I became a nurse in 2004, which was before I became mentally ill. Even then, I wasn’t a fan of using a 1-10 mood rating scale with my patients. It struck me as a bit of a cop-out, and a poor substitute for actually exploring with the person how they were feeling.
Adventures in hospital
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 wide range 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.
The arbitrariness of mood rating
Reducing mood to a scale ranging from sad to happy seems very 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 mood rating scale is also arbitrary, since 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 might 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 when I felt suicidal six months ago?
My own system
I get that it’s helpful to track mood using some form of mood rating scale. I track my mood in my bullet journal with a numerical ranking, but I set zero as the neutral point. For me, a zero neutral makes more sense than something like a 5.
I also use coloured coded letters to record specific emotions. Different days may have the same rating but a very different mix of emotions, but a numerical rating alone wouldn’t capture that. The mix of emotions is just as important as any number I come up with.
Why this matters
What’s really important here is that mental health professionals should be taking the time and effort to dig a little deeper than what a 1-10 mood rating scale can yield. 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.
Depression symptom rating scales
Depression symptom rating scales are a whole different creature from the 1-10 mood rating. They measure the whole picture of depressive symptoms, and they can be useful for tracking changes over time.
Here are a few examples:
- Center for Epidemiologic Studies Depression Scale (CES-D)
- Clinically Useful Depression Outcome Scale (CUDOS)
- Depression Anxiety Stress Scales (DASS)
- Hamilton Depression Rating Scale (HAM-D)
- Patient Health Questionnaire (PHQ-9)
- Quick Inventory of Depression Symptomatology Self-Report QIDS-SR)
These aren’t a substitute for a professional actually talking to you about how you’re doing. I’ve been handed the PHQ-9 multiple times by GPs who have zero interest in asking about my depression, but they want to make a show of covering their bases. I sometimes wonder if they’re aware of how half-assed it comes across. Either ask me about it or f*** off.
Why this is on my mind
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. When I told him I wasn’t doing very well, there was a pause before he came out with the 1-10 mood rating scale BS. 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 mood rating scale and stick it where the sun don’t shine.
The Coping Toolkit page has a broad collection of resources to support mental health and well-being.