On A Scale From One To Ten

If you wish to skip the narrative, jump the first two paragraphs and you will get to the explanation of The Scale Of One To Ten with their definitions.

I would lie curled up on my hospital bed in a fetal position squeezing my legs tightly against my chest so hard I could barely breath and then I would hear it, tap-tap-tappity-tap.  There, that sharp staccato of heels on the ward’s newly waxed linoleum floors closing in on me.  Never hurrying, never faltering, just tap-tap-tappity-tap.  I just knew they were coming my way, it was my turn, closer, and I would wince as they clipped across the threshold of the door to my room.  My eyes would close ever tighter and my lips press together vowing not to let slip a word.  Tap-tap-tappity-tap, they would come to a stop so close to the edge of my bed, then complete silence.  I could feel her presence standing beside me looking down at my posture, which screamed, “send help now, emotionally imploding”, with a clinical and well-seasoned eye I could feel her gaze scan my body. There was a pause, laced with a professionally imposed patience and a somewhat threadbare belief she still clung too that she could yet make a difference in the tilt-a-whirl reality of the gaggle of wackoes she was stuck with.  I know she was thinking this, and why, you ask?  Because just as I finished this thought she sighed, an exhalation tainted with resigned dismay.  I did not look up though, my eyelids never budged, they were firmly locked in the closed position.  I heard her taking a breath, yes, a quiet whistling influx of air, and then…..

“Ms. Tasha, on a scale of one to ten how do you feel this morning?And, there it was.  The most detested question in the whole of the known universe.  My mind would race with saucy comebacks, nasty filthy nuggets of cruelties, and pathetic desperate pleas for pity.  No, no thought provoking insights, just a number, now tatty, that was the question, remember.  My head would instinctively seek refuge deeper between my knees.  I would feel my arms tighten their grasp around my legs and my feet began to flex causing my calf muscles to ache.  She would wait, I could hear her shifting position from one foot to the other, like she could possibly be more uncomfortable than I was at that moment, right.  What, what number?  My mind would be a mass of worms, all tangled and writhing upon each other.  Too low, it would give her the impression I wasn’t as bad off as I truly was, too high and well, who knows?  They could be on you all day like a person suffering a mania stuck on a credit card. But what could be higher than “emotionally imploding”?  8…No…10…No….9….“ 10!” It would come out before I would even feel it claw its way up my throat.  Dang it.  And I had vowed my lips would never betray me like the last time she asked me that same question not an hour before, evil little things.   So I bit one just to teach them a lesson.

Now, this little excerpt pokes fun at a very valuable tool for measuring a person’s mental health status at any given time.  It is, however, in most of my experiences on the psyche ward, one of the most detested questions a psyche patient is confronted with on a daily basis, sometimes hourly.  Perhaps, it is because patients are forced to compress their emotional/mental state, as a whole, into a small seemingly indefinable number.  What is the difference between 5 or 6, or 3 and 4?  Now, 10, being the worst you can be, may seem a little more substantial.  It could mean EMOTIONAL TRAINWRECK, WHOA! WHOA!  Whereas, 1, being the best you could possibly be, could mean, just stable.  But, the question does get a bit grating after you have been grilled with it eight or nine times by several staff members before lunch time.

Seriously though, this question is employed by nurses and physicians alike to assess patients as a method of discerning a person’s current mental stability and/or emotional pain/turmoil at the moment it is asked.  It is not a method to diagnose a disorder, rather a way of determining how the patient is coping at that moment and if they are in need of any immediate attention or aid.  This little question is like taking a patient’s vitals, they can basically take a person’s emotional temperature/pulse with the Scale of One to Ten. They use the person’s numerical answer, along with interaction with him/her, and a trained nurse’s eye, to determine if the patient is still stabilized on the treatments he/she is currently being treated with or if their care needs to be adjusted at that particular time. There is a great benefit in using this question since it keeps the caregiver current on the sufferer’s condition at all times because of its simplicity and ease of use.

It can play a factor in helping healthcare providers determine whether they should consider reassessing the patient’s care to better provide for the sufferer’s needs or leave their daily treatment as is.  And, it can also aid in the decision process of whether or not to reduce the day to day restrictions on the sufferer’s activities because he/she is improving in his/her mental health and is no longer a risk to him/herself or others.  Now, the Scale of One to Ten does not greatly affect a sufferer’s overall diagnosis or treatment, it will not bring about direct or significant changes in medications or therapies, but in the immediate day to day interaction with healthcare providers it will allow them a better grasp of how to care for him/her on a moment to moment one to one level.

