Community Contributions: The Great Trade-Off

Too many days ago I received a set of questions from forum member Meredith. She addressed some of those questions here.

What price do you pay for being high-functioning?
Upfront, once again, let me be clear on how grateful I am. OK. With the exception of most psychotic symptoms, most people experience something akin to the symptoms that get us diagnosed as “mentally ill.” The difference between the MI and the non-MI is the extent to which sadness, anxiety, dissociation, elation, fear, and a variety of other things interfere with one’s ability to “function.” I do not believe there is a clear-cut threshold that some cross and others do not. There’s a grey area in there, a No Man’s Land between the trenches. The price I personally pay is in that grey area.

By that I mean that I experience a level of confusion about my self. My self-conceptualization is neither here nor there, neither black nor white, not always “functioning” or “not functioning.” For me, personally, that is a significant price. While it has real-world implications, I acknowledge that this is a seriously vague answer. My hope is that the answers to the following questions will clarify.

How hard do you work at being high-functioning?
Well, now, that really depends on how I’m defining “functioning” at any given moment. Sometimes, if I’m being completely honest, I’m not working too hard at all. Those are generally the moments wherein my definition is based on how others see me. I can work at almost any time. I am NOT complaining about that, and we know that work is therapy for me. When I’m defining “functioning” in terms of how I feel or the extent I’m able to actually take care of myself or do things like, say, the dishes, then I have to work really fucking hard.

Do you ignore parts of yourself?
Everyday — ignoring a different part at different parts of the day. In the interest of conserving space in a longish post, I’ll just say that I ranted last weekend about Inside Me versus Outside Me (along with a stupid amount of mathematical allusion) on my blog. Self-sacrifice for self-preservation. (That seems to be my thing this week.)

What price do you pay for being in the closet (this may not apply to everyone)?
Ditto. Self-sacrifice for self-preservation. Confusion regarding my self-conceptualization. I feel I give up a level of comfort in who I am. I feel I give up a level of validation — particularly from myself.

How often do you pay it?
I pay said price when Inside Me doesn’t so much look or feel like Outside Me, which is to say that I pay that price when I’m experiencing some episode. That’s the answer I would’ve given four months ago.

The strange effect this forum is having on me is a growing dissatisfaction with my Closeted status. I’m starting to notice more times when I self-censor. Having a place to discuss where my head is seems to have a side-effect, namely that I’m noticing how frequently my head is in one place and I’m pretending it’s somewhere else.

Your turn.

  1. This forum is having a strange effect on you…and probably everyone else frequently visiting it. Thinking will get you everywhere, and fast. We, of all people, know how much thinking can get us into lots of trouble, but it’s easy to forget how much inner “trouble”/work we can get into with thinking. Suddenly we become more aware as everyone adds their specific ingredients to the thinking pot. Awareness can be painful, or just a pain in the ass. I am not surprised it has led you to being more uncomfortable with being closeted. You provided a forum for people like you to be honest and open about who they are, including you. You probably didn’t think about it all much more than when you went to therapy, until you came along…and us. Funny the way that works. (

    • said:

      Thinking does a lot of trouble sometimes. For instance, I maintain the last paragraph I wrote…but maybe have already changed my mind about the rest of it. Apparently, as a self-definer, I get to do that. This morning’s rethinking about what I wrote and drew led to this: The warning about the nature of its content should be implied in that I posted it on the blog and not on the forum.

      Also want to say that I wouldn’t be able to make these steps in thinking if it weren’t for you guys. Really. Thank you for joining this forum.

  2. Natalie said:

    Totally agree with Meredith, it has a strange effect on all of us, in that it allows us to question many things we likely once took for granted (I must point out that I’m not entirely sure what I mean by that, and yet, it rings true for me right now).

    I don’t actually work hard at being high-functioning, it’s just me, and has been me my entire life. That said, I do feel I have to ignore some parts of myself and/or be “closeted” at times, which indeed requires work and a certain amount of “stuffing it,” to quote Meredith. But I think most people experience that same thing on what is probably a much lesser scale. For example, they are suddenly reminded of their grandfather’s death in a public setting, and they choose to think of kittens rather than burst into tears in public. The difference is that I (we?) experience such cognitive dissonance on a much more regular, consistent basis. And yes, it takes a toll on us. But personally, even though I’m desperate to change the terminology (no matter what, I personally will never identify as “mentally ill”) and desperate to break the stigma for me and my fellow crazies, I don’t think there will ever be a point at which I am comfortable bursting into tears in public (not that it hasn’t happened). Now, something like ripping into the ignorant ass who called my pregnant wife a “f*cking dyke” in one of her most vulnerable moments, in line at a *very* gay Target no less? Whole different story. I’d do that any time, anywhere. (Yes, my hypomania at that time probably contributed to my ability to break social expectations and do so, but you know what? I felt better for not allowing my wife or I to be bashed, and he apologized.)

