Home Mental Health & Well-Being “High-Functioning Depression” Is a Misleading Term That Minimises the Struggles of Those With Depression

“High-Functioning Depression” Is a Misleading Term That Minimises the Struggles of Those With Depression

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Language matters in mental health. It shapes how we think about disorders, how we relate to those experiencing them, and how they perceive themselves. One term that has surfaced in social media with increasing frequency is “high-functioning depression.” At first glance, it may seem like a helpful descriptor for individuals who manage their daily lives despite their depressive symptoms. But this label may do more harm than good upon closer examination.

The misleading impression of “high-functioning”

The term “high-functioning depression” typically refers to those who continue to meet life’s demands – such as maintaining a job, relationships, and other responsibilities—despite battling depression. While this might sound like a mild form of depression, it is anything but. The descriptor “high-functioning” unintentionally conveys that this form of depression is less severe or debilitating. This is misleading and minimises the profound struggle that individuals experience.

Depression, in any form, is a severe disorder. I have seen patients firsthand in the hospital appear catatonic because they were so depressed. Experienced clinicians know that depression can manifest in a wide array of symptoms that significantly impact a person’s emotional and physical wellbeing. By focusing on the “functioning” part, we risk overlooking the pain and suffering beneath the surface. Individuals might feel invalidated or pressured to cope without seeking help, perpetuating their struggle in silence. “High functioning” unintentionally minimises the struggle of those who suffer in silence. It suggests a hierarchy of suffering where those who can perform daily functions are often overlooked regarding the empathy and support they require. This can lead to significant barriers in seeking help, as individuals may feel their suffering is not “severe enough” to warrant attention.

Symptom severity and visibility

Depression is not a monolithic condition; it affects each person differently. The symptoms can vary widely in intensity and manifestation. Some individuals might experience intense sadness and despair, while others may struggle with profound fatigue or irritability. The term “high-functioning” obscures these experiences because it focuses more on a person’s ability to perform tasks than on the actual symptoms of the disorder.

This perspective can lead to harmful misconceptions. For instance, someone might assume that because a person is high-functioning, they don’t need support or treatment. This could not be further from the truth. Everyone who experiences depression deserves compassionate care and effective treatment, regardless of how well they seem to manage their daily tasks.

The importance of comprehensive assessment

The DSM-5 emphasises the need for a comprehensive assessment considering all aspects of an individual’s life and functioning. This approach aligns with the critique of the “high-functioning depression” label, which oversimplifies and minimises the complexities of depression. By focusing solely on an individual’s ability to function in certain areas (like work or social engagements), we may overlook other critical aspects of their health and well-being.

For instance, someone categorised as “high-functioning” might be performing well at their job but struggling significantly with emotional regulation, experiencing severe loneliness, or dealing with dysfunctional family relationships. These issues might not immediately appear in their day-to-day functioning but are critical to their health.

The spectrum of depression symptoms in DSM-5

The DSM-5 lists several symptoms that define major depressive disorder, including depressed mood, markedly diminished interest or pleasure in activities, significant weight loss or gain, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or excessive or inappropriate guilt, diminished ability to think or concentrate, and recurrent thoughts of death. Notably, the DSM-5 requires the presence of five or more of these symptoms during the same 2-week period, where at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

This detailed symptomatology in the DSM-5 underscores why the label “high-functioning” can be misleading. It doesn’t account for the full spectrum of what an individual might be experiencing. A person could be performing well at work or maintaining social relationships while silently suffering from symptoms like intense guilt, insomnia, and chronic fatigue. These symptoms might be invisible in professional or social settings but devastate the individual’s quality of life.

A call for more accurate and compassionate language

We need to shift away from terms like “high-functioning” and focus on more precise and empathetic language. It’s essential to recognise and describe depression for what it is – a severe health condition that requires understanding and appropriate treatment. Instead of labelling someone “high-functioning,” we should discuss their specific symptoms and challenges.

Encouraging open, symptom-focused discussions about depression can foster a better understanding and remove the stigma associated with not meeting societal expectations of functionality. This approach also highlights the need for tailored interventions that address the unique challenges faced by each individual.

The role of society and healthcare professionals

Society and healthcare professionals play vital roles in reshaping how we discuss and address depression. There is a pressing need to educate the public and medical practitioners about the nuances of depression and the dangers of labels like “high-functioning.” Enhanced training for healthcare providers on the complexities of mood disorders and the spectrum of their manifestations can lead to more nuanced and effective care strategies.

Moreover, public awareness campaigns and mental health advocacy should focus on demystifying the symptoms of depression, emphasising that needing help is not a sign of weakness, regardless of one’s level of functionality.

Takeaway

While “high-functioning depression” attempts to describe a particular experience of depression, it ultimately falls short. It can minimise the severity of the disorder and hinder proper recognition and treatment. As advocates for mental health, we must use language that accurately reflects the struggles of those with depression, promoting a more nuanced and supportive approach to mental health challenges. Let’s focus on the symptoms and the individual experiences behind them, not just how well someone can function daily.




Maxwell E. Guttman, LCSW is a psychotherapist and owner of Recovery Now, a mental health private practice in New York City.

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