Why My Bipolar Disorder, PTSD, and Anxiety Are Not ‘High-Functioning’
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The last few weeks have been a struggle for me. My energy levels have been low. Motivation has been nearly nonexistent, and I’ve had a hard time focusing on the here and now.
My mind is scattered like sprinkles on a cake.
Couple that with numbness and extreme apathy and — I’ll be honest — there’ve been days where I feel like giving up and giving in.
But if you looked at me, you wouldn’t know it.
My hair is done, though unwashed. I am doing “things.” I only missed one day of work this month, and I am staying active. I walk or run most days of the week. I am also engaged with my kids, my friends, and my partner. There’s a smile on my face. I laugh loudly and often.
But inside, I am crying. Inside, I am dying, and that is because I live with “high-functioning” mental illness — and yes, it is a real problem.
What Does ‘High-Functioning’ Mental Illness Mean?
The “high-functioning” part of it can refer to a broad spectrum of things, such as having a job, being in school, dressing well, or having a seemingly ideal family lifestyle. But like any other mental health issue, “high-functioning” mental illness can still be very draining and difficult to deal with.
“When people refer to ‘high-functioning’ mental illness, they are speaking about the impact and severity of an individual’s mental health symptoms,” says Niya McCray-Brown, a licensed professional counselor and director of community engagement with Mental Health America.
“They are referencing someone who has a diagnosable mental health condition but continues to perform daily tasks of living [like working or going to school],” says McCray-Brown. This is in contrast to someone whose symptoms may inhibit them from doing these things or make it difficult for them to bathe or shower or care for their other basic needs, for example.
They’re also describing the way one’s mental health condition appears to others, which may not necessarily be how the individual perceives their condition.
Of course, it’s worth noting that doctors and other clinicians do not diagnose mental illnesses as “high-functioning.” Rather, my diagnoses of bipolar disorder, anxiety, and PTSD are just that: diagnoses of medical conditions, not a state of said conditions or how much they affect my ability to carry out other aspects of my life.
In my own case, no one told me I was “high-functioning.” Rather, I learned this over the years, through my experiences and comments from friends and family. Many remarked how impressed they were by my ability to manage my illnesses so “successfully,” or that I always seemed so “put together,” even at my lowest (a hallmark of “high-functioning” mental illness).
The Problem With ‘High-Functioning’ and ‘Low-Functioning’
“High-functioning” is a colloquial term. While the phrase “high-functioning” is used to describe anxiety or depression, again, there’s no such thing as “high-functioning” anxiety or depression (at least not from a clinical standpoint).
That said, for me, knowing mental illness can and does appear on a spectrum has helped me to better understand my own condition. In other words, I realized I didn’t have to look like a person in a depression commercial to need (or ask) for help. But labeling illnesses as “high-functioning” or “low-functioning” can also be problematic.
Describing conditions in this manner can create and perpetuate long-standing stigmas about mental health conditions. It can lead to assumptions that individuals with certain illnesses are better able to integrate with society than others. It can invalidate how disabled we feel and how much we struggle with daily living skills. It can be insulting, creating unnecessary division and causing those with mental illness to compare the severity of their condition with the severity of others.
And, it can be harmful.
“It’s harmful to continue using language such as ‘high-functioning’ and ‘low-functioning’ because it creates a narrative of a binary experience of these mental health conditions that simply do not exist,” McCray-Brown says. In other words, not all people with mental illness are “high-functioning” or “low-functioning” 100 percent of the time.
“It doesn’t allow space for the possibility that folks who proactively manage their mental health symptoms may also have days where they struggle significantly,” she explains.
It also paints a picture that there are “low-functioning” individuals who may never be able to function in ways that support their needs, says McCray-Brown. What’s more, this type of language does not take into consideration factors that may affect someone’s ability to manage their mental health condition, such as income, access to treatment, or stressors in their surroundings, she adds.
RELATED: Is High-Functioning Depression a Real Diagnosis?
The ‘High-Functioning’ Label Makes It Hard to Ask for Help, Too
I have also found that my “high-functioning” mental illness makes it more difficult for me to ask for help. Because things seem so put together in my life, reaching out feels impossible. I have it all. A good job. A loving family. A great life. What can I possibly complain about? I should be okay. On paper, I am okay.
But the truth is, mental illness knows no bounds. No one is “too healthy” to need help. Plus, using a term like “high-functioning” can lead some people to believe that their mental health issues cannot shift or change in intensity. McCray-Brown notes that is something mental illness can certainly do.
“Most people naturally fluctuate — ebb and flow — in their ability to perform activities of daily living based on a number of factors, including a possible mental health condition,” McCray-Brown explains.
For this reason, the “high-functioning” label is one we should avoid, McCray-Brown says. “The risks of using this language far outweigh the benefits because the nature of the language is so permanent and finite when the human experience is much more expansive.”
So while some may view me as “high-functioning ”— and I have viewed myself as “high-functioning” in the past — it’s a label I’m now trying to avoid using. Not only does it stigmatize certain people with mental health conditions, but has kept me from reaching out for much-needed help at times. And in the end, that’s what I need — help. That’s everyone with everyone with a mental health condition needs.
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