And, believe it or not, it is a rather useful method of determining how a person feels and how to convey this emotional/mental status to a caregiver once a person fully comprehends its application.  It has its benefits.  It is not invasive at all; it is just one little question, provided the caregiver doesn’t ask it too many times in a day.  The sufferer doesn’t have to disclose any further information about what is going on inside his/her head if he/she doesn’t feel like talking, only the number he/she thinks he/she is at.  Now, presuming the sufferer has laid out an established set of definitions for the Scale of One to Ten with their caregiver, he/she can rest assured that when a dangerous mental status (number) is reached his/her caregiver will be prepared with the knowledge of what type of measures must be taken at that immediate time and be able to implement them.  And, action can be taken at once to prevent any further deterioration of the sufferer’s mental health.  A person may find himself/herself faced with this question not just in the hospital psyche ward, but also in the emergency ward and their own personal psychiatrist’s office. If one can get past having to pigeon hole the magnitude of one’s emotional maelstrom into a seemingly inane number, it can be a rather efficient means of analyzing one’s current mental status at any given time necessary.  It is important for a sufferer’s caregivers to be able to monitor his/her mental health status at all times, especially since it can change so very rapidly from one moment to the next when he/she is doing poorly.

The trick to its success is to have a well-established understanding of the definitions of each of the numbers and the necessary actions that need to be taken when your caregiver is confronted by each allotted mental status (number) as it is reached.  Ask the medical staff treating you what each number represents and how that number’s representation of your mental status affects your mental healthcare.  Their scale will be different than the one described in this section, and they will most likely use theirs for different purposes than the one used here.  All medical institutions are different and some may not even use a scale method in their treatment of psyche patients.

My husband and I use this technique to gauge my mental health status during times when I am not doing well emotionally, whether I am experiencing a mania or a depression.  I encourage other people and their caregivers to do the same.  We have established our own defined meanings for all the numbers so that my husband will have an exact idea as to how emotionally fragile I may be at the time he asks me the question.  It gives him a well-defined impression as to how to care for me and what measures to put in place when needed.  It is simple and quick, it doesn’t take a psychiatric degree to figure out, and it is effective.  And, when you are rendered relatively incoherent by emotional distress it is much easier to blurt out a number than a cohesive description of whatever is crippling your mind.  I understand why the hospitals use this question as a means to gauge the emotional/mental status of their patients; I have come to respect it as a viable tool in my own personal mental health care.  But, it can still be annoying when you hear that tap-tap-tappity-tap honing in on you and you know you are next contestant for another round of On A Scale Of One To Ten.

These are my husband’s and I’s definitions for the scale of mental health states from one to ten, they are not an established psychiatric institution’s or a medical association’s authorized diagnostic format.  However, they work for us in our daily struggles, as we are always desperately trying to identify where I am on the ever-changing terrain of emotional and mental instability associated with bipolar disorder.  It is so important for caregivers to know how you are faring stability wise, so they can help with your care and provide you the proper assistance when necessary, and this is an ideal method to employ to get the needed answers quickly and with as little intrusion on the sufferer as possible.

The Meaning Of “On A Scale Of One To Ten”

ONE: Stable, experiencing a healthy mental health. (Happy, Contented, Satisfied with Life)

Care:  Maintain a medication regimen and a healthy mental health lifestyle.  Make sure, as a caregiver, you stress that even though the sufferer is doing well mental healthwise, they must still continue to take their medications faithfully.  It is imperative that they understand that they did not reach stability without medication and they will not remain so if they discontinue their medication.

TWO:  Stable, experiencing a healthy mental health with very minor symptoms that are manageable and do not hamper daily activities.  (Relatively Contented, Mildly Satisfied With Life, There May Be A Few Anxieties About Life In General)

Care: Take care that the person maintains their medication regimen and makes an effort to keep themselves physically and mentally healthy, by getting adequate sleep, not overtaxing themselves, and avoiding stress.

THREE: Relatively Stable, experiencing a moderately healthy mental state with minor symptoms that are manageable and do not hamper daily activities too greatly.  ( Feeling Less Contented, A Tad More Anxious).

Care: The person should start to pay more attention to how stress is affecting them.  They should remain evermore vigilant to their medication regimen and consider visiting their therapist to unload some of their anxieties.

Four:  Stability With Difficulty, experiencing slightly unstable mental health, symptoms are more apparent and may become less manageable.  This number, however, is not indicative of poor mental health, it is more representative of a reasonably functioning bipolar sufferer who is experiencing a little more than normal severity of their symptoms. (Gets Emotional Easily, Contented But Irritable, Anxious About Life’s Problems).

