To Function or Not to Function?

A lot of mental health (and addiction) conversations have a bottom line question: Is the person functional?

Can they go to work? That is the fundamental question, coming out of the industrial revolution where the Western world was told we needed as many workers as possible to keep the assembly line going. The purpose of this was to keep profits growing for the already rich, at the expense of whoever could be exploited.

Ironically, if must have been some inclination towards a less “functional” society that was the impetus for creative technological advances in the last two centuries.

It is also a military state and warfare mentality, one of competitive violence, that needs as many highly functioning troops as possible to defeat the enemy. So what would happen in more and more people ceased to function in that way? And how do we define high functioning now? Or DID we ever stop to define it amidst all this talk about how high or low functioning different mental patients are?

The insightless definition of high functioning would be someone who can be as close to a machine (or rifle in some cases) as possible, getting done the most rote tasks per hour regardless of how many pills, cups of coffee or sleeping drugs at night it takes.

There’s another area where the word functioning is used: in Bowen family systems theory. Members of family systems (which could be translated into other social systems) are said to have tendencies to under-function or over-function in different areas of their lives, for example, in different relationships, at work, and for oneself. So if I were under-functioning for myself, I might not be eating well or exercising, not honoring my own feelings or taking time for my creative projects. If I were over-functioning for another family member (which often goes along with under-functioning for oneself), I might be taking responsibility for his actions, cooking for him everyday, reminding him to exercise and thinking about his problems more than my own.

There are infinite combinations and roles that can be plugged into this framework, and under or over-functioning aren’t always major problems. It is rare for someone to stay in a state of “optimal functioning” for long, according to Bowen theory.

Clearly Bowen systems is rooted in Western dualism and individualism.

However, the fact that these roles exist in this theory points to one model where more isn’t always better as far as “functioning” goes.

The problem with excessive functioning in one area of life is that it almost always leads to a crash and burn later on and extreme under functioning in other areas of life.

In family systems, under-functioning is also seen as a positive step by some psychologists, when taken in a situation where someone tends to over-function. For example, if I always cook my family member dinner, one day I might under-function and get sick, which could result in him being prompted to remember not to take me for granted and to realize he needs to help me out as well.

The identified patient in a family system is nearly always seen as under-functioning since they are likely identified the patient because they are in so much emotional turmoil they can’t work in the current capitalist system. Yet, by holding the role of the person with the problem, they are usually over-functioning in the area of self disclosure, which is providing a large service to the rest of the family, who are generally hiding their less functioning parts in addictions or other strategies of escape/avoidance.

Often times, as well, the identified patient has such a history of over-functioning, that they experience a need for a lower functioning role. They may have been in the role of the family therapist, caretaker, or “keep it all together” person for a long time without acknowledgment before they became the mental patient.

Being the identified patient may be the only way for them or their needs to be noticed at all.

Ceasing to function in socially presented ways can be an incredibly powerful step in a person’s healing or grieving. In fact, with so much current societal functioning going toward warfare, and violence in a variety of forms, a whole society of low functioners might be progressive.

It shouldn’t take too long to find out with the way things are going.

We are at the stage of our collective evolution where the over-functioning and excess has burnt us out and our true functionality may be approaching an all time low.

Yet, there’s something powerful about low functionality. There’s a receptive state, a slower pace, a contemplative mode that comes with it. It is fertile ground, the place where all great insights, inventions and works of art are born. In fact, it is only from the abyss of dysfunctionality that we can see something brand new: a way of functioning that is more harmonious with who we really are and that could never have occurred to us if we had to function at all costs.


Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.


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