Updated: Jul 3
When it comes to current brain function, we often think of energy and focus as being important ways to gauge how well our brains are working. Turns out that there are technical ways to objectively measure specific parameters like memory, processing speed, executive function, and attention. But such tests are often cumbersome and expensive to administer.
So we end up relying heavily on a patient’s subjective experience of how well their brain seems to be working. This approach is clearly prone to interference as well as recall bias, but it is often helpful to apply a quantitative scale to what we are experiencing.
If you’ve ever been in a clinic or hospital before, you are probably familiar with the pain scale. Usually a nurse or doctor is asking you to rate your pain on a numeric scale from 0 to 10, with 0 being no pain at all, and 10 being the worst pain you’ve ever experienced. Because pain is a subjective experience and can’t be measured objectively, the pain scale is a tool that’s meant to help communicate how much you are suffering. This is not always easy when we’re in pain, but after a few tries even a child can learn how many fingers to hold up, to show how much it hurts. The smiley or frowny face graphics help too.
Pain sensations are electrical impulses communicated through nerve fibers to our central nervous system. But our experience of pain may be affected by any number of factors separate from those signals. For example, if I fall and break my leg while hiking in the boonies, I may experience more pain because I’m also fearful about being far from help. Or I may experience little or no pain because I’m with my child, and I need to protect her, so I’ll do whatever it takes to get us to safety. The point is that our experience of pain must always be taken in context, because our minds (i.e. past history and emotions) play an important role in how pain is interpreted.
This is why, as doctors, we will often see such different reactions to painful experiences. Some patients are very fearful of having blood taken, while others don’t have a problem. This may be related to a fear of pain, blood, or even of what the blood test result will show. Others may have had a traumatic or shaming interaction with doctors or needles from childhood. Mindset and psychology are very much part and parcel of how we think about and experience pain.
Apart from facilitating communication, the pain scale teaches our brains to compare this pain with other painful experiences and to put a number on it. Turns out that this skill of being able to go inward in our minds to ana;yze what is happening is a uniquely human attribute.
And when we begin to analyze a sensation, we shift from our limbic system, which is all about sensation and emotion, into the prefrontal cortex or higher cognitive centers. We get to rise above the experience of suffering when we get curious about it. That curiosity actually creates some distance from the physical sensation and gets us out of our emotional experience into a thinking experience.
Furthermore, when we have acquired the skill of tapping into how our bodies are feeling when it comes to pain, we can begin to do this with other subjective sensations like hunger or energy level. When you can put a number on that sensation, you are giving yourself a tool to gauge and track your progress as you go about trying out different solutions. For example, if I am always exhausted mid-afternoon, I might decide to try cutting back on carbs at lunch time, to see if that helps.
I’ll often encourage my coaching clients to do a baseline energy audit on a typical work day, and then on a weekend day, to see how their energy feels as they go about their daily business. If they have highly variable work schedules, they may need to average their experience over the course of 3-5 days. Don’t worry - there is no way to do this wrong. It is subjective after all, but as long as you can describe it to yourself, that’s good enough.
We get to rise above the experience of suffering when we get curious about it
So you would begin the day by recording a number from 0-10 first thing in the morning, where 0/10 feels like you can’t get out of bed and 10/10 is where you want to be at a dance party. You can do it in your journal, or on your phone. I might be 6-7/10 when I first wake up, and then an hour later, I’m usually 8-9/10. By mid afternoon, I’m usually more like 4-5/10, and then closer to 3/10 by evening time. And of course this fluctuates depending on whatever is going on that day, what I’ve had to eat or drink, and how much sleep or exercise I’ve had.
When I first started doing this kind of energy audit, I noticed that there were certain days when I would feel full of energy as I thought about what I had scheduled for my day, and on other days, I felt drained before the day had even begun. It’s like I had to dig deep with a “hunkering down” mentality in order to face the day ahead.
So that gave me considerable insight into how to mindset could help me manage my energy.
And this makes intuitive sense. Because I’m sure that like me, you know that certain people, situations, or tasks are exhausting, whereas others actually give us energy. The trick is to become aware of what is happening to your energy, because energy can be a fickle resource to manage.
