There’s a lot of ink being spilled these days on a new subset of mental health diagnoses that describe the experience of people who don’t appear to fit our cultures classic image of a depressed or anxious person. They’re the ones who, you know, are able to get out of bed in the morning and brush their teeth and crush their to-do list and mingle with their co-workers and get their bills paid and make it through the company holiday party without getting tanked.
They don’t look like the average depressed person — this they stress repeatedly. And why is this suddenly so important?
Thanks to the combined efforts of those who aim to dispel the myths plaguing the narratives around mental illness, and those who’ve taken it upon themselves to come out and share their stories, heedless of the consequences — the stigma around mental health is slowly dissipating. In certain circles, it has not only emerged from the shadows into relevance but has even become a relatively ‘safe’ topic to rally behind. And as such, I can’t help but think that there is something of a bandwagon effect happening here. Yes, mental illness is disturbingly common and pervasive, of that there is no doubt. Yet it seems that everyone has a mental illness these days. Every celebrity and every influencer loves to prattle on and on about her ‘struggles with anxiety.’ Please note, I’m not suggesting that influencers and celebrities can’t have a mental illness. But I will come out and say that something doesn’t quite pass the smell test, as far as I’m concerned. Even if the experiences of many of our cultural icons have, in fact, been destabilizing, painful ordeals — there is a distinct quality of opportunism in the less-than-subtle strategic push in crafting ones personal brand. Crafty marketers and magicians of public image have figured out that it makes their client come off as ‘real’ and ‘relatable’ to their audience when they share such experiences. Capitalizing and this is a no-brainer.
I get it, and despite my temper, I do get how some good can come of all that. However, it irritates the fuck out of me when big-league actors and icons act like they’re being bold and ‘pushing boundaries’ when actually they are not, not when they have been plucked out of the lived reality of the average person. No established influencer is going to face significant blow-back to her career in talking about how she got depressed after her grandma died. A lot of it feels as fake as T Swifts obnoxious pandering to the LGBTQ+ community with her lame ‘Pride’ anthem, ‘Calm Down’ about her getting shaded on Twitter. Being an out-and-proud rainbow-hued ally sells albums in 2019! But in 2007, back when such support may have actually evoked some controversy of actual consequence, where was our girl then?
Furthermore, ‘high-functioning’ depression and anxiety aren’t actual medical diagnoses. You either have depression or you don’t. You either have an anxiety disorder or you don’t. The illness can range from mild to moderate to severe in its symptoms, but there actually isn’t a second category for people with depression who wish to stress that they’re able to take a shower without a problem and can make it to work on time. I mean, sure, how wonderful for you.
There is something to be said for the fact that living a life is going to involve a myriad of experiences and times of emotional turbulence that is difficult, grueling, painful, and challenging for everyone. It’s part of the game. Stress—even high stress—is a part of life. So is doubt. And grief. And sorrow. And fear. And a loss of direction. And an identity crisis or two. And a creeping dread that all of this is for nothing and everything is meaningless…
This is where we broach the uncomfortable terrain of where is the medical community to draw the line. At what point, from a clinical perspective, does the turmoil of a persons emotional, inner reality stop being just a part of life and crosses over into the territory of being considered a disease?
The history of this conundrum— at what point can we concretely determine that a person is mentally ill? Under what circumstances can a mentally ill person be forcibly deprived of his or her rights, and for how long? —is long and contentious and yes, deeply problematic. The most relied upon signifier that a person has crossed over into the territory of definitely unstable concerns primarily whether or not there has been a measurable disruption of ‘normal functioning’. But how can we just accept such an arbitrary standard of measurement? What defines normal function? For all this discussion around high-functioning and not-functioning expressions of mental illness there is hardly any acknowledgement that what a society considers ‘normal’ functioning is in no ways a fixed, universal understanding. Up until only a few decades ago, homosexuality was believed to be a mental disorder, one that prevented the patient from living a ‘normal’ ‘healthy’ life. How are we to approach addiction? At what point does a persons habit spiral out of their control? But does that even matter if they’re still able to hold a conversation and get home every night in one piece? At what point do we sentence a woman to bedrest because she’s been thinking about things too hard and is now too upset to set the table and not able to perform her womanly duties?
