The terms “high functioning” and “low functioning” need to be removed from everywhere

I’ve always had an issue with the terms high functioning and low functioning when describing people with disabilities and mental illness. They’re very limiting and hurtful labels. They don’t take into account a person’s whole being, we’re not just a collection of symptoms and things we can and can’t do checked off on some form. It doesn’t take into account how people’s ability to cope can change throughout the week or day or hour. It makes people feel like if they don’t fit in one box than they have to fit in another. And worst of all these boxes determine what services you get and how you’re treated by the people who are supposed to be your allies and genuinely support you.

People dealing with any myriad of disabilities have a fluid spectrum of how they cope as I said from one minute to the next. Examples of this are chronic pain, any kind of mental illness, and though I don’t know anything about this, perhaps those with autistic/ cotnitive disabilities have ups and downs. No one seems to have a problem with someone who needs glasses in one situation but doesn’t in another. That’s an example of functioning not being static. But they can’t seem to understand when someone presents in a conflicting way.

For example, I can be very articulate about what I’m going through. Very intelligent ( I’m speaking for others that have said this I’m not being conceded!) I understand a lot and am kinda nerdy about psychology, social services and the like. And yet I can get just as knocked down by depression, anxiety, PTSD triggers and urges to self-harm as the next person who doesn’t present as “having it together” or “normal”

This really got to me this week. I’ve always hated this whole hang up professionals have on functioning and try to correct/ give another perspective. But this week my new caseworker Stephanie and I were talking with Jess present. Stephanie said that both Jess and I were “very high functioning, as close to a normal person as I could imagine.” That made me wonder what she thinks of others here. She was basically trying to say I think how it might be hard to be around people who’s interpersonal way of being is dictated by their illness most of the time. Notice I didn’t say all of the time. Even with people who are really drowning in symptoms there are moments of clarity or times they’ll talk about things they used to do, so even then functioning is not inflexible.

So it brought up feelings about how much I hate those terms. Because here’s what happens at least for myself and others I know with mental illness.

Before I came to Albany and had my huge breakdown I was still intensely mentally ill. Like really. The only difference between then and after is that I was holding it together through shere mental powers of “turn off your emotions and just get on with it.” Plus meds, which weren’t really working but it was still some meds. Anyway I would call places or go for intakes, and even when I got into trilogy. I was told I was so “high functioning.” And was told I didn’t need these services. But I was really having a hard time, I needed help. I would have preferred to choose my own therapist, or a group program that I was attracted to, bhut with Medicaid you have no choice. So I’d call the recommended list of places and they told me that I was too high functioning. Or that like there was a waiting list for psychiatrists but you could tell they had a priority on people “more in crisis.” Basically.

So blah blah high functioning followed me around. Then I had my breakdown. And then it was like OMG we have this suicidal, self-harming

Girl! Who by the way is blind. (another subject for another post.) What do we do! Because with cutting almost every place says that’s too “low functioning.” Same with active substance abuse, eating disorders or personality disorders. This is the opposite end of the line. You’re so sick they can’t help you without spending a lot of money on intensive long term treatment that’s not covered by Medicaid.

And it goes back and forth and back and forth. Somehow you have to maintain this balance of being in need enough to get services but not too needy in ways that they can’t handle or else you get no services.

As a last example I know that if Jess and I were to move out ( considered high functioning) still with our same exact symptoms, same spectrum of how our illness is, same everything except we’re tired of this place and want some more freedom. We would be given the same services as far as I know as anyone else living alone would. They assume that if you’re living alone, bright articulate ETC you don’t need such intensive services. Even if the services, are what’s keeping you on track. And then a self-harm episode happens or a person gets suicidal. And then oh look they’re not so high functioning anymore! This is the cycle people go through. It’s so sad and infuriating. And I don’t know how we can ever get people to not think in black and white terms when it comes to trying to help people. Because you really can’t support someone if that’s how you think with an either or mentality.

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2 thoughts on “The terms “high functioning” and “low functioning” need to be removed from everywhere

  1. This happens all the time and sometimes even people dictate your function level, as if some test will certainly proove what or how functioning you are. tired so sorry if this comment is a low functioning construction! LOL.

  2. i hate those terms as well. they’re too loose. used too often. as my therapist always says, recovery is not linear, people are high functioning at times and low functioning at times. its not straightforward. XXX

    Private emails are always welcome, you can reach me by emailing me at

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