Functioning Labels Don't Help Anyone

Using functioning labels to describe the level of someone's abilities is a widely disputed topic in the Autism community right now. But what about using these labels when referring to other mental illnesses? Doctors, therapists, and so many other people categorize mental health patients as "high functioning", "low functioning", or somewhere in between to describe the severity of their conditions. This seems ridiculous to me since no one would ever describe someone as a high or low functioning cancer patient, right? The same should apply when referring to mental health.

I'm not going to say much about the harm caused by labeling someone as "low functioning" because I don't really have personal experience with that label, and I don't know what it's like to receive it. Even reading that sentence, you might be thinking I'm lucky for not being in that category, and for some reasons I am. My stance, however, is that making these categories at all is extremely harmful, and I do have enough experience with the "high functioning" label to know it can be just as much a disservice.

My first experience being labeled as "high functioning" was when I was thirteen and a therapist was officially diagnosing me with OCD. She told me I could probably benefit from medication and continued therapy to help with my anxiety, but she wasn't recommending them at the time because I was getting along okay without it, and it might be best to wait a few years. Basically, she thought it was a good idea for me to continue suffering for a few more years because I was a successful student and athlete even though my symptoms were impairing my day to day life. This still doesn't make any sense to me, and I resent her a little for letting me walk away without any extra support in place to help me live a higher quality of life.

Later, when I was twenty-two and had recently left the college I was attending because my mental health was declining so severely, I ran into more issues related to my perceived functioning level. I was experiencing a lot of symptoms that I couldn't really explain, and I was trying to find care in my area. Finding the right support while in a mental health crisis is one of the most difficult things I've ever done. Dealing with insurance companies, private therapists, public psychiatrists; all of it is so much to manage, especially when just getting out of bed seems impossible. While looking, I finally found a phone number for my county's public mental health services. I made the call and spoke to someone who asked me a few questions: How are you doing? Are you working? Are you eating, showering? What kind of support are you looking for? I answered: Alright, yes, yes, I don't know. While these answers were technically true, I was really doing the absolute bare minimum, and things were getting worse every day. I wasn't ready to open up a lot during this preliminary phone call though. The woman on the line informed me that their services were only for people with moderate to severe mental illness, and I didn't seem to fall into that category based on my answers. Keep in mind I am now diagnosed with a "severe" mental illness.

A couple of months later, I was feeling desperate, so I want into the county office in person to have an intake appointment. After opening up a bit more, they reluctantly took me on as a patient because I seemed to be struggling just enough for them to see that I needed help. A year and a half later, I still receive care through the county, and I've seen a therapist regularly and quite a few psychiatrists. Most of them listened to my opinions and concerns fairly well, but one stands out as someone who didn't provide me the care I needed because he decided that I am "high functioning". He was hesitant to prescribe me antipsychotics even though I was consistently complaining about my hallucinations, delusions, and disorganized thinking. He saw me at a surface level as someone who was working, going to school, and socializing, so he figured my symptoms couldn't be that bad. He told me his other patients had it worse. I worked hard to be professional and put-together at my

appointments, and I felt like I was being punished for it.

In March of 2020 I was hospitalized for having serious plans for my suicide, and after that experience, my depression as well as my other symptoms seemed to be taken more seriously by my doctor. I suppose I was knocked down to a lower level of functioning. I was glad to finally have my symptoms be acknowledged, but it shouldn't have taken an experience like that to make it happen. I also noticed other changes in how my doctor conversed with me after my hospitalization. She seemed less focused on my ambitious, long-term goals, and more interested in praising my abilities to do more basic things such as live independently and have a long lasting relationship. She seemed to have lost sight of what I want to accomplish because I'm no longer quite as "high functioning".

Now I'm starting with a new doctor, building a relationship through our short appointments. I feel like I have to make a decision about how I present to her. Do I show her the sides of me that are really struggling with symptoms, consistently suicidal, hearing voices, and barely keeping up with my house chores, and risk being labeled as "low functioning"? Or do I dress well for my video appointments and tell her about my high GPA in a hard major and my successful relationships? If I convince her that I am "high functioning", my symptoms might not be taken seriously. My ultimate goal when working with my psychiatrist is to address my symptoms with as little medication as possible and to keep my long term ambitions in sight. I want to work to find the best possible combination of medications for my lifestyle, not the combination that just mostly works well enough. I strongly believe that labeling me with a specific level of functioning gets in the way of this and my overall mental health goals.