Things I Want to Write

  1. Why Using the Words High-Functioning vs. Low-Functioning is Bullshit
  • The main question becomes – High functioning compared to what? In terms of what?
  • func·tion ˈfəNG(k)SH(ə)n/: verb 1. work or operate in a proper or particular way.

So, if we’re going to use the labels, let’s say what we really mean. High functioning becomes able to blend in with neurotypicals and low functioning becomes the opposite.

For: Help identify capabilities

Against: I don’t like it because the term “functioning” can be too vaguely defined and lead to misunderstanding. Social functioning? Physical functioning? Mental functioning? And the unfortunate conclusion is that if some people are “high functioning”, are others “low functioning”? Who judges that and by what measure? I worked with a non-verbal man diagnosed with classic Autism and considered very low functioning, but after he mastered using an iPod to communicate, he clearly showed himself to be just-as-if-not-more intelligent than average folks. I have Aspergers and am quite poor at making small talk and conversation, but excel at knowledge in my field. According to some standards, such as social functioning, I might not be considered very high functioning then; but mentally, intellectually, I am quite high functioning. You see, the terminology lacks clear definition, and could too easily be used to misdiagnose people and set up limitations or perceived limitations that may or may not actually exist.

It’s dehumanizing: Degraded to high and low functioning people

  • “To them, “high-functioning” autistics were “better”, easy to deal with. The “low-functioning” autistics required a lot more work because their lives was “misery”.That’s the first problem: lack of understanding of autism, leading to rushed judgments based, largely, on appearances.” Source
    • I can hear some parents saying: “but some adults ARE low-functioning. They still cannot care for themselves.” (they are talking about autistics like me). My answer: neither can Stephen Hawking.

The Odyssey

  • Essentially, people with high functioning mental illness are those people I mentioned earlier who are behaving neurotypically in front of others, but confront their mental illness when alone.
  • Creating a hierarchy to mental illness.
  • The name ‘high functioning mental illness’ implies that the people who are ‘high functioning’ are fundamentally better than those deemed ‘low functioning’ –that they have some sort of willpower or strength that those silly ‘low functioning’ people who can’t get out of bed or practice personal hygiene, or interact with others don’t have.
  • Functioning labels are problematic because they can separate people and remove them from the conversation entirely; if someone is too ‘high functioning’, they clearly can’t comment on the life of ‘low functioning’ people because they are barely mentally ill or barely disabled, so how can they comment on the lives of people who can’t even take care of themselves? On the flip side, if someone is too ‘low functioning’, they clearly can’t be a part of this conversation because they can’t even take care of themselves, how can they be trusted to advocate for themselves?
  • In addition, there is simply no need to differentiate in this way. It simply creates a dichotomy that separates people with similar experiences and needs. Everyone has days where they are ‘high functioning’ or ‘low functioning’-not everyone can be perfect and ‘power through’ all the time, and even ‘low functioning’ people can take care of their responsibilities.
  • If my depressive episodes lead to me missing practices and failing classes because I’m too depressed to get out of bed, not cleaning my room and living in a pile of my own dirty socks, and forgetting to shower on a regular basis, do I deserve to be in this conversation among my ‘high functioning’ peers?

 

HuffPost Article

  • “High-functioning depression is when someone seems to have it all together on the outside, but on the inside, they are severely sad.”
  • “People often say being ‘high-functioning’ is better than being ‘low-functioning,’ but that’s not really true because the most important thing is for a depressed person to get help—which a high-functioning person is limiting herself from,” Landau says.
  • Leventhal doesn’t identify with the mopey women in antidepressant ads. Her symptoms manifest themselves in other ways. “For me, it was irritability,” she explains. Landau says this is totally normal. “You might have a friend who is cranky all the time, or who people think of as a ‘bitch,’ but inwardly that person is really struggling. Other subtle signs to look for: ironic or morose jokes—if they are out of character—or often seeming out of it.

 

Upworthy

  • We don’t see the student with the 4.0 GPA or the student who’s active in choir and theater or a member of the National Honor Society or the ambitious teen who takes on leadership roles in a religious youth group.

This classification is for others to be able to understand and make sense of our experiences. 

