I’m really not comfortable with that “high functioning anxiety” and “high-functioning depression” thing going around (I think it started on The Mighty or on Tumblr). While I think there’s a lot of the validity in the point it is making, can we please choose a different term than “high functioning?” “Hidden” is good, but “high functioning” has a really, really problematic history.
“High functioning” in the autism world was a potential diagnosis for years, and it has frequently been used to deny support whereas “low functioning” has been used to deny agency. It is used as a “compliment” in the same vein of “you pass as neurotypical really well!”, usually with very little understanding that what has been basically said is either “when you put a lot of effort and energy into it you can almost pass as neurotypical, good job!” or “you are so clearly good at these things that you don’t need support! you are being lazy to ask for these things.”
But there’s a danger of people hearing high functioning, with its “not that defective” undertones, and equating it with “doesn’t need supports or services or accommodations or even any sort of understanding or acceptance.” (Decoding the High Functioning Label)
That’s got a complicated, problematic history behind it:
In 1938, an Austrian pediatrician named Hans Asperger gave the first public talk on autism in history. Asperger was speaking to an audience of Nazis, and he feared that his patients — children who fell onto what we now call the autism spectrum — were in danger of being sent to Nazi extermination camps.
As Asperger spoke, he highlighted his “most promising” patients, a notion that would stick with the autistic spectrum for decades to come.
“That is where the idea of so-called high-functioning versus low-functioning autistic people comes from really — it comes from Asperger’s attempt to save the lives of the children in his clinic,” science writer Steve Silberman tells Fresh Air’s Terry Gross.
Remember in this that those deemed “low functioning” were thus being categorized as less than human. That their lives were not meaningful or important.
The quote “Those are YOUR labels, they are not part of who we are” resonates firmly here.
It is an actively harmful way of classifying autistic people. It frequently has the undertone of dividing us into “almost human” and “not human” (and that’s pretty much it’s literal history). It has been turned into a way to turn autistics against themselves. It is used as an othering tactic:
I have heard “high-functioning” used to mean many things, from “has an IQ several standard deviations among the mean” to “has a job” to “talks.” But I have never, not once, heard “low-functioning” to mean anything but “hopeless tragedy.” And I have never heard either of these labels deployed to mean anything but “still not quite, you know…one of us.”
To see this label getting used more widely and now being used to talk about another condition that I also have is not precisely the most comfortable thing in the world. It normalizes it as an expression and, without realizing it, ties into the conceptual idea that “high functioning” means “passing, but not one of us.”
I get the desire to distinguish what is perceived as a category of anxiety, especially for those who suffer from undiagnosed anxiety or who have complicating factors so that it doesn’t look like what is perceived as “typical.” I get the need to say “I have anxiety that you don’t necessarily see” or “I have anxiety that I have coping skills around that renders it seemingly invisible.” These are good and useful things to talk about. That said…
Please, please, find another term.
- Why I Hate Functioning Labels
- Functioning Labels, Again
- I am a person, not a function
- When Autistics Grade Other Autistics
- Autism Awareness, Acceptance, and Cure Stories (by author)