Permission to choose
It’s important not to judge ourselves during this process of discovery. If, for example, we find that being with our kid or parent is exhausting, it doesn’t mean we’re a bad person. It just means that we are a human being having a human experience. And by noticing that experience, we are giving ourselves the power to change it.
For example, perhaps you like being with your mother when you are watching a fun TV show together, but not when she is nagging you about your weight. This gives us an opportunity to set boundaries. We usually think of setting boundaries with loved ones as being harsh, because it can feel like a way to exclude others. But you can choose to do it in a way that is kind, clear, and actually intended to nurture the relationship.
Noticing that we are having a human experience gives us the power to change it
To be clear, it’s totally okay to love someone, but to not want to spend all your daylight hours with them. When my son was a toddler, there was a brief moment when I considered quitting my day job to stay home with him. But then I realized that I only have a certain amount of patience and attention, beyond which I’m likely to become irritable and frustrated. It was not easy to admit to myself that I didn’t have what it took to be a full-time stay-at-home mom. But my acceptance and forgiveness of myself allowed me to be a happier human, who was ultimately a better mom.
As human adults, we get to set our own boundaries and choose how we want to experience our own lives. Managing our energy requires that we get curious about how our energy levels may be affected by people and circumstances, and it will probably take some experimentation to get to Goldilocks.
Enough is enough
When I first became a caregiver, I constantly felt like I was not doing enough to help my grandma, and not spending enough time with her. When I was with her, I felt frustrated, heartbroken, and overwhelmed by not being able to help make her better. And when I was away from her, I felt guilt, shame, and fear that she would forget me even more than she already had. So I had created a no-win situation for myself that was stressful and exhausting, and negatively impacted my brain health.
It’s taken many years and a lot of coaching for me to learn that “enough” wasn’t an amount, but rather a feeling that I desired. And that that feeling was available to me through setting boundaries. I chose to set a boundary for myself by forgiving and accepting my own limitations as a doctor. My grandma’s brain was sick, and while I could choose to love and take care of her, I wasn’t going to be able to fix her brain.
Now when I’m with her, I’m fully present to connect as doctor and granddaughter, without being mired in the whys and wherefores of how we got here. I kiss and love on her as much as she’ll let me, and I appreciate the lessons she continues to teach me. Of course I still grieve our emotional connection, but I’m grateful to see her content and well looked after.
Energy and brain health
Our energy levels are not a core measure of cognitive function, but they definitely impact our experience of how our brains are functioning. When I’m tired, I find that I will have trouble focusing on the task at hand, and that my sentences often don’t make sense. And in those situations, my first instinct is to reach for some caffeine to wake myself up, so that I can soldier on through to get the work done.
Our fatigue can be a function of overwork, sleep deprivation, excessive alcohol, poor nutrition, chronic stress or other lifestyle factors. But our social conditioning teaches us to seek out the quick fix solution so that we can keep going, rather than addressing the underlying issues. And because our bodies have the ability to acclimate and adapt to adverse conditions, we will naturally get more tired, accepting that our brains are doing the best they can given the circumstances.
The irony is that when fatigue is interfering with peak brain performance, we become less efficient and have less time to engage in activities that regenerate our energy.
Enough wasn’t an amount, but rather a feeling that I desired
Some activities that bring me more energy are moving my body, creating art, learning new things, laughing, and connecting with loved ones. Just knowing that my energy levels are intimately tied to my experience of brain function has helped me to be more mindful of how I allocate my time. After all, there are only 168 hours per week. And I get to choose how to steward my energy so that it becomes a renewable resource that will fuel me sustainably through to my 100th birthday!
Dr Em coaching tips
If you are interested in improving your brain function, start by doing an energy audit. You can learn a lot about yourself just by noticing how you feel around certain people or situations.
Notice how your nervous system responds to the three people you spend the most time with. Do you feel comfortable, safe, open, or are you tense and guarded? Is your energy being automatically shunted into maintaining a “guard and protect” mode? Or is it in “rest and relax” mode?
To learn more about gauging your current brain function and risk for dementia, check out the Brain Health Index Quiz.