High Functioning Anxiety (HFA) is not a diagnosis recognised by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Nor is it limited to the discrete behaviours commonly associated with generalised anxiety disorder (GAD), such as interpersonal avoidance, social paralysis, and persistent fatigue.
Instead, HFA has emerged as a nebulous, catch-all term to describe anyone who lives with anxiety but manages to function reasonably well on a day-to-day basis. Those characterised (or self-identified) as âhigh-functioning anxiousâ tend to be proactive, outgoing, successful, high-achieving, put-together, and reasonably calmâuntil they are notâthe typical âtype A personalityâ who excels at work and life.
Discussions of HFA have become more widespread in recent years because they emphasise a positive side to anxiety. According to Melanie Badali, it is for this reason very little research has been done by mental health professionals to scrutinize the term. Since nobody wants the social stigma that comes from acknowledging they have a problem, HFA allows sufferers and practitioners alike to stress the bustling and instrumental aspects of anxiousnessâ”anxiety can help push a person to perfect tasks at work, get all the chores done at home, to be a more attending partner, colleague, friend, etc.â
However, what someone thinks and feels can be very different from the outgoing, ambitious, proactive, detail-oriented, or self-sufficient exterior they present to the world. And when anxiety accumulates it can become immobilising, leaving a person unable to cope with the demanding routines and expectations it once enabled. While, in recent years, there has been a 25% surge in reports of anxiety worldwide, making it the most prevalent mental health challenge, in this productivity-driven age it is virtually impossible to know just how many people struggle with HFA. What is clear, is that there is an increasingly prevalent correlation between the relentless pressure to be âhigh-functioningâ and the arresting guilt of feeling useless and unproductive.
The demands of HFA often drive people to try and ignore symptoms, or âpower throughâ their struggles. This is done by fashioning false persona that conceal the need for constant reassurance, a fear of failure, tendency to compare oneself negatively to others, nervous habits, and the potential for substance abuse through an outward facade of confidence and levelheadedness. It is not until people are alone that they âcrash.â
Anxiety and Productivity
Despite being celebrated as productive and even beneficial, HFA fuels a myriad of nervous habits in the bodyâracing thoughts, lost time, procrastination, cracking knuckles, lip and nail bitingâthat cannot be so easily separated out from the dominant narratives about productivity and efficiency within the current social and economic order.
As Joanna Moncrieff points out, capitalism has created a culture of relentless productivity by requiring people to produce enough surplus value to be employable. Whereas in pre-capitalist societies there were lots of opportunities for people contribute to their communities, in the capitalist system labour only has economic value if it generates sufficient profit. As Moncrieff continues, this process of exclusion from the productive workforce deprives people of a connection with and investment in their communities, thus contributing to individuals becoming marginalised and demoralised, which is then labelled (wrongly) as mental illness.
If we look at HFA through the lens of political economyâthat is, how peopleâs preferences, opinions, and identities are shaped by their material conditionsâunemployment and low productivity transform from a personal failing into a socio-political problem that extends beyond the horizon of any one individual and into the everyday norms, values, and contexts we inhabit, all of which are underpinned by the ways we perceive work and working life. After all, it is the unrelenting pressure for increased outputs that transform oneâs toxic busyness and self-destructive overwork into âkey strengthsâ that can shine on a rĂŠsumĂŠ.
It is not that people are unable to take the occasional break from the unrelenting drive to produce. It is that they often struggle to understand what this break really means, for every thought of taking one triggers the question: âWhat have I done to deserve it?â Since value in a capitalist society is determined by the labour people produce and not by the ambitions and principles they hold, we have accepted that the busier we keep ourselves, the happier we can expect our lives to be.
This marks the problem of anxiety, or any other form of mental distress connected to larger social structures and processes, as oneâs own fault and thus oneâs responsibility to fix. Such a prioritisation of profit over participation inundates any practice or treatment that frames anxiety as something that is wrong with youâbe it your own behavioural deficiencies or faulty coping mechanismsâby pushing people to internalise their health and wellbeing as synonymous with productivity and purchasing power.
