Why My 'High-Functioning' Mental Illness Remains Invisible


I have an invisible illness.

It doesn’t typically present when I’m at work, walking down the street, or on the subway. To my particular chagrin, it sometimes doesn’t even present when I’m in therapy. Not unless you know the signs to look for. And few do. Even the most experienced therapist can hardly be faulted for failing to notice a virtually invisible disorder.

Anyone who has ever had the unique pleasure of nursing a “high-functioning” mental illness probably knows this position: working full-time, a top performer, having relatively stable relationships and knowing how to struggle “politely.”

Having just begun seeing a new therapist, I recently retold my life story for what seems like the hundredth time. And, somewhere en route to arriving at present day, she made the most telling comment.

Pausing almost dramatically, she said, “I can’t piece this story you’re telling me with the person who I see before me.”

Having known me for less than two sessions (under an hour and a half), she determined that I could not possibly be struggling as profoundly as I had indicated.

I looked at her rather pointedly and replied: “Yes, I understand. That’s exactly the problem.”

I can be engaging in problem behaviors, entertaining suicidal thoughts, or having a full-blown panic attack and still not be seen as anything other than “high-functioning.” It’s hard to imagine that an entire world, a completely different life, exists beneath someone’s surface.

Don’t get me wrong. This can be a great thing. As a social worker, surrounded by social workers day in and day out, there’s something empowering about doing my job to the best of my ability and never being questioned or doubted.

But then there are those moments when my mental health conditions overwhelm me and I desperately need someone to intervene. In those moments, it is fundamentally beside the point that I am “high functioning.” I am in crisis. My ability to articulate and analyze the situation, in no way, changes this simple fact.

I think the mental health community needs to be especially careful in the way that it approaches invisible illnesses. This may mean suspending belief for a moment when a carefully composed client discloses that they are feeling suicidal, or responding gingerly when they begin to discuss troubling behaviors they have engaged in.

It can be challenging for a professional to reconcile their first, second, or thousandth impression of someone with who that person claims to be. I think it is crucial, however, for those within the mental health community to take a step back and question their own judgments and preconceptions before they react.

Having an invisible illness should not prevent someone from accessing the care they need, but misconceptions can often do just that.

With a broader understanding of mental health, our community can work to change this. We can accept that many serious conditions are invisible and embrace all those who are struggling, regardless of how they present.

As someone with “high-functioning” BPD, depression and anxiety, there are quite a few facets of myself that I keep under wraps on a daily basis. I can maintain light conversation and laughs, or engage with my clients on topics that personally affect me, without showing a glimmer of pain. This does not make my struggle any less valid or any less real. To struggle quietly is still to struggle and still to need.

We are all — all of us — more than what we appear.

As Walt Whitman wrote: “I am large, I contain multitudes.”

If you or someone you know needs help, visit our suicide prevention resources page.

If you need support right now, call the National Suicide Prevention Lifeline at 1-800-273-8255, the Trevor Project at 1-866-488-7386 or reach the Crisis Text Line by texting “START” to 741741.

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Getty image via betyarlaca


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