Why I hate the 1-10 mood rating scale

happy face rating

mohamed_hassan on Pixabay

I became a nurse 14 years ago, before I became mentally ill.  Even then, I wasn’t a fan of asking people to rate their [mood, etc.] on a scale of 1-10.  It struck me as such a cop-out, a poor substitute for actually exploring with the person how they were feeling.

And then depression hit, and I ended up in hospital myself.  Almost every day someone was asking me to rate my mood, and I hated it.  That feeling I’d had before about it being a cop-out?  Quadruple that – at least.  It felt like none of them actually cared how I was doing; they just wanted to get in and get out.

There is a huge array of different emotions that we can experience.  While we may label some as good and others as bad, they all have their time and place.  No one wants to be excited when something bad is happening just like we don’t want to feel angry when we’re getting a relaxing massage.

Reducing mood to a scale ranging from sad to happy seems totally arbitrary.  What if I feel anxious?  That’s neither sad nor happy, but somehow it has to be slotted in on the scale.  What if I’m angry because the professional asking me the question is being a prick?  That’s not happy, but telling them to go f*** themselves might be rather satisfying.

The idea of imposing a 0-10 rating is also arbitrary, because the frame of reference is subject to so many different influences.  What’s “normal”?  If I was bipolar, maybe 5 would be expected to be my normal.  But since I have depression, people may expect me to cruise along at an 8 most of the time.  What’s a zero?  If I’d experienced childhood sexual assault would that be my zero and anything else is pretty much automatically an 8 or above?  My zero before I got depressed was a whole lot different from the zero when I was trying to kill myself, so how’s that supposed to work?  And does my zero if I’m suicidal today necessarily correspond to the zero I was at if I felt suicidal six months ago?

I get that it’s helpful to track mood.  I track my mood in my bullet journal with a numerical ranking from -3 to +3, with zero being neutral.  I also use coloured coded letters to record specific emotions.  Different days may have the same ranking but a very different mix of emotions, but a numerical rating alone wouldn’t capture that.

What’s really important here is that mental health professionals should take the time and effort to dig a little deeper.  A number that I pull out of my ass has very little meaning on its own if someone doesn’t try to understand the complexity of what’s actually behind that number.  If the person asking is just looking for something to write in my chart so that it looks like they’re doing their job… well, chances are, I’m going to sense that, and whatever I tell them is going to be a load of BS.

The reason this has come to mind recently is something a friend of mine said.  He’s in psychiatric nursing school right now.  He tries to be understanding of my illness,  but in many ways he’s clueless.  I’ve tried to explain to him what it’s like, and he just doesn’t get it, although not for lack of trying.  I was talking on the phone with him on Boxing Day, and he hadn’t asked how I felt about Christmas.  He can’t seem to wrap his head around the concept of anhedonia, and I think he just figured I chose not to do anything for Christmas.  He was babbling on about some stupid work-related anecdote, and then finally he asked how I was doing.

I told him I wasn’t doing very good.  There was a pause, and then he asked me how I was feeling on a scale of 1 to 10.  Oh for crying out loud.  I told him he could f*** off with his stupid 1-10, and I hung up on him.

He wasn’t trying to be a jerk, but the last thing I need is a friend making a lame-ass attempt to assess me using a crappy assessment tool that pisses me off to begin with.  I’m not sure what to do about this whole thing.  I’ve tried explaining, and he just seems to be a bit thick when it comes to this issue.  So maybe I need to either just put up with it, or back off on the friendship (except he’s my only in-person friend).

I don’t know, but what I do know is that people can take that 1-10 and stick it where the sun don’t shine.

24 thoughts on “Why I hate the 1-10 mood rating scale

  1. Invisibly Me says:

    I agree, I find it too simplistic, too reductionistic. I had problems with a lot of these types of ratings and scales when I did my psych degree because I didn’t like them. I get why they want things straightforward so numbers can be written and calculations made, but it’s not enough. As you say, “mental health professionals should take the time and effort to dig a little deeper.” xx

    Liked by 2 people

  2. howikilledbetty says:

    Oh God it’s so hard isn’t it … I suspect it’s just more form-filling and a way of covering the professional’s backs if we are under their care. I don’t thing it’s precise enough at all, it’s too general and simplistic. I hope you manage to explain to your friend so that they really understand. We’re nearly at the end of the year … 2019 will be a good year, a fresh start and a happy time for us. Katie xx

    Liked by 2 people

  3. Meg says:

    Shut the front door! Oh my. So many thoughts.

    When I was in mental hospitals, they never asked me this. Maybe it’s a Canadian thing? I was actually in some good hospitals as a teen. We’d start the day by choosing a goal for the day. (Have a good family therapy session, stay calm and manage my anger, etc.)

    So I’m trying to wrap my mind around the 1-10 scale of sad/happy mood.