Throughout most of the history of psychology, the medicalization of those whom society has deemed ‘outside’ the parameters of ‘normal function’ has been weaponized against them. It has been the argument by which we have justified lobotomies and institutionalizations and sterilizations and unethical experimentations and mandatory drugging and all such practices that deprive a person of their right to self-determination. It is imperative that as a society we look at all this and come to a carefully researched and informed decision about where we draw this line. Because its implications are serious and cut to the core of under what circumstances can a person be denied her freedom. And when we have an individual who has crossed that line—what, exactly, can the State decide what to do with them.
Can we throw a woman in a psych ward because she is refusing to take her meds? Can we straight-jacket a man who has made indications that he is considering suicide? What are we going to do with the scrawny antisocial asshole who spends all day on 8chan ranting about jews and gays and blacks? Is unbridled hatred a sign of mental dysfunction? What do we do with the homeless person wandering about with their dong hanging out and arguing with the devil? When we come across someone who is clearly unhinged but is not making any kind of contribution to the society, do they even warrant the care we can offer? Does the State owe him anything? Or do we just opt to lock him up for a few days whenever he becomes a public nuisance and takes a dump on some white lady’s front porch?
Given all this, it is fascinating to me how things are playing out now, with more and more people with a wider, and frankly, milder range of symptoms are tripping over themselves to be clinically recognized. Someone who gets capsized day after day by unrelenting panic attacks has an anxiety disorder—but now, so does the person who gets butterflies in her stomach before getting on an airplane, or who spent a couple of months super stressed out during a summer internship. It’s all quite surreal to me, given what became of a young girl who everyone dismissed as crazy and unhinged, that so many are now pounding on the door to get let into the mentally ill clubhouse. Come on in, I guess. Welcome to my house.
But now I wish to move on to those of you who I’ve probably pissed off by now— all you who know your depression and anxiety is real and want that to be recognized, and have collected yourselves beneath the ‘high-functioning’ umbrella. If you’re still interested in my two cents, here it is: if my life has taught me anything, its that the ‘high-functioning’ label is a fucking death trap. It means nothing.
What, honestly, is the difference between a person who cannot hide her anxiety attacks and the person who looks like she’s holding her shit together but who on the inside is FALLING THE FUCK APART? What difference does it make that person A who is suicidal hasn’t gotten out of bed for 5 days and person B who is suicidal has perfect attendance, straight A’s, and a basketball scholarship? To me, all that is relevant about these two individuals is that they are both actively planning to kill themselves. Person A’s social phobia is such that she drops out of absolutely everything at the last minute and hardly ever leaves her house anymore but Person B with social phobia has managed to make it to the function but only because she’s so fucking zonked on Ambien she hardly knows where she is at all. How is ‘functionality’ so relevant in these cases that it needs to be considered separately? Focusing on the facade of ones ability to maintain appearances often does more harm than good in two significant ways. 1) The sufferer thinks that she is being an overdramatic piss-ant who needs to get a backbone because she’s clearly not that sick and her life isn’t visibly in shambles—given how she and her life is perceived by outsiders. Take it from me, please, as I learned this the hard way. How you appear to the rest of the world is not relevant. Go see a fucking Doctor. 2) The sufferer acknowledges her depression/anxiety but takes it on as a test of character, striving to overcome and achieve in spite of it—often under the illusion that once she ‘makes it’ her illness will dissipate on its own. Nope. Learned this one the hard way too. Shit doesn’t work like that. Go see a fucking Doctor.
I admit I have a bug up my ass about this, but that is because I went about for years cradling myself in the false security that I was high functioning. As the water slowly boiled, and the perpetual onslaught of symptoms slowly and steadily intensified over the course of many years — I just went about my business, gritting my teeth and white-knuckling through it all. I showed up to class. I worked. I went out. I studied. I drew. I filled out forms and paid bills and made phone calls and occasionally fetched my mail. On the surface, things seemed like they were moving. But what all did it cost me to maintain such appearances?
