🧠 Let’s talk about “high-functioning” mental health

By Sarah Sloat

Hello! My name is Sarah Sloat and welcome to Sunday Scaries #126! Thanks for signing up to read this chill newsletter for not-chill people. 

I’m very happy to be here. If you’re new to Sunday Scaries, each week we tackle a topic related to mental health (for past installments, check out the archive). Each installment is designed to be a soothing hodgepodge of advice and explanations, with the hope that you’ll walk away feeling ready for the week ahead.

This week’s chill icon

This week’s chill icon is Pete the pelican. Sunday Scaries reader Mike says “Pete Pelican always eats my fish scraps” and describes him as “the most chill pelican I have ever seen.” 

Have you encountered a chill icon (or icons) IRL or during your internet browsing? If so, I want to hear from you! Send an email over to sundayscaries@inverse.com and you may see them in next week’s newsletter.

Let’s talk about “high-functioning” mental health

As Grimes coos, “girl, you know you’ve got to watch your health” a woman looks you dead in the eye and explains you might be displaying the “four hidden signs” of high functioning anxiety. 

This massively popular TikTok is one of many: Videos related to high functioning anxiety have more than 113.3 million views on TikTok, while videos related to high functioning depression have more than 47.1 million views. 

Meanwhile, the mindfulness app Headspace offers to describe what it’s like to live with high-functioning anxiety, and the online mental health company Talkspace offers the same for high-functioning depression. Google search for both terms peaked this past year in February but has remained relatively steady. Most queries are looking for symptoms or a definition of the condition. 

The issue is there’s not really an answer for those questions. 

“There is a gap between scientific knowledge and public understanding of this topic,” Melanie Badali tells me. “As a clinical psychologist, I practice and promote science-based assessment and treatment of anxiety. ‘High-functioning anxiety’ is not a term that I use.” 

For example, PubMed, which is comprised of more than 33 million citations for biomedical studies, doesn’t have any results for high-functioning anxiety or high-functioning depression (though there is one paper on the need for more research on how to support “high-functioning” people who have recovered from depression). 

However, “the fact that there is no research does not mean it does not exist or that it is not a topic worth studying,” Badali says. 

“Could professionals be missing a part of lived experience?” she asks. “It is possible, but I think it is more likely that mental health professionals use different terms to describe the lived experiences people are labeling as ‘high-functioning anxiety.’” 

While it could be that these terms are capturing something professionals are missing, Badali thinks it’s more likely they are capturing the result of stigma. Conversations about mental health may be more accepted than ever, but that doesn’t mean identifying your own mental health needs is not a difficult process with its own hurdles. 

Videos like “4 hidden signs you have high-functioning anxiety” describe high-achievers and people-pleasers — palatable phrases that side-step the difficult parts of anxiety. 

“I think it might be easier for people to come to terms with the fact that they are experiencing an anxiety problem if it is also associated with being intelligent or highly accomplished,” Badali says.

What does “high-functioning” look like?

Despite the lack of study around high-functioning anxiety and depression, the phrasing “high-functioning” obviously still resonates with people who are coming to understand their mental health. 

Dana Gionta, a psychologist and consultant, tells me that the term signals to her that a person is still able to do and maintain their everyday responsibilities and chores. 

“Basically their to-do’s get done regularly and no one perceives any challenges in their everyday abilities and relationships,” Gionta says. “Oftentimes, the individual also may not realize they are experiencing some depression or anxiety, because it’s not impairing their daily functioning nor having a noticeable impact on their life or relationships.” 

A key difference between perceptions around “high-functioning” and not, she explains, is consistency. If depression and anxiety are consistent, this can compromise a person’s “ability to be as consistent in their everyday performance, motivation, and energy levels, despite their intentions.” 

The way we use words related to mental health is not necessarily harmonious to their many meanings. You can feel anxious or depressed without being clinically anxious or depressed. What often signals to a mental health professional that you’re experiencing something diagnosable is if symptoms are severe enough to interfere with everyday activities and relationships. 

For example, the American Psychiatric Association describes grief as something that comes in waves and major depressive disorder as experiencing symptoms like loss of energy and feeling worthless for at least two weeks.

But it’s possible that what you’re experiencing doesn’t match these categories. Research shows that mental health exists on a spectrum. And while official terms can help people identify an experience — dysthymia, for example, is technically a mild but long-lasting form of depression — this also helps explain why some people would be drawn to non-technical phrases like “high-functioning depression.” 

What gives Badali some pause is the language used in this situation. If you look up high-functioning anxiety via Google Scholar, for example, what you will find are a number of studies on high-functioning autism. Badali explains that “there are numerous people in the autism community who are trying to stop the use of ‘functioning’ labels.” Arguments against functioning labels are many but include that they’re ableist and don’t tell the whole story. 

“While I’m generally in favor of people using their own words to describe personal experiences, I am concerned that there are people who talk about high-functioning anxiety as though it is something that has been scientifically studied,” Badali says. “Labels can be helpful, especially for research purposes. But labels can be harmful, too.”

You may be a high-achieving people-pleaser, but you may also be experiencing anxiety — not high-functioning anxiety, but anxiety. If anxiety or depression are causing you distress, then it may be time to talk to a professional about your experiences rather than coping because you can.

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Now look at this oddly satisfying thing

This oddly satisfying image was created by artist John Edmark, who is inspired by nature and geometry. 

Have you noticed any beautiful patterns in nature? If so, I’d love to include your photo as a satisfying image in upcoming newsletters. If you’d like to share, send an email over to email to sundayscaries@inverse.com. 

What I’m reading this week

Distract yourself from the scaries with these reads:

• Covid-19: We’re already forgetting the best lesson from the 1918 pandemic. Why our “amazing ability to forget recent traumas” can harm us.
• “Aharon said it was healing.” This difficult but important read discusses abuse and how a critical form of therapy can move forward. 
• Scientists accidentally discovered a first-of-its-kind mineral from deep inside the Earth. How X-ray beams and lasers revealed something incredible. 

And if it’s midnight and you’re still feeling the scaries . . . 

• Watch this teeny tortoise be better than any pair of scissors. 
  

That’s it for this week! Until this time next Sunday, you can find my musings and bad jokes here.

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