I originally introduced the rainbow model of mental illness functioning last year to capture some of my thoughts on the relationship between symptoms and functioning in mental illness. This is something that exists in my head rather than being an actual thing, and it’s not a model in the scientific sense, but it shows some of the complexity in what I see as the bigger picture of mental illness.
I’ve thought about it more since I initially wrote about it, so I wanted to write more about it. Before getting into the details, here’s a quick overview of the rainbow model:
- It considers symptoms and functioning separately. Symptoms affect functioning, but someone might have severe symptoms in one area but still be able to function in certain areas. Saying someone is “high-functioning” can imply that symptoms aren’t that bad, which isn’t necessarily the case.
- Symptoms and functioning are each split into six domains. These domains are fairly arbitrary, but I’ve tried to generalize the areas of life that mental illness tends to affect. Each gets a different colour of the rainbow, to make it pretty.
- Each symptom and domain is on a spectrum of light to dark, representing more or less severe symptoms and higher or lower functioning. Where we are on each spectrum changes over time depending on how we’re doing. My symptoms might be quite mild in one domain but at the same time quite severe in another domain, and I might function quite well in some domains while doing quite poorly in others. It’s spectrum-based rather than numbers-based because I feel like it’s hard to quantify subjective experiences.
Rainbow model symptom domains
I split symptoms up into six domains based on what they involve rather than specific symptoms to make it fairly applicable across different illnesses.
These are the domains, along with a few different kinds of symptoms that might fit into each, although exactly what might fit into each domain for you would depend on what you experience and how you experience it.
- Emotional: depressed mood, anxiety, guilt, anhedonia
- Cognitive: worry, rumination, obsessions, delusions, overwhelm, impaired concentration/memory
- Perceptual: hallucinations, sensory processing issues
- Disturbed view of self: shame, self-loathing, emptiness, dissociation, distorted body image
- Physical: physical symptoms of anxiety, fatigue, restlessness, psychomotor retardation
- Behavioural: avoidance, freeze response, isolation, compulsions
Each spectrum is shown with pale colours as no/mild symptoms and dark colours as severe symptoms. I’ve stuck in a few arbitrary dark blue markers to show how, at a given point in time, someone might be at different places with each area of symptoms. Over time, each of those markers might slide up or down the spectrum.
How I’m doing
Here’s a look at where I am right now:
- Emotional: I’m somewhere about midway along the spectrum. Anhedonia (inability to experience pleasure) is ever-present, but I’m pretty used to that by now. September was really bad mood-wise, but that’s improved this month.
- Cognitive: This is also about midway. My depression-induced slow brain was doing better for a while, but it’s started slowing down more lately.
- Perceptual: This is mild. I tend to be easily overstimulated when I’m depressed, but I’m really isolative, so stimulation is generally pretty minimal. Hallucinations have been an issue on rare occasions in the past, but not for quite a while.
- Disturbed view of self: This is pretty mild. I was having some issues with negative thoughts/feelings about myself last month, but it’s settled down now. I’m not feeling suicidal, but I’ve lacked the desire to live for quite a while. That’s more of a background issue than a foreground one, though.
- Physical: I’m towards the severe end on this one, at least in terms of the effects of my depression. Psychomotor retardation is an ongoing issue, and it’s had by far the greatest impact on my level of functioning out of any of my symptoms.
- Behavioural: I have turned into a full-on hermit. Dealing with other people in person is unpleasant and exhausting. Stress makes my psychomotor slowing worse, so I try to limit that as best as I can. Then there’s the anhedonia, so there’s no enjoyment in doing stuff. I feel best when I’m home with the guinea pigs, so that’s what I do. It works well for me, but it’s a substantial difference from how I would be living if I was not depressed.
Rainbow model functional domains
I think it’s really dismissive to refer to other people as high- or low-functioning, because real life is more complicated than that. Sometimes, functioning in one domain will pretty much completely shut down to divert resources to other areas. Someone might be able to manage working because they need the money, but everything else goes to shit. Someone might have high-functioning autism in the sense that they don’t have an intellectual disability, but occupational functioning might be totally off-line.
Different symptoms also have different degrees of impact on functioning. In the past, I’ve worked while feeling suicidal, but even moderate psychomotor slowing tends to shut down multiple functional domains.
These are the functional domains I’ve come up with or the rainbow model:
- Social: interpersonal interactions
- Occupational: work, volunteering, school
- Daily living: eating, hygiene, getting dressed
- Self-care: mental/physical/spiritual
- Health maintenance: seeing therapist/doctor, taking meds/supplements, routine physical health maintenance and labwork
- Meaningful activities: doing things that are important to you and give you a sense of purpose
Contrast this to the GAF
The DSM used to use a 5-axis system of diagnosis, which was done away with in the DSM-5. Axis 5 was for the Global Assessment of Functioning (GAF) scale. A score from 0 to 100 was given to quantify the level of functioning at the time of assessment. The GAF was anchored using a series of descriptors, which you can see in the copy of the GAF scale here.
The GAF considers functioning in terms of both functional domains and symptoms. Someone may be functioning well at work and thus appear overtly to be functioning well, but if they’re feeling highly suicidal, their functionality would rate low on the GAF. However, reducing it all down to a single number on a single scale seems pretty overly simplistic.
How I’m functioning
Here’s how I’m doing in terms of functioning:
- Social: My in-person socialization is limited to seeing my brother and niece every couple of weeks. I don’t have to try to mask at all, which is good, but if the visit goes longer than an hour I’m pretty wiped out afterwards. I get my social fix in the blogging world, which works well for me, but overall, I’d say I’m pretty impaired in this domain.
- Occupational: I’m low-functioning in this area. Work/volunteering is not doable at this point.
- Daily living: I’m somewhere in the middle on this. I’ve lowered my standards a lot, particularly when it comes to hygiene/grooming, but I am maintaining those standards. Lack of caring is the issue rather than lack of energy. Brushing teeth doesn’t happen very often; it’s very low down on the caring list. I seldom bother with cooking anything that requires much effort, but I go grocery shopping and I feed myself.
- Self-care: I’m pretty good about this. It’s fairly high on my priority list, which is easy enough since there’s no one else I need to look after. I get massages every two weeks, journal, snuggle with the piggies, use aromatherapy, and bird-watch in the courtyard.
- Health maintenance: As things got harder with COVID, I got worse with this. I want to find a new doctor, but currently, there’s nowhere nearby that’s taking new patients except walk-in clinics.
- Meaningful activities: I’m doing pretty well in this area, as this is where I’d slot blogging and writing. I choose to put it here rather than in occupational functioning because my brain isn’t sufficiently spontaneous in functioning to be able to write for anyone’s purposes or timelines but my own.
The bigger picture
Mental illness life is complicated. There can be a lot of different things going on, and a lot of things can change, sometimes abruptly. Trying to simplify too much risks losing sight of the person that’s underneath that high- or low-functioning label.
I hope this refined version of the rainbow model of mental illness functioning makes sense; I know I wasn’t all that clear when I explained it the first time around.
How well does this fit with how you conceptualize symptoms and functioning in your own illness?