The term ‘high functioning’ is used to describe people with mental health issues (and other conditions) who appear or behave in a way which is ‘normal.’ This often means holding down a full time job, having stable relationships and being able to carry out mundane tasks, like cooking, shopping, using the phone, travelling on public transport, etc. It can be a useful term, for example when explaining how people whose lives appear successful can be suffering from a mental illness, but it’s very problematic. Especially for those of us who aren’t ‘low functioning’ but can’t be described as ‘high functioning’ and/or whose mental health problems vary over time.
I propose using ‘differently functioning’ to acknowledge the full spectrum of people who experience mental health issues. It’s a more flexible term which avoids many of the assumptions evoked by using evaluative language to define people’s experiences of mental health. It identifies the need to accommodate difference without creating discrete categories which are imposed on people with mental health problems.
‘High functioning’ implies a binary position – and a hierarchy.
When people use the term ‘high functioning’, it is usually in contrast to ‘low functioning’ individuals. They don’t talk about the people who fall between these two definitions. This means that people with mental health problems who don’t meet the criteria for either definition are ignored or shoved into whichever category someone else decides is the best fit. Their specific needs are not considered.
Describing individuals as high/low functioning also suggests that their value as a person is either high or low. The implication is that ‘high functioning’ people contribute to society, whereas ‘low functioning’ people are a burden on society. You might not intend to create these assumptions when you use the terms, but that’s the effect of the language you are using.
‘High/low functioning’ are terms which invite judgement.
There are expectations built into the descriptions: ‘high functioning’ people should be able to cope with anything, whereas ‘low functioning’ people can’t be expected to cope with anything. You are either under pressure to meet society’s definition of ‘normal’ (which is variable in itself) or devalued as ‘subnormal’. You are judged by the terms themselves, then you are judged if you fail to meet the expectations evoked by these terms.
Unfortunately, the UK benefits system is based on these terms under different guises: ‘fit for work’ and ‘not fit for work.’ Little to no consideration is given to people who can cope with some types of work but not others, or people whose ability to cope varies. This exposes vulnerable people to judgement from the general public: if you are declared ‘not fit for work’ and someone sees you on a rare good day, enjoying a meal out with friends, you are labelled a scrounger. Even if you have to ask your friends to go to the bar on your behalf, because anxiety prevents you from speaking to the bartender.
These definitions and the associated judgements help nobody. They perpetuate ignorance of mental health issues and prevent people from seeking help and support.
I have been on both sides at various times in my life and neither is easy. When I was ‘low functioning’ I felt like a lost cause and any improvement made me feel like a fraud, because it deviated from people’s perceptions. I felt guilty for having a good day. When I was ‘high functioning’ I felt like I constantly needed to prove myself and anything less than perfection was a failure. I felt guilty for not being able to do things – anything, even things most people find difficult – and was crumbling below the surface.
Describing people as ‘high/low functioning’ in a medical context may be useful, but it’s still limiting. Using these descriptions in daily life is damaging.
‘High/low functioning’ are fixed terms.
Defining people as ‘high/low functioning’ implies permanence. There is no obvious route from one category to the other – particularly from the undesirable (low functioning) to the supposedly desirable (high functioning). It takes away hope for people whose mental health prevents them from functioning ‘normally’ – and hope is a rare commodity for many people who have mental health issues – while failing to provide a safety net for ‘high functioning’ people, because if they fail to meet expectations (their own and/or other people’s) they are condemned to the ‘low functioning’ category, since there are no other options available.
You are either consigned to a category which (according to some people) defines you for the rest of your life, or your individual requirements are permanently ignored as people try to shoehorn you into a category.
‘Differently functioning’ offers an alternative, more realistic and flexible viewpoint.
Mental health is variable – regardless of whether you have been diagnosed with a mental illness. Everyone has good days, bad days and days which are inbetween. This is often exacerbated when you have mental health problems, as your symptoms can vary a lot and these symptoms affect other aspects of your life – and other symptoms. This means your ability to perform certain tasks can vary a lot.
To complicate matters, your ability to cope with different activities may vary over different periods of time, ranging from years to hours. You can fluctuate between the categories of ‘high functioning’ and ‘low functioning’ on a short-term and/or long-term basis.
For example, I couldn’t take my dog for a walk on my own for over a decade, but now I can – except when my anxiety is worse than usual. Before March last year, I couldn’t go for a walk alone even on good days. Just to emphasise the illogical nature of mental illness, I could walk on my own in specific circumstances during that time, such as when going to lectures at university. Other times, I couldn’t leave the house – alone or with other people.
People who haven’t experienced mental health problems find this difficult to understand (and so do I, sometimes!), because they are stuck in a black-and-white mindset which dictates that if a person is ‘well’ they can do anything, while if they are ‘ill’ they can do nothing. Even when paying lip service to the notion that everyone has good and bad days, some people don’t understand how dramatically one’s abilities and coping mechanisms can vary. They can’t see why people with mental health problems can’t force themselves to undertake these activities all the time.
By using the term ‘differently functioning’, we can acknowledge the variable nature of mental illness. This provides a starting point for enabling people to cope with mental health problems – whether they are the one experiencing mental health issues or a caregiver, partner, friend, employer, teacher, etc. of someone with mental health problems.
‘Differently functioning’ is an inclusive term and values people for their abilities.
