Dopamine is the neurotransmitter of executive decisions. It's a daughter chemical of adrenaline, and your adrenal glands share blood supply with your kidneys; interestingly, Chinese medicine views the need to make too many decisions as being hard on the kidneys. Makes perfect sense to me. But that's a red herring.
The key is, without dopamine, the decision can't get from the frontal lobe to the action parts of the brain. Dopamine levels can be knocked back by pain, drugs (including the prescribed ones), depression, poor diet, and -- of course -- overuse.
People who have crippling pain have to make exponentially more decisions than those who don't. Every action is measured against an internal set of standards that don't exist for normos: how much pain will lifting that cost me? That car door -- which way should I turn my hand to minimize damage when I pull it? How many function-dollars do I have left in my body's account -- enough to do laundry _and_ shower? Or should I do just one? If so, which one is more necessary?
Poor people have a similar ceaseless train of calculations running in their heads, but with different parameters. Can I get a little meat this week? What are my produce options, since there's no good market in this area? Which neighborhood's market has the best prices? Have I got the bus fare? Will I get into trouble over there? How do I blend in? Can I call in a favor to get some Tylenol too? These headaches are killing me.
As a poor person with pain, I figure I make easily 20 times as many decisions -- on a slow day -- as a normal person my age. When I was still overmedicated, I used to feel like a loser for not making 100% perfect decisions 100% of the time; in fact, I occasionally just goofed. And the trouble with living within such narrow parameters of function and finance is, the occasional goof can put you behindhand for a very long time.
It's easy to sneer at those who make weird decisions like paying for a flat-screen TV instead of a semester of junior college. But try wringing out your dopamine every single blessed day, week after month after year, and see how well you do. These people don't have decision-making disorders, so much as decision-making overload.
If you're poor or in pain, take some credit for getting through the day. Cut yourself a little slack. Take a moment to rest and relax. See, it's easier already.
Being hypercritical just uses up your dopamine faster. Why? Because criticism is the result of long strings of decisions. It's very dopamine-expensive. (Ever wonder why hypercritical people don't seem very happy? Now you know.)
Take a moment to be happy, to notice what's good. Those moments rebuild your store of decision-making, anti-depressant dopamine. Each natural, happy little sigh is a shot of the stuff.
Sniff that flower one more time. Scratch where it itches (preferably in private.) Feel the sun warming your head. Laugh with your friends. There's a reason why it feels so good. It really does make you stronger. It freely gives back what life makes you use. And it's not too hard to find a reason to be happy.