HFA and the DSM
We are living in a context where it has become preferable to comprehend mental illness in the same way as physical illnessâthat is, with clear-cut categories and curesâwithout fully weighing the evidence against this position. Such a paradigmatic shift towards a sort of medicalisation of productivity is reflected mostly clearly in the changes made to the DSM from the publication of the first edition in 1952 (DSM-I) to the fifth edition in 2013 (DSM-5).
According to Bruce Cohen, whereas DSM-I and DSM-II make few references to the workplace, from DSM-III (1980) onwards there is a substantial jump in work-related terminology that mirrors productivity-driven reforms across society. In particular, the introduction of an emphasis on workplace performance in terms of âsocial phobiaâ and âsocial anxiety disorderâ to DSM-III and DSM-IV coincides with the advent of a general tendency in people to entertain the use of drug treatments for their âfailuresâ to be sociable and assertive at their jobs.
With the introduction of DSM-5 two decades later, many of the issues afflicting the previous manuals have only intensified. Allen Frances, chair of the DSM-IV task force, describes the fifth iteration as a âcolossal wasteâ mismanaged by a âsmall, withering, cash strapped, and incompetent association that feels compelled to regard its bottom line as a higher priority than having a safe, scientifically sound, and widely accepted diagnostic system.â The resultant effect is a diagnostic process that further pathologizes what are often relatively commonplace behaviours and temperaments to serve the market-driven interests of employers.
As Susan Rosenthal observes, Cohenâs textual analysis reveals the increasing degree to which psychiatry has been positioned as an authority on âacceptable behaviorâ at work, at school, and at homeâacceptable behavior being defined by increased productivity across all aspects of life. A person no longer needs to perceive their anxiety as excessive or longstanding to be instantly prescribed addictive, anti-anxiety drugs. Additionally, shyness and introversion become social phobias, hopelessness and despair related to the burden of precarity becomes depression, and restless or non-compliant employees are diagnosed with ADHD.
By encouraging sufferers to question their own feelings rather than the organisation of wider social, economic, gendered and cultural structures dominated by the ideals of individuated patient-centric Western health policies, tools like the DSM legitimate the extension of non-productive stigmatisation into job training, contract work and even unemployment. This aids in the proliferation of the neoliberal focus on the rational, self-serving actor as the primary site of mental health transformation which simultaneously depoliticises the rise of increasingly alienating work environments and the constant pressures to re-brand and up-skill they engender.
You Are Not the Problem
Widespread experiences of mental distress are far more than isolated instances of illness to be âcuredâ by psychotropic drugs or personalized treatments. They point to the ways structural deficiencies and imbalances are coded into our lived experiences, compelling us to make excuses for the system but never for ourselves. If a person cannot cope with this rigid, internalised understanding of mental health, they are likely to conclude that they are âabnormal,â unwell, or otherwise deviantâthat they are âthe problem.â
As David Smail traces out, this has created a situation whereby any symptoms arising within individuals are divorced from the cultural, political, and economic interactions between people and from the nature of the social world we have created. Yet anxious people everywhere are connected by a pervasive condition that has spread into our homes and workplaces, our dreams and desiresâalways tracking along the contours of exclusion and marginalisation. How else can we comprehend why racialised or queer people are, on average, more anxious than white or straight ones? That working-class children are more stressed than middle- and upper-class ones?
When we internalise the dominant capitalist narrative of productivity above all else, which portrays people who rest and take breaks as unworthy of amity and contentment, it becomes an ideological apparatus through which we make sense of the world. As a result, many of the supports on offer are eclipsed by market logics that have little interest in eradicating or even suppressing mental ill-health. All too often, what counts for âhelpâ seeks to expand our capacities to continue producing while remaining unwell, exploiting possible every moment of time and spare resource for the purposes of âself-actualisation.â
Such trends are poised to continue with the release of the DSM-5-TR (TR for text revision) this year. As Sarah Fay makes clear, the architects of the DSM could have spent the past decade revaluating the intensified relationship between productivity and mental health. Instead, DSMâs invalid, unreliable, and suspect diagnoses have been further entrenched in an updated version through the same pathologizing logics and loosened diagnostic criteria.
