One of the most persistent symptoms in my mental illness is the need to sleep for most of the day. The medical community and the mental health community have differing terms for this symptom. My therapist would say I am suffering from lethargy. My physician might call it obtundation. Whatever you may call it, sleeping all the time prevents me from getting a lot of tasks done, getting necessary exercise, and contributes to the continuation of my illness. I have slept about 14 hours today.
Lethargy is found in history, both in literature and in reports from the era. More than one person is reported to have “taken to their bed” and stayed there for years or decades. In The Natural History of Pliny, Volume 5, in the first century AD, notes the condition. A History of Epidemics in Britain notes lethargy having caused fatalities in the 1360s.
Severe fatigue can be a symptom in many mental illnesses. Among them are:
- Major (or Clinical) Depression
- Bipolar disorder
- Generalized anxiety disorder
I readily admit that I use fatigue as an excuse at times to escape the stresses of my life. I have for decades.
There are three types of fatigue or lethargy that I experience that appear to be less driven by a conscious decision.
In a very stressful life experience, it is not unusual for me to become overwhelmed by lethargy. It arrives like a tidal wave.
If I am unusually physically active, or accomplish a greater number of tasks than I usually do in a day, it is not unusual for me to be extremely fatigued the following day (or even days). This is often accompanied by muscle aches and/or joint pain.
I also have, rarely, what I call “I’m going to fall down” moments. Fatigue hits rapidly and so strongly that I have to go directly to bed or risk collapsing.
Now for the “rule outs”. Medical conditions and substance abuse can also cause similar fatigue symptoms. I do not drink or take any non-prescribed medications. My thyroid and other blood tests are normal.
My prescribed medications may contribute to my lethargy. Many of them have fatigue or drowsiness as a side effect. Other than serving to trigger my anxiety when I read the side effects, I cannot tell if they are causing a portion of my symptoms.
Dialectical Behavior Therapy encourages the use of a skill called “opposite action” to fight lethargy. The Mindfulness Muse describes the symptom thus:
The experience of lethargy is often accompanied by a lack of mental, physical, and emotional energy. There may be urges to avoid doing much of anything. Lethargy may be accompanied by the sense that just about anything would take a colossal amount of effort. There is often a strong desire to sit and do nothing at all.
As the Muse notes, lethargy produces lethargy. There is no progress or movement.
The opposite action for lethargy is to throw yourself into activity. It does not have to be a major task. A list of several, small but doable, activities can be accomplished and produce an emotional reaction opposite to the lethargy. This is often described as a “just do it” or “push through” moment, because you will have to push yourself to achieve the goal of an opposite emotional experience.
The title of this piece is a play on words. I do want to tell you that life is not all lethargy, that it is a limited experience, and can be overcome. The use of the DBT skill “opposite action”, even once, can bring you a sense of accomplishment that negates some of the lethargy that you are feeling. Lethargy leaves the control of your life to chance while opposite action places control of your life in your own hands.