So you are depressed. And you ask yourself: would it be wise, would it help me to systematically register my depression level on a daily basis? My answer would be: probably not.
Before I explain, here is the 1599 painting Narcissus by Caravaggio. Do you know Narcissus? The famous story character from ancient Greek mythology?
Narcissus became obsessed with himself to such an extent that when he saw his reflection in the water of a pool, he could not stop looking at it. Totally fixated on his own mirror image, he was unable to leave, and lingered on the spot until he died.
His name lives on in the terms “narcissism” and “Narcissistic Personality Disorder” to indicate people who are focusing far too much on themselves, in an unhealthy way.
Narcissism is often interpreted as a kind of personal vanity, based on excessive self-love. But there is also narcissism that is equally self-centered, but based on excessive self-doubt or self-hate. Depression often comes with that kind of narcissistic attitude. Locked in the negative self-image caused by your depression, you focus too much on yourself and too little on the outside world. And this, in turn, will make you only more depressed.
The basic problem with systematic, daily “mood monitoring” is that while giving you hardly any real benefits, it tends to worsen this narcissistic nature of depression. It can lure you into staying focused too much on your own depression level and how bad it is today again. Rather than help you cope by refocusing on something else, this will just rub it in.
Still there are websites that actually advocate this kind of narcissistic activity as a way to handle depression. Let’s take a brief look at a prime example.
Below is a partial screenshot of the website for the Mood 24/7 SMS-based mood monitoring tool. Not shown in the screenshot is their somewhat misleading title Get to Know Yourself – what they actually mean is just this: Get to See The Graph of Yourself That You Constructed Yourself.
Mood 24/7 is the modern online equivalent of Narcissus’ pool. What they offer you, is very simple.
You subscribe to their SMS service and they’ll send you this phone text message at an agreed time every day: “On a scale of 1 to 10 what was your average mood today?” You start thinking about the past day, you try to remember exactly how you felt at different moments, you evaluate your overall mood levels for that day, make a final guess as well as you can, and then hit Answer to send them your score. If you like, you can add a small tweet-like comment that they will save with the score.
With your user password you can access your personal Mood 24/7 webpage where all the daily scores you sent them are represented in a neat graphical chart (see the screenshot example). This can show you the variation in the daily scores you sent them over a longer period of time. In the chart’s peaks and dips you’ll recognize the levels and swings of your daily mood, just like they were reported by you.
Basically this is it. Now what’s the point, apart from the fact that sending in a daily “mood score” requires you to make it a habit to somehow analyze and evaluate your own mood every day? A habit that, when you are really depressed, is perhaps not a healthy habit at all?
Frankly I fail to understand how this would make you “to Know Yourself” as claimed by their webpage title. Did Narcissus get to know himself any better by staring, for however long, at his mirror image in the pool? Would you get to know yourself any better by staring at a graphical sequence that simply reflects the self-assessment figures that you determined beforehand yourself? Yes, it will tell you that for day or week X you evaluated your mood as better (or worse) than for day or week Y. But this you did know already – it’s just what you told them.
Maybe you can generate some extra pseudo-statistical results along the lines of “from January to December my average monthly reported mood gradually declined from 6.4 to 5.7, interrupted by a brief temporary peak of 7.1 in July”. But apart from the question what exactly is measured here, would this really help you to get to know yourself any better? I don’t see how.
If the Mood 24/7 service serves mainly to satisfy your narcissistic self-fascination, would it then perhaps still be useful to others around you? In a PDF brochure the Mood 24/7 people suggest “your personal mood chart can be shared with doctors and loved ones, allowing everyone to see the effects of treatment in real-time”. This claim I find, to put it mildly, a little weird.
Doctors know that the effects of treatment can vary wildly in many respects. An antidepressant treatment can have a positive effect in some respects, while at the same time having a negative effect in other respects. It can for example make you less suicidal, but at the same time also less lucid and alert. So to judge the actual mood effects of a treatment, a doctor would have to objectively assess several such concrete factors separately: this means that looking at some global, average mood score estimated by yourself simply will not do.
