MH@H Mental Health

Introducing the Rainbow Model of Mental Illness Functioning

Rainbow model of mental illness symptoms and functioning

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. It’s also a colloquial term, so it doesn’t have a medical definition. When terminology isn’t clearly defined, it ends up meaning 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. grocery 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; however, 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).

The rainbow model of mental illness symptom and functional domains from Mental Health @ Home

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.

Since writing this post introducing the model, I’ve published the refined rainbow model here.

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

COVID-19/mental health coping toolkit from Mental Health @ Home

The COVID-19/Mental Health Coping Toolkit page has a wide range of resources to support better mental health and wellbeing.

42 thoughts on “Introducing the Rainbow Model of Mental Illness Functioning”

    1. Sorry I didn’t explain it well! Basically the idea is that there are multiple areas of symptoms and multiple areas of functioning, and some areas may be really bad while others are pretty good.

  1. There are times when I am doing very well with memory. Then for some unknown reason at another time my memory goes right out the window.
    I hope I am understanding your article.
    Then with emotions at any given moment I can go from mountain top straight down to the valley.
    When I write I try to stay away from trying to say if you have this then this is what you should do. I just write from my personal experience. I have learned over the past two years now that it is not “one size fits all”.
    Ashley, I hope I am making some sense of understanding “The Rainbow Model of Mental Illness”.

  2. I found this really interesting to read.

    Recently I was told because I appeared to be functioning so well, I.e. always turning up on time and not avoiding certain situations etc, that I didn’t need any help or support.

    I wish it was as straight forward as that, the impact from the symptoms, exhaustion and how I saw myself wasn’t taken In to account.

    It has been quite a fight to get the help that I need at the moment. It takes a lot for me to ask for help.

  3. Very interesting. I think there is some overlap with the functional domains; maybe six is a bit of an arbitrary number. But I like that it captures complexity, and also that it can be used with co-morbid issues e.g. sometimes my concentration and energy levels are poor because of depression, other times (like today) because of autistic burnout, but this shows how I’m doing without needing to decide what the cause is.

  4. This is helpful to my understanding. When I was depressed in 2017, people didnโ€™t take my emotional pain that seriously because I was โ€œhighly functional.โ€ I worked, I cleaned house, I took care of my physical health. But inside was all darkness and tears…

  5. I think it’s a wonderful model! People don’t see the grey areas, nor do they sense the variations. They like to put mental illness (like many things) in black and white terms. I’m also glad you brought up the problems with the term “high-functioning.” I used it in my previous comment (in the context of people with mental health diagnoses being able to function in the workplace), but I have heard it used in reference to ME in ways that I found dubious.

    I remember flying a sign on a sidewalk in a certain city in California, and a social worker approaching to ask me if I wanted to have lunch with him, because he noticed that I was “relatively high functioning.” It made me wonder if he feared going to lunch with a “less high functioning” person whom he might have encountered in the same position (down on their luck, etc.) I also wondered what the metric of “high function” truly was, because at the time I thought I was functioning better in MY world than this chap was in HIS.

      1. Well – haha. I did develop a bit of a history with this particular person, and I occasionally called him on his bullshit He didn’t take it too well however, because he was a person with an exaggerated sense of self-importance.

  6. Brilliant! I also hate the term “high functioning” but this captures the idea that people are incorrectly trying to make. Will share with my therapist

  7. I like this Ashley. I think it is cleverly constructed to capture the many variables which can be experienced across a continuum. A very nice model (or roadmap) to aide understanding that many variables exist and can be experienced at varying degrees by the individual who experiences them.

  8. Very interesting. I love how this can be used to view conditions and symptoms in a more complex way, and it can be used over time to see how someone is doing at certain points in their life. I also disagree with the term high-functioning, and I think it erases the fact that a person might be suffering in more unseen ways.

  9. This is something new for me though I have heard the term “high-functioning” before. I mean the rainbow model. My postgraduate research is about depression recovery experience. I am still scratching my head on how I am going to capture this visually as a form of conceptualization for the experience. At the same time, I am worried that it might turn out to be too prescriptive. As you say, mental health experience is complex and diverse. This is something for me to ponder on. Thanks for sharing this, Ashleyleia <3 stay safe:)

  10. I like this! I may use this to explain things to my friends. I like that it allows for complexity and for things to change from day to day. And it’s so pretty and colorful ๐Ÿ™‚ The little rainbow feather in the corner is so pretty, too!

  11. I don’t know why but I have a problem with the expression “suffering with mental illness” I always think “living with bad mental health”. I don’t like the “bad” in this expression but to me it shows that I do not always suffer and I am not ill as such when living with Depression and Anxiety. Do you think that ties in with your thoughts? I like your rainbow model but need to read again to fully understand ๐ŸŒˆ

    1. I think there isn’t a single way of phrasing it that’s going to capture everyone’s experience, because those experiences cover such a broad range. In terms of my own personal experience, I conceptualize what I have as an illness, and it wouldn’t be an illness if it didn’t cause at least some suffering. I think we all find the language that works best for us. I know we’re not “supposed to” say “suffering with mental illness,” but I’m not convinced that getting into supposed to’s accomplishes all that much.

      1. That is very true. The problem is just: if we want a conversation we need to understand each others way of expressing things. But maybe this would teach us to stop assuming and rather ask when we don’t understand. ๐Ÿ˜Š๐Ÿค—

        1. I think it also makes a difference whether people are defining words differently, having different word preferences, or having different philosophical viewpoints. For example, there’s a difference between someone who chooses not to talk about mental illness because they prefer to focus on the possibility, and someone who fundamentally disagrees with the illness model. Both of those are also different from the people who seem to think that mental health is a synonym for mental illness. So asking when we don’t understand may be the way to go.

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