ON MENTAL ILLNESS: Diverse Levels of "Functioning"

By Jack Bragen
Thursday October 25, 2012 - 05:34:00 PM

In many of my columns, I admit, I have made assumptions about persons with mental illness. The profile I have used has been of people who are usually not employed, who require daily medication, and for whom living a normal existence is a challenge. For the most part, I have used myself as an example, and as a source of information. I suffer from paranoid schizophrenia as well as a mood disorder. I can't do a lot of the things you might assume "normal" people can do. 

For example, driving in San Francisco: on my best day I could do so if very focused and with a navigator at my side. Secondly, I can't work full-time because I can't deal with the quantity of stress. (Thus, I am dependent on public benefits.) These are but two examples out of numerous things which I have difficulty doing. 

Ancillary to that, I don't know very much about the adult world. I have spent most of my time either alone or in various kinds of institutionalized settings, albeit they have been outpatient. These are deficits thought typical for people with schizophrenia, even those who are relatively high functioning compared to other people with the same illness. 

Luckily, I am blessed with above average technical and linguistic abilities. This is helpful in dealing with people in the "adult world" because it brings more respect than I would otherwise receive. 

However, people with bipolar, especially those with an onset of illness later in life, do not necessarily have the same limitations that I have. (Later onset of mental illness gives a person more time to develop a "normal" identity and life skills before the illness yanks the rug from under their feet.) 

I am somewhat guilty of, in this column, making it seem as if all persons with mental illness are abnormal. 

A research psychiatrist said that most persons who have bipolar are higher functioning compared to most people with schizophrenia. When I am among a group of people with bipolar, I find that many of the people are able to do things that I can't. 

It is not safe for me to assume that most mentally ill persons are less capable than I am. Nor can I assume that most people with mental illness live on public benefits and can't work as a result of their disorder. There are all types of persons with mental illness, and this classification inhabits the entire spectrum of "levels of functioning." 

It is important that people with mental illness have some belief in their ability to succeed at something and have some hope of going somewhere in life. Believing in the stereotypes and applying this to oneself could encourage giving up. I have seen people with mental illness both before and after they have given up on life. The change in personality is very obvious. Upon giving up on life, a person's downslide swiftly follows. 

When I spoke to my wife about this week's column, she added the opinion that calling someone "low functioning" or "high functioning" is insulting. It's like telling a person, "You're very smart for someone with Down's syndrome." 

Stereotypical beliefs held by people at large, treatment practitioners, and persons with mental illness ourselves, are part of the discrimination that we experience. Persons with mental illness are a minority, but one that frequently goes unrecognized. It is still socially acceptable to voice put downs, calling us names like "a psychotic" or, "whacked." 

In fact, there are many people with mental illness in the work force in the U.S. Most are forced to keep their condition in the closet, for fear that this information, if it got out, would cause them to lose their job. If it gets out that an employee has a mental illness, even assuming that the employer doesn't immediately fire that person, their work situation is ruined due to a hostile work environment. This is created by coworkers and supervisors who will pick on anyone who appears vulnerable. 

If someone has a mental illness, one can not assume that they are unable to work, or do the things other people do. My column has focused mainly on persons with mental illness who are in the outpatient institutionalized care system. This is also a group more readily identifiable as being mentally ill, compared to those who hide their illness. The person with mental illness who is "in the closet" and who does not participate in "the system" could be your supervisor, coworker, or could be the owner of the company in which you work.