The problem with talking about someone having “high-functioning autism” or “a high-functioning developmental disability” or “a high-functioning personality disorder” or “being a high-functioning sociopath” (thanks Sherlock) is that how well you function is a product of a whole fuckton of stuff, only one of which is your impairment.
For instance, what’s the environment like? I do great in environments where I have a lot of expectations and structure, and poorly when my brain has a lot of time to eat itself. An autistic person might appear a lot more autistic if they happened to live in a place with sirens going off constantly. This is particularly true because a lot of people tend to behave in more dysfunctional ways under stress.
Another important aspect is what people expect of the person. If you define “functions well” as “can speak”, a lot more autistic people are going to function well than if you define it as “can hold down a forty-hour-a-week job and have a romantic relationship.” That matters on a more micro level too: if no one expects me not to break down in response to routine life problems, I don’t have to hide my emotions, and then I can devote more energy into recovering better from my breakdowns.
Similarly, the person’s other abilities matter a lot: an autistic person who’s a tremendously gifted writer might easily find a workplace that tolerates her eccentricities, while an equally severely autistic person might join the 58% of autistic people who are unemployed. It also matters what coping skills they’ve developed or been taught: a person with a personality disorder who’s spent a year working with a really good therapist will probably do better than someone who hasn’t.
This is a problem because a lot of times people use high-functioning to describe the disorder, rather than the person. Saying “Joe has high-functioning autism” makes it sound like Joe’s autism is very mild. But, in reality, someone exactly like Joe, but with comorbid bipolar disorder, no knowledge of how his brain works and what sets him off, and a noisy environment full of people constantly talking to him and expecting him to do complex neurotypical social games– and Joe is going to look a hell of a lot less well-functioning.
Even if you use “high-functioning” to describe the person, it’s inaccurate to treat high-functioning and low-functioning as binary categories. A lot of times, whether someone comes off as high-functioning or low-functioning depends on what traits they choose to emphasize. Stimmy Abby writes powerfully:
Let’s take two girls with autism.
Trisha is an articulate and eloquent writer. She has autism, but that hasn’t kept her from presenting and preforming for large audiences. Her teachers have described her as introverted, bookish, gifted, and eager-to-please. She has multiple friends, she can take a train across the city independentally, and her mother thinks nothing of leaving her home alone with her younger brother.
Kailey cannot bathe herself and has trouble with dressing, eating and most activities of daily living. She spends hours engaging in self-stimulatory behavior and she routinely self-injures to the point of bloody sores. She has meltdowns in which she hits herself, bashes her head into walls, and destroys things; medication cannot control them. She has limited verbal ability and a wandering problem that has led to her almost walking into cars. She cannot function in a normal school.
Which of these people sounds “low functioning” and which sounds “high functioning”?
Guess what? They are both me.
For instance: a lot of people who come off as Aspie are nonverbal sometimes or otherwise have poor expressive language (for instance, forgetting common words and having to be like “that purple thing (makes rectangle hand gesture)” “you mean the Skittles packet?”). A lot of people who come off as Aspie headbang. I guarantee you, every single fucking thing you hear described as something that low-functioning autistic people do, there’s a ton of people who come off as high-functioning who do it too.
A lot of neurodiversity advocates think we should throw out functioning labels entirely. I don’t think that’s true! I think it’s important to talk about how some people function better than other people. However, when we’re talking about this, we should remember that it’s a vast oversimplification of a more complex reality. We should never say that a person’s disability functions well– instead, they function well. And we shouldn’t use functioning labels as a way to silence people, either by saying that people who function less well can’t speak for themselves or have opinions, or by saying that people who function better don’t count.