Measuring Functionality In Depression and Bipolar Disorder

Many bipolar people say they are "high-functioning," but most of them mean they function OK when in remission and cannot function when things get too intense. How well one functions during depression or mania defines the difference between Bipolar Disorder and Bipolar IN Order. At every intensity, functionality influences the comfort of everyone involved and whether they see value in the experience. Functionality should be the central focus of any approach to bipolar instead of simply trying to make it go away.

Many think intensity of depressive or manic episodes is the determining factor in functionality, but evidence contradicts such belief. Far more important are awareness and right understanding as outlined in the previous articles in this series. With enough education and practice, intensity becomes far less relevant to functionality than most people believe.


Functionality does not mean driving as fast as your car will go or talking so much you take over the conversation. It must include the ability to do the things necessary to function in society. Measurements for physical, mental, emotional, spiritual, social, and career/financial productivity need to be part of the analysis. Real functionality includes the ability to get along with others and for them to be comfortable with your behavior.

The functionality scale, like the other items in the graph, runs from zero to one hundred percent in increments of ten. Fifty is a normal person during normal times. Less than fifty means that depression or mania is causing one to function less well than normal, whereas above fifty means functionality is enhanced.

With bipolar having the reputation for lowering functionality it is no surprise when someone's functionality score is below fifty. We nonetheless need to bring clarity to the score by detailing exactly what has changed. It is often a combination of enhancements in some aspects and diminishment in others, such as social enhancement and physical diminishment during low level depression with the combination of all aspects resulting in perhaps a forty average.

Claims of enhanced functionality should be met with serious challenges. Hypo-manics tend to score themselves much higher than circumstances justify, so we need to get concrete examples of the physical, mental, emotional, spiritual, social, and career/financial aspects and how they add up to a more accurate score. If one is making others uncomfortable, the zero social functionality score will bring down any perceived enhancements in the other areas.

As one would expect, functionality for those without training approaches zero during the most intense states of both depression and mania. Zero means dead, so if you are still alive you are at least functioning above that. It is very rare that someone would score above ten percent functionality during intense episodes without advanced training and skills in Bipolar IN Order based tools.

At the lowest intensities that most are aware of (The yellow L scores in the graph), there are many who legitimately justify how their functionality is enhanced by hypomania. You might be amazed, though, of how many depressives find enhanced functionality too. This is especially prevalent among creative types: writers, poets, musicians, artists, and the like.

Notice, though, that functionality is only slightly enhanced during the lowest levels. The reason appears to be due to the inability to recognize low intensities (as mentioned in the awareness article). When we teach how to recognize depression or hypo-mania earlier, students become aware of the optimal level where functionality is at eighty percent or higher. This "Comfort Zone" is illustrated by the blue C scores in the graph.

Part of the optimized functionality is a result of raising both awareness and understanding along with recognizing lower intensity. As understanding increases, awareness goes up. With increased awareness, students begin to recognize lower levels of intensity. The combination of the three factors (yellow arrows in the above graph) increases functionality, which brings comfort and value scores along with it.

The understanding and awareness gained during lower intensity high-functioning episodes applies also to the more intense depressions and manias. While not necessarily raising functionality to even "normal" levels of fifty percent, small increases can buy critical time to take actions that will avert another crisis. What we learn by increasing functionality at lower intensities can be the difference between life and death during the next intense episode.

Contrary to popular belief, the level of intensity one can become highly functional in has no limit. We have helped people become highly functional in states that were previously thought impossible, but the amount of work necessary inhibits all but a few who have the resources and desire to challenge the boundaries. The same can be said of climbing the Himalayas, racing cars, or any number of things some of us do to explore our capabilities.

High-functionality becomes substantially more difficult at each level of intensity. Most people find a range of intensity that works for them and they take steps to avoid or mitigate any intensity beyond their comfort zone. Like the casual hiker who is comfortable hiking in the mountains and does not push beyond the safe limits, they recognize the skills and effort it would take to function at the next ten percent level and choose whether it is worth the effort.

The comfort zone range for most people tends to be twenty to forty percent intensity for the manic side and forty to sixty on the depressive side. Beyond that takes takes too much effort. Very few people climb the Himalayas for the same reason, but we do recognize those who do as the top experts in the world.

What are your comfort zone intensities for depression and mania? What would need to change for you to function highly at the next ten percent intensity? Who do you know that understands how? Do the people advising you know how?

The next articles in the series will cover comfort, value, and the effect of time. In the mean time, please share your questions and insights in the comments or contact me through our Facebook Page if you prefer. Be sure to check out the other articles about  Awareness and Understanding too.

About the author 

Tom Wootton

Tom Wootton is a passionate agent of change. He is pioneering concepts and challenging our thinking about mental health more than anyone else in the field today. Tom designed and delivered the first Bipolar IN Order workshop in 2003 and after many revisions it remains his signature program. It is now a worldwide on-line program that offers multi-media learning and live internet group sessions.

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