Have I talked about my Mental Health Scale before?
It’s how I tell myself, and others, what my mental health status is. I often can’t do that in conventional terms because my mind and emotions don’t work in conventional ways that most people can understand. I don’t even understand them very well. But, I can kind of generalize. I’m one of the lucky ones who, while I suffer from a condition that confuses my emotions and thought processes, has some insight into what’s ‘normal’. So, the scale is built on that insight to kind of indicates generally how healthy and/or unhealthy my state of mind is in terms that others can understand and that help me to understand where I am in relation to ‘normal’. It’s also an indication, generally of how well I can function at any particular time. And it can be an indicator of my risk level for dangerous behavior and therefore when intervention is needed, such as changes in medication, therapy or, if necessary, hospitalization. Fortunately, in the almost 30 years I’ve been in treatment, while I’ve been on lots of medication, hospitalization has only been necessary once.
So, the Mental Health Scale goes somethings like this:
It ranges from -10 to +10.
The ‘normal’ range is from approximately -5 to +5.
+5 is a typical good day. You feel good. You are looking forward to the day. You’re optimistic, hopeful and maybe even happy. You have interesting things to do. The future looks reasonably positive. There’s nothing excessively stressful happening. You’re not overly anxious about anything. You’re enjoying hanging out with friends, family, your partner, your kids. You’re enjoying leisure activities and hobbies. Maybe you’re enjoying binging on your favorite TV series on Netflix.
0 is neutral. You’re not feeling up or down particularly. Things are just ok. Maybe this is how you feel when your just waking up and having breakfast.
-5 is normal discouragement, anxiety or sadness. Your overly tired. There’s too much work to do and you don’t know if you can get it all done. You’re boss is hassling you. Maybe things are a little rough with your partner. Maybe your kids are giving you problems. Maybe you’re depressed about Donald Trump leading in the GOP polls.
From +5 to +9 is the really good range. I don’t have much experience with this range, so I’m kinda speculating. But I think you would put things like getting a promotion, getting a new car, a dress or a cat in the +6 or +7 range. Maybe going on a first date with someone you really like or celebrating your birthday.
+8 to +9 are really special days. This is graduating from college, falling in love, moving into your first house.
+10 is a perfect day. Getting that perfect job, getting married, having a baby.
I’m more familiar with the other side of the scale.
On this side of the scale, -5 to -7 is where you start to cross over into crisis. Maybe work is not going well. You’re in danger of being fired. Maybe your relationship is on the rocks. Maybe your child or a friend is sick and you’re worried it’s serious. Maybe your wrecked your car. You’re stressed, anxious and depressed. You’re really sad. You’re not sure how you’re going to deal with this. You’re life is going to change. But, you think you can handle it. You’ll find a way.
Beyond -7 going down to -9, things get more serious. This is something more like, you have lost your job. What are you going to do? You’re marriage is breaking up. Your partner, a parent or a friend dies. This is a serious crisis. You don’t know how you’re going to deal with it or if you can. You may start to question everything. Values. Priorities. Goals. Your decisions, plans and strategies. The world is turned upside down. It’s more than sadness. It’s depression, hopelessness and despair. Somewhere in this range is what I call the ‘soft-suicide line’. You’re not necessarily really thinking about suicide but you are starting to think about whether life is really worth living.
By the time you reach -9, you can’t deal with it yourself. You’re losing control of your thoughts and emotions. Your ability to think clearly and your judgement is deteriorating. The depression, hopeless and despair are turning into total, seemingly inescapably blackness. You’re starting to seriously question whether life is worth living and you may be having serious suicidal thoughts and may be thinking about suicide plans. You are in danger. You may try to cope with it by ‘self-medicating’ with alcohol, drugs, sex or other high-risk activities. You need outside intervention from friends, family, professional support, or you’re likely to slip further, possibly past the point of no return.
-10 is the most serious. This is, simple put, the hard suicide line. You are in mortal danger. You *are* past the point of no return. If you reach this level, and stay here for any length of time without intervention, you will kill yourself. I think everyone has built in resistance to suicide and some reserves even at this level. But they are finite and won’t last, unless there is intervention.
I’ve logged a lot of time in this state. So much, and during some periods for such long stretches of time that, honestly, I really don’t understand how I survived it.
-10 is very, very dangerous. But, many people don’t know that there are people who also get into danger at the top of the scale too. For healthy people, +10 days are wonderful but they are transitory. Too much +10 is very dangerous though too. This can be the result of the euphoria of drug use, such as cocaine, for example. But, this is also a characteristic of the Manic Phase of Bipolar Disorder. People who are manic may appear happy, positive and euphoric but they can also be very unstable. They can be prone to very poor judgement and risky behavior. And, much like it is with drug use, someone in the Manic Phase, can suddenly crash into the Depressed Phase. Someone in a +10 state can suddenly and unpredictably crash into a -10 state. This is why Bipolar Disorder is arguably the most dangerous mental health condition. It has a very high mortality rate. Approximately 50% of people with Bipolar Disorder attempt suicide one or more times. And about 25% die by suicide.
I’ve experienced the Manic Phases a couple of times. The euphoria is intoxicating and it was a wild, fascinating roller coaster ride. Your brain is on fire and you can do, think and feel things that you can’t in a normal frame of mind. It’s a kind of window into what our minds are truly capable of. But you can’t control it and I’m a first-hand witness to the kind of collateral damage that someone can do to themselves and others in that state. For all the excitement, I would never want to repeat it.
Sometimes, it’s hard to tell the difference whether someone is in a dangerous +10 state because of drugs or because of Bipolar Disorder because people with Bipolar Disorder, especially when it is undiagnosed and untreated, sometimes self-medicate with alcohol, drugs, sex or other things in order to cope with their mood swings.
Having said all of that, I kind of imagine that the ideal would be to range from 0 to +5 day to day with occasional dips to -3 to -5 and occasionally ranging up to +7. Hopefully there are special events that reach up toward +8, +9 and even +10. And, while inevitable, hopefully events that lead to dipping below -5 are rare. I would wish that going into the -8 and -9 range is extremely rare. I wish that no one ever had to deal with -10.
But everyone is unique. Each individual has their own pattern and there are countless factors that influence it.
In future posts, I’ll explain more about this and try to use it to help you understand what people with mood disorders experience and how it is different from ‘normal’ emotional experience.