As for your “loved ones” (spouse, parents, children) do they need to see your superficial mood chart to know what’s going on? They see yourself “in real-time” every day, in much richer detail than this global mood score can give them: they see what you are doing, hear how you are talking, know how you sleep, etc. Sometimes they may already know your mood even better than you do yourself: it’s a known fact that family members will often notice and recognize a beginning depression at an earlier stage than the patient herself. So again, I fail to see the point.
Well, now let me try to give a somewhat more systematic overview of the main problems with this kind of daily mood monitoring.
What’s Wrong With This Mood Monitoring?
1. This kind of mood monitoring doesn’t really measure your mood itself, only rate your superficial and incidental assessment of your mood.
To name just one possible distorting effect: you’re not always objective yourself. A good mood may lead you to assess yourself a little too positively and bad mood may do the reverse, leading to your reporting up-and-down peaks that are exaggerated.
2. This mood monitoring reduces your very complex, continually changing reality to one general, oversimplified score point.
Like, you can be very active but feel suicidal at the same time, or very lethargic while not suicidal. How do you weigh such nuances in one average score? You can’t.
Nor does the score register important mood swings within a day, like being very depressed in the morning but not in the evening.
Nor does it correct for the fact that you may label the same mood you scaled as “bad” today, as “not too bad” ten days later (when it follows after a much worse bout of depression).
3. So it does not measure your actual mood by any fixed, well-defined, constant, objective criteria.
Example? To really measure your depression, you would need to answer not one single dumb scaling question but a whole slew of very specific questions, such as “Did I sleep more than six hours last night?” “Did I eat a full breakfast this morning?” “Did I think about specific suicide methods today?” and so on.
4. As one of the results of this extreme simplicity, a few haphazard data will pose as a pseudo-exact representation of your actual mood.
Like, when you look back at your scores chart over a longer period, the graph format by itself will already suggest this is a complete overview of the hard facts. It’s not: it’s just an incomplete registration of your emotional judgments at some points in time.
5. This will give you the idea you have done something about your depression while in fact you’ve done nothing.
You’re a bit like the fireman who, when asked why he doesn’t climb the ladder to put out the fire, replies that right now he wants to take care of the paperwork and register a heat score for the department’s statistics.
6. In this way, mood monitoring can give you an unfounded and possibly false sense of insight, security and control.
To name just one example, viewing your mood graph can easily lead to the notorious Post Hoc Propter Hoc fallacy. This refers to the wrong idea that when two events are connected in time, this necessarily means a causal relation.
Does your chart show a bad depression dip right after your birthday? Then it is Post Hoc Propter Hoc to jump to the conclusion that this depression was caused by your birthday, and to forget the possibility that there might have been a totally different cause that just happened to coincide with your birthday.
7. At the same time, mood monitoring will in fact tell you nothing new: nothing that you didn’t already know.
Did you see the sample graph in the above screenshot from the Mood 24/7 website? Right: in their example, they show a depression dip during the Christmas days. But if this was your graph, then you registered that low score yourself, so you were already aware of your depression dip at that time, weren’t you? So does it tell you anything new? No.
8. This kind of monitoring requires you to daily focus on your mood while in a depression it’s much better to not focus on your mood, but on the world around you.
I’m sure you know this already. Any focusing on how bad you feel will often make you feel even worse, get you brooding even more. If you are very depressed this can be dangerous, sending you into a downward spiral. Pondering about what might be your correct depression score for today is exactly what will set you on this wrong track.
It’s much better to try focusing fully for a moment on the lawn and the garden flowers outside your window, to count the leaves, so to speak. And unless you’re so depressed you haven’t any energy left, trying to actually mow the lawn will help even more…
9. In a therapy setting, a mood monitoring graph will tempt you to analyze your daily mood swings instead of your structural, long-term core problems.
