Time Blindness Has an Opposite — and We Don’t Talk About It Enough

In mental health assessment, one of the things I screen for is the person’s attention to time.

Some of us are very attentive and emotive to what’s in the “here and now”. When it’s about the past and future, it’s often described as hazy, fuzzy, blurry, zoomed out, uncertain or very “meh” emotionally.

In this pattern, time blindness can be a feature. If something is in front of us in the “here and now”, it has a tendency to be more relevant and emotive, and with that, there may be an impulse to take action with it. If it is in past or future, it’s less relevant and less motivating. So things can be left to the last minute and there may be more distractibility in the here and now with the external sensory stimuli and/or internal current thoughts. They may have a tendency to underplan and may have less attention to future consequences.

The opposite of this is what I would call “pan time” attention. Where one is naturally have a strong attention to past and future orientation but often at the cost of the present moment. They may be better with planning, future prediction and organization but may not be good in the present moment and going with the flow. They may have a tendency to overplan.

Of course, there is often an attention of both patterns but often with a bias towards one pattern more than the other like right and left handedness. It’s often the extremes that can create challenges.

Interestingly, as a Family Doctor, I have observed that folks with these opposing patterns often do end up together as they complement and scaffold for each other. When they have kids, they may have a mix of both. In a family system, this can be a source of strength, stress, misunderstanding and conflict if not aware. We may share the same reality but not the same “time reality and perspective”.

As a School Doctor, I often see the extreme of both in the school children creating challenges with their functioning and mental health.

I wonder if you can recognize these patterns in our patients and in ourselves.

Emotional Regulation: It’s Not Just About Calming Down

In counseling work, helping our patients understand the function of an emotion is important.

From a DBT (Dialectical Behavioural Therapy) perspective, there are 3 functions of an emotion.

1. It helps us to communicate with others without the need to say anything. It’s a very important part of non verbal communication.

2. It helps us to communicate with ourselves without the need for words or thoughts. It’s sensing…. Is this moving towards what matters to me/people I care about, or moving away from it. Are my needs of stability/connection/growth met? Am I in danger? Is this in line with who I am?

3. It helps us to take action. Emotions are like “fuel for action” like stepping on the gas pedal. Too little is an issue at times. Too much is an issue at times. And then it depends on which emotion and the context that we are in. Emotions can also affect our thinking and subsequent actions.

More emotions = more urge to act. Less emotions = less urge to act.

Too much = crash and burn or even freeze.

So patients have to learn how to “down regulate” and “up regulate” emotions and know which ones to “down regulate” and which ones to “up regulate” if they want to regulate holistically their emotions, motivations, and where they want to go in life.

Some medications try to “down regulate” their emotions. Some will “up regulate” their emotions. But knowing which ones to “up regulate” or “down regulate” will require counseling work in addition to medications.

We try to at times “down regulate” anxiety, frustration, shame and anger, and “up regulate” hope, faith, compassion for self/others, gratitude and acceptance. It is unlikely that medication alone is going to achieve that.

Everyone Lives in Time. Not Everyone Lives in the Same Part of it

In counseling work, I often see folks with more extreme difference in time perception or the attention to time.

For some, their reality is more biased/focused on the “here and now time spectrum”. Past time spectrum and future time spectrum can be a bit blurry or uncertain. Some may refer to this as “time blind”.

Their strength is the ability to solve tactical problems in the here and now. What’s in front of me. If it’s more future or past focused, then awareness and effectiveness may drop. This may lead to leaving things to the last minute, distracted by the sensory input of the here and now rather than something that may be very important downstream, and avoiding projects that require sustained actions over the span of time stretching into the future. It can also lead to impulsivity in the here and now and less attention to the consequences in the downstream of time although cognitively, they may be very aware.

Sometimes I would frame this as being good for “close range combat”.

At times, I see the complete opposite where folks may have the extreme bias/focus on “pan time perception” and lack perception of the “here and now” leading to too much living in the past, planning for the future and forget to be in the here and now. They are more built for “medium to long range combat”.

Pros and cons.

In family therapy and couples work, not surprisingly, I often see these folks with different biases in time perception, ending up together because they can cover for each others blind spots. It is complementary. However, if unaware, it can also be a common source of conflict due to a lack of shared reality based on time.

In DSM, these patterns can show up in different diagnoses and I wonder if you can relate to them. 

The Car Metaphor That Changed How I Explain ADHD

In counseling work for ADHD, I often use the metaphor of driving a car and simplifications around this for workability.

We have the fuel and the gas pedal to accelerate. This is like “zooming in”, sympathetic nervous system, stress, adrenaline, noradrenaline, cortisol, dopamine, and stimulants.

We have our brakes and shock absorbers. This is like our “zooming out”, parasympathetic nervous system, serotonin, SSRIs, relationships, oxytocin, antipsychotics, clonidine, guanfacine.

But many may forget that we have to drive/steer this car as well. Knowing where to go. Which direction. How to use our Sat Nav. Knowing our blind spots with rear and side mirrors. Mindful of what is on our dashboard. Getting along with our co-passengers and aligning destinations with them. Which time frame are we focusing on because this car can also Time Travel. It can take us to the past, present or future.