    He’s your only in-person friend? Hmm… Meg is brainstorming… (by the way, while Meg brainstorms, back when I used to track my mood, I too did -3 to 3, for depression, neutral, and manic–good thinking!! Great minds.) He does sound like a bit of a clod with some lack of awareness of depression. And yet he’s training to be a psychiatric nurse? That means, on some level, he either wants (or downright NEEDS) to understand. But you’ve tried explaining it to him. Is he aware of the realities of his chosen profession? I hate to say it, but I think you should just tolerate his lack of understanding, because you’ve tried to get through to him, and his mind isn’t letting it in. 😦 He seems obtuse.

    But keep us posted!!

    Liked by 2 people

  4. Karen says:

    I hear you sister xx
    The scale is arbitrary, is a five for me good or bad? When I have to do PDQ 9 and GAD 7 questionnaire I always say it’s subjective, it’s slightly better than a straight mood rating number but if I’m answering on a good day my scores are skewed towards the positive and conversely if I’m having a really bad day.
    Right now I’m mostly good but I can’t translate that into a single number.

    And about Christmas… meh, it was ok but only because it was low key, low peopley-ness and the kids mostly ignored us and me and hubs got to do our own thing.
    Just keep doing what’s best for you xx

    Liked by 2 people

  5. Looking for the Light says:

    I’ve never saw any value in the chart but know it’s used because the people asking are not trained professionals. Maybe a Med student but no “real” world experience that nails the accountability to their ass. What the Psych sets down to talk, I don’t talk numbers, he trained to listen to spot changes, good or bad, trained to see if meds are working, that I’m improving. His job is to take the conversation and use the training and life experiences assess how you are doing. I’ve only been in three different Psych hospitals, two were a joke, like robots going thru the days, how much money am I getting from insurance, how long can I stretch her stay till the max allowed. The first time I woke up really late the first day, why set an alarm. I went to the glass enclosure to get my meds. Now I need my breakfast in order to cram all these down my that. She yelled at me that I hadn’t laid my ass in bed I could have had breakfast that I had to wait till lunch. I handed the pills back, then she know I wouldn’t kiss her ass, she went and found my something to take my meds with. I’m glad I’ve seen the worst so I can appreciate where I go now when needed. Great topic. Maybe you could explore the topic forward. Have a great day. M

    Liked by 2 people

  6. Luftmentsch says:

    I would have expected someone training to be a psychiatric nurse to understand anhedonia and depression a bit better!

    I’ve used a 1-10 scale to monitor my depression (and another for anxiety) for well over a decade, but lately I’ve been finding it less helpful. It’s OK for monitoring from day to day, but I get the feeling that my baseline for ‘normal’ has moved over time so I don’t know that I can really compare to earlier episodes of depression. Factor in alexithymia and autism and this can get quite messy. I think I don’t really know what I’m feeling a lot of the time. Plus, I think if I’m doing more, as I have done for the last couple of years, I unconsciously rate my mood higher, even though I’ve become quite capable of a reasonable degree of functionality while very depressed.

    Liked by 2 people

  7. Sunny says:

    My care providers ask me how well I feel I’m doing in regards to my functionality on a scale of 0 to 100%. I find that just about as useless as the one to ten scale. Does the 100% signify when I’m manically hyper-functional? Or is this a 0 to 100% scale for a normal person? I just don’t know.

    They also have a checklist that helps them to decide whether I’m depressed, functional, manic, experiencing mixed episodes, but sometimes I am not aware of my symptoms, as such. And if I only see my doctor once every four to six weeks, this form does nothing to diagnose rapid cycling.

    Verbal communication is key. My provider doesn’t even glance at that form. It’s up to me to let him know what’s been going on with me, special areas of concern, any side effects, and any questions I have about my treatment.

    Liked by 1 person

  8. DV says:

    My problem is that the number is good for all of 5 minutes. OK so that’s a bit of an exaggeration, but I can swing from “normal” to “anxious/agitated” to “suicidal” multiple times in the course of a day, and at any given time the emotions are real and complete and feel as if they’ll never end or change. Plus, my mood doesn’t necessarily correlate with my level of functioning. To even come close to being useful I need something that uses a multidimensional scale and summarises the overall feel of the day in retrospect.

    Liked by 1 person

  9. nursingknowledge18 says:

    Hi!
    I am a psychiatric nurse and I know EXACTLY what you mean! The only explanation I can come to is that we are trying to quantify patient’s experience and if they come in with an 8 and are now a 4 maybe something is working… but I agree with you wholeheartedly. I don’t think the number thing works in terms of really gauging the individual’s depressive or anxious mood. My way of getting around that is initially I say – “This is just a standard question I have to ask all my patients for documentation purposes, how would you rate your depression and anxiety?”
    Generally patient’s are okay with me saying that and depending on how they answer facilitates my response. I prefer the mild, moderate or severe – depression or anxiety rating more than a numerical value as it makes more sense to most people.

    Anyways, thanks for this post. I am trying in my own practice to find a solution to this as it has always felt off asking a person to “rate their emotions”. Unfortunately, electronic medical records requires us to ask this question as a part of our assessment question, but I will take into consideration what you have wrote here as well.

    Thanks! & Take care.

    Liked by 1 person

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