Posted: 2026-02-22

🔗 Cognitive Impairment Is Not "Feeling Bleh"

This is apparently not obvious, so it's probably something that everyone who interacts with me should know.

You know how I end every essay with a brain percentage? That's not my mood. Here is what it actually means.

Generally I can give a pretty good percentage number to within 5-10% when I'm below 50%. Above that there's too much going on to be fully conscious of all of it.

🔗 Incapacity

Something that's repeatedly come up for me is saying "I don't have capacity" / "I can't deal with this right now" and it being taken as one of the following:

• I just can't be bothered replying
• I don't care enough to reply
• I want to do something that actually matters instead
• I'm tired/feel bleh and don't want to put the effort in to reply despite it
• This is uncomfortable and I'm dodging talking about it
• I think you're an idiot and replying isn't worth my time (???)

I have no comprehension of where these assigned implications come from. A partner brought up that this might be the product of a divergence between how most peoples' brains work versus mine.

When I am at low capacity, my brain is inelastic. I can't just push through it.

If my current cognitive capacity is too low, I am not able to give a useful response to a complex question. It's not a matter of caring enough or pushing through, it's a structural constraint that I do not have the ability to change. Additionally, while this capacity fluctuates on a day-to-day basis, its overall trajectory is measured in months whether I like it or not.

This is not a question of "feeling stupid". This is actual, serious cognitive impairment, something most people don't actually have a full concept of.

Forcing a response when I don't have capacity creates more problems and misunderstandings than it resolves.

🔗 Some Info About Lewis Brain

Here is a sampling of some of the most common factors which impact my ability to think:

🔗 Lithium And Gastric Disturbance

I take lithium.

What is lithium as a medication? Well, it's an electrolyte. A salt, basically.

What happens when you have diarrhea? The flow of salts through the colon reverses, which is a core part of the mechanism purging their contents.

For this reason, gastro fucks me up pretty hard. When I was working this was a regular point of confusion: I would need a week or more off from it. People would be taken aback: which demonic super-gastro did you have?! — well, I had normal gastro, then I had to spend the next week or so replenishing the chemicals which keep my brain operating (and re-acclimatising to them) before I could function again.

In that period, I'm not only not receiving the therapeutic benefit of the drug, but effectively experiencing a rapid mini-withdrawal from it too. This usually involves irritability along with the cognitive impairment, but mercifully usually settles down to broad incapacity in a matter of days.

Interestingly, this tends to start happening a day or two before the actual diarrhea starts: it seems the malabsorption begins earlier in the digestive process and begins affecting lithium levels before we see external manifestations.

I eat a lot of takeout, so that's one route for potential infections to come from. I also have a fascination with spicy food.

One of olanzapine's jobs is to catch me (safety-wise) when the lithium can't.

🔗 Kava

Kava is really critical to my anxiety management, ability to leave the house, and controlling arousal.

It's also super expensive and incredibly rough on the stomach.

I am living on a shoestring. This means I have to use cheaper and lower-quality sources of kava, which are more likely to be contaminated and cause further digestive problems.

In high doses, kava is not incapable of causing intoxication and impaired judgement, though the character is different to how alcohol affects most people.

🔗 Alcohol

Alcohol is my plan B after kava for those things. It's not a constant, and I don't identify as having a "drinking problem". This also impacts electrolyte balances, digestive conditions, and brain functioning more directly.

I broadly retain judgement on alcohol until I'm physically unable to; bystanders describe it as "you were completely fine no matter how much you drank, then you fell off a cliff."

🔗 Olanzapine

Olanzapine is a high-potency and "dirty" antipsychotic with a very broad mechanism of action. It's extremely effective, but as usual we have to ask "effective at what?"

Higher doses directly and profoundly impact cognition in ways that most people will utterly fail to grasp. It structurally changes your cognitive architecture and ability to engage in higher order reasoning. These are traits which most people will simply assume are just inherent to you; they're not.

Olanzapine's acute sedative effect is profound, about 60-90 minutes after I take it I generally shut down completely and am forced into bed, whether I want to or not.

Withdrawal or rebound from even small dosage changes is hardcore.

The downstream effects of a dosage change take many months to fully manifest; you can't just skip a dose and be different for a day.

🔗 Work

A lot of people (who had specific motivations) have repeatedly tried to collapse my reaction to overwork to "burnout", a nearly-universal and extremely common thing to complain about (so that they could dismiss what I was going through with "that's normal! we have to deal with that too! burnout sucks for everyone! now you know how it feels!"). It's not. What I experience from overwork is completely unrelated to burnout.

