This is the second guest post by Katja P. (she/her), a secondary MFL (modern foreign languages) teacher and mental health activist. In her previous post, Katja describes how education needs to become more inclusive and accepting of education staff with BPD (borderline personality disorder). In this second powerful piece, Katja shares how the label 'high functioning' has been used by professionals to invalidate her very real and very painful difficulties, as well as deny her the support she needs and deserves.
*Just to let readers know, this post mentions suicidal ideation, self-harm, bullying, binge eating and alcohol.*
'The label ‘high functioning’ has followed me my whole life. Back in the early 2000s, mental health provision was a million miles away from how it is now. Precisely why the bullying started is a mystery, yet it continued from year 7 right through until the end of year 11. My lunch breaks were spent in the toilets, and I spent an hour hiding there after school until I could be sure that the group of girls in the year above wouldn’t follow me home, shouting abuse, spitting at me and throwing rocks. I was also having additional major problems outside of school, so schoolwork became my escapism. I was a high academic performer, so how could someone like me possibly have mental health problems? Teacher expectations of me became ever-increasing, and their approval gave me validation. Even as a teenager, my lack of identity was evident and by becoming outstanding academically, I finally felt I had a sense of who I was- an overachiever.
After excelling at my GCSEs, the school made it clear I was tipped for Oxbridge. Three months into my A level studies, I was involved in a serious accident and off school for four months. For a sizeable proportion of that time, I was unable to walk and in constant pain, which prevented me from being able to focus. When I returned to school amid constant hospital appointments, it was clear the school had lost interest in me. I stopped eating and was also secretly drinking heavily and self harming as a way to cope with feelings of failure. I dropped out and went to college. I opted to resit my AS levels alongside taking my A2 papers, doubling my workload- I didn’t want to repeat a year and lose another of mine.
That autumn I went to university. I’d relocated to allow myself a fresh start, but straight away problems emerged. I found university culture to be very enabling for someone prone to extremes. This was where most of my impulsive behaviours really started to take hold. At the same time, problems with relationships began. Although I made friends, I lost them quickly, usually as a result of them telling me something I didn’t want to hear. Romantic relationships started out as intense but became unpredictable and fiery as I repeatedly tested partners’ commitment to me. I would also act very irrationally and put myself in dangerous and damaging situations on a regular basis. This behaviour continued into my year abroad, where my issues were compounded further by the language and cultural barrier. I had no friends and became withdrawn, isolated and lonely, which pushed me further into destructive habits. I returned to the UK three months early as I was suffering from suicidal ideation. Despite this, I consistently came out with firsts and 2:1s in my exams and assignments, which masked the chaos of my private life.
For several years, I was caught in a cycle of seeing my GP and being referred to wellbeing services who would carry out an assessment. None of the criteria ever applied to me, so they would look at my responses and say exactly the same thing each time- there is nothing we can do for you. Once, I ticked the boxes I thought they wanted me to tick and actually got to meet one of the psychological wellbeing practitioners. She encouraged me to talk about my most traumatic experiences. At the end of the session, she looked up from her notes and informed me that actually, having five or six very traumatic experiences in life is totally normal and I appeared to have worked through my trauma all by myself and was fine now, so there’s nothing she could do.
After six years of this back and forth, I was finally referred to psychiatric services in January of this year for a BPD diagnosis. However the psychiatrist admitted they didn’t like issuing a BPD diagnosis and preferred to treat with medication where possible before diagnosing, due to the stigma and lack of treatment options. They questioned how useful a diagnosis would be for me personally. I felt like I needed it on paper. Although I now have my diagnosis and am on antipsychotics and mood stabilisers, DBT is unavailable to me. I’ve done the best I can to help myself- working through DBT workbooks by myself, becoming vegan to stop binge eating and quitting alcohol to keep my mood more stable. But I strongly suspect that clinicians have placed me near the bottom of the list of priorities because I’m considered high functioning.
Mental health professionals seem to only look at my life through a superficial lens. I do not present as someone with a serious mental health condition. I have a strong marriage, a happy and healthy child, am educated, articulate and well presented, have a respectable career with a stable income and have made some impressive accomplishments. What they don’t see is that, in order to maintain this facade, I am constantly trying to keep my head above water.
My quirky fashion sense and eccentric outfits? Courtesy of a previous spending addiction. My outstanding work ethic and achievements? Thanks to an innate fear that if I stop being occupied, my descent into paranoia and intrusive thoughts will be inevitable. My reputation as being sensible? Down to my abstinence from alcohol because I am unable to have one drink unless it is followed by twenty more. My socially-acceptable sized body? A product of obsessive over-exercising to try and rid myself of [x number] of calories I’ve just consumed in a binge eating session. My ability to be calm and rational under almost all circumstances? Well, that’s a skill I’ve developed thanks to dissociation. This is usually the point at which a psychiatrist rubs their hands with glee and congratulates me on my “excellent coping strategies” and prepares my discharge paperwork.
It’s time that we lost the high functioning and low functioning labels- everyone deserves a right to help for BPD.'
- Katja P.
Thank you again Katja for this piece exposing the harm caused by 'high/low functioning' labels. Reading your experiences of being denied help makes me emotional, firstly because it makes me angry that so many people are not given the care they need and secondly because I relate so much.
I too have been called 'high functioning' due to certain aspects of my life. I have been ridiculed, shamed, invalidated and denied help on this basis causing me further trauma and pain. It's high time professionals stopped using a person's work or academic performance, their family, friends, clothes, make up, personal hygiene etc as 'reasons' why someone doesn't need support. Mental health problems are so much more complex than what someone is wearing or what grades they got- surely that should be obvious by now. A huge attitude shift is needed from some professionals and services, as well as much easier access to specialist, high-quality and empathetic mental health services. Anyone who needs help for am mental health difficulty should be given help.
Thank you so much again Katja P. I am sure this post will be validating for many readers who will relate. You can read more by Katja P. and find out more about her work by following the links on her previous guest post.