I’ve been consulting with someone abroad who is currently pre-diagnosis and struggling to navigate chronic pain and fatigue while negotiating the pressures of the workplace and the difficulties of obtaining a diagnosis.

Lately, we’ve been talking about brain fog: that on-again, off-again, but mostly on-again experience of cognitive impairment, including forgetfulness, difficulty retaining or recalling information, difficulty concentrating, inability to focus, and confusion and disorientation. It’s literally like moving through a fog. It’s embarrassing, especially in settings where you’re expected to use your brain. Like the university. You know, where I work.

In the Canadian horror film The Shrine (2010), there’s a plot-pivotal scene where the protagonists are stumbling through a dense, impenetrable fog that seems to have a mind of its own—dissipating to reveal a demonic statue that, when perceived, results in supernatural possession. And frankly, that feels a lot like the experience of brain fog to me.

I ended up emailing them a list of thoughts and basic tips for dealing with brain fog, cribbing from my own highly personalized strategies. (As with a lot of disability hacks, these strategies might sprout from a broad foundation, but they must be individually tailored to really work for you.) It’s a pretty basic email, but I thought I’d share it in case anyone else finds it useful!

SUBJ: Brain Fog Tips!

First thing is to realize you don’t improve executive dysfunction by trying to impose executive function onto it. The goal is to create a system that harnesses executive dysfunction in a way that makes it easier to work well according to “normal” cognitive parameters. That is, you want to appear optimized for hyper-productivity without overextending yourself, which means figuring out how to work with brain fog, not against it. Which yeah, is easier said than done, and setting up viable, future-proof (as much as possible) systems requires a lot of front-loading. But it’s not like the brain fog is going away, even with diagnosis and treatment, so I personally feel it’s time, energy, and labor well-spent. So, here are some steps you might consider taking to start setting up systems for yourself.

Step 1: Work Autoethnography

Figure out what your patterns of remembering, forgetting, “efficiency”/”inefficiency” are: e.g., rank the kinds of things you’re likely to forget and times of day when your distraction/overwhelm is highest/lowest. This is essential to figuring out the system you’re going to use. Dr. Rua Williams (@echolalia) offers free webinars on this stuff that might be helpful, particularly this ~1 hr video: Hacking Executive Function—Being Kind to Ourselves and the Magic of Friendship

Step 1.5: Understand Executive Function

Executive functioning is not just organizational or planning skills—it also includes anticipatory, preemptive management, task initiation, attention- and goal-shifting or -sustaining, etc. Depending on how you work, repeated task switching could improve your efficiency or negatively impact cognition. (For example, I can’t rapidly task switch without negatively impacting my cognition; I have to absorb myself fully in a single task for a marathon session, which means intentionally distancing myself from other tasks and projects while working on that one.)

Reflect on what you forget and where you start to miss things or make mistakes or get stuck, based on your experience and feedback from friends/colleagues, and write that down too.

Step 2: Identifying a System Framework

What modality (digital, analog) helps info “stick” in your head better? Where in your home/office are you likely to look? Do you work better in solitude or with a work buddy (body doubling)? How are tasks best represented to you, as a project in which you define task “chunks” for yourself, or a project with predefined task chunks? How small and explicit should these chunks be to help you be most effective? Visually, how should tasks be represented to help you be most effective: e.g., bulleted lists, a kanban-style visual system, a system repeated across digital and analog calendars or lists, a fully time-blocked digital and/or analog calendar, etc.?

What digital organization system works for you? What keywords (for retrieval) do you tend to associate with specific tasks? Where on your computer are you likely to look? (For example, I’ve been slowly shifting to the Johnny Decimal system, paired with Obsidian, which has been a grueling process given the amounts of data I’ve hoarded over the years, but promises to be a future-proofed, static folder system that can keep expanding with my storage needs.)

Create a nested folder system that is intuitive to you, (re)name files to reflect keywords you might search for to find them, place files in the folders that are intuitive to you, and replicate this system and naming convention across all your platforms: desktop, tablet/phone if applicable, cloud-based drives like Google Drive, Dropbox, Sharepoint, etc. (I use voidtools’ Everything, a freeware Windows desktop search engine, to help me find things when brain fog makes it impossible to remember keywords or folder hierarchies.)

Organize your browser bookmarks in a way that is intuitive as well, with names or tags in the bookmark name that make it easy to find them. You might also want to bookmark Google Docs you reference a lot for easy access and star them in Google Drive to find them easily. Move them to folders that make intuitive sense to you/reflect the organization of your local drive. And where applicable, you might also want to replicate your naming conventions as folders and tags in your email.

Step 2.1: Locations

Reminders and systems are useless if you don’t look at or use them. Where do you look when working during the day? How will you remind yourself to refer to your systems?

I personally find that repeating my tasks over and over on digital and analog systems, in places I can and can’t instantly see, really helps me remember what I need to do and separate my tasks by type, priority, and time-for-completion (though I’m still pretty bad at estimating how long it’ll take me to finish something).

