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.
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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.
How Constant Availability Can Worsen Anxiety and Attention
Constant connectivity has a cost that is easy to miss because it rarely appears as a crisis. It more often shows up as thinning attention, shortened patience, shallower thought, and a nervous system that never fully stands down. Many people now live in a state of continuous low-grade readiness: always somewhat available, somewhat interrupted, and somewhat on call.
That is not just a cultural inconvenience. It can change the way the mind functions. When attention is repeatedly broken, continuity becomes harder to sustain. Thoughts stay shorter. Reflection is more easily replaced by reaction. The day may feel full without feeling coherent.
Over time, people may interpret this as a personal deficiency: poor discipline, weak focus, low motivation, or lack of self-control. Sometimes the better explanation is that the nervous system has adapted to chronic fragmentation.
This matters clinically because constant interruption can worsen anxiety, attention problems, irritability, sleep disruption, and emotional regulation. A person may rarely feel fully at rest, but also rarely feel fully engaged. The mind moves from cue to cue, demand to demand, message to message, without enough time for thought to deepen or emotion to settle.
The problem is not simply technology. It is the repeated training of attention toward interruption. A phone, inbox, or messaging platform does not only deliver information. It also creates a pattern of anticipatory readiness: the sense that something may need a response at any moment.
Connectivity also blurs an important distinction: the difference between contact and claim. A message may be only information, but it can feel like an immediate demand on attention, mood, and response time. Enough small demands accumulate, and the body begins to treat availability itself as a background obligation.
A careful psychiatric evaluation may be useful when distractibility, anxiety, irritability, insomnia, or mental fatigue become persistent and difficult to interpret. These symptoms can reflect ADHD, anxiety, depression, burnout, sleep disruption, medication effects, substance use, workload strain, or the cumulative effects of chronic interruption. The right treatment depends on understanding the pattern clearly.
Restoring steadiness does not require rejecting technology. It requires restoring conditions in which attention can gather itself again: fewer alerts, more monotasking, protected silence, clearer boundaries around response time, and more moments in which a signal can arrive without automatically becoming an obligation.
A practical starting point is to protect one 25-minute period each day in which nothing can reach you. No notifications, no parallel tabs, no checking between tasks. Treat it as training in mental continuity, not as a productivity trick. The point is to remember what your mind feels like when it is allowed to stay.
“What constant connectivity steals first is not time, but continuity.”
References
- Mark G, Gudith D, Klocke U. The cost of interrupted work: More speed and stress. Proceedings of the SIGCHI Conference on Human Factors in Computing Systems. 2008:107–110.
- Rosen LD, Carrier LM, Cheever NA. Facebook and texting made me do it: Media-induced task-switching while studying. Computers in Human Behavior. 2013;29(3):948–958.
- Kushlev K, Dunn EW. Checking email less frequently reduces stress. Computers in Human Behavior. 2015;43:220–228.
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 High Functioning Starts to Become Burnout
It all begins with an idea.
Burnout rarely begins with obvious collapse. It often begins while someone still looks capable, responsible, and productive from the outside. The early signs may even look admirable: staying responsive, taking on more, solving problems quickly, and pushing through fatigue without complaint.
That is part of what makes burnout difficult to recognize. Many people think of burnout as a failure of resilience or simply the result of working too much. More often, it is a prolonged mismatch between demand and recovery. A person may keep functioning, but the cost of functioning keeps rising.
Clinically, burnout can overlap with anxiety, depression, sleep problems, irritability, loss of motivation, emotional blunting, difficulty concentrating, and physical stress symptoms. It can also be confused with poor discipline or lack of gratitude, especially in high-achieving adults who are used to measuring themselves by output.
Ambition itself is not the problem. The problem develops when drive, self-worth, fear, and responsibility become too tightly linked. Rest starts to feel unearned. Limits feel like weakness. Slowing down feels less like recovery and more like falling behind. Over time, exhaustion stops feeling like a warning signal and begins to feel like the normal cost of being serious.
This is why burnout can remain hidden for a long time. A person may still be meeting expectations while becoming flatter, more brittle, less emotionally available, less able to enjoy success, and less capable of real recovery. Achievement continues, but nourishment drops out of the loop.
A careful psychiatric evaluation can help clarify whether burnout is occurring by itself or alongside anxiety, depression, ADHD, sleep disruption, medication effects, medical illness, or other contributors. That distinction matters because the right response is not always simply to “do less.” Sometimes the treatment target is mood, sleep, anxiety, workload structure, perfectionism, medication strategy, or the internal rules that make rest feel unsafe.
A practical starting point is to ask what currently counts as “good enough” in your work or responsibilities. Then ask whether that standard is actually required, or whether it is being maintained by fear, identity, guilt, or momentum. Burnout often persists because the internal rule is never examined.
If you remain outwardly functional but feel increasingly depleted, irritable, detached, or unable to recover, it may be worth looking more closely at whether high functioning has become a way of overriding important signals.
Burnout often begins while a person still looks competent from the outside.
References
- Salvagioni DAJ, Melanda FN, Mesas AE, González AD, Gabani FL, Andrade SM. Physical, psychological and occupational consequences of job burnout: A systematic review of prospective studies. PLOS ONE. 2017;12(10):e0185781.
- McEwen BS, Gianaros PJ. Central role of the brain in stress and adaptation: Links to socioeconomic status, health, and disease. Annals of the New York Academy of Sciences. 2010;1186:190–222.

