On more than one occasion while doing trainings on assisting people in recovery with returning to work, I’ve heard participants refer to the people they work with as “low functioning.” I always ask what that means, as we all “function” at different levels at different activities. Some people are better at math than others, so does that mean poor math students are “low functioning?” After processing with the group on what they meant by “low functioning,” the reply is that it is a way to refer to program participants whose impairment from their psychiatric symptoms tend to be more severe than other participants. However, I point out that mental illness tends to cyclical, and often there is great variation in level of symptoms and impairment. Also, the recovery process has been defined as a dynamic, non-linear process. So ultimately, the term “low functioning” is a meaningless, damaging label.
Aside from being meaningless, there are other problems with the term. First of all, it is highly disrespectful to label someone as “low functioning.” Also, it denotes low expectations that recovery is possible, thus negatively impacting the quality of services the person is likely to receive. At the typical training, after addressing these concerns with the group, I suggest they bring these concerns back to their programs to change the use of this language. Inevitably, I hear, “then what do we call the low functioning group?” After some reflective listening and responding, the participants are confronted with the fact that they don’t need to label anyone, and their job is to facilitate the recovery process.
Another way to look at their concern is that different individuals may have different support needs among their program participants. However, if someone has more support needs at a certain stage of their recovery, there is no reason to suspect that they will always have higher support needs, because as mentioned above, the recovery process is a dynamic process. Therefore, the consensus is that using language such as low functioning doesn’t ease the recovery process. USPRA has language guidelines which could be a useful resource to bring back to programs https://uspra.ipower.com/Certification/2003_Language_Guidelines.pdf,
The point is to always be respectful and assume that recovery is both possible, and the expectation of all service delivery in the mental health field. I am interested in hearing from the blogosphere on the prevalence of the use of the term “low functioning”, and to hear some ideas on how people address the use of this term in order to help the mental health field become more recovery-oriented.
augellsl
Brittany Stone
francine m bates
Joni Dolce
Melissa Roberts
Ni Gao
George H. Brice, Jr.
Vocational Voice
Bill Waynor
vocationalvoice: the integrated employment institute 
As I was reading this blog post I found it to be very revealing and insightful into things I was doing in my day to day ‘work life’ that I did not realize. In this field we are constantly talking about stigma and how we have to be advocates for individuals with mental illness in order to fight that stigma. In doing such we stay away from labeling individuals as their mental illness. For example we never refer to someone who is diagnosed with schizophrenia as schizophrenic because a person is so much more than their mental illness and it is counterproductive to recovery to wrap an individual’s whole identity around their mental illness. As a new practitioner I am constantly trying to avoid labeling in that sense. This blog opened my eyes to labeling that I did not even realize I was doing and that is the distinction of consumers being high functioning or low functioning. I have to completely agree with the words of Mr. Waynor, it is harmful, hurtful and essentially unethical to label individuals in this way just as it would be to label them as their mental illness. I think saying this individual requires more supports or less supports is a better, more positive way to go about it. Labeling only hinders recovery and as practitioners it is our job to do everything we can to foster recovery.
When I first started reading this blog the first thing that came to mind was my cell phone. My cell phone is a smart phone that is about four years old. This phone’s storage is damaged, so completing a simple task such as taking a picture is a challenge. If too much is stored an alert comes up on the screen that says “low functioning”. How are we to label an individual with mental illness the same way we would label an old piece of technology? When I hear anyone in the field use the label “low functioning” I quickly take out my phone and show them what my phone does. I found this is an effective way to prove the point. I am glad this blog was posted. I wanted to spread the word about not comparing a human life to a cell phone and this was a great opportunity to do that.
Excellent point!
Bill Waynor – Sent from my iPhone
I am still in shock that people use this disrespectful language in the field today. If you are in the field helping people with their recovery then I don’t understand how they don’t see this as a damaging label. “Low Functioning” makes people feel inferior and incapable to perform certain tasks that promote recovery. We need to promote “dignity and self worth” and to make people feel that they can “learn and grow”. These are core principle values in the field of psychiatric rehabilitation and by labeling them as “low functioning” your not abiding by these values thus not helping them effectively. This labeling is part of the stigma that is around these people with mental illness and it’s not right because there more than able and proven to be able to perform any tasks. We as practitioners are here to advocate for these people but we can’t do those if we are labeling them and thinking of them as inferiors. I also see this as unethical and we should substitute “low functioning” with “needs more support” just as Mr. Waynor suggested. It lets people know that they just need extra help other than saying that they are not able to accomplish something. We really need to watch our language as practitioners in order to give people the right impression that they could recover.
I am a student doing interning in the field. Every week we meet with our professor to discuss our experience at our internship site. The first week we met, I remember trying to describe some of the consumers I interacted with. I struggled for a few minutes to find the “right label” and decided on the term “low functioning” to describe how stable or severe their symptoms were. Immediately afterward I became aware of the negative connotation of this label. I think my professor could sense that I was struggling with this and opened up a conversation about what the term really implies and how it can be stigmatizing.
Working on the field I was always aware of the language practitioners used to refer to consumers. I’ve even pointed out mistakes of labeling consumers as their mental illness. Like millswil said, we never refer to someone as their mental illness. Not only can it damage the identity they had of themselves but it’s unethical. Labeling someone “low functioning” has the same damaging effects.
I’ve worked in retail, where customers have told me I do not know how to do my job. It can break someone’s self- esteem. Actually being labeled a term that potentially degrades someone’s skills and abilities, I think, has a stronger negative effect on the person. This term is not needed in the mental health field, or in any other field, when we are trying to promote recovery and maintain the dignity and worth or every individual.
