On a Scale of One to Ten: Charting, Tracking, and Managing Extreme Moods
Written by: Lane Gormley, EdS, LPC, NCC
When leading morning group for the psychiatric patients at Ridgeview Institute, I frequently asked my Clients to “check in” by assessing their current mood. I drew a line on the dry erase board and numbered it like this:
I asked everyone to assess their current mood on this scale of 1 to 10, with 1 being the worst day ever and 10 being the best. I learned a lot from this exercise. You would not believe how many people checked into group with moods that were, literally, “off the charts”. Minus 5, -10, and even -100 on a scale of 1 to 10 were frequently charted by depressed Clients who had attempted suicide. Twelve, 17, and higher on a scale of 1 to 10 were often specified by Clients experiencing various stages of mania. Once, I checked in, myself, at my usual 5 or 6; and a patient with manic symptoms who had been diagnosed with Bipolar Disorder asked, “Is that all???”. To her, an average mood seemed like depression. She felt sorry for me.
Charting daily moods can be a lifesaver for Clients seeking emotional stability. I encourage Clients to keep a calendar where they jot down a number describing their mood at approximately the same time each day. How are you feeling right now on a scale of 1 to 10? Why is this helpful? Because, as Mary Chapin Carpenter’s song says, The stars may lie, but the numbers never do. Long before one of my Clients admits to himself that his mood is drifting downward, the daily numbers might tell the story. Look at these daily numbers over two weeks time: 5… 6… 5… 5… 6… 5… 4… 5… 5… 4… 5… 4… 4… 4… 3… What do those numbers say to you? To me and to some of my Clients, they say that someone’s mood is sinking. It is time to have medication assessed and to investigate, perhaps with a therapist, the cause of the decline.
Sleep is another indicator. Depressed persons may sleep too much in order to escape the doldrums. They may sleep too little when the negative thought patterns cannot be stopped or slowed long enough to drift off to sleep. Clients inclined to mania (prolonged euphoric, angry, or overstimulated moods) usually stop sleeping. Mental and physical activity is keeping them awake. A first sign of rising mania is decreased sleep.
Some moods are dangerous – for my Clients, their families, and sometimes even for society. Mood disorders can be treated, but it may take both motivation and discipline to live with them. The following is a therapist’s view of common mood disorders. I wish that I could be more authoritative about them, but I have never had one. Everything I know about them I learned from my Clients.
Dysthymia is persistent low-grade depression. Psychiatrists often say that it has to go on for two years in order to be diagnosed; but who wants to live like that for two years? If you are consistently sad and without happy, positive energy, that should not be. Make an appointment for a medical check-up to rule out physical causes (for example, undiagnosed diabetes can have symptoms not inconsistent with depression), and then see a psychiatrist and/or a therapist.
Depression is marked by consistent sadness or emptiness; a lack of interest or pleasure in people, activities, and things; possible sleep disturbances; a feeling of being “slowed down”; feelings of worthlessness, shame, or guilt; problems thinking, focusing, or concentrating; and even recurrent thoughts of death. It should not be confused with normal sadness. Normal sadness is 1 or 2 on a scale of 1 to 10; depression can feel like -10 or -100 on that same scale.
Some researchers distinguish between exogenous depression which is for a known reason (the death of a loved one, the loss of a job, financial dire straits) and endogenous depression which is depression existing within the individual for unknown reasons. Major Depression is sometimes experienced as endogenous; a Client once told me that he was depressed because of “everything and nothing”.
I always tell my Clients that depression is not caused by the sadness they feel; it is caused by the sadness that they refuse to feel, the sadness they deny. They “depress” it; they push it down inside themselves and refuse to feel it. They avoid it, and it grows and grows until it casts a shadow over life itself. At this point, medication might be necessary for my Clients until they have processed their feelings in therapy. You have probably heard the expression, “Don’t even go there”… Well, in therapy, we go there. We express and release both old and recent sorrow.
Anxiety is persistent and uncomfortable worry – specific or non-specific. Some researchers say that Anxiety and Depression are two sides of the same coin and that they may co-exist and even co-create one another. One of my professors said that anxiety may cause us to use up all of our uplifting or relaxing brain chemicals (like serotonin and dopamine). Then, without these positive and calming brain chemicals, we depress.
Mania is a prolonged, extremely high, and energetic mood. It is abnormally high. It may be euphoric (joyously excited), irritable, or angry; and it can end in disaster for the individual and the people with whom she or he comes into contact. It can be the upper “pole” of Bipolar Disorder. At its zenith, delusions of grandeur (grandiosity) and of great power can accompany it. A Client might believe that he is Jesus Christ ( a Messianic Complex) or that she has “special” knowledge or insight that others do not have. One of my Clients told me, “It’s like having a drug factory in my head.”
As the high, with its huge expense of energy, sleepless nights and frequent forgetfulness about eating regular meals continues, it can take a huge toll on the health of the manic person. When euphoria exhausts itself, it might dissolve into paranoia, or irrational fear. Paranoid delusions that I have heard more than once are: fear that CNN is broadcasting my Client’s thoughts to the nation, fear of being pursued by the FBI, fear that someone evil is sending my Client hidden “messages” by telephone or through the Internet, fear that the “Mafia” wants to harm my Client and others. Manic people are very convincing about their delusions simply because they are, themselves, convinced that they are true.
Persons with mania can also spend a lot of money in a short time, bankrupting a family with excessive and irrational expenditures. They can be hyper-sexual, hyper-verbal, and labile (have bursts of uncontrollable emotion). They might begin (and abandon) overly ambitious projects on a spur of the moment basis.
Hypomania could be described as a low-grade mania minus the delusions and with less or even no impact in functioning. What am I saying?? It can even have a positive impact on functioning. I grew up with a friend named Cathy who, I now think, may be hypomanic. She thinks so, too. Cathy has always been the life of every party. Her energy never flags. At children’s sleepovers, she never went to bed. She is and was fabulous… And exhausting. She has been that way for years. She goes to work and does her own work. When she has finished, she does everyone else’s. She has children and many hobbies. She is the head of a department in a large non-profit. She can, and would, redecorate your home in two hours. She is a Master Gardener and gourmet cook. She never sits still. Her daughter has been diagnosed with full-fledged Bipolar Disorder.
When emotions are tempered by reason, they can be very beautiful; they can light up our lives and lend wonder to relationships, moments, and endeavors. When they are ungoverned, they can endanger the wellbeing and the sanity of an individual and those who surround him or her. I have Clients who have mood disorders, and I have Clients who were raised by parents with mood disorders. If you have difficult moods or suffered from close contact with someone who had them, consider talking it over with one of us. Difficult moods can be treated for the benefit of all concerned parties.
If you like to read and if you would like to know more, I suggest that you read Kay Redfield Jamison’s books. Dr. Jamison’s book on suicide is called Night Falls Fast: Understanding Suicide. Her book on extreme moods is called Touched With Fire: Manic Depressive Illness and the Artistic Temperament. In it, she details the high incidence of famous creative geniuses who had unstable moods. Her autobiography, An Unquiet Mind: A Memoir of Moods and Madness, is the narrative of Dr. Jamison’s own, eventually successful attempt to live with Bipolar Disorder.