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.

Practice availability

The writing remains available while scheduling is paused

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.

Writing archive

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.

Vivek Jayadeva Vivek Jayadeva

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

  1. 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.
  2. Inzlicht M, Schmeichel BJ, Macrae CN. Why self-control seems but may not be limited. Trends in Cognitive Sciences. 2014;18(3):127–133.
  3. 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.
Read More