Over the last five-seven years, I have been seeing a lot of individuals, aged 28-50, excelling at work, productivity, performance—and showing up in therapy for concerns related to sleep, psychosomatic issues, or because they feel they cannot experience any emotion fully and are constantly dissatisfied. This holds true for both men and women but more men have been reaching out with such concerns.
These clients do mention that they are high-functioning individuals and their concerns aren’t urgent—but they are looking for perspective on their lives.
As therapists, our definition of what it means to be “high-functioning anxious” or “high-functioning” individuals with mental health concerns is limited, and, as a result, misleading. Like many professionals, I think I have been guilty of this from a semantics perspective; it’s time we begin to rethink this. Generally, any reference to high functioning gets limited to individuals who may be doing well at work, are able to participate in day-to-day affairs, take care of their hygiene, show up socially, and perform their tasks.
What this definition doesn’t take into account is how people feel emotionally when engaging in these tasks and how much effort these take. On the surface and at work, they may be thriving but from an interpersonal relationship lens, overall life quality, vitality and engagement, they may really be struggling. Given the turbulence of the last few years, the label of high functioning can make it even harder for individuals to reach out, for they may feel they are doing better than others.
They tend to reach out only after referrals from their doctors or when they reach a stage where they feel depleted, or are on the verge of making difficult life decisions. A huge part of my work in therapy is to explain to such clients that there is no hierarchy when it comes to emotional suffering. It’s okay to seek help even if they are doing well professionally.
A 35-year-old male who got a promotion last month tells me: “I don’t wake up feeling good about life and it has been a few years. My partner tells me that while I am paying the bills, showing up for dinners, family trips, she finds me absent. I don’t even remember when I last felt happy. I reached out only because my dermatologist felt that my urticaria was stress-induced. Nobody would believe that someone like me, who is happy, committed and ticks all the boxes, would feel the need for therapy. I need it, I am struggling to acknowledge it.”
Their concerns include feelings of being consistently wired, perfectionism, a constant unhappiness linked to a sharp inner critic, feelings of imposter syndrome, a lingering sense of emptiness, and psychosomatic concerns like irritable bowel syndrome, constant headaches, an inability to feel refreshed even after eight hours of sleep. They often talk about lower thresholds when it comes to social interactions, and putting on a mask socially while operating on autopilot. Some of them, who struggle with moderate- to high-intensity or consistent low-lying moods, talk about how they manage these using methods that may not be productive or even helpful in the long run—such as binge behaviours, a tendency towards, and dependence on, drugs or alcohol to soothe themselves.
To begin with, we need to broaden the definition of good mental health for ourselves, including components of vitality, engagement, life satisfaction and flourishing. As organisations, the key is to ask ourselves whether we are actually listening to the full story when we focus on high-functioning individuals.
We should drop the label of high functioning and move to a holistic definition of mental health that goes beyond professional effectiveness and includes physical, emotional and interpersonal flourishing and well-being.
Sonali Gupta is a Mumbai-based clinical psychologist. She is the author of the book Anxiety: Overcome It And Live Without Fear and has a YouTube channel, Mental Health With Sonali.