Most treatments on offer todayâfrom enduring psychiatric and pharmaceutical interventions pushed by the DSMs to mindfulness, CBT, and the other psychotherapeuticsâput forward increasingly personalised and customised means to such ends. In the place of treating it as incumbent on individuals to resolve their own mental anguish, instead, that is, of accepting the vast personalization of stress that has taken place over the last thirty years, perhaps we should be asking: âWhy has it become ânormalâ that so many people today are anxious?â
Thank you, A.T. Kingsmith, for your excellent blog.
Itâs disturbing how insidiously the DSM has come to influence both our collective culture and personal values.
And the question âWhy has it become ânormalâ that so many people today are anxious?â is worth asking, but I think it can be answered in three letters:
DSM.
Psychiatry let it become a tool to service political and economic interests, rather than peopleâs âmental healthâ.
And âThe Big Book of Sickâ keeps doing its dirty work. Itâs psychiatryâs worst legacy.
Report comment
“When we internalise the dominant capitalist narrative of productivity above all else, which portrays people who rest and take breaks as unworthy of amity and contentment, it becomes an ideological apparatus through which we make sense of the world.”
As one whose medical records incorrectly state I was “unemployed,” when the truth was I was a stay at home mom, very active volunteer, and artist working on my portfolio. I do see most psychiatrists and psychologists – some of whom don’t bother to even speak to those they psychiatrically “snow,” and the rest who don’t listen or hear their clients – have seemingly adopted that belief system, and believe they are the “unemployment” police.
And given the fact that the “mental health” system does seemingly target the artists. Perhaps, the “mental health” workers should be taught that artists may work on their portfolios – for years – prior to trying to market their wares. But this does not mean they are “unemployed” – nor “unworthy of amity and contentment” – it means they’re self employed, and likely content.
And I will say “a picture speaks a thousand words,” so visual artists do have a powerful form of communication. It was not my choice for my portfolio to be about psychiatry’s iatrogenic bipolar epidemic, but it is. And not long ago my “too truthful” portfolio turned a psychologist into a God complexed, attempted thief. Since a lot of pictures did tell an entirely “too truthful” story, for him.
Learn to live, and let live, omni-potent moral busy bodies. Leave us happy artists alone. Not everything is about “internalizing the dominant capitalist narrative of productivity above all else.” Some of us artists are about quality, over crap.
Report comment
Someone Else says, âa picture speaks a thousand wordsâ, so visual artists do have a powerful form of communicationâŚ.And not long ago my âtoo truthfulâ portfolio turned a psychologist into a God complexed, attempted theif. Since a lot of pictures did tell an entirely âtoo truthfulâ story, for him.â
Artists express unspoken truths that others cannot see or are afraid to say by exposing the lies weâre told. And visual artists do this in ways words cannot.
âLearn to live, and let live, omni-potent moral busy bodiesâŚNot everything is about âinternalizing the dominant capitalist narrative of productivity above all elseâ. Some of us artists are about quality over crap.â
Thank you, Someone Else. That about sums up what Iâd like to say to any omnipotent moral busybody out there, but especially those known as âmental health professionalsâ, most of whom canât distinguish quality from crap, which is why theyâre in love with âpsychologyâ. They have no idea theyâre working in an authoritarian system.
Report comment
An interesting article in The New York Times is, âWhy Authoritarians Attack the Artsâ. The closing paragraph is a wake up call, but not just for artists, but for anyone seeking âhelpâ from the âmental healthâ industry.
Report comment
Most âmental health professionalsâ are working FOR an authoritarian system, but donât even know it. They are âthe blind leading the blindâ. And how can you tell if they know this or not? Just tell them the truth and see how they react: if they get angry, condescending or accusatory, youâll know what your dealing with.
Report comment
A quick scan tells me to save this article to read again. I gotta rush. THANK YOU for your interest in this topic.
Report comment
I’m a stodgy and dodgy nitwit, who’s going to see if your serum magnesium’s low before I even dream how your inner life’s reflected by your syndrome, much less immediately take action (but not use pharmaceuticals).
Report comment
Yup the question âWhy has it become ânormalâ that so many people today are anxious?â.
birman cats for sale
Report comment