem may not be solved by telling oneself to “try harder.” The more useful question is often: what is repeatedly draining the system, and what structure would reduce unnecessary load?
Structure is not the opposite of freedom. It is often a way of protecting thought. Simplifying repetitive routines, reducing unnecessary choices, improving sleep regularity, limiting overstimulation, and making important decisions earlier in the day can preserve capacity for the decisions that actually matter.
A practical starting point is to identify one part of the day where the same low-value decisions keep consuming energy. Meals, clothing, scheduling, bedtime, email, and household routines are common examples. Simplify one of them in advance. Fewer trivial choices can leave more room for judgment, flexibility, and follow-through.
If decision-making, avoidance, impulsivity, or follow-through have become persistently difficult, a psychiatric evaluation can help clarify whether the issue is primarily stress, sleep, anxiety, depression, ADHD, burnout, medication effects, or some combination of these factors.
Better judgment often depends less on stronger will than on better conditions.
References
- Vohs KD, Baumeister RF, Schmeichel BJ, Twenge JM, Nelson NM, Tice DM. Making choices impairs subsequent self-control: A limited-resource account of decision making, self-regulation, and active initiative. Journal of Personality and Social Psychology. 2008;94(5):883–898.
- Inzlicht M, Schmeichel BJ, Macrae CN. Why self-control seems but may not be limited. Trends in Cognitive Sciences. 2014;18(3):127–133.
- Sirois FM, Melia-Gordon ML, Pychyl TA. “I’ll look after my health, later”: An investigation of procrastination and health. Personality and Individual Differences. 2003;35(5):1167–1184.
When Sleep Problems Look Like Anxiety, Depression, or ADHD
Sleep problems are often treated as secondary to mental health symptoms, but clinically they can sit near the center of the picture. Poor sleep can worsen anxiety, depression, irritability, attention, emotional regulation, and the ability to recover perspective after stress.
This matters because sleep disruption does not only cause fatigue. When sleep is shortened, irregular, or fragmented, the brain has less reserve for the next day. Minor stressors may feel larger. Thoughts may become more repetitive. Frustration tolerance may drop. Attention may become more scattered. A person may feel more emotionally reactive, less motivated, or less able to experience reward.
In psychiatric evaluation, sleep is important because it can both worsen existing symptoms and create symptoms that resemble anxiety, depression, or ADHD. Someone who is chronically underslept may appear inattentive, emotionally thin, forgetful, irritable, or overwhelmed. That does not mean sleep is always the whole explanation, but it often changes the terrain on which every other symptom is unfolding.
Good sleep is not always noticed when it is present. Its effects often show up indirectly: steadier mood, better frustration tolerance, clearer thinking, more flexible judgment, and more room between impulse and action. Poor sleep can be deceptive because people often adapt to feeling off-baseline and begin treating that version of themselves as normal.
A careful psychiatric evaluation looks at sleep as part of the whole clinical pattern. The question is not simply whether someone is sleeping “enough.” Timing, regularity, depth, awakenings, daytime sleepiness, medication effects, alcohol or substance use, medical conditions, anxiety, depression, and circadian rhythm all matter.
This distinction is important because treatment depends on the underlying pattern. Insomnia related to anxiety may need a different approach than delayed sleep phase, depression-related early morning awakening, medication-related sleep disruption, untreated sleep apnea, or ADHD-related bedtime dysregulation. Treating the wrong problem can lead to persistent symptoms even when a person is trying hard to improve.
A practical starting point is to look at the past two weeks of sleep before assuming that worsening mood or concentration means something new is wrong. Consider bedtime, wake time, awakenings, total sleep time, sleep quality, alcohol use, caffeine timing, screen exposure, and whether sleep feels restorative. The pattern usually matters more than one bad night.
If mood, anxiety, attention, or irritability are worsening alongside disrupted sleep, psychiatric evaluation can help clarify whether sleep is the main driver, a contributor, or one part of a broader clinical picture.
Sleep restores more than energy. It restores margin.
References
- Yoo SS, Gujar N, Hu P, Jolesz FA, Walker MP. The human emotional brain without sleep — a prefrontal amygdala disconnect. Current Biology. 2007;17(20):R877–R878.
- Xie L, Kang H, Xu Q, et al. Sleep drives metabolite clearance from the adult brain. Science. 2013;342(6156):373–377.
- Baglioni C, Battagliese G, Feige B, et al. Insomnia as a predictor of depression: A meta-analytic evaluation of longitudinal epidemiological studies. Journal of Affective Disorders. 2011;135(1–3):10–19.
When Attention Problems Are Not Simply ADHD
Attention problems are one of the most common reasons adults begin to wonder whether they have ADHD. That question is often worth taking seriously. But attention is also affected by anxiety, depression, sleep disruption, chronic stress, medication side effects, medical conditions, substance use, trauma, and the constant interruption built into modern life.
This matters because poor attention is not only a productivity problem. It can affect emotional regulation, frustration tolerance, working memory, decision-making, and the ability to stay with a thought long enough to understand it clearly. When attention becomes fragmented, people may feel scattered, reactive, forgetful, inefficient, or mentally thin. They may also begin to interpret these difficulties as laziness or lack of discipline.
A careful psychiatric evaluation looks at attention in context. The goal is not simply to decide whether someone “has ADHD” or does not. The more useful question is often: what is interfering with attention, and what kind of treatment would actually fit?
For some adults, longstanding ADHD is part of the picture. For others, attention worsens during periods of anxiety, depression, burnout, sleep deprivation, grief, hormonal change, or excessive task-switching. In many cases, several factors are interacting at once. Treating the wrong problem can lead to frustration, unnecessary medication changes, or a continued sense that nothing is working.
Improving attention often begins with restoring the conditions under which continuity is possible: adequate sleep, fewer interruptions, realistic workload, treatment of anxiety or depression when present, and medication decisions that match the actual clinical picture. Small changes can matter, but they are most useful when guided by an accurate formulation.
A practical starting point is to protect one 20–30 minute period each day for uninterrupted attention. No notifications, no parallel tasks, no background stimulation. The goal is not just productivity. It is to rebuild the capacity to remain with one stream of experience long enough for thought to deepen.
If attention problems are persistent, worsening, or difficult to interpret, a psychiatric evaluation can help clarify whether the issue is ADHD, anxiety, depression, sleep, medication effects, stress physiology, or some combination of these factors.
Attention does not just shape performance. It shapes the kind of mind you have to live inside.
References
- Posner MI, Rothbart MK. Research on attention networks as a model for the integration of psychological science. Annual Review of Psychology. 2007;58:1–23.
- Smallwood J, Schooler JW. The science of mind wandering: Empirically navigating the stream of consciousness. Annual Review of Psychology. 2015;66:487–518.