    And now, I am officially tangential and rambling. Which leads me to my next point – I think we (or at least I) need to be mindful of the doors that are opened in these discussions, and in reading Whitaker’s work, etc. Sometimes I can only take it in doses, and then it becomes overwhelming, I start to obsess, and yeah, bad news. In recognition of this, I opted to skip Whitaker’s entire section on kids. Just not something I can’t read right now without adverse consequences to my peace of mind. (No different than my realization that, once our son was born, I could no longer bear to read media coverage of cases involving the harm of children, and so on. My wife calls me an emotional “open wound” for a reason!)

    All that to say, I am immensely grateful for this forum. I am immensely grateful for the work of folks like Whitaker. And I am also immensely grateful for my increasing self-awareness, which lets me see when I need to put the book down for a moment, and stop tasting the salt of the world’s tears, and which lets me see when picking apart my own thought processes on this front might prove problematic. Insight is powerful, but sometimes I need to pace myself, let things simmer, and then move on from a place of transformation.

    On a much lighter note, one of the comments I left at Huff Po last night with your statement on the Charlie Sheen media fiasco is proving to be quite the conversation starter. So, ∃, you’re making people think!! And not just your fellow crazies. This is how change begins. :)

    • Natalie said:

      “I felt better for not allowing my wife or I to be bashed, and he apologized.”
      Please note I am horrified at the utter lack of correct grammar reflected in this sentence. :)

      • Natalie said:

        “Just not something I can’t read right now without adverse consequences to my peace of mind.”
        Ditto. I really need to proof read before hitting post.

        • yes you do!!! Just kidding. totally lol. It’s allowed in our crazy perfect-crazed world (handily handed down to us). Natalie, great comments about being able to take, let go, take let go, process, move on, etc. It has been easy for me to obsess about self-awareness and productive forward movement to the point that I dreamed about it last night, I think. stay tuned to daily bipolar.

    • tell us the link, please.

      • Natalie said:
        (About halfway down. This was the first one I posted, so the link back here is in a separate comment right above the text – I got my act together by the second post.) ;)

        And, not Sheen related, but I took an opportunity to stir the pot in a few places (okay, maybe 8 or 9 places) on the post below, too – actually received emails from two supportive loved ones of fellow “mentally ill” folk as a result!:

        Thanks for getting me back on this track, ∃. I used to comment in mainstream forums quite a bit, then stopped. Now I’m heading back, but remaining calm, being selective, and not letting others draw me into their chaos!

  3. Alan Smithee said:

    I have been remiss in joining in the conversations here from avoidance and some purposeful cocooning, but right now I am waiting for steak to cook and drinking beer, so here I am.

    The price I pay is this: sometimes by being “high functioning” I am invisible to people who could actually help me with my illness, and I tend to be surrounded by those who become completely immobilized when I finally show the face if my true awful reality. I tend to repress, as a counter productive self preservation mechanism, but I am trying to slowly stop doing that, much to my husband’s confused surprise.

    How hard do I work? The thing about my repression is it is instinctual. All the hard work happens without me noticing, and that repression makes me high functioning, not any conscious work On my behalf. Hell, I am researching dry shampoo because I cannot bring myself to clean myself, so that’s gotta tell you something there. When my instinctual repression mechanism decide to strike and not do the dirty work behind the scenes, I cannot do anything to consciously repress how I am feeling, and being an over truthful person, it is not long until the truth comes tumbling out.

    • said:

      First: Alan, hit me up with the results of your dry shampoo research. Really could’ve used that a week and a half ago. Also, Meredith sent me this link that I’m now sharing with you:

      There’s a cosmically upside-down thing in what you wrote — to which I (and probably many more) can completely relate, but upside-down nonetheless: the basic intuition toward “a counter-productive self-preservation mechanism.” Right. Check. I think you hit the metaphorical nail on its metaphorical head. When I don’t feel “high-functioning” (again, whatever that means) on the inside, the price I pay to seem so on the outside is the repression of the very things that would make me feel better. “Sucking it up” does not actually do us any favors. And the only “self” we’re preserving by doing that is the Outside Self, the one that — as a matter of reflex or decision — crafted. I realize I’m applying some sort of objective-ish logic here, which doesn’t really have any effect because we rarely think in logical terms when it comes to this kinda thing. [Insert my voice saying to my husband, “Stop trying to reason with me right now. I did not say that I’m being rational. Logic will not work.”] I guess what I’m getting at is this: I feel ya, and I’m glad to hear what you’re trying to do. We’re here when you want to talk about it…or if you just want to let us know how it’s going.