 

Mad in America

  • The Worried Well — High Functioning 
  • I’ve also heard about the term “high functioning” used by service providers to deny treatment to people who want it because they aren’t “sick” enough. The term “low functioning” is used to deny people voice and choice over their health care decisions. And what’s worse is that many people with disabilities have internalized the oppression and describe themselves in this way.
  • “Functioning is so much a matter of definition, and I feel that the definition is used as the basis for invalidating the experiences of those who are defined as high functioning, and denying that they require any supports or that their experiences have any value. There is a policy of referring to those defined as low functioning as the ‘truly mentally ill.’ It is a divide and conquer policy…”
  • Arbitrary categories of “high” and “low” functioning assume that these are fixed and immutable states of being. People may look at me today and assume that I am among the “high functioning” ones. I have a job, I own a home, I am a parent, I pay taxes, and “contribute to society” like a good little citizen. No one would know by looking at me today that twenty years ago, I was not functioning by the above definitions. I saw personal messages from God in billboard signs and in advertisements on the side of buses, and was convinced that at the appointed hour my “sacred role” as “savior of humanity” would be revealed to the world. Sometimes I was in such distress that I was literally unable to communicate with the outside world. I couldn’t go to school, or work, or do any of the things that society expects us to do in order to be considered “high functioning.” And I tried to kill myself several times, which would have ceased all functioning.
  • “’Functionality’ isn’t a fixed given. What you observe, behavior-wise, is just one piece of information about one given person during one moment of their lives. I was labeled as ‘low-functional’ during a hospital stay. No s–t, I was in the hospital. I was ‘high-functional’ when I was well dressed, articulate, with a full-time job — no surprise there, again. Confirmation bias, much? I bet the folks in the hospital would not have expected me to ‘switch’ functionality levels.”
  • This comment reflects another fundamental underlying assumption that “functioning” has to do with our expected role as producers and consumers in a neoliberal capitalist economy. Those who neither produce nor consume are considered to be “low functioning.” As one commenter noted, these terms are a “remnant of the industrial age, where people are understood as machines now on schedules by time increments…we’ve lost parts of humanity that have nothing to do with having products, producing products or being products.”
  • “To reduce humans to beings that “function” at different levels is to measure us as parts in a (society as) machine. ‘He contributes poorly to the economic machine’ and ‘she contributes well to the economic machine:’ this is the perspective of a society that is profoundly sick!”
  • Neurodiversity Movement
    • This movement frames autism, bipolar disorder and other neurotypes as a natural human variation rather than a pathology or disorder, and its advocates reject the idea that neurological differences need to be (or can be) cured, as they believe them to be authentic forms of human diversity, self-expression, and being.
    • Neurodiversity advocates promote support systems (such as inclusion-focused services, accommodations, communication and assistive technologies, occupational training, and independent living support) that allow those who are neurologically diverse to live their lives as they are, rather than being coerced or forced to adopt uncritically accepted ideas of normalcy, or to conform to a clinical ideal.
    • Shoelace tying example
  • The social model of disability lays the responsibility on society to address the varied barriers to “functionality” that so many people undoubtedly face.
    • The social model of disability is a reaction to the dominant medical model of disability which in itself is a functional analysis of the body as machine to be fixed in order to conform with normative values. The social model of disability identifies systemic barriers, negative attitudes and exclusion by society (purposely or inadvertently) that mean society is the main contributory factor in disabling people. While physical, sensory, intellectual, or psychological variations may cause individual functional limitation or impairments, these do not have to lead to disability unless society fails to take account of and include people regardless of their individual differences.
  • But can or should we truly compare “gradients of suffering” in an unjust world? Imagine what our society would look like if we truly honored human diversity rather than classify people into binary categories of “high” and “low” functioning?
  • Imagine what would happen if we began to have some respect for the varied ways that people do their best to adapt and function, sometimes with amazing creativity, in a deeply dysfunctional world? I would like to see us cease to blame or shame individuals for their level of functioning in society, and instead work to create a more equitable and just world that meets our basic human needs and human rights.

 

  • Clinging to the high functioning label allows us to separate ourselves from the low functioning folks; thus, distancing ourselves from how to help ourselves in crisis moments.

 

The Mighty

  • Autism isn’t a competition. I don’t care where you or your child fall on the spectrum. My child doesn’t care where you or your child fall on the spectrum. People are different. Autism is different. Not one of us is the same.

 

The Odyssey

  • If we are making it through days, weeks, and even months without a panic attack or a major depressive episode why should we be wasting our (or likely our parents) money on medicine? Why should we take a chunk of our therapist’s time when someone else who is in more need could be using it? Having a high-functioning mental illness makes it hard to validate not only our use of resources such as medicine and counseling, but identifying as someone who has the illnesses as well.

The Mighty – High-Functioning Anxiety

Sources:

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