Hasn't Showered in a Week: Executive Dysfunction

"Executive dysfunction is commonly seen in major depression. The types of executive deficits seen in depression include problems with planning, initiating and completing goal-directed activities. Executive dysfunction may vary as a function of the severity of depression." (Source) 

Executive dysfunction is sleep paralysis for people who are awake.
Photo by Jose Pablo Garcia on Unsplash 

Awake Paralysis

Executive dysfunction is hell because it turns the simplest tasks into a feat of endurance.

Our brains are complex creatures. The sheer array of functions and processes that a human brain carries out on a daily basis is astounding. The term "executive function" refers to a large collection of such processes. (Source)

So the term "executive dysfunction" is also a catch-all. It can mean the interruption of any of these functions. So we see this term crop up in a variety of contexts, ranging from brain injury to depression. 

I want to discuss executive dysfunction in the context of depression. It's nice to know that a term exists for the inexplicable. It's nice to know that the hell I've gone through for the past 14 years has a name. That other people have recognized it, at least to the extent of giving it a label. 

Even if that label has to be shared with a whole bunch of other stuff. 

For me, executive dysfunction is mental paralysis. It's half-heartedly binge-watching Rake while every part of my body screams for water. Four and a half hours of being so thirsty that I cannot sleep, cannot think, cannot even switch a tab. 

It's the forty-five minutes of effort it took to send a simple text to my flatmate. "Are you up?" Why? Because I need bread, and I need milk to be able to make the simplest breakfast I can muster up the energy for. And I need to know if the stuff she ordered has come, or whether I need to also make the additional effort of ordering more. 

All that translates into three words: "Are you up?" And an immediate collapse back into paralysis when no response is forthcoming. 

Executive dysfunction is hell because it turns the simplest tasks into a feat of endurance. It interrupts stuff like eating, drinking water, or going to the bathroom. If even these most primal instincts can be left in disarray, what hope do I have of getting a degree or finding a new job?

When All Else Fails, You Still Have Stigma

The phenomenon that has caused depression sufferers to be labelled "lazy".

Executive dysfunction may turn me into an inanimate lump, but there's a secret bonus! I also get to hear all about how I'm lazy and useless from "well-meaning" people around me. 

"Did you spend all night and all day watching TV again?" "Why didn't you register for your exams?" "All you had to do was attend four hours of class a day." "Why aren't you eating well?" "You're wasting your potential." "Have you even taken a shower this week?"

Depression sufferers have heard that we are "lazy" for so long. Most of us have even internalized it at some point or another. People around us tell us that we are not even good enough to do the most fundamental things. We believe and accept this notion because it's coming from people we love and trust. And also because depression naturally lends itself to negativity. Anything that reaffirms your worldview of low self-worth must be true. 

This in turn worsens the depression and the executive dysfunction. We end up accepting that this is who we are: someone who doesn't shower, and who wears the same thing for days on end. Someone who won't eat properly or study anything, or come to work on time. 

And the further down our own estimation of our social worth goes, the harder it becomes to get out of this cycle. 

What To Say To Your Friend Who Hasn't Showered in a Week (Or More)

Getting your friend an understanding and experienced therapist may be the greatest gift of them all. 

Stop Judging! 

Let's start with what not to say:

• Eww!
• What is wrong with you?
• Have you even showered this week? 
• You're to going to get [insert consequence] at this rate.

Your friend knows the consequence they're going to get hit with. In fact, they're probably already dealing with it. It's probably making things even more difficult for them. 

So lay off the judgment. How can you be helpful instead?

Help them with some task that is weighing on them.

If you have the spoons for it, help them with smaller things that are easy for you right now, but not for them. Maybe it means tidying their desk or bed. Maybe it means helping them arrange something they've been putting off. Maybe it means getting them an appointment with a/ their therapist. 

Make it easier for them to do the thing they're dreading

You can do this for them, or suggest it to them, depending on what works. Maybe it means reducing the amount of effort required to do something. Like filling a bottle of water so they get some respite from the dysfunction until the bottle is empty. 

Or it can be about incentivizing. Introduce a new element - a sweet-smelling shampoo or shower gel, a bathrobe they can wear after their shower. 

Pull them out of the rut 

Sometimes just conversation can help. Tell them a funny story. Maybe they're the type of person who can help other people but not do anything for themselves. If so, ask for their input with something you're working on/ struggling with. 

Be Mindful of Boundaries

Helping people who are struggling with depression is always subjective. "Helping" doesn't mean trampling all over their boundaries with your idea of what's helpful. 

For example, my room in college was always a dump. But any of my friends coming in and forcibly cleaning stuff always put me in unimaginable distress. I eventually got a single room so I could live inside my dump in peace, where it didn't bother anyone else. For me, the mess was comforting. It was disgusting, but it was also my cocoon. I had important things hidden somewhere in the mess. Things I would find eventually when I cleaned the mess up. 

If you don't know what works, ask

Ask if they'd feel better if you did Xyz thing. Ask what needs to happen for them to feel better. And if there's anything in that list that you can do, do it for them. 

Check Your Own Spoons 

Don't help unless you have the energy (the spoons!) for it. It's perfectly alright for you to focus on sorting out your own problems instead. It also means you're less likely to get annoyed and lash out at them when nothing you try works. 

Nothing Worked. And That's Okay.

Depression isn't an easy thing to fix. There are often layers upon layers of answers to the question of "what's wrong?" Recovery isn't linear either - people feel better and then maybe they feel worse. That's why intervention from mental health professionals is so crucial.The best solution for disordered habits or executive dysfunction is a therapist. Getting your friend an understanding and experienced therapist may just be the greatest gift of them all.