  4. Jen said:

    The price I pay for being high functioning is that I have mental health professionals who are my support system, becuase I don’t have a lot lof friends, but thos professionals, always want to make comments about how well I do, and how supposedly “gifted” I am (my therapist erroneously believes this; in fact I am not at all gifted and never was), and how I advocate for myself so much better than their other clients, and then they assume, well, I really don’t need that much help. I have a case manager because I was psychotic for years, and I really needed a case manager when she was assigned to me in 2005. Now, they don’t think I need one at all, and I don’t qualify for one, because I have not been hospitalized in three years. My case manager has kept my case opened, and told me so, because she wanted to. She and I get along well, and though I really could be fine without her, I would miss her a lot. It’s nice to have a person who, every three months, visits my apartment, which requires me to clean, or should require me to clean, in order to avoid the humilation of her seeing it the way she has seen in numerous times – in a state of total disaster. My ARNP who prescribes my meds, and my therapist, see people who are not all higher functioning, and they see them a lot, because they work at a community mental health center. So I walk in, and I’m having auditory hallucinations, and I’m seriously anxious nad depressed, and having delusional thoughts, but they think I’m “gifted” or “higher functioning” because they can’t tell this stuff unless I tell them. If I am actually gifted at something it’s that: I hide my illness well.

    I think the disadvantage here comes when I actually need someone to understand I am seriously not doing well and they do not understand that because it is not incredibly obvious. Once in a while I really need someone to get that I really need to figure out what’s going on in my head, and my therapist, she can’t always tell this from what I say, in those times. She did figure out after a long time, that when I’m having delusional thoughts, and auditory hallucinations, I won’t look her in the eye. I can’t, because I’ll be thinking she works for the C.I.A., and I can’t look at her and have a conversation as if I trust her because I don’t trust her at all in those times. So now, if that happens, she’ll say something like, “what are you thinking right now?” Or, “You seem to be having some perceptual problems. Do you think so?”

    But when I’m NOT hearing voices the psychiatrist will say something like, “I heard form your therapist you’re getting A’s in your classes!” Um, yeah big deal. So what? I have gotten A’s in my classes most of the time in my life, it is not a sign of stelllar mental health, considering that when I couldn’t get A’s, I simply dropped the classes or dropped out of school, which is why it took me 15+ years to earn an Associate’s Degree. I go to a community college. This is not whaere I wanted to be in life, when I wwas looking foreward to the future years ago. I should have gotten a Master’s Degree by now, because I wanted to and I could have, and I could have gone into one of the colleges I was accepted to but didn’t attend, because I was sick. So maybe compared to someone who can’t manage community college classes I am doing great, but I don’t compare myself to those people. I compare myself to where I would like to be in life, and I am definitely not there.

    Another problem that has arisen is that I was so “higher functioning” I was chosen to speak to the staff of the community mental health center at their training day, about my life and my illness. After that, everybody there knew my serious history of psychosis, but they also knew that I can talk about it without sounding like I am clueless, so this led to them coming up to me to say, “You’re so amazing!!” “You’re so brave and so intelligent!” “You should write a book!”. And I’m just struggling to keep my head above water, here. I am not feeling so amazing at all. I can’t keep a one-bedroom apartment clean enough to ever have company. I can’t manage to do my dishes most days. I’m very depressed. I don’t date, and have no relationships romantically and few friendships. I’m extremely insecure and often hate myself. So, is that amazing? My memory sucks, my cognitive abilities are nothing like what they once were, and I usually can’t read a book, because I can’t concentrate well enough to do so. This does not make me feel gifted.

    At the sametime that I am very open with certain people about my illness, as in, when I’m speaking to them about it at an event, so it’s pretty obvious why I’m there….I am still in the closet at work. I do not tell anybody at my job anything about my illness. I made the mistake of doing that at my last job and was ostracized and treated like total shit by people because I had confessed to having spent a few days on a psych ward. I quit the job shortly after that. I vowed to never talk about the illness to anyone at a job place again. Is this fair? Of course not! We all should be able to be open and out of the closet. But it’s not that simple.