And most importantly, are we on autopilot or manual?

The challenge is to know where the primary problem is.

If the problem is no fuel, then easy. Give more fuel. If the problem is not enough brakes, then give better brakes. If the problem is in the driving/steering, then skill building here is required.

The biggest challenge is that the problem is often all of the above and driving/steering this Time Machine is not easy. And a word of caution, if we add acceleration to poor steering, then problems can magnify.

I wonder if you can relate.

Your Anxiety May Be Coming From These 2 Blindspots

One thing I’ve noticed when working in the mental health space is that people’s anxiety can sometimes arise from their 2 key blindspots.

Their unconscious competence and their unconscious incompetence. The “very good” and the “very bad”.

The things that they have naturally talent in, they are underutilising and the things they are not good at, they are over exposed to. There is a mismatch leading to being a “fish out of water” with “secondary anxiety”.

The key pivot point is to make those unconscious processes more conscious.

I wonder if you are aware of your own unconscious processes.

Finding Wise Mind Balance with DBT

In DBT Dialectical Behaviour Therapy, the word dialectical can relate to the idea of holding 2 opposing ideas (often opposites) and integrating them.  This is often refer to as the “wise mind”. 

But in reality, in Family Medicine, I think we often have to hold multiple opposing ideas (not just 2) and trying to integrate them all don’t we?

For example, with every consult, we have to integrate what is evidenced based, what is workable, what fulfils the patient’s agendas and makes them happy, what fulfils our agendas and makes us happy, what fulfils the community’s agendas and makes society happy, which decision is best for the here and now, which is best for the future based on past and present patterns, what’s best for the individual, what’s best for their families, and what’s good for one body system may come at the costs of other body systems.

There is tension among all of the above so trying to find a Venn Diagram for that is not easy especially given our inherent blindspots.

I wonder how much we all struggle with the above and whether some “DBT types of upskilling” can help. 

Every Doctor Faces This Dilemma Daily — No One Talks About It

As a Doctor, we often have to make decisions that considers all 4 of the following criteria.

1. It’s pragmatic and workable in the real world with all the limitations of the real world.

2. It makes logical sense and correct factually and evidence based.

3. It makes patients happy.

4. It makes you happy and helps you to sleep at night.

The problem is, when we can’t find the intersection of all 4 domains, we often neglect/suppress 1,2 tor 3 of the criteria leading to long term issues.

If we neglect No4, we risk burnout.
If we neglect No3, we risk complaints, loss of therapeutic relationship, and increased risk of being sued perhaps. 
If we neglect No2, we risk not following evidence based and good guidelines.
If we neglect No1, we risk inaction and being impractical.

We all have our blindspots and depending on which blindspots, dictates which problems we are likely to face. Some are good with the thinking stuff (No1+2). Some are good with the feeling stuff (No3+4).

Part of good self care require good self awareness and self understanding.

I wonder if you can work out what your blindspots are by reversing engineer your recurring troubles.

The Missing Half of Metacognition: Thinking About Feelings

I recently been invited as a guest speaker to explore and share ideas around metacognition with fellow GP supervisors.

Traditionally, I think metacognition often refer to the “Thinking of thinking” but it’s also important to include the “Thinking of feelings”.

One can also frame this as the “Mindfulness of thinking, feelings/emotions”. Focused and engaged with our thoughts and feelings but not too fused/hyperfocused and not too detached/dissociated either. It’s the “sweet spot”.

In this mental state, the aim is to process the information and find the “Venn/intersection” of both thinking and feelings. I think this is especially important in healthcare as we have to deal with both “things” and feelings.

Hence the saying… 

Follow your head and take your heart with you OR for some…

Follow your heart but take your head with you. 

It’s a real challenge of course especially if there is a mismatch in the development of one’s “thinking” vs “feeling” abilities.

What If Mental Health Education Started With Emotional Literacy?

I am a Primary School Doctor on Fridays helping kids and their families with struggles around poor emotional health.

One can frame this as their “EQ” perhaps. EQ for Emotional Quotient (also often called Emotional Intelligence).

Some struggle mainly with processing the “feelings of others” leading to predominantly social anxiety.

Some struggle mainly with processing their own feelings/emotions leading to shame, anxiety, anger, emotional dysregulation, self doubt, and depressed mood.

Some especially with ADHD/ASD wiring, can struggle immensely with both.

Counseling whether it’s in the form of CBT. Psychoeducation, ACT, DBT. EFT, IPT are simply ways of teaching “Emotional Literacy”.

I hope that if we can frame “therapeutic frameworks” as “emotional literacy”, more kids can have access to the above skills at a school level, and if as a society, we are more emotionally literate, then less mental health issues perhaps.

Internal vs External Emotional Language: Why Both Matter

The 2 important functions of an emotion is to communicate with others through the “language of emotions” and also to communicate with ourselves through our own emotions. This forms a significant part of our non verbal communication externally and internally.

Being great with one does not mean that we can be great with the other. In my mind, they are two forms of “emotional intelligence”. One is more important for “social intelligence” and the other is more important for “self intelligence”.

In counseling work, the challenge I often see is that many can struggle greatly in these domains and hence, impacting relationships and/or self esteem.

I wonder if you have seen what I have seen.