Before Adderall, I routinely wasted upwards of 4 to 8 house trying to pull my act together enough that I could focus on my schoolwork and get on with my creative projects. During lectures I took notes so furiously the sheets were practically smoking because I knew I probably wasn’t going to register a goddamn thing by just trying to pay attention and listen. I was mystified at the disconnect between my intent, my interest, my drive to do something— and my baffling inability to translate that intent into productive action. It decimated my sense of self worth. Constantly waging war with myself 24/7 trying to ground my basic cognitive function into something I could work with was a perpetual drain on my inner resources, resulting in feeling depleted and fatigued basically being my baseline. It wasn’t just that I couldn’t make my continued efforts translate into actual outcomes when it came to my soaring dreams and ambitions, I couldn’t rely on myself to not fuck up the most basic things. To not lose my debit card 14 times over the course of a single evening, or my glasses, or my phone, or my keys, or my friends keys, or my concert tickets, or my sweater, or my entire fucking backpack which held all of that shit. If I wanted to read something, which was often, I had to re-read a paragraph at least three times before I could dare hope that any of it would stick. Whenever I was talking with someone, or listening to someone, 9 times out of 10 I would just space the fuck out and just find myself floating around the moon. I felt so unbelievably, incurably stupid for the longest time. So powerless and ineffectual to influence how my life will unfold, to affect my fate, to have some kind of say in what may become of me.
The demoralizing and self-defeating influence of untreated ADHD spilled into everything, eventually making all the anxiety and depression and the ADHD indistinguishable from one another. I could get myself to go out, but if I wasn’t properly plowed with alcohol I could not relax in a room if there was more than 3 people. I just couldn’t do it. I was always in 18 places at once because I was constantly freaking out about everything all the time.
And so, when I look back now on my body of work and the things I made while I was in school, I mostly just feel grief. I did what I could, but I cant not mourn all the things that I did not do but had so deeply wanted to. All the collaborations I didn’t contribute to. All the projects I could never finish. All the parties I didn’t attend. All the people I didn’t meet. I know it’s useless, but I cant not help but mourn the loss of so many missed opportunities. But through all that I just swallowed my shame and soldiered on, as like so many I was caught in the trap of just looking at my life from the outside and coming to the determination that I was obviously not sick enough to deserve looking into medical intervention.
I assumed during those years that what I was managing to pull off and accomplish was the absolute height of my human capacity. I thought, miserably, that this was the best that I can do. And why wouldn’t I think that? I had no proof or experience to the contrary. Things were obviously not that bad. I was clearly not that sick, because, at the end of the day, I was usually able to do the bare minimum of what was required of me—the fact that managing the bare minimum was an exhaustive effort of Olympian proportions that continually drained the entire reserve of my energy and willpower was besides the point.
At the end of the day, if you are holding on by a thread, how is it at all relevant that your coworkers think you appear to have your shit together and your friends think you seemed fine last time they saw you? Why are we even talking about them? They’re insignificant.
This is why I say that considering oneself to be high functioning can be a death trap. At some point during high school, the fact that I clearly had some ‘mental’ problems became an unavoidable truth—but I insisted on calling myself high functioning for years. Despite the obvious effect that this insistence cost me when it came to my academic performance and my personal creative ambitions, this delusion spilled over into every aspect of my life, poisoning everything.
I feel a deep grief when I remember the week a friend from my first college came to stay with me and my family during her Thanksgiving break. She had repeatedly indicated that she was romantically attracted to me—and I was into her too. But I was also having multiple panic attacks every single day and I was so depressed and hopeless that everything was hollow and grey and hardly anything registered at all. I had form and matter and my body took up space, but I wasn’t there at all.
The thought of, like, being with somebody… of intimacy, was too godamn much for me to handle. I had exiled her to the trundle bed instead of letting her sleep next to me. I could tell that my coldness was making her nervous and self-conscious, but I didn’t have it in me to do anything about that. On the last night of her visit, we were watching a movie on her laptop—she was on the trundle bed, and I was laying sideways on my bed, perched like a cat sprawled on the back of the couch around her shoulders. And then she asked me, “Rae, are you afraid of me?” And it sent my dulled, distant mind into something of a tailspin. Jagged pieces of information crashed around inside my skull—how my behavior was obviously hurting her, my resistance to a person trying to love me, how my own desire had frosted over into frigidity—I could not meaningfully respond. From what I remember, I simply sputtered, “No, of course not,” and offered no further explanation, and she had resigned to that. When she left, finally, she appeared as much a gargoyle to me as I must have appeared to her.