It’s genuinely descriptive, rather than judgemental. There are no implied expectations. You don’t feel as though your value as a person is being evaluated when people use the term and you aren’t forced into a category which doesn’t reflect your reality. People with mental health problems can feel ostracised if we don’t measure up to what society considers ‘normal’, which is emphasised when people insist on defining others as high/low functioning. In contrast, everyone is ‘differently functioning’, but these differences often need more consideration when someone has a mental health issue.
The specific differences may not make sense to a lot of people. For instance, anxiety often prevents me from using public transport and driving – but I find driving easier. I can drive at a level of anxiety which would stop me from getting on a train. Most people find this difficult to understand, because driving is more dangerous and involves a higher level of skill and responsibility than being a train passenger. However, I experience social anxiety as well as general anxiety, which makes interacting with people – especially strangers – very difficult. I’d much rather drive than interact with people I don’t know.
My example may seem arbitrary, but it underlines the fact that being differently functional often means you can do some tasks which people consider hard, but are unable to perform some tasks which people think are easy. For instance, I can write essays well, but can’t make phone calls most of the time. In fact, I would rather write ten essays than make one phone call! I’m aware of how ridiculous this sounds, but it’s the way it is – for me.
Your abilities may also depend on other factors, such as location and who else is involved. For example, I’m now able to go to the hairdresser on my own (which wasn’t the case a few years ago), but I can only go to my regular salon and it’s much easier if the hairdresser is one who has cut my hair before. I can do far more when accompanied by my mum than I can alone, or even with a friend, such as talk to shop assistants and go to gym classes. Yet all of this is variable – I went to a gym class on my own when my mum was on holiday, though it was much harder and less enjoyable, but I can’t rely on my anxiety to be low enough for me to go alone every week.
Thinking of yourself and other people as differently functioning is more positive than using the high/low dichotomy. It places an emphasis on what you can do, rather than what you are currently unable to do.
Thinking in terms of ‘differently functioning’ opens up more possibilities.
Along with emphasising your abilities, thinking of yourself as ‘differently functioning’ encourages a growth mindset which highlights the importance of developing your skills. Improvement is possible. You start to value yourself and what you can do. Instead of fostering fear and despair, it creates hope.
I started to think of myself as ‘differently functioning’ last year. I was fed up with feeling stuck between ‘high functioning’ and ‘low functioning’ because that is how our society views people with mental illness. I’m not well enough to do everything which most people take for granted, but neither am I ill enough to do nothing and be satisfied. I have to find a way to negotiate life to the best of my abilities – especially when those abilities fluctuate.
Thinking of myself as differently functioning has helped me to focus on my strengths, rather than berating myself for not being able to do simple tasks, like talking on the phone and shopping alone. I’m pushing myself to improve my skills and gain confidence. I’m managing my mental health better. Perhaps I will meet the criteria for people to consider me ‘high functioning’ one day, but it doesn’t matter to me – as long as I know I’m doing my best, working hard to achieve my goals and contributing to society.
‘High functioning’ is not a good goal.
The trouble is, ‘high functioning’ gets presented to people with mental health problems as a goal. Even when people who use the term are trying to make a valid point, such as how mental illness makes it difficult to cope even when your life looks great from the outside, this is the subtext: lots of people with mental health problems can work, get married, have kids, go on holiday, buy homes, etc. so if your mental health has prevented you from doing any (or all) of these things, you are a failure. You can’t blame your mental health, so it must be your own fault.
Mental illness is not a homogenous experience and adhering to a high/low functioning dichotomy ignores both the range and intensity of symptoms. It also ignores the complexity of individual situations. Some people have highly supportive employers, for example, who allow them to work flexibly and take time off when needed without sending them on a guilt trip when they return to work. Some people have supportive families who help them cope. Some people have the security of large financial resources. Some people have all of these advantages and more; others have none. When being ‘high functioning’ is presented as a goal, allowances are not made for people who lack these resources and the implication is the same – if you don’t reach this goal, it’s your own fault.
‘Differently functioning’ abandons the myth of the ultimate goal.
I advocate thinking in terms of ‘differently functioning’ because there is no ultimate goal: people are free to choose their own goals and don’t have to worry about not measuring up to the ideal.
Except the high functioning ideal isn’t necessarily an ideal. ‘High functioning’ often refers to people who are struggling with mental illness while maintaining a façade, rather than managing their mental health and achieving their goals. They may be considered successful, but they are neither happy nor healthy. This has more disturbing implications when it’s portrayed as an ideal: it doesn’t matter if you are suffering, as long as you bear the hallmarks of success.
I followed this philosophy for a long time. I thought having a job was more important than being healthy, so I stayed in jobs which damaged my mental health. I believed exam results were more important than being happy, so I focused on studying as I grew more miserable. My coping mechanisms were destructive: self-harm, alternately bingeing and starving myself, cutting myself off from friends.
Nowadays, I’m trying to follow a different philosophy: managing my mental health and achieving my goals without sacrificing one for the other. I may never be able to work in a conventional full time job, but I hope I can build a successful career through unconventional work. Perhaps I will struggle with my mental health all my life, but I’m determined to cope as well as I can and pursue my interests whenever I can.
I’m functioning in a different way to ‘normal’ people, but I’m still functioning.