Is “High Functioning” Stigmatizing?

Posted on May 8, 2015 in Civic Responsibility Stigma

Some advocates for the mentally ill think we are doing too much for “high functioning” patients. “High functioning” is not, as far as I know, a word that anyone with a mental illness applies to herself, but is a label affixed to our records by social workers, other mental health workers, and bureaucrats. It signifies that the person in question is able to care for herself without assistance from caretakers or government programs. For the patient, it feels like a kick in the pants and, like most stigma, is based not on how the patient feels but on an outside evaluation that culminates in a “I know what is good for you better than you do” prescription.

A speaker at a DBSA conference that I attended some years back described what happens when a person is labeled “high functioning” too soon:

What concerned [George Nostrand] was the cycle that the mental health system thrust its clients, whereby they were only managed in the event of crisis and until they were just self-sufficient. Once stabilized on the needle’s point of what bureaucrats fobbed off as recovery, the state abandoned these people when they were still fragile. When the client faltered, agencies blamed lack of resolve on the part of the health consumers and/or the care providers for the failures. Nostrand contended that agencies should not merely aim to have their clients mere self-sufficient but thriving in the face of the challenge of the illness.

“High functioning” has more to do with balancing costs than the welfare of the patient. It opens a patient to ridicule and other abuse by those who accept the designation at face value. The patient may be expected to get a job, for example, before he is ready. I have been labeled “high functioning” for many years, but I suffer from trauma relating to my last workplace. People yelled at each other and threatened violence. I was called names and accused of shirking my duties when, in fact, I kept up. My work was subjected to relentless reviews by the boss. I was abused for being depressed and shunned by my coworkers. I was monitored on the suspicion of being a spy for a union. Yet my psychologist thought I was ready to go back into the workplace full time despite this history.

Fortunately for my sanity, I did not listen to her. I took my time and ramped into volunteer hours and photography. Today I thrive. Nature’s course however, took longer than the psychologist’s schedule.

I have not been on the dole (my wife supports me); I can only imagine how devastating the pressure to go to work when one is not ready can be. Having services dropped abruptly, as Nostrand points out, often results in having one relapse into “serious mental illness.”

All mental illness is serious. Every one of us living with mental illness faces the risk that we will lose our footing and fall again into our symptoms. Yet there are advocates out there — who claim to be working to help those with serious mental illnesses (another stigmatizing term) — who call for funds to be shifted from institutions such as Orange County’s Wellness Center to forced medication programs and mental institutions because, in their opinion, “high functioning” patients don’t need help. Programs such as the Wellness Center, however, are vaccines against relapse. They work best because their staffs remember that their clients are sick. A better solution for patients who are not ready for Wellness Centers and similar programs are group homes and the community mental health clinics that were promised us when deinstitutionalization began in 1963. Many people who cannot get their meds otherwise and who can’t escape the cycle of recovery and relapse — including many high-functioning patients teetering on the edge — would obtain the treatment that they need.

When you ask patients what they want, they bring up similar ideas. They also mention peer support and peer evaluators who have a real idea of what they endure from day to day. Very few patients mention forced medication programs because these are not meaningful or helpful to them. What they want is sufficient funding for programs that help them recover and thrive independent of caretakers and guardians. The other solutions, like the “high functioning” stigma word, are imposed from the outside by people who don’t talk to patients and who have other agendas. Consequently, the current wave of “mental health reform” doesn’t try to create and fund these kinds of institutions. Instead, its advocates choose to perpetuate a broken system that routinely lifts patients up and then lets them fall again and again — with the addition of a few draconian measures. It is time to stop blaming the patients for this cycle. Drop the label “high functioning” and see that patients have a reliable health care that stays with them regardless of improvements in their condition.