I use the weekly planner in my Traveler’s Company journal for everything, life and work, and I use my Stalogy Editor 1/2 Year notebook in my Roterfaden for work-related tasks and notes. I also use a whiteboard. I experiment with time-blocking sometimes… it has yet to be fully effective for me, but (right now anyway) I don’t really need to visually plot every minute of my day on my digital calendar. To make sure I remember to review my hard-copy notebooks, I use digital reminders like an email digest or reminders I set on my phone. If I’m in really dire straits, I put Post-It Notes on my laptop or desk or bathroom mirror to remind me of things until they become a habit for me: like where to find documents, time-sensitive deadlines, etc. I use Google Calendar to consolidate all my scheduled appointments, and Gmail sends me a digest in the morning as a reminder. I also use a self-care app that has general reminders to check my systems and adhere to these reminders.

I color-code obsessively across all my platforms using a consistent color schema that also has been extraordinarily effective (e.g., purple = research; orange = service; red = teaching; green = health; blue = digital processing work; black = home, organization, anything else).

Despite my need to focus on one task at a time, I work best with background noise (a familiar song, a familiar movie), total silence, or in a body doubling session (like a flexible standing weekly appointment with a friend to sit in Discord voice chat together and just work). I work best when I’m reclining or lying perfectly flat. I need to work in marathon sessions if I’m writing or creating content or reading (high attention to detail and level of focus). If I’m extremely distractible on a particular day, then I work best in silence or with noise-canceling headphones and a familiar song on loop. 

It’s easiest for me if a task has already been broken down into chunks in a bulleted list. If it isn’t, I start by breaking it down into tasks myself and setting flexible dates for each task. If it’s associated with a calendar date, I note the major project in every week of my planner under a category called “progress” and set dates for each chunk, with reminders beginning 2-3 weeks before the deadline.

Step 3: Scheduling

Chronic pain and fatigue mean I’m not a person who can always schedule tasks the way most people can, but I can stick to a schedule of work. I have yet to figure out a system of time-blocking that works for me, so I’ll plan to work on a set of things in a week, and based on how I feel each day, I’ll select 2-3 of those things and work on them. Sometimes I only end up working on one. Sometimes I work on something unexpected. If that’s the case, I shift my priorities and tasks for the following days.

I always prioritize time-sensitive tasks, or tasks I’m working with other people on, for the days I feel best/most cognitively sound.

Also, you have to accept that you will never get things done in an ambitiously short amount of time. I give people three deadlines: my aspirational estimate (lmao) and the more realistic, longer deadline I’ll probably need and the extension I might need on top of that if an unexpected medical issue crops up. Sometimes I ask in advance what the absolute latest deadline is for each task within a project, then make plans to meet earlier deadlines while feeling safer knowing I have some wiggle room if needed.

And finally, I leave time for rest and doing nothing. Don’t forget that socializing increases brain fog too, so I plan my work/social balance accordingly), and I always build in extra time in case something unexpected knocks down the house of cards.

Step 4: Consistency Across Platforms/Software

As much as possible, repeat your system across platforms and software. Color codes in a hard-copy notebook should be used to color-code labels and categories for emails across Gmail, Outlook, etc. If you use all-caps for something in one place, use it everywhere, etc.

Extra: Memory Stuff

Write everything down. Keep apps or paper handy that will allow you to write everything down. Use phone apps, voice memos, a notebook you keep on your person at all times. Don’t tell yourself you’ll remember it, because you’re lying. If you have a break in the brain fog or are having a particularly efficient day, you can maybe reassess, but right now treat everything as though you won’t remember it otherwise. Set reminders (automated emails to yourself, phone alarms with names that remind you of the task) and keep Post-Its and other tangible reminders in visible places you know you’re going to look.

Step 5: Supplies – Only What You Use is Useful

If you’re not going to use it, there’s no point in trying to use it. I opt for cuter, costs-more-upfront purchases because I know myself—I’m more likely to use something that’s cute, especially if I’ve personalized it in ways that make me happy to see it.

My stationery, including my Traveler’s Company and Roterfaden notebook covers and inserts, comes mostly from JetPens. I use Pilot Hi-Tec C Coleto 4-color pens to color code everything. I use a blank dot-grid weekly planner insert so I can customize the dates to the academic year, and I can use the dates page for time-sensitive tasks and the blank page for a running list of tasks that can be completed at any time during the week and/or for notes to myself during meetings etc. Other people I know swear by: Erin Condren Planners, Plum Paper, Harriet Wright, and Hobonichi. Imperfect Inspiration is neurodivergent specific, and I hear Happy Planner has ADHD/attention-oriented layouts.

Metacognitive Strategies

• Task-chunking: Break down big tasks with lots of implicit steps into smaller explicit tasks
• Visual and Tactile: Represent task lists in prominent spaces to visualize or “feel” your progress, handwrite them in some places for tactility, and repeat them across analog and digital systems
• Body Doubling: Work alongside someone else, whether in person or over Discord, Zoom, Teams, or some other video and voice platform

Bonus: Get Checked

This is not medical advice, and I don’t know the situation, but if you feel your brain fog is getting worse or you’re more easily distracted and can’t put your finger on why, it’s a good idea to get tested for some basic causes: iron, ferritin, hemoglobin, B12/B Complex, thyroid and parathyroid hormones (TSH, T3, T4, TpoAb, PTH, calcium, vitamin D, etc.), reproductive hormones, serotonin, other vitamins, minerals, and heavy metals (zinc, copper, magnesium, vitamin C), general inflammation and/or late-onset autoimmune stuff (CRP, ESR, ANA, etc.), histamine response stuff (histamine, IgE). You can also consider if an ADHD or post-COVID syndrome screening is worth it, especially if you had COVID more than once.