So, I read an article today on the Mighty titled: ‘I Have a Mental Illness. I’m Not “High-Functioning”. And I’m Fine with That‘. So, this is more complicated than it seems, to quote the article. In the DSM-IV, the GAF (Global Assessment of Functioning), attempts to capture the ability of a person to ‘function’ or met certain demands in life across different domains. These domains were in fact conjured up by the people that designed this assessment scale to rate a person’s ‘abilities’. This is problematic for several reasons. I won’t explore all these problems, or the problematic aspects of diagnosis, which, I am sure many of the readers already understand. In summary, these terms and clinical assessments are artificial, totalising, and do not capture the organic nature of real life.
In short, people that rate highly on the GAF are termed ‘high-functioning’. The term has become extremely insulting, and rightfully so – for people with lived experience who understand what people are trying to say when they make suggestions that a person is so-called ‘functioning well or highly’ in their life. These so-called high-functioning people are people who ‘hold jobs’ or aren’t hospitalised often enough to pass through the public mental health system. I understand quite clearly what high-functioning is supposed to mean to people that don’t understand mental health issues or stigma.
Aside from the limiting nature of inorganic summations of a person’s ‘abilities’. Given my lived experience as someone labelled high-functioning and later, after losing what would point to the GAF from unemployment, I am suggesting it is fine to be low-functioning, as if, that is a real thing.
Aside from identifying with a false identity, manufactured by the APA (American Psychological Association), which is complex on its own terms, I must pose the question: Is it ever OK to lose ground in your recovery? Or, if you don’t like to use the word recovery, is it OK to lose ground in your health? Here is where I get confused. When is it ever OK to be less OK than you once were?
Sure, we are all human. We have ‘ups’ and ‘downs’ that hopefully are not so high and low that life feels like a roller coaster, or doesn’t meet the clinical threshold for mania and depression. Either way, that is OK too. But is that the goal? To experience life as it is and be OK with the hands we are dealt? For some people, this might be OK. For others, for myself, the hands I was dealt require a constant pushback on my symptoms or aspects of my health I am not happy about. The issues with my health or symptoms require daily upkeep. When I lose ground I need to figure out quickly, in no uncertain terms, why I am losing ground and how to go about a course correction quickly before my symptoms outpace my ability to cope with life.
I am writing this because I worry about people being passive with their problems. This is partly from the personal experience I just revealed but also from what I know about the nature of problems to multiply, issues to become so overwhelming when we become passive players in our mental health.
Being OK with where you are in life is one thing. Being OK with failure is another. But being OK with not being the very best you can be, well, that is where I part from the author’s message in The Mighty. I get it, lets’s disable these disabling terms in mental health that stigmatise. But let’s not overreact to them to the point where we say something in which the message is not only unclear it’s teaching people unhealthy behaviour.
Max E. Guttman, LCSW is a psychotherapist and owner of Recovery Now, a mental health private practice in New York City.