    So at work, I have to hide my whole identity, and put on a big act. I can see from some of the posts here that other people here do the same. It gets tiring, sometimes, putting on an act. Sometimes, I’d like to call in sick for mental health reasons and not have to lie and say I have the flu. Sometimes, I’d like to tell my coworker what she wants to know from her nosy questions about my ability to see doctors when I only work part-time – “Hey, I have Medicare. Yes, I am on disability. That is how I survive with only working here 20 hours a week. Get over it. Sure, I get to see doctors without paying for insurance, and you don’t, but you also don’t HAVE TO SEE DOCTORS EVERY WEEK for various illnesses, because you’re actually healthy. You don’t have to take medications that make you gain 100 poiunds. You get to be free of all that. Be glad you didn’t have Medicare in your thirties. Your 62 and you’ll be getting it soon enough.” But I’ll never say that. I’ll remain closeted because that’s what society will allow me to do.

    • Jen, thank you for iterating what many of us feel to some degree. There is a price to pay for being high functioning and most of it has to do with the outside world and how it views us. The other way it can manifest for me is in the repression. I’ve been in a 2-month symptom hiatus and I’m convinced I’m not bipolar anymore, but I’ve had to step it up for the sake of the family. So that begs the question: am I symptom free because of all the things that have happened to me in the last 2 months (like ∃) or is it because I’m stuffing it and will explode at any moment? I, too, wish you could say that to your coworker. I’m sure it would feel good.

    • said:

      Jen: Thank you so very much for sharing. I think your response has touched on almost every theme we’ve discussed so far on the entire site, while still managing to stay on topic (which I can never seem to do). I can’t respond to everything you wrote right now, but know that this is all part of one big ongoing conversation, so it will come.

      There is one thing you talk about that I find really frustrating and upsetting (that also hasn’t been talked about in this thread yet): One of the prices we pay for being “high-functioning” is that our mental health professionals — our front-line help — might not always believe us or even see when we need help. We are so good at “blending in” or “passing” or “so much better than other clients” that our needs aren’t all that important sometimes. Our care isn’t always based on What We Want For Our Lives. For some reason, much of the profession doesn’t seem to understand that the goal should be living a meaningful and fulfilling life, rather than just living. They don’t seem to think it’s all that important to ask us what “functioning” means to us! (And here I am again, yelling about the one thing I keep yelling about.)

      And it’s twisted, right? Because in order to get random people to believe we’re “normal,” we risk losing our support system’s ability to see when we need help. Needing to be closeted because we have some serious things we want to do with our lives, sometimes means we sacrifice our base. And what’s more: While I’ve never had a therapist say to me that I’m gifted, they’ll point to certain achievements as evidence that I’m really doing alright. The thing is that NO ONE would tell a non-mentally ill person that they could/should derive their self-esteem, self-worth, or self-concept from his/her resume. Who I am on paper is not who I am, and what I’ve done so far is not everything I want to do; it’s not even what I wanted to do by now. Why is this different for us? Clearly, we’re able to demonstrate capability…why isn’t that capability further supported? And why is it so hard to understand that said capabilities are sometimes fragile?

      Last thing: I too wish I could call into work and take what other people casually call “a mental health day.” I don’t do that, because I’m scared to say something like that. I’m sorry you’ve paid the price of being ostracized at work and needing to leave your job. It’s not fair. There’s nothing fair about it. Bullies. Ignorant bullies.

      • Meggy said:

        I’m amazed that someone else uses the phrase “perceptual problems”! I didn’t know that that was a term.

        Jen, your thoughts about your therapist’s response to your behavior when you’re delusional reminded me of my old therapist (whom I’m no longer seeing). His whole thing was that when I was delusional and scared witless, that I should not ACT delusional. I’m still not sure what I think about this. It seemed incredibly unkind to me at the time — I was wearing sunglasses with a hoodie pulled over my face, and I was so scared.

        So you (Jen) then cause me to wonder whether I was right in being upset with his response, which I interpreted as a lack of empathy/sympathy. Or if anyone else would have felt the same way. Or how that fits into “high-functioning” as a category, because he definitely saw me as HF, and me behaving the way I did that night broke those views.

        Lots of food for thought. Thank you.

        • Jen said:

          Meggy I’m not sure I could explain anything your therapist said since I’m not you and don’t know him. My therapist has learned from me telling her that I have these problems sometimes in her office and she eventually figured out how to tell if I was hearing auditory hallucinations or delusional thoughts, by the way I acted, sometimes. I don’t have these problems happening much right now, but when they do happen, it’s nice to have someone who can notice. She doesn’t always notice, just sometimes, which is a lot more than most people. Also she still thinks I’m HF.

