I am defining functional impairment as an impairment that disrupts and makes the performance of completing a goal either difficult or impossible in the wake of a prevailing mental health disorder.
Functional impairments are disruptive. They are also emotionally taxing.
Imagine you are living your life. Picture a typical day for you. On this particular day, your mood is average. Your mood is neither too up nor too down (this is just an example). You generally can plan your next few activities and complete them without incident.
The day is starting to come to a close, and you are internally wrapping things up and doing an inventory of what went right and what went wrong, and for the most part, things are looking A-OK.
As you continue to finalise the day’s plans, you open up some outstanding mail that you left on the counter to deal with later. That’s when you read that this letter requires a response from you personally.
That’s when life stops. Because you know, for you, interacting with the Post Office and writing letters is not happening.
You are afraid of the Post Office and its employees and have been since 2012. This issue has been chronic since your initial diagnosis and the activation of your symptom.
In terms of writing that letter back (with response required)? This is serious; think of the mortgage, the bank, IRS, or a car note. Sometimes correspondence is needed. Some folks are not able to handle their mail, and this is just one example of a common functional impairment. I picked it to use as a case example because I have been, and continue to be, frightened of mail and my mailbox to this day.
Right now, though, throwing therapy at what most clinicians call fixed delusions or isolated instances of contained, episodic psychosis, is like spitting into the wind.
I can think of a thousand vignettes of seemingly ‘normal’ or ‘high functioning’ or people that 99.5% of the time accomplish what they set out to do on a given day. The 0.5% of the population believed to have a diagnosable mental health condition, I later discovered, maybe underneath the radar of friends, family, and most of their collateral contacts (people in their life). Or, it may be the ongoing issues talked about during treatment: ‘How do I deal with this issue?’
In the system, you either get help when you are in crisis or at the onset of a significant incident or diagnosis. There are no emergent needs in between as far as the system is concerned. I have said it before – it is people in clinical-case management grey areas that are in the most need of our help and whose situation should signal the real crisis in mental health.
Now, back to Pat Deegan’s quote. I never feel like a hero when I can’t open my mail or mailbox. And, when I ask for help, I feel less than human – so much for the humanising Dr Deegan describes as the reason why she writes on mental health.
The hero imagery does not resonate with me.