This is the third of a series of blog posts on the context behind my Physics World article: A physicist’s experience of the mental-health system. There is a lot of backstory. So during the editing process, I sent documents to the editor to help explain some of the views I express in the article. I have decided to add them as blog posts.

Alex discusses the use of rating scales in the mental health system, which he encountered during his rTMS treatment. Alex provides an analogy of how rating scales can be problematic by comparing them to rating the weather over a two-week period. He explains that symptoms of mental illness are complex and unpredictable, and that they fluctuate and change over time, making it difficult to provide accurate ratings. Alex attended a support group meeting with other patients receiving treatment and found that none of them knew how to answer the rating scale questions. The author concludes that rating scales are not very good at capturing the complexities of mental illness.

It was during my rTMS treatment that I first encountered the rating scales. And, had I been completely honest, I would have said that I could not answer the questions. That I could not give a rating at all. Especially as every scale asked for an average over the last 2 weeks. I have thought of an analogy that I hope might get across the reason why I felt it was pretty much impossible to give a rating.

Say you have lived in Southern California USA for your entire life. You are used to warm, dry and sunny weather year-round. In the previous two weeks however, the weather has been very unCalifornian. On the first day it was foggy and a bit chilly out, the next few days were pretty warm for this time of year (winter) temps going up to 24 Celsius, with a lot of Sun. On the weekend though it rained persistently. Last week however started extraordinarily with snow, possibly the first time you had seen it in your life. The rest of the week then stayed pretty chilly, five or six degrees Celsius, before returning to warm and cloudy.

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