a thought on what it means to function

For most mental health disorders, the extent to which symptoms affect a person’s ability to “function” is a make-or-break criterion for diagnosis. For instance, everyone gets panicked every so often, but if your anxiety interferes with your ability to work, interact with others, go outside, or just generally be a person in the world, then you probably have something more serious on your hands. The same goes for mood swings, fears and phobias, and anomic feelings of dissociation. All humans with critical thinking skills have those solipsistic moments wherein they wonder what’s actually real. This is all within the range of “normal.” There’s a threshold, though. And the line is crossed when normal feelings, worries, and wonderings, start to reduce one’s ability to “function.” They say that when you cross this line, your “feelings” become “symptoms.”

“Functioning” is problematic for me, terminology-wise. The ability-to-function criterion for diagnosis reminds me that the mental health disciplines often exist less for the individual and more for the society at large. The equivalent of judging the extent to which I “play well with others,” it’s about social and societal acclimation. I think it’s fair to be a little pissed off about this fact and to feel a little distrustful of the discipline. Here’s a story:

Shortly after diagnosis, I was working hard at finding medication I could tolerate. (It turns out that I was actually waiting for it to be invented, developed, tested, and approved.) The cocktail they had me on kept my mood stable, neither incredibly depressed nor dangerously manic. I could function, in that I could maintain daily showers, sleep regularly, remember to eat, and leave my apartment without debilitating anxiety. I was doing alright. Everything I heard were sounds actually produced in the room. So, my psychiatrist was a little more than surprised when I showed up to say that the prescription was absolutely not working out for me. I was stable and taking care of my basic needs, but I was dumb. More than that, I was embarrassed. I couldn’t explain to my friends and colleagues what had happened to my humor, quick thinking, or memory. I was told that I would have to let some of those “talents” go, in order to function better.

That psychiatrist was serious: “You will might not get those talents back, but you will be stable. You have to come to terms with the fact that some were symptoms of your disorder.”

I was expected to be happy with my progress, while I watched what was I thought was my very SELF disappear and felt my self-esteem plummet as a result. To summarize, improving some areas of my “functioning” required having to sacrifice others.

As I understand it, the standard continuum for biological mental health disorders of seems to max out at “sustaining one’s basic human needs” and “playing well with others.” The truth is that functioning also requires sustaining the self, what we know of ourselves, and who we know ourselves to be.

I left treatment that day. I spent six years determined to prove that my mind could get me out of the mess that my mind got me into, determined to prove that I could be myself and do what I love even if I’m a little crazypants. Necessity brought me back into treatment when the life I left treatment to make was being ruined by my disorder. This time I was careful, weary, and scared that the help I needed could also take that life from me. I had learned the hard way that, for me, “functioning” does not mean the eradication of my symptoms. I had learned that some of my symptoms are integral to my understanding of myself. While I rarely identify with my diagnosis, I do identify with some of the things that led people to give me that diagnosis.

I hold axiomatic that what it means to “function” is deeply personal and often requires intense reflection. Through the eyes of others, to function means one thing which we all pretty much know how to do: getting by. Through our own eyes, what it means to function is something we battle, reevaluate, and often redefine on a daily basis. I wonder if I might do that better with others fighting their own battles.

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