In the past couple of weeks, I’ve found that I’ve been hearing several references to “high functioning” people with anxiety disorders. In the examples I heard and read, it was the anxious person themselves who used the term “high functioning,” usually in the context of something like, “I might be high functioning, but I’m still struggling underneath,” and suggesting that being “high functioning” puts them at a disadvantage because people don’t “see” their illness. I actually heard one person use the term “The ‘not sick enough’ stigma.” It got me wondering what calling someone “high functioning” really means, particularly in the case of folks like me who have Generalized Anxiety Disorder.
Last week, I read an article that was all about the author’s experience of living with what they called “high functioning” anxiety. That person referred to symptoms like negative thoughts, muscle tension, restlessness, procrastination, sleep disturbances, and relationship difficulties – check, check, and check, all very familiar to me! I’d say that these are pretty significant symptoms.
For that writer, the “high functioning” part relates to the fact that they can live their life effectively enough that they can keep their anxiety issues a secret from the people around them. I get that idea too, for sure. Most people I know or encounter would never guess that I’ve been diagnosed with a mental illness – I generally come off as a pretty upbeat person, I have a good job, I rarely call in sick, and I’m surprisingly good in a crisis (as long as it’s a crisis unconnected to my own anxiety triggers). It’s behind closed doors that most of my anxiety disorder is on display: things like the fatigue (or, alternatively, the inability to relax), the self-doubt, the constant worrying, the frequent irrational requests for reassurance from my husband that he’s not mad at me for some random reason, the avoidance of my anxiety/phobia triggers, the staying up way too late.
In fact, before I sought treatment for my anxiety, even I didn’t believe I could have a mental disorder. I imagined someone with mental illness as a person who couldn’t leave the house, or who missed a lot of work. When I first started seeing a psychiatrist I felt like I was probably wasting his time, and was kind of amazed that he actually kept wanting me to come back to see him, and told me that I could probably benefit from antidepressants. Me? Taking psych meds? That seemed pretty over the top at the time.
Before long, though, I started to realize that my anxiety disorders were affecting my life in a lot of negative ways, ways that I’d been in denial about. First there were those symptoms that I experienced in private, and I realized that just because I thought they only happened behind closed doors didn’t mean they’re not affecting my life overall, and maybe I wasn’t coping as well as I’d thought I was. Then there were the more substantial impacts of anxiety on my life. Yes, I might have a good job, but it’s a part-time job – I started working part-time at one point because it was the only job I could get, but now I don’t know how I ever had the energy to work full-time. I also do little socializing because it tires me so much, and because I’m usually too anxious to enjoy myself when I do. And a few years ago I stopped travelling, largely because I felt like I couldn’t handle being away from the safe, controlled comfort zone of my home.
Slowly but surely, it dawned on me – I have a mental illness. And maybe I’d become pretty good at hiding my disorder from the people around me, and maybe I’d even gotten pretty good at denying it to myself, but that didn’t mean that it wasn’t affecting my life. Maybe I really did need to be going to a psychiatrist. Maybe I did need to take medication. Maybe I could benefit from a support group.
So sometimes I wonder when those of us with a mental disorder use the term “high functioning” to describe ourselves, how highly are we really functioning? Does holding down a job and being able to fool people into thinking we don’t have a mental illness mean that we’re “high functioning?” Actually, given that my diagnoses are Generalized Anxiety Disorders and Phobias, I’m not really sure what it would look like if I wasn’t “high functioning.” I don’t have panic disorder or agoraphobia, so I think most people with my diagnoses could function in public to a substantial degree, as do I. But that doesn’t mean my ability to function isn’t affected by my disorders – it affects my ability to function every day, in some way or another. Maybe describing ourselves as “high functioning” can sometimes be a way of minimizing (to ourselves) the true effect of our mental illness on our lives.
I would also tend to challenge anyone who imagines that being “high functioning” is some sort of burden, in that those around us don’t take our illness seriously. The fact that I was able to get up, get dressed, and go to work today isn’t a burden, it’s a gift that I don’t take lightly, especially when I think about the extra challenges of fellow sufferers of mental illness, like the person whose depression means they have to miss work, the person who is too fearful of a panic attack to ever leave their home, or the person with bipolar disorder who alarms their coworkers when their manic phase kicks in. Those people aren’t much different from me, it’s just that their particular illness means they don’t have the luxury of being able to to hide their symptoms if they so choose, as I can.
I understand that having a mental illness that allows us to appear to be “high functioning” comes with its own unique challenges, especially the contrast between how we’re actually feeling versus how we might appear to be feeling, and the disconnect with those around us that such a dichotomy can produce. And so we’re left with two choices. If we’ve been keeping the effects of our mental health challenges mostly to ourselves, one choice we have is to simply carry on with our lives as we have been, electing not to reveal our struggles. For some of us, this is the option that works best for us at this point in our lives, and I totally get that. But in doing so, we must also accept that we can’t and won’t be fully understood by the people around us.
Our second choice is to decide not to hide the effects of our illness any longer. To tell our friends the real reason we aren’t coming out with them tonight. To confidently tell our family members that we’re seeing a therapist. To take the opportunity to reveal to trusted coworkers that hey, while we’re talking (gossiping) about the fact that Tom in Accounting is taking sick leave due to depression, have I ever mentioned that I struggle with an anxiety disorder?
Being so honest and vulnerable is a challenging route to take, thanks to the stigma that many people continue to attach to mental illness. The thing is, that stigma isn’t going to go away as long as those of us with mental disorders go on hiding our condition, continuing to leave many people around us with misunderstandings and misinformation about what mental illness looks like. If we want to be a part of the solution to the supposed “not sick enough stigma,” and all stigmas around mental health, we’ll have to start to drop the “I’m fine” mask, and open up to being our true, authentic selves. It might sound scary (it kinda does to me!) but nothing will change around us until we do.