          And yeah, I like that term “Perceptual Problems”. Sounds such much less harmful and related to mass murder than “psychosis”.

      • Jen said:

        ∃ –
        Thanks for your response to what I wrote. This part of what you said is an issue I think about a lot, and it really, really bothers me: “One of the prices we pay for being “high-functioning” is that our mental health professionals — our front-line help — might not always believe us or even see when we need help. We are so good at “blending in” or “passing” or “so much better than other clients” that our needs aren’t all that important sometimes”

        It’s very true that this happens to people, and so far I have been the only person I know who I know it happened to. I’d be interested in how many others on this site have had that experience.

        • said:

          I had a conversation today with someone who may or may not appear in this thread, but just in case, she suggested that we may need to switch doctors every time we make marked improvement…just so they can’t say that we’re “so much better now than before” instead of focusing on where we want to be.

        • Natalie said:

          Jen – Thanks so much for sharing so intimately. For what it’s worth, when I first started seeing my current therapist, I was still very raw from recent psychosis (I’m not even sure I was clear of it at that point). I was having a really hard time and was sure that during one session in particular I came across as completely off my rocker. When I mentioned that in the next session, he was floored. He said I hadn’t come across that way at all, which let him know just how good I am at hiding it, even when I don’t intend to. We developed some ways to get around it to varying degrees so he could better gauge what was really going on with me at any given time, but yeah, we can “blend” in the presence of even the most skilled and helpful practitioners. Which I find equally amazing and fucked up all at once. I’m so sorry it keeps some of your support folks from validating your need for help and actually providing said help.

          (Side note: Have you ever checked out Dr. Loren Mosher’s “Models of Madness”? From what I can glean from your writing, I think you might find his approach to psychosis really interesting.)

  5. Jen said:

    Man, I wish there was a way to edit posts. I have many typos in the above, mostly because my computer is running so slowly that it takes like five minutes for a sentence to show up after I type it, and I tend to make a lot of mistakes when I cannot see what I’m wriiting. And “Your” in the last part of my post should have said “You’re actually healthy”. Sorry! If my computer worked faster, by the way, I’d be posting here more often.

    • said:

      First off…no worries about the typos. If we know what you meant, you’re good. Although, now that you’ve written this “Damn Typos!!” comment, we will not only know what you meant, but also know that you meant it without typos!

      • Jen said:

        Thanks, that helps!

  6. Jess said:

    I’m still not quite sure if I would classify myself as “high functioning” or “in remission.” I’ve never had the “in remission” label on my diagnosis, but who knows. Regardless of where I am now, there was a time when I was “high functioning” in the fact that I hid what I was truly feeling from everyone except my partner. There were times when I was extremely depressed, and I somehow made it through school. Like Meggy said, just because I made As and was Valedictorian of my high school didn’t mean that I had my shit together. I’ve become good at hiding when I’m depressed; only those really close to me can tell when something’s up. Even though, inside I’m trying desperately to think of what to say, because I’ve lost all self-confidence completely. I could go on, but I think I’m digressing :)

    The price I pay is being completely congruent with myself. In today’s society, unfortunately, I cannot be as open about my bipolar diagnosis to everyone. It’ll come up in conversation to the people I trust, or I’ll allude to my “psychiatrist” or “therapist” but I won’t go into details about what MI I have. Since I am also a lesbian, I’m having to come out twice, so to speak. Now, it’s easier for me to come out as gay, but the MI is still a HUGE problem to overcome. And some people would probably brush me off because I’m not symptomatic at the time, so I don’t seem “crazy” or whatever they’d call it. It’s unbelievably frustrating.

    My career goals are to be a licensed mental health counselor. I just finished my first year of graduate school. There are some people that would shudder to think that someone with bipolar disorder would actually BE a therapist. I think it gives me a unique perspective and that I can relate to some people with MI. Not to say that I would be better, or that I would treat them how I’ve been treated. That’s the main thing I know: Just because something worked for me, doesn’t mean it will work for someone else.

    I would like to be open about my diagnosis to my colleagues. You think the MI professionals would understand. To the professors and classmates I’ve told, I’ve received support, which I am grateful for. I hope the rest of my journey has similar positive outcomes; but I know that’s a fairy tale. Really, I hope that the negativity is minimized and that I can handle it well.

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