Rainbow Model of Mental Illness Functioning

“High-functioning” often doesn’t reflect the complicated reality

This post is based on some of the conversation generated by a recent post, Is It Helpful to Sanitize Mental Illness? Those of us living with mental illness have a whole rainbow worth of experiences, and I wanted to find a way to represent that. Hence, the rainbow model.

Mental illness symptoms

There are no mental illnesses out there that only have one symptom. The symptoms may fall under domains like cognition, emotions, perceptions, and physical effects, depending on the illness and on the symptoms we tend to have as individuals.

Symptoms aren’t necessarily consistent over time. They flare up and they ebb back down again. While some may change in similar ways at the same time, that’s not necessarily the case. Some symptoms may be severe, while others are mild or not present. There might be consistency from one episode/flare to the next, or there might be unexpected curveballs.

Level of functioning

While people can certainly use the terms of their choice when referring to themselves, I’m not really a fan of the term high-functioning to describe how others are doing. There are a few reasons for this.

One is that high-functioning is not a clearly defined term; there are no specific criteria that differentiate high-functioning mental illness from, well, not high-functioning. With terminology that’s not clearly defined, it means the terms means whatever the person using it happens to think it means. That may be quite different from someone else’s interpretations.

Functioning is not one-dimensional; it’s just not that simplistic. We may function differently when it comes to domains like social, self-care, adulting tasks (e.g. shopping, managing money), and occupational (e.g. work, volunteering, hobbies, other meaningful activities). Someone might be functioning very well in one domain, but experiencing significant disability in another.

Of course, functioning in different domains can vary over time. Some illnesses are, in general, more likely to have a progressive decline in functioning over time, but that generalization can’t be applied to a unique individual. Overall, the reality is a lot more nuanced than simply high vs. low functioning.

How diagnosis fits in

While there’s sometimes a clear relationship between degree of symptoms and level(s) of functioning, that’s not always the case. As with all of this, it depends on the illness, and it depends on the person. Certain symptoms may be more likely to produce greater disability than others. For me, regardless of the severity, suicidal ideation generally doesn’t contribute all that much to functional disability, but psychomotor retardation produces significant disability. It doesn’t mean one symptom is inherently “worse”; it just means there’s no simple link between symptom severity and level of functioning.

Also, the fact that I have a diagnosis of major depressive disorder doesn’t predict my level of functioning. Diagnosis tells you what your symptoms could be some of the time; however, it doesn’t dictate how you’re feeling and how you’re functioning at a specific point in time.

The rainbow model

The rainbow model captures the symptom and functional domains separately, and assigns a colour to the specific domains that are relevant to a given individual (and yes, I realize I left out a colour from the rainbow).

Each colour is shown on a gradient to represent intensity/severity. The gradients are flipped from the symptom domain to the functional domain. The two aren’t necessarily related, but lesser symptoms and greater functioning are generally where most of us would rather be, while greater symptoms and lesser functioning aren’t so desirable.

Taking a snapshot of how an individual is doing at a given point in time, they might end up being at quite different points on the spectrum for each domain.

Earlier in the course of my own illness, the symptoms were more of an issue than functioning. In the last few years, though, the steady burn of physical symptoms has produced a level of disability that goes beyond the mental distress produced as a direct result of the symptoms. Even if all of my other symptom domain colours are pale and minimal, the intense blue of the physical symptom domain has a disproportionate effect on my functional domains.

Capturing complexity

Going back to the term high functioning, it’s just too simplistic to capture the complexity for anyone who’s at anything the less than the brightest colours for the functioning domains. It also minimizes the experience of people with bright, high intensity symptoms who are getting by without too much impact in functioning despite how very, very difficult it is.

While this model simplifies too, just like any visual representation of human experience does, I tried to capture, in a simplified way, some of the complexity and diversity of mental illness experiences.

And of course, my inner geek likes coming up with this kind of thing.

How does this model fit or differ from your own conceptualization of mental illness?

Originally published at https://mentalhealthathome.org on September 14, 2020.