Words and illustrations by Sophie Buck


CN: OCD, ASD, depression,

grades, achievement, eating


While based on real experiences, what’s considered ‘sick’ (or ‘disordered’) – and at what point – is a cultural interpretation, tied to what’s hegemonically considered ‘functioning’, which in turn varies over time and between societies. In capitalist societies, ‘functioning’ is inherently associated with work-related productivity, meaning to be considered ‘sick’ necessitates a lack of such productivity. But this overlooks the less obvious struggling of individuals with so-called ‘high-functioning’ versions of ‘mental disorders’, like depression, obsessive compulsive disorder (OCD) and autism spectrum disorder (ASD). While (arguably) somewhat privileged in their ability to ‘pass’, such individuals – often not deemed unproductive enough to be classed as the sufficiently struggling kind of sick – are less able to access support, including validation and everyday adjustments. Social attitudes must change to recognise and accommodate these individuals.


“Productiveness is an iceberg tip, and mental ‘sickness’ may lie beneath.”


Particularly at Cambridge, many individuals have both mental health problems (and/or other potential disabilities) and high achieving tendencies – myself included. Throughout my education I consistently achieved high grades (A-A*s or 2.1s) and juggled demanding extracurricular activities, yet I also had poor mental health and an undiagnosed developmental disability, meaning basic tasks frequently crumbled. I can recall periods drowned in shaken tears: my stomach as if at sea, throat of tar, tongue of sand. Wishing the ground would consume me, while I struggled to consume anything myself – nauseous, guilty, attempting to find control. Spending hours (and hours) tossing between sheets trying to find sleep as newsreels of anxieties played on repeat. While basic abilities (like eating and sleeping) may disintegrate, externally I remain productive: constantly collecting achievements, setting goals ever higher. Productiveness is thus an iceberg tip, and mental ‘sickness’ may lie beneath.

Scan 36

In several ways, mental health problems and high productivity can be linked. In my experience, not only can high-intensity work environments exacerbate mental health problems, but also work and other focused activities can become a necessary distraction from one’s thoughts (e.g. of self-hate), particularly when alone. Similarly, general busyness can diffuse restless energy, and work itself can become a space for attempting to regain lost control. Lastly, measures of success and roles of responsibility can cover felt worthlessness like badges, in attempts to seek external validation for existence, though leaving individuals continually striving after each hollow-feeling achievement. Overall, the general assumption that productivity always reduces in sickness must be challenged: it can also increase.

This heightened productivity is not good though. While it may be preferable from the perspective of shortsighted capitalism or perhaps a Cambridge DoS, it’s maladaptive in the long-term – concealing, rather than alleviating, underlying problems, and preventing recognition of a need for support. Work itself may even worsen problems by inducing (further) isolation and exhaustion, with ‘successes’ multiplying expectations, until the individual, and their productivity, crashes. Such crashes reflect capitalist society’s exploitation and subsequent failure of these individuals. Ultimately, this problem-driven productivity is problematic: it’s missing the ability to comfortably stop working and relax.


“Approaching my college counsellor, she told me I was ‘fine’ if I was still able to work.”


With regard to accessing support, while an identity cumulatively built around being a self-sufficient high-achiever can make it difficult to admit struggles, the main barrier for such individuals is others minimising their problems. Indeed, on eventually approaching my college counsellor, she told me I was ‘fine’ if I was still able to work. Similarly, my DoS told me that stress was expected and meant I would do well in exams. Regarding my undiagnosed autism, a GP said that she wanted to avoid labelling me because I was managing, and appeared socially competent. And people have often asked for such official confirmations of my experiences (i.e. diagnoses) before they can take them seriously. Scan 35

There’s a sense that if one’s able to manage, they must not be truly struggling, truly sick or truly disabled. I feel myself not ‘passing’, but slipping: deprived of any stamp of validation to say ‘Yes, you’re struggling enough; this is real’. I feel I’m making a fuss, exaggerating any difficulties or sensitivities. Even writing this I feel guilty: guilty both for struggling, and for thinking I deserve help when there are other people that struggle more. Particularly as problems tend to get worse and harder to address with time, society needs to take more seriously individuals that, regardless of how they appear, say they’re struggling.

This doesn’t mean everyone with mental health problems is a high-achiever, nor for all of the time. Rather, it means that in capitalist society, where productivity overshadows struggling, individuals with high-functioning disorders are being erased and failed. Society must recognise the multiple ways in which a given disorder may be experienced, from a seemingly-motivated depressed person to an apparently-socially-competent autistic person, who may both struggle in less apparent ways. It’s not that no support services are available, but more barriers are experienced in accessing them. Overall regardless of outward productivity, individuals’ experiences of struggling need more validation for being real and difficult enough for support. While there’ll always be debate over what’s ‘sick enough’, if you’re struggling, that’s real.

3 thoughts on “Am I sick enough? On ‘high-functioning’ mental health problems

  1. Yep – it’s all about capitalism and productivity. True for physical and even moreso mental health.
    For example, DWP stats between December 2011 and February 2014 showed 2,380 people died after their claim for employment and support allowance (ESA) ended further to work capability assessments (WCA) finding them fit for work. https://www.theguardian.com/society/2015/aug/27/thousands-died-after-fit-for-work-assessment-dwp-figures

    Just keep going till you drop …. chin up


  2. Thank you so much for this. As a child abuse survivor I have ‘shut up and got on with it’ since I was very tiny. Any problems were minimised, by NHS professionals as well as people in the street. People I work with have dramas over the slightest thing but anything that happens to me is minimised. I hate capitalism and its insistence on endless productivity. Academia is one of the worst offenders and I’ve learned to ignore bitchy academic criticism and the pressure to publish. It’s all a mirage. I am a valued person regardless of academic ability or anything else.


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