While reading this blog I could not help but nod my head in agreement. I have witnessed a person being labeled as “low functioning” by a practitioner solely because going on interviews for jobs was not their strong suit. I have yet to understand the purpose of labeling an individual. I believe this only creates a bias towards the person. Labeling an individual can be extremely damaging. It can even make the person begin to believe in “their label”, which can cause a major setback in their recovery process.
If we take it upon ourselves to think about the certain areas we may lack in, we can get a better understanding on how that does not necessarily mean we are “low-functioning” because of it. There are always other stronger abilities we have. However, even when a person does not have certain abilities, it does not mean that they cannot improve or alternate the behavior/skill. I strongly believe that every individual has the capacity to learn and grow. By negatively labeling a person you are not giving the individual the opportunity to do so.
Humans have a natural desire to want to categorize everything in our world. It is an evolutionary trait that has long served us well. This tendency, however, speaks to the pervasiveness of such damaging labels as “low functioning.” Effort is required by the individual practitioner and institutions to stand in opposition to that inclination to label or categorize. While it may at first glance seem helpful to group the people we serve, it is indeed quite harmful in that it creates a sense of predetermination that does little but limits recovery possibilities, impacts the efforts of providers, and inhibits hope.
There is a fine line to walk when it comes to labeling. It is easy to get lost in the weeds, mired in competing values of pragmatism, sensitivity, political correctness, and respect. Debating the merits of euphemism can sometimes lead to the more clumsy verbiage of such now-advocated terminology as “persons served,” which satisfies a desire to appear sensitive to stigma while arguably doing more harm than good. That said, the notion that anyone can determine someone else’s level of functioning is a fallacy. And the resulting label ultimately serves no one, neither practitioner nor client. The classification of level of functioning is an archaic premise that does little to consider the fluid nature of mental health and the constant adaptation/personal evolution of individuals.
For me, it is upsetting how people who work within the field of mental health services can be so stigmatizing. In one of my classes this semester I have a professor in abnormal psychology who placed labels on people who live with borderline personality disorder (BPD) She stated that they were “clingy” were an “emotional mess’ and to keep individuals who have BPD away from her. Petty much stating that people with that diagnosis do not recover. I am one who lives with BPD and found this hurtful and offensive just as people who are considered as “low functioning”.
There is no one cookie-cutter way to experience life in recovery. There are as many pathways as there are leaves on a tree. Labels are very hurtful and can prevent others from moving forward because people feel that they are unable to obtain their definition of recovery. Individuals experiencing mental illness have the ability to learn and grow. Every individual deserves the chance to achieve their personal dreams. All treatment plans need to be non-linear and individualized and include the member in shared decision making. All labels need to replaced by names and individuals treated with respect
In reading this exert, I am immediately drawn to the fact that since the beginning stages of the de-institutionalization period, there has been constant evolving and changing of the system toward individuals with mental disabilities on many different scales. The usage of such language, such as “low functioning” resonates with the very notion that progress is still needed in our discussions on a broad platform.
I think your actions to have your individuals bring the labels back to their program in an ultimate platform for change was the first step in evoking change. I believe there is no change without at least, struggle. The struggle here is changing such damaging labels on an already delicate population of people. I cannot help but to revert back to of all of the issues one with mental illness must get through during recovery and the fact that being labeled “low functioning” can in no way further their process, instead perpetuate stagnation and feelings of self-doubt. I am enthralled with your usage of the term “disrespectful” in relation to the term “low functioning”. I think it encompasses the exact verbage of what belittlement of a human can be, especially when one is trying to go back to or maintain employment. The term delineates that a person isn’t capable of optimal performance due to their diagnosis. This in turn may become internalized on how that individual feels about themselves because they are not looked at for their strengths but rather, their perceived weaknesses. This counteracts the notion that work can foster recovery, because that individual may feel incapable, of maintaining, or keeping a job, let alone reach for educational goals.
As I mentioned previously, your suggestion to the individuals you work with is the key factor in evoking change. Education is key. By those individuals discussing the ill implications of the damaging labels used; ultimately provided an educational basis to illicit changed future response from those program workers. I feel that education on damaging labels and the usage of person first language on a multifaceted spectrum, reaching programs, hospitals, care facilities, government agencies, and all other entities which would have some involvement with individuals with a mental health diagnosis is needed. I feel it would have nothing but a positive implications on this population of people. They would not only feel the needed level of respect, but they would hopefully be spared of the feeling of inadequacy and possible inferiority due to their illness. It would ultimately help them on a clearer path to reach their goals without the hurdles of labels in which can lead to a path of self- doubt and self-destruction during their recovery.
I agree with Waynor’s points in this post. Labeling someone as low functioning or high functioning is damaging because with the label comes a certain set of expectations that otherwise would not be there. As stated in the posting mental illnesses tend to be recurring and if an individual is labeled as low functioning, they may be unsure of setting achievable, greater personal goals. If the individual did not have this stigmatizing label they may be more apt to focus and complete their rehabilitation goals. Conversely, by labeling someone as high functioning when they are experiencing fewer symptoms may make the individual more hesitant to reach out to their support network when they are experiencing an increased number of symptoms and would fall into the category of low functioning. If an individual can recognize when they could benefit from additional support without the fear of being categorized and stigmatized by others it would assist in the progression of the rehabilitation process.