And now it burns my heart when I remember her. She was sharp, witty, adventurous. She was staggeringly beautiful. And she was unbelievably brave—being that she was openly lesbian and a foreign exchange student from a country where homosexuality was still a crime punishable by death. And in our overwhelmingly white all-girls college in the middle of the woods in central Indiana, she was deeply self-conscious about openly expressing her sexuality, often worrying that she came across as aggressive or predatory in the eyes of our classmates.
Yeah. Alright. I was high-functioning. Sure. No one who interacted with me had any idea that I was in the middle of a complete fucking breakdown. No one had any ideas that I was having panic attacks because I always quietly left the room when I could feel one coming on. No one could tell by looking at me that I had basically given up on my life. Hooray for me.
I waitressed through the last year and a half when my social and general anxiety had reached an all-time record-breaking high and—once again!—no one had any idea. I beat my face and did my hair and when I walked up to a table I smiled and did all the right things. But every shift was absolute torture. I often felt sick to my stomach when someone was seated in my section I got dizzy and thought I would throw up. A few times I did throw up—and I immediately swallowed it and soldiered on. When guests tried to talk to me I felt like my insides were being twisted into a tight ball. Whenever a guest had some kind of attitude or threw a monkey wrench or complicated things in any way I felt like my brain was going to explode and there was no way I was going to get through this. Absolutely no way this is it. This is what kills me.
And then I got them their caesar salmon salad or whatever the fuck it was and everything carried on just fine and there was never any kind of incident. My coworkers all thought that I was kind of weird and standoffish but that was it. I showed up. I was reliable. I did my job.
Every night I shuffled home, gasping for air, feeling like I’d just had the absolute shit kicked out of me. I got home, to my sad, lonely apartment. I felt alone and broken and hollow but didn’t want to deal with all that right now. I was too tired. I was just too damn tired. So I guzzled vodka and watched nature documentaries until I passed out. Tomorrow I would do it all over again. And then the day after that. And then the day after that. Because one day this will end—one day, when I’d finally hit my dreams, this will all end, and will all have been worth it.
I vowed to hang in there—because I was high functioning. And one day when all my labor and all my toil has finally come to magnificent fruition— all this pain, all this loneliness, all this despair, and all this anxiety that has been eating me alive— will serve as testament to my god-like perseverance and devotion. This is not a mental breakdown requiring medical treatment— this is a test, a trial of your willpower, a crucible shaping the mold of your future, realized self. The block of steel in the bed of fire. It has to be hammered and pounded and grinded into its form by the blacksmith. By enduring without ever crying out you impress the gods and earn the favor of the cosmos.
If you are one of those forcibly trying to deceive yourself as high-functioning with the veneer of how you appear and how the world perceives you—I ask you to take a moment to consider what this substantial effort of maintaining appearances is costing you. What opportunities have passed you by like ships in the night? What have you lost—who have you lost—by pouring every inch of yourself into your hustle and looking like you’ve made it to something? How large has grown the mountain of your regrets because of all that you were too tired, too drained, too burned out, too lost to pursue?
How stable really is the foundation of your house? The paint job looks great and the garden is lovely—but are you trapped inside its walls, holding up the columns, the ceiling, the staircase—keeping the framework from collapsing by the sheer power of your physical effort? Holding up the weight of this collapsing structure on your shoulders.
I know I’m being dramatic. I’m a dramatic person, it seems. Maybe your circumstances aren’t as severe as mine. Even still, the fact that you’re able to manage and even succeed in your life does not indicate that you are not sick enough to go seek help. If your symptoms are such that they are measurably impacting the quality of your life—measurably undermining all that could be—appearances don’t mean anything. Go see a Doctor.
Take it from me, for whatever its worth—it’s actually pretty liberating to finally let go and just let the whole thing completely collapse. There’s something to giving yourself permission to finally fall apart. To howl like a wild, feral creature and to just let it die.
There is life after death. Or at least there is more freedom. You can’t build a house over a structure that is caving in and collapsing on itself. As much and as hard as you try to force it and make it work all you will ever manage is to prolong the inevitable.
Build a new house. Fuck what the neighbors may think. You can’t begin anew if you don’t let go of the production you’re killing yourself to keep on Broadway. Let go. Let the theater collapse, let the stage burn. Let the whole thing burn.