The combination of long-term externally controlled sleep-wake and mandated directed-attention deplete resources that I can't get back without many months of full-time rest. People seem to assume that this is normal, I'll just settle into a job after a while and just kind of try to... cheerfully encourage me to push on? When I keep getting worse and worse.

They assume that because they always "settled in" after a while, I must just be whining about the adjustment period, and when that doesn't match reality they just double down because they have no other model except "burnout" which doesn't match in timescale or circumstances either. The lack of a fitting script means they just stretch the two they know to breaking point.

The other trouble is that many assume that in most professions, if you go a year without being fired, you must be doing something right. The reality is that, for a range of reasons that are outside of scope, software engineering has gigantic termination inertia. "My job is completely pointless, I haven't gotten a single thing done in 12 months" sounds like hyperbolic complaining to someone who doesn't know the field, which enables the application of those two wildly inappropriate scripts of settling in and burnout.

Anyway. This whole situation directly causes a very serious cognitive deficit which cannot be pushed through. Combined with a partner who was completely fucking hell-bent on "middle-class" life and some mutual friends who resented their own work and were intensely motivated to de-pathologise what I was going through, this became extremely serious. Actively preventing someone from leaving this situation turns into a forced episode, one of the highest forms of abuse.

I am structurally incompatible with this mode of work. My actual work trajectory is a downwards slope: great for a few months, okay up until about a year, then endlessly getting worse and worse with no bound. I repeatedly ended up in squarely Graeberian situations: "Bullshit Jobs" as a (provocative) title is itself a rebellion against the social enforcement of the exact moralised productivity narratives that were weaponised against me.

Navigating this maze of bullshit with actual severe cognitive impairment was impossible. The behaviour of the people who built it was indefensible.

🔗 Hypocalcemia

What do agoraphobes not do? Go outside. What are they not exposed to? Sunlight. What does sunlight give you? Vitamin D. What happens when your vitamin D is extremely low...?

You can't absorb calcium. Hypocalcemia is fucked up. The way some people treated me when I had it was also equally fucked up.

It's a horrifying feeling. It's like the worst hangover you've ever had multiplied by the worst migraine you've ever had, and you don't just "feel" stupid — it objectively drastically reduces your ability to think. It is one of the worst, most oppressive feelings I've ever experienced.

Endocrine surgeons who specialise in removing tumours which cause this regularly get thankyou notes from the partners of their patients.

There was an intense, continuous effort to psychologise what I was experiencing. No matter how many times I said "something is seriously physically wrong", people who couldn't see it invariably felt the need to invent a psychological explanation or call it "distress".

The fact that I had been managing my mental illnesses consistently for two decades with my giant clinical team was simply ignored. Too many people wanted a comfortable answer, and "he's having psychological problems" was more comfortable than "something is physically wrong with him but we can't see it." I kept being asked "well how are we supposed to know the difference?" and "I will tell you. And I did. Repeatedly." was not acceptable.

Navigating this maze of bullshit with actual severe cognitive impairment was impossible. The behaviour of the people who built it was indefensible.

Yerba Mate

Yerba mate really is just an absolutely fascinating drug. I'll do a writeup on it separately at some point, but: it's more than just caffeine, and it's one of the few things that often seems to give me capacity back over the course of several days of regular use.

Relational Conflict

As counter-intuitive as it sounds, yes, having conflict with the people close to me actually changes my capacity to think on a cognitive capacity axis, not an emotional one.

Some Kinds Of Thinking Are Most Costly Than Others

Critically assessing conflicting information takes an order of magnitude more cognitive resources than reciting previously synthesised information. I might be severely impaired but still able to repeat previous thinking, even if that previous thinking was extremely smart, and then basically shut down when challenged — this is expected and unavoidable. It doesn't mean you "won". It just means you need to take me at my word regarding capacity.

I'm Dealing With A Lot

There are a lot of variables here, and a large number of factors I'm wrestling with every time I say the phrase.

If I say I "don't have capacity" to reply to something right now it is because I do not fucking have capacity to reply to it right now.

I am not able to do some elaborate neurotypical social dance in situations where I don't have the capacity for even very simple thought.

Stop making up bullshit stories so you can make me the bad guy for saying I can't respond right now.

🔗 Checkin

Version: 1

Written: 2026-02-21 to 2026-02-22

Written on: 7.5mg olanzapine since 2025-11-11

Mental health was: very poor - estimate 10-15% brain and currently wrestling with gastro