This is obvious. You’ll be trying to explain the peaks and the lows in your graph, because those fluctuations are all it shows. You’ll easily forget to look at the more constant, underlying factors that are not shown in the graph: such as problems that already existed for years, long before you even started monitoring your mood.
10. In daily life, this kind of monitoring will tempt you to view a given mood score as that day’s reality, easily making a low score into a self-fulfilling prophecy.
Example: if (as suggested in the screenshot) at 8 PM you registered your day score, let’s say “Mood Level 3”, then for the rest of the evening you may already subconsciously have labeled this in your mind as “A Typical Mood 3 Day”.
As a result in the next hours you may keep behaving accordingly, even when you might have done better.
• Summary: over all, this kind of mood monitoring will not help you in any way to find an active, goal-oriented personal strategy to cope with your depressions.
By consolidating the narcissistic focus that is already inherent in depression, in some cases it can make a depression even worse.
Needless to say, the Mood 24/7 website does not go into any of these shortcomings, problems and dangers.
They’ve simply established that there is demand for something like this – a kind of primitive mood mirror tool for people who want to keep focusing on their own depressed mood. And so, they provide this narcissistic consumer with what she appears to ask for. They just want to make money, and of course we cannot blame them for that.
Big Money Background
Actually this is a matter of big business. Really big. The Mood 24/7 site is just one of over 30 health websites run by a company in Arlington, Virginia: HealthCentral. Health websites like theirs do require little investment and generate great profits: they are money trees. With only 82 employees, HealthCentral made a revenue of $19.3 million from its websites in 2010.
So last year, they and all their money tree websites were bought by Remedy Health Media, a privately owned company in New York that claims to be “America’s fastest growing health information and technology company”. One of the owning partners in the background is Veronis Suhler Stevenson, a large private equity investor firm.
Again: we cannot blame them for running a profitable business. But one thing that surprised me at the Mood 24/7 site (and the related HealthCentral and Remedy Health Media websites) is that they all appear to be affiliated in various ways with Johns Hopkins University.
So even though Mood 24/7 is just a dead simple SMS service with a backing website, this mood monitor thing is promoted as “developed by HealthCentral based on technology licensed exclusively from Johns Hopkins University”. True, in the small print, this university “expressly disclaims any responsibility for the use of this tool” – but still, what makes them willing to be associated with something like this? One can only guess.
To be honest, it left me wondering about the ties between Johns Hopkins University and those big-money health website companies. Can we be sure that the Baltimore university has taken all the necessary steps to prevent commercial funding from interfering with their academic integrity? Can we still trust them? I just don’t know.
What I do know, is that I myself will never need to make a cent with this blog here. Along with things such as my long-time personal experience with serious depression, this lack of any financial interest helps to guarantee you my complete independence, integrity and objectivity.
And I promise you, if one of those big money makers ever decides to buy me off with a few millions, I’ll warn you… ;-)
• tip: My advice will be clear. Give this kind of vapid, narcissistic mood-monitoring nonsense a wide berth. When you are very depressed, it can even be outright dangerous to keep evaluating your own mood. You should concentrate on something else than the supposed severity scale of what’s inside your tormented head.
Instead of focusing on your mood, it’s more positive and productive to focus on your surroundings and on a feasible program of activities. Just a brief daily walk in the park will do you far more good than contemplating and registering your “mood score” day after day!
• footnote: The 1599 painting Narcissus by Michelangelo da Caravaggio is in the Galleria Nazionale d’Arte Antica in Rome.
The anonymous ca. 1500 painting in the style of Leonardo da Vinci is probably by a pupil of Giovanni Antonio Boltraffio, who himself had been a pupil of Leonardo. It is in The National Gallery in London.
The surrealistically petrified one from 1937, Metamorphosis of Narcissus by Salvador Dali, is in the Tate Modern gallery in London.
Author: Henk van Setten