Why Am I Always Tired?

Dear GoodTherapy.org,

I’ve been looking everywhere for an answer to this question, but nothing medical seems to make any sense to my life, so I figured I’d reach out here. Basically, I’m exhausted all the time, despite pretty good efforts to be healthy. I eat okay—could be better, but it’s not frozen pizza every night; I exercise a few times a week, I work a normal 40-hour schedule, and I seem to get the required eight hours every night.

My relationships are mostly good, with a few inevitable rough patches. And I’ve been to the doctor and don’t have thyroid issues or anything metabolic that would affect my energy levels so drastically. I’m just constantly tired, and it doesn’t seem like any amount of caffeine helps.

Am I looking for answers in the wrong places? Is this more mental than physical? Are there potential mental or psychological explanations for this sort of thing? —Tired of Being Tired

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Dear Tired,

Thank you for your question … which is particularly well timed, as somatization is one of my specialties. This term basically refers to physical or bodily symptoms, such as aches and ailments, being at least in part psychological.

First and foremost, I am not a medical doctor and it is beyond my scope of practice to rule out medical issues; this also holds true for your question, incidentally, so what I have to say here should not preclude ongoing medical investigation. (Has a food allergy been considered?)

Secondly, body and mind are more intertwined than many people believe. Sometimes a psychological problem can become a bodily issue, to the point where the root or genesis of the issue fades into the background so that only the medical symptoms remain. Or certain medical or physical challenges can lead to anxiety or depression, and so forth, and then body and mind become ensnared in the same hard-to-define problem.

So while I’ll be answering your question from a psychological perspective, my feedback should not stand in for professional medical advice—though it sounds like seeking answers from doctors has been frustrating for you.

Now, to brass tacks: You give a fairly complete outline of your life from the outside looking in; the mechanics, in other words. However, such a description could fit any number of people who may happen to be struggling with depression, addiction, anxiety, relational challenges, and so forth (not that you are). Many are highly functional, in other words, while any suffering remains beneath the surface.

I would be interested to hear more about your inner, emotional life—the “quality” rather than the “events” of your daily experiencing.

I would want to know how happy you are, or not, in your job. Do you feel personally fulfilled? How are your relationships there with coworkers, your boss or supervisor, and so on? Sometimes fatigue or feeling worn down can be a “symptom” of emotional emptiness or feeling a lack of purpose or fulfillment. It sounds like you are “checking the boxes” in terms of a healthy lifestyle: sleep, work, exercise, and so on. But how content are or aren’t you in your emotional and psychological life?

Sometimes fatigue or tiredness is a sign of dysthymia, or mild depression, based on a lack of personal or emotional fulfillment. I would want to understand the existential or deeply personal experience you have being you; are you living out an ideal or “blueprint” of life inherited from family or society? Does your life feel truly yours, or at least in the ballpark?

While I could never give a “diagnosis” based on your note—that would require a thorough assessment—I can outline a few possible issues I would be curious to explore further, were you coming to my office with this issue.

Sometimes fatigue or tiredness is a sign of dysthymia, or mild depression, based on a lack of personal or emotional fulfillment as outlined above. I would want to understand the existential or deeply personal experience you have being you; are you living out an ideal or “blueprint” of life inherited from family or society? Does your life feel truly yours, or at least in the ballpark?

I once knew a person, for example, who became an attorney because that’s what his father did, and what he assumed he should also do. He was so unhappy as an attorney—dragging, as it were—that he dropped out and got a master’s in psychology. For many colleagues, including yours truly, ours is a “second career” after an unfulfilling first one. (I am a refugee from the entertainment business.)

I would explore the quality of sleep you are getting. Is it sound and seamless? Are there restless nights before sleep, or interrupting it? Are you having memorable dreams? Sometimes our dreams can tell us what’s missing, with some interpretation. For example, I will often have dreams of taking tests in high school or college, with a sense of anxious pressure, if I am feeling particularly under-the-gun with a project or work, without necessarily realizing it. The meanings of such dreams are rich and multilayered.

I would also ask if you take any particular medication for anything, if this has any side effects, and ask without any assumption or judgment what your alcohol/drug intake is like, and whether these are used to socialize or unwind. Some substances, even alcohol or marijuana at moderate levels, can have a cumulatively depressive aftereffect.

You did mention a few “inevitable rough patches” in your relationships, and this is where I am most curious. Perhaps these rough patches are triggering deeper, more longstanding concerns or anxieties; what, exactly, are these “patches”? Often people are surprised when they look at relationships more closely, past and current, and discover they are more emotionally impacted by them than first suspected. They may also, as I say, provoke other memories or issues which come with some unprocessed emotions.

It could be, for instance, that while you sound successful you may not feel successful, for any number of reasons. As one example: for people neglected or abandoned in childhood, a current success becomes a trigger for feeling unnoticed or unsupported as in the past when achievements were minimized or ignored. This can lead to feelings of hurt or sadness which are set aside.

Often, repressed or “stuffed” emotions, such as fear, anger, or hurt that remain unexpressed, can well up inside us and become heavy, dragging us down. It takes some psychological work to continue keeping them at bay, which may be tiring. Relief comes in unburdening ourselves to an understanding other (such as a therapist or counselor, trusted friend, etc.), meaning we don’t have to carry it all on our own.

Unexpressed emotion, we are learning in our field, is often stored in the body; anxiety or hurt feelings which are “put in the closet” or unexpressed to anyone can result in digestive or sleep issues, as one example. Many people experience physical ailments resulting—again in part—from repressed or dissociated emotions, feelings resulting from painful past experiences never acknowledged or shared with anyone. A person with intense, unconsciously stored emotion may develop migraines or digestive issues or depression and can’t understand why. Their own emotional life lacks attention or understanding, and most of all value.

A word about the latter: In general, we tend to worship externals in our society—appearance, money, success, “hard data,” and so forth. We understand more and more about the brain while becoming more and more confused about how to have close relationships beyond Facebook (including friends as well as partners). In a strange way—and assuming you do not have a serious medical condition, which I hope is the case—this is an opportunity for you to get to know yourself better, a deeper understanding of who you are and what may be missing, even if that “missing piece” is just the beginning of a deeper awareness and attunement to what’s going on behind the scenes.

Thanks again for your letter. I hope what I said was helpful!

Sincerely,

Darren

Darren Haber

Darren Haber, PsyD, MFT is a psychotherapist specializing in treating alcoholism and drug addiction as well as co-occurring issues such as anxiety, depression, relationship concerns, secondary addictions (especially sex addiction), and trauma (both single-incident and repetitive). He works in a variety of modalities, primarily cognitive behavioral, spiritual/recovery-based, and psychodynamic. He is certified in eye movement desensitization and reprocessing (EMDR) therapy, and continues to receive psychodynamic training in treating relational trauma, including emotional abuse/neglect and physical and sexual abuse.