Care: This person should visit his/her psychiatrist and review his/her medication levels and reassess whether they are effective or not.  Perhaps he/she needs to see his/her therapist a little more often than usual for the time needed to get him/herself back to a healthy mental status.  This is a very tricky time for a bipolar sufferer, it is that funky state of mind when people start to believe medications are full of #*% and stop taking them (or they monkey around with the dosages of the different medications).  Caregivers should pay close attention to whether or not the bipolar sufferer is properly administering his/her medications.  But, be subtle about it, please!  Try to reduce stress.

FIVE:  Experiencing Some Difficulty, the person is not experiencing stable mental health and their symptoms are apparent in their behavior.  They may find it quite hard to manage symptoms like paranoia and panic attacks.  They can still function in daily activities, but may find certain tasks overwhelming. (May Seem Irrational At Times, Irritable, Emotional/Cries Easily, Can’t Seem To Focus Sometimes)

Care:  The bipolar sufferer should strive to visit his/her mental health care providers on a more frequent basis during this state of mind and keep them constantly aware of their compromised mental health.  It is important that the sufferer reduce stress and make efforts to take care of him/herself both physically, as well as emotionally.  He/she should eat well and get enough sleep. Medications are so important; the person should remain vigilant in their medication regimen even if he/she does not feel they are helping.  Startreducing the amount of social commitments/functions or demands on the bipolar sufferer.

SIX: Experiencing Difficulty, the person is definitely exhibiting some instability in their mental health.  Symptoms will be pronounced and it will be difficult to control urges or anxieties caused by mania or depression. (Anxious, Emotional, Irritable, May Become Reclusive, May Become Obsessive About Certain Things, Will Start To Show Signs Of Mania Or Depression, Sleep Too Much or Sleep Too Little, Stop Eating Properly)

Care: Perhaps the caregivers of this person should seriously consider having his/herpsychiatrist review and adjust his/her medications to more effective therapeutic dosages. Reduce stress factors in the bipolar sufferer’s life like social commitments, volunteer positions, and extra work around the house. The caregiver should begin to pay close attention to the bipolar sufferer’s behavior and what they say.  They may be able to glean a bit of insight into the sufferer’s condition by paying heed to their actions/words and also get an idea of how to approach his/her care.

SEVEN:  Unstable, difficulty dealing with the world and social networks, symptoms are becoming more severe, overwhelming thought patterns, symptoms may become unmanageable. (Quite Fragile, Rather Emotional, Irritable, Paranoid, Anxious, Reclusive, Signs Of Mania or Depression, Interrupted Sleep Patterns, May Have Difficulties With Substance Abuse, Stop Eating Properly, Obsessive)

Care: This mental state should be watched closely.  The bipolar sufferer is incrediblyvulnerable at this point in time.  The caregiver should pay close attention to how the sufferer is acting and what he/she is saying when they converse with others.  Ask the sufferer often where they are on the Scale Of One To Ten (but not too often!) and keep a constant track of their mental status.  Be adamant about the sufferer’s medication regimen and keep them faithful to it. The caregiver should make sure to engage the sufferer in conversations often.  The sufferer must not be allowed to lose touch with the world around them, or let his/her paranoia’s take root.  Keep sufferer away from alcohol and other such substances.  The bipolar sufferer should strive to simplify his/her life as much as possible in this state of mental health, reducing the amount of stress and demands on their life as they can.  The sufferer should also maintain constant and increased contact with his/her mental health care providers, especially his/her psychiatrist.  Be sure to notify healthcare providers of the bipolar sufferer’s state of mind, as well as close friends/relatives who may also be able to help watch out for him/her. Make sure the sufferer eats and sleeps well. This state of mind can deteriorate rapidly, so keep a close eye on it.

EIGHT:  Unreliable Unstable State, will be experiencing dangerous urges and negative thought patterns will be pronounced, symptoms will be unmanageable and the person will find daily tasks extremely difficult (Highly Emotional, Pessimistic, Obsessive, Reclusive, Self-Defeatist, Full Blown Signs Of Mania Or Depression, Disrupted Sleep Patterns, Urges to Self Harm, Difficulties Eating, Strange Or New Habits, Panic Attacks, Increased Anxiety, Irrational Behavior, Self-Centeredness, Loss of Empathy)

