The problem with high functioning mental illness

The problem with high functioning mental illnesses is that they make an invisible illness a hundred times more invisible; and the problem with invisibility is that people are far less likely to take seriously that of which they cannot see.

For the most part of the duration of my mental illnesses, I myself have been considered to be high functioning. There is a familiar paragraph at the end of every psychiatric assessment I have ever received, a paragraph which states:

“Good eye contact maintained. Well dressed with evident care taken on appearance.”

But every time I read this sentence, I am once again reminded that I am not and never have been sick enough.

I completed my GCSE’s with a clean board of A*’s whilst in the depths of anorexia. I maintain a very tight group of friends on a daily basis. I achieved top grades in my A Levels despite having spent nearly seven months in hospital following a suicide attempt. I attend every single medical appointment without fail and when I do, I do take pride in my appearance. I like to know that I look presentable, so I do not leave the house without my makeup fully in tact. Within this appointment I am able to express myself effectively. I am able to discuss the maintenance of full time employment. I am not your typical patient with mental illness.

But whilst these are all the faces of me that an outsider sees looking in, what the outsider does not see is this.

The outsider doesn’t see the unhealthy level of perfectionism it takes for me to succeed academically; I actively punish myself for every single mark dropped in an assignment. During my GCSE’s I made a rule: for every examination grade that wasn’t an A*, I would not eat for 24 hours. They do not see the limits beyond which I push my exhausted body, the lack of sleep, the lack of food, the lack of any self care or nourishment as I focus all of my attention into achieving and into being the best I can possibly be.

They do not see the absence of self esteem beyond my made up face and coordinated outfits. I do not spend a large proportion of my morning applying makeup because I am well, but simply because I despise my face without it. The professionals at every appointment see my carefully applied winged eyeliner but what they do not see are the black, tired circles under my eyes, beneath layer upon layer of foundation. Nor do they see the three attempts it took for me to complete my makeup that morning because I cried it all back off again each time. They also do not see the lack of effort paid to my appearance outside of those appointments. They do not see me fail to even brush my teeth for days on end nor change from my pyjamas should I have no reason to leave the house.

An outsider does not see the fear behind my eyes in every photograph I am tagged in on Facebook of me socialising with my peers. They do not see the loneliness I feel despite being in a sea of people. They cannot feel my sense of not belonging, of not fitting in, of being different, or the tears I have shed in the lead up to an event as I convince myself that I will not be wanted there but still attempt to muster the strength to go. The outsider may see the three events I have attended but they do not see the fifteen events before that to which I have not.

Nobody else can feel the chronic exhaustion that I feel at the end of every shift, nor hear the criticising voices I hear inside my head every single second of the day. You’re not good enough to work here. Who employed you anyway? Look at all of your colleagues who perform each task naturally and efficiently. Watch you struggle to get by. Why do you have to be so awkward? Useless. Failure. Not good enough. This is not your calling in life. Do you even have a calling? Probably not. Although I may attend work every day, this does not make employment a walk in the park. Every hour of every day is both mentally and physically draining but no outsider can see that. And nobody bothers to ask.

As long as you’re still doing, going and being, the high functioning mental illnesses get forgotten. Lost within the system.

The thing is, on paper you’re too unwell for primary GP services to treat you. You score insanely high on every questionnaire for depressive thoughts or risky behaviours or levels of anxiety. But on observation you’re not sick enough to become a priority for secondary mental health services, so you vanish into this Bermuda triangle in between. The professionals decide that if you have enough insight to be able to express the emotions you feel or the criticisms you hear or the self damaging acts that you engage in then you cannot be that high of a risk. You’re not as risky as the patients who are dishonest of their feelings. So long as you keep talking, you’re safe, you’re ok. You don’t need help.

Those who talk about suicide never do it. Right?  Wrong.

Appointments become less regular. You call for urgent referrals but in your case, you’re told, the only emergency appointment is three months away.

All the while your health is declining but still, nobody sees. You’re getting up for work every morning because you know that right now, it’s the only thing that’s keeping you even remotely sane, but because of this, your decline isn’t valid. Isn’t worthy. Isn’t sick enough. Never sick enough. Never enough.

You start to think, what will it take for them to see how bad things are? Maybe if I hurt myself, they’ll finally see. They’ll finally believe me when I say that I am sick.

Over, and over, and over again you hear, “it’s just for attention”. To an extent, this is accurate but what we should really be considering here is how neglected must an individual have felt in the first place to have resorted to such an extreme measure just to be noticed? Just for somebody to care?

Being the high functioning mental health patient is being the person in the pool who is unable to swim but just about manages to float with their arm bands compared to the other weak swimmers stood at the side of the pool, too afraid to even step in. This is the person who gets taught to swim, not the person with the arm bands because if they are already managing to enjoy the water with their arm bands then their priority falls. But what then happens is that eventually the wave machine will come on. Arm bands no longer suffice and this person is the one to drown, not those stood safely on the side of the pool, not even being splashed by the movement of the water.

When my own waves hit, I find it far too difficult to receive the help that I need, emphasising the feelings of unworthiness already existent in my mind.

It is those with the mental illness who are still actively participating in the world, who are most affected by life’s own natural waves and this is why it is equally important that we are provided with just as much support as those whose struggles are more visible than our own.

The most important improvement I could wish to be made in the treatment of mental illnesses is for high functioning illness to be better understood.

I hope that I will one day stop being punished for not being society’s expectations of ‘sick’.

Shann x x x


One Comment Add yours

  1. Katie Marsh says:

    Such a true account of what so many people with mental illnesses feel including myself just because they see me functioning day by day going through the motions I’m deemed not ‘ill’ enough for treatment I’ve been waiting just over a year for any input and support . Each day I’m dying and struggling a little more with the weight of my mental health problems weighing me down down more and more until eventually do I react so they take me seriously ? They only see what we let them and the outside is the polar opposite to what’s going on within. Thank you so much for putting down in words exactly what I and many others feel on a daily basis!


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