If you’ve engaged with any autism or mental health services you’ve probably heard the term ‘functioning’. This basically means how well you are able manage practical needs in life, i.e. how well you are able to look after yourself, if you are able to maintain employment or study etc. It focuses on practical ability and ignores the emotional.

Functioning is important to understand in the short term. It’s important for mental health and autism services to understand how well someone is able to physically look after themselves in order to ensure they can access any additional practical support they need right now. But in the long run, judging the needs and struggles of someone based on the level that someone is able to practically function is wrong, because….

1) Functioning differs on a daily basis and this applies to everyone. We all have days where we are functioning at our best. On those days you might get all the chores get done and you may have time to spent on friends and hobbies. On other days functioning will be a little lower and for some people with mental health issues or autism this functioning level might be much lower. You might have days when you can’t get out of bed, don’t eat, don’t wash, don’t talk to anyone. If professionals only see an individual on their highest functioning days and decide this is their constant ability to function this means individuals miss out on the support, they need to cope with lower functioning days.

2) Some people function best in crisis. For some individuals when they are at crisis point, they disconnect, dissociate or for whatever reason they box away the crisis and emotional turmoil and function, at least superficially, very well. Sometimes and for some people this is a choice and sometimes it’s not. It’s important that everyone recognises this because the people who function in crisis are often those high-flying professionals who have break downs or die by suicide to the surprise of others around them. Hiding or boxing away the struggles and being able to do things like maintain a job doesn’t work for long. Sometimes the emotions will flood out and overwhelm the person in private spaces like when they get home or once everything practically around them is going better and they no longer need to function to survive. People who function well in crisis will still be struggling just as much as the people who have meltdowns and very outward behaviours when in crisis.   

Being High functioning doesn't mean you struggle less

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3) Lots of people change their behaviour and personality to conform to social pressures or expectations. This masking can make people appear to be functioning and coping far better than they really are. For example, a person may spend all week cuddled up in bed without showering and living off takeaway until it comes to their appointment with a medical professional. On that day, they get up early, get showered and dressed in smart, clean clothes. They go into the appointment and talk calmly and clearly in the way they’ve seen other people converse. They don’t talk about the days in bed and the lack of personal hygiene because these do not conform to the standards of behaviour, they know they are expected to meet. Sometimes, the individual won’t be aware they are mirroring or masking but they often feel like they don’t belong and are not good enough which can be very distressing for the individual.

So, why does this really matter? Because it means that people’s suffering goes under the radar. So many people have their struggles dismissed, belittled and misunderstood by professionals, their friends and their family because they function. That means that lots of people go without much needed support and treatment and ultimately this sometimes means that people suffer and die needlessly.  Functioning does not mean someone isn’t suffering.

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