The Untold Side to ‘High Functioning’

By Rachel Horton, from The Culture Vulture 

Room 101 is a BBC comedy television series in which celebrities are invited to discuss their pet hates and persuade the host (currently Frank Skinner) to banish them into oblivion in Room 101. If I was a guest on Room 101, there is one mental heath term that I would argue for banishment into the depths of Room 101. It’s a term that I really dislike; I find it unhelpful, damaging and entirely problematic….yet its existence pervades our mental health language. It is a term, that I have been labelled with many times over the years.

The term is “high functioning”; a term regularly used to describe, label, qualify mental illness and issues. You might have heard it in relation to anxiety or depression; it can also be used to comment on someone with an addiction or eating disorder. High functioning tends to mean that someone appears to function reasonably well in different aspects of their life whilst having an issue or diagnosis. (I know the term is also seen as problematic in autistic communities – but I’m focusing on it, in a mental health context.)

When we talk about functioning, we’re often referring to an individual’s adaptive skills; those practical skills or behaviours necessary to function in everyday life and to live up to every day societal expectations placed upon them. If you’re high functioning depressed person – all the stereotypes you might think of when you think of someone who is depressed may not really be recognisably present– they may not behave or seem “like” a depressed person.

And that’s where we get into dangerous territory – high-functioning in mental health does not really refer to someone’s functional ability, it refers, in my opinion, to someone’s ability to hide “something” from the rest of the word. You can pass as “normal” by masking it – as if the mental illness doesn’t exist. It is invisible. The individual can proactively create the illusion of being fine! And it IS proactive because it takes LOTS of effort and is exhaustingly performative from experience.

Using “high functioning” as a term means we place the importance on the manifestation of set behaviours that we (society) expect to see in someone with a mental health issue for a diagnosis or to secure help and yet, we know that appearances are often deceiving and that mental health issues are individualistic, often invisible and present themselves differently in different people. We are therefore inadvertently perpetuating a cycle that denies high functioning people access to services and support that they may need because we assume that if someone is “functioning” then they don’t need help.

Just because, you can’t SEE the manifestation of depression, doesn’t mean that it isn’t there behind closed doors. And there are a whole host of reasons why someone may chose to mask; being high functioning often isn’t a choice – it can be a response to feeling shame, potential stigma, societal pressure, lack of supportive environment etc. And in my experience, high functioning folks have areas in their lives where they aren’t functioning very well at all, you (society/their network) just aren’t aware of it. Like Monica in Friends with her “room of doom” in her apartment.

The label also hinders recovery – it enables a mental health issue to exist within a person forever unmanaged and unchallenged; as long as you “function” adequately, then you don’t need to do anything about it; fostering this weird self-acceptance that it’s ok to be miserable or anxious inside forever, as long as you continue to function. It enables the person and depression (or another issue) to co-exist without any recovery or self-management thoughts because you measure someone’s mental health issue not on their quality of life, thoughts or well-being but on their ability to achieve expected outputs and societal expectations of what is “normal”.

My own experience as “high functioning” barred me from treatment and early interventions, I’ve felt like a prisoner at times in my own lies whilst desperate for SOMEONE to see through my bullshit, I’ve been able to hide within the masking using my functioning ability as proof that I am ok and don’t need help and I’ve felt more palatable to society (and my network) – my messy side is an inconvenience, a shameful secret, an uncomfortable conversation, a burden – it’s just easier to pretend. It’s also top of the pile gold star stuff in doctor’s offices. I say this, as someone who has sat with a grin as therapists and doctors have applauded (in some cases) my ability to function, achieve, stay silent and mask what is really going on behind the scenes – I am thoroughly believable as a happy, well person and I took some weird validation from being told that.

So, please can we put high-functioning into Room 101? PLEASE! It is problematic for individuals, for professionals, for treatment and diagnosis and for society when trying to understand mental health.

Using the term discounts or dismisses the individual, their needs or struggles and places value and access to support on outputs and “functional” ability. By using it, you are legitimising that mental health is about what you “see” as opposed to acknowledging what is going on inside someone’s head and their experience. And most importantly, high functioning’ is not how a person with mental health issues experiences their world, it is how society experiences and perceives the person with the mental issue…..and this is why it’s so limiting and misleading.