Care: This person should be monitored at all times.  He/She is not in a healthy state of mind and is likely to engage in irrational or harmful behavior.  The sufferer may not eat for long periods of time and his/her sleep may be serious disrupted, so the caregiver must try to encourage him/her to maintain his/her physical well-being. The caregiver should frequently ask the sufferer where he/she feels he/she is on the Scale Of One To Ten (but do not be intrusive) and monitor his/her mental status often.  Listen to the topics and the phrases the sufferer uses in his/her conversations with people, are they dark and pessimistic?  Does the sufferer talk about suicide?  In this way the caregiver can gain some insight into the inner workings of the sufferer’s thought processes. Watch for signs of self-harm and indications of suicidal plans/attempts (sometimes the sufferer will consider it for a time before acting on the urges, sometimes he/she will drop subtle hints of it in their conversations).  Caregivers must insist the sufferer remain faithful to his/her medication regimen and not cancel or miss any doctor’s appointments.  The caregiver may even have to go so far as to escort the sufferer to their mental health appointments to ensure they are getting to them.  It may even be a necessary measure for the caregiver to sit in on therapy sessions with the sufferer and their healthcare providers to learn more of the sufferer’s care and contribute his/her thoughts on what he/she believes might improve the situation.  But, this should only be done if this does not cause the sufferer great discomfort or make them feel violated in any way. Do not encourage the sufferer to spend long hours alone in secluded places especially if there is a danger they may be prone to suicidal tendencies.  Remove medications that can be dangerous to O.D. on.  My husband even goes so far as to clean out all the knives from the kitchen and the razors from the bathroom.  He also screens my calls so that I don’t have to speak to people who may cause me emotional turmoil or relationship angst.  I have in the past taken sick leave from work commitments and volunteers positions during this state in my mental health due to the fact that I am not longer able to function as a productive and functioning member of these organizations.  The bipolar sufferer may wish to take a period of time sick leave during this state in their mental illness.  Having family and close friends at this stage isvitally important especially when the main caregiver must hold down a full time job and cannot be there in the home every waking moment.  And, besides even the caregiver needs a break.  Close friends and family can cover the time periods when the primary caregiver needs a break or must work.  Be sensitive to the bipolar sufferer’s paranoid delusions and fears, to him/her they are quite real in his/her mind. Don’t try to reason with him/her, just sympathetically try to show empathy for his/her pain.  BUT, do not agree with them or pander to their delusional beliefs. Don’t let them suck you into their warped concepts of reality.  Firmly but in a kindly manner, establish with them that you do not agree with their delusional ideas on paranoid conspiracies of the world around them.

NINE:  Highly Unstable, this person is experiencing an extremely unstable mental state. They will be exhibiting very pronounced symptoms of either mania or depression. Suicidal tendencies and negative/paranoid thought patterns might be quite prominent in their behavior at this point.  They will be unable to function in both a work or social environment (Extremely Emotional, Highly Anxiety Ridden, Irrational Behavior/Thinking, Reactions To Environment/People Are Extreme And Apocalyptic, May Suffer Suicidal Tendencies/Violent Tendencies, Full Blown, Mania Or Depression,  Sudden Change In Lifestyle, Change In Personality, Self Centeredness, Loss of Empathy)

Care:  This person should be under supervision around the clock he/she is not safe left to his/her own devices.  He/She should even consider hospitalization at this point in his/her downward spiral of mental instability.  He/She should alert his/her mental healthcare providers, his/her psychiatrist, etc., of their instability immediately.  Hospitalization, medications, and the therapeutic care of a psychiatric institution/hospital should seriously be stressed as a treatment for the sufferer before his/her condition progresses into something more severe.

TEN:  Mentally Incapacitated, experiencing severe and pronounced symptoms, cannot function without the aid of medications, in need of round the clock therapeutic care and attention.  Is a danger to themselves or potentially others, and is at the absolute end or limit of their emotional/mental reservoirs.  This person will not improve without some form of professional psychiatric intervention. (Highly Charged Emotions, Severe Paranoid Delusions, Crippling Fears And Anxieties, Cannot Comprehend Extenuating Circumstances To Present Situation,  Irrational, Behavior, Crying, Babbling, Refusing To Speak, Suicidal/Violent Tendencies, May Experience Hallucinations, A Break With Reality, Gaps In Memory, Hysterical Behavior, Emotionally Exhausted)

Care: Immediate hospitalization, medications, intensive in-hospital therapy

I want to stress that this scale of mental states is not a medically acknowledged document.  It was not taken from any existing medical journals and has no legitimate medical authenticity.  I tried to get an actual list of definitions from several different psyche wards and other sources, but they all were highly uncooperative.  So, I was forced to supply my readers with my own definitions.  These definitions have served my husband and I well over the years, I must admit.  And, I feel they have helped me tremendously in communicating to him the state of my mental health during difficult times and how I need him to care for me.  Please remember, everyone is different in his/her own illness and will show their symptoms in different ways to varying degrees.  My mental health states and their descriptions may not apply to your personal mental health experience.  Make your own definitions for the numbers with established instructions for your care for each mental/emotional status and make sure your caregiver knows of them.  They will serve you well.

I have found in the last several months my number has ranged from 5 to 7, 7 being the most frequent of late.

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