Living in survival mode and decision making

When you are living in survival mode, making decisions can become particularly difficult & you can find yourself struggling with indecision, avoiding decisions or handing them over to others, or making suboptimal decisions. 

Suboptimal decisions can range from those that are ok-but-you-could-have-chosen-better (especially for the longer-term) to those that are outright bad or dangerous (for you). 

The aim here is not to criticise the decisions made but to try & understand why they were made i.e. why do we make (and keep making) decisions that are not in our best interest?

We’ll think about the more general case of decision making in survival mode & emphasise some of the particular impacts of trauma, mental illness & disability.

A few points about decision making first:

-decision making is cognitively effortful and takes time.

-it requires cognitive and emotional reserve

-it requires consideration of the timescale of the execution & consequences of the decision.

-it requires taking into account, your interests and goals, the various options to decide between and their relative merits, downsides and costs, often over different timescales. One of the major costs to be taken into account is the cost to yourself.

-it depends on the capital (financial, self esteem, social network) you have available at the point of the decision.

-it depends on the options you really have available to you as opposed to options that could theoretically be available. 

A lot the time when it comes to more critical decisions (as defined by you), we make the best/least worst/only decision we can/feel able to at the time in the given circumstances (includes our state of mind & body at the time). This is by no means unique to survival mode.

What’s different in survival mode are the following:

There is less/little spare cognitive and emotional capacity to make decisions

This also shortens the decision timescales (you are only able to think so far into the future). 

This can mean that you end up making decisions that are ok for the short-term but not for the medium or longer term ‘I just need to get through to the end of the week’, ‘this is the most pressing thing right now’.

However a more dangerous aspect of the shortened time perspective is that you can end up not really thinking about decisions that will impact you in the future (beyond the farthest you can see now). ‘It’s only going to happen 2 months later, I’ll think about it then’

This puts you at risk of making decisions that are unwise/bad for future you. Thinking about future you requires doing the difficult task of future projection. It’s difficult because we don’t know what our future state of being or the future version of us will be like.

We usually hack this by just projecting our current self into the future and think what we would do in the future circumstances we imagine. 

This is effortful but in survival mode it can be v. overwhelming because it involves an awful and often realistic possibility.

Namely, ‘I may still be feeling this awful in X months time, nothing will have changed’. This a very common experience in depression and other mental illnesses and in survivors of trauma and it is understandably easier and self-protective to not project into the future. 

Capital: depending on how long you have been in survival mode and your wider circumstances, you will have access to varying amounts of capital. Financial capital is a straightforward one, if you have enough, it can take care of a huge part of the business of surviving.

Financial capital provides a great deal of stability and other resources. It provides a buffer against some adversity as well as against the consequences of sub-optimal decisions, which makes the decision making less stressful, & gives you more options (see below).

Social support capital is fairly straightforward as well, who do you have available to support you? The more people you have, the more help you have to take decisions and buffer their cost and consequences. Let’s move the next one, which is particularly important.

Self esteem capital (how much you value and care for yourself) is an especially important factor and one that is often eroded (or never built up) by prolonged periods in survival mode, serious mental illness and experiences of trauma (esp recurrent trauma).

Self esteem capital is vital for considering one’s own interests and the costs to oneself. If you are short on this, you may not particularly care about your interests or what happens to you or what the costs and consequences are to you. 

This is something to particularly consider when you see someone making decisions that put them in harm’s way or at risk of harm or making decisions that are more about looking after (or serving the interests of) other people and actually disadvantageous to themselves. 

One of the very sad consequences of trauma and abuse is that it can make one rather enured or numbed to the costs and harms to oneself ‘I’m used to not being cared about’, ‘I’ve known much worse’, ‘At least this way I’ll be helping someone else.’

Which brings us to the last point which is about options. The decisions you have to make are about/between the options you have available to you. The more options you have to choose between, the more difficult the decision making task. 

So when you’re depressed, the huge numbers of choices on a menu can be absolutely paralysing. But in such states, so can deciding which of 2 outfits to wear.

On the other hand having too few options can often means that the decision is often a more critical one.

To understand the above, consider this, one of the most valuable options to have is that of not having to make the decision and being able to bear the cost and consequences of that. If you do not have this option, then the decision is more likely a critical one. 

Having financial capital means that you are more likely to have more options including the above particularly valuable one. The more critical the decisions, the more each of the (few) options has to be weighed up, the greater the consequences and costs. 

So putting all this together, what happens to decision making in survival mode?

1. It becomes very anxiety provoking and can lead to decisions being taken to abort/avoid anxiety.

2. Your decisions become more short-term ‘I need to get through this week’.

3. They become more suboptimal & you consider fewer costs and consequences, especially future ones.

4. You find it harder to step out of the overwhelmed moment & think about possible decisions & futures more broadly.

5. You keep avoiding & postponing decisions. One way of avoiding/minimising decisions is to make life more regimented. This minimises daily decisions (what to eat & wear, where to go), and the chances of new decisions coming up ‘Do you want to go for coffee?’

6. You try and hand over decisions to other people where possible ‘You order for me’, ‘what should I wear?’.

7. You stop thinking about the wider and longer-term consequences of your decisions and increasingly prioritise what is easiest (least effortful) now. 

8. You make decisions quickly, either before being overwhelmed by the process, or on the basis of a limited set of considerations, or repeating previous decisions (what I have done in situations like this before). Such decisions can be impulsive or reflexive/habitual.

9. The problem is that these decisions are either:

-not well thought out in the moment

-previous optimal decisions but in different circumstances (e.g. decisions that helped you survive previous abuse or trauma)

-are previous suboptimal decisions that were made in comparable states of mind and/or body. 

The intersection with low self esteem capital is particularly dangerous here ‘I’ve never thought I deserved better, even from myself, so I never cared what happened to me’. 

One of the most important consequences of our decisions is the set of future decisions they set up and the options that we have for those decisions. The longer you’re in survival mode, you have less capital, fewer options and harder decisions. 

This is perhaps the best perspective to take on the impacts of mental illness, disability and trauma and how they accumulate over time. 

All of these greatly increase the cost of functioning and reduce the reserve available for decision making.

All of them limit options, either through structural reasons or because options and opportunities were never available or had to be given up. 

All of them impact the available capital, often because there was never the chance to build up capital.

What might help? It can be helpful to examine one’s decisions and decision making processes with a close friend/relative or therapist who can help you step out of yourself to look at the decision without the intense emotions being so closely involved. 

The short cut version of the above is to consider advising a friend on how to make the same decision. It is crucial however to skip what is often the last part of this process which ‘but it’s different it’s for me/about me’.

However one particular area to focus your efforts and use your support systems for help with is to create time for decisions i.e. stop the anxiety taking over and driving the process. Creating the time gives you the chance to consider options, consequences and costs.

Finally, try and be kind to yourself. 

It is easier to learn from the decisions of your past self if you can feel compassion for those past versions of you and how they took the best/least worst/only decisions they could in the circumstances they were in.

Hisham Ziauddeen @HZiauddeen Consultant Psychiatrist CPFT, Clinical SRA Univeristy of Cambridge

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