Wednesday, April 11, 2012

Visual Analogue scale for Anger

As a medic I'm a little obsessed by trying to understand other people's subjective experiences of the world using a scale of 0 - 10 (based on the visual analogue scale (VAS) for pain). I even annoy myself with my relentless "On a scale of zero to ten where ten is on top of the world looking down on creation & zero is the very depths of despair - where are you?" etc, etc, etc - pain presents itself in many forms.

I've spent a little bit of time this weekend devising a visual analogue scale for Anger - there is currently a lot of anger in my life & I thought that quantifying & qualifying it would help me to make sense of things.

Every day I visit a website called moodscope, I think I've mentioned it before, which was introduced to me via a midweek podcast, the founder - Jon - was telling his story of setting up moodscope. It has been a useful exercise to answer 20 question 'cards' every day with one of four options 1) Very slightly or not at all 2) A little 3) Quite a bit 4) Extremely. There are ten positive 'cards' such as 'Strong', 'Determined' & 'Proud' - although the latter I always view as a negative trait & often score that one as 'not at all'.

The ten negative 'cards' include 'irritation' - always high scoring for me & 'hostility'. But after a week of fluctuating levels of irritability, hostility & anger (not an option on moodscope) I wondered if I could perhaps devise my own tool - with a little help from my friends whilst at the Victory swimming pool.

Just to talk you through the tool, as if it needs any explanation;

0) Obviously found to the far left of the line & depicts a state of complete calmness, inner peace & a sense of full well-being. I have never been there in the last 39 years so didn't feel the need to add it.

1) Annoyance - this can be mild, moderate or severe & is when a stimulant provokes an awareness but not a true emotional response to it. Mosquitos in your mosquito net are an annoyance, sweating in the hot season can be annoying, no water when you turn on the tap, toilets that don't flush, living next door to a Wat, dogs in my compound - are all an annoyance to some degree or another.

2) Frustration - this occurs after prolonged exposure to annoyance with an additional attempt to engage, change or modifying the annoyance unsuccessfully. Trying to get doctors to order a full blood count is frustrating, people saying 'yes' when they mean 'no', errors made in communication based on translation, people deliberately messing with your head, the sense of non-urgency & general pace of life - these can all be frustrating.

3) Agitation - after prolonged frustration comes agitation which is a physical manifestation of frustration. This can reveal in many ways; shouting, pacing, tearing ones hair out, not sleeping, not eating, eating too much, smoking, drinking alcohol, crying for no reason. It tends to be short lived & can be addressed my removing the source of the frustration.

4) Irritation - when there is prolonged frustration, annoyance & agitation or you have a mood disorder then the result is irritability and this can be low grade to a full on state of heightened irritation. Its pathological but sometimes I quite enjoy it. Every day in work is irritating, certain people are irritating, online banking, my flat situation, weddings/funerals/festivals here - all tick the irritation box.

5) Vexation - I love this word, it so very Jane Austin. I like to think of this as 'very cross' - a combination of irritation, agitation, frustration & annoyance. Being vexed with people is always a lot more polite than being bloody angry at them. Not getting your lunch when everyone else has, after no breakfast & you've had little sleep, a bumpy journey and you are already annoyed & agitated results in vexation. People giving you mixed messages - that can be extremely vexing. The bus company charging me a ridiculous amount of money because it is Khmer New Year then refusing to drop me off in the centre of BTB hence I had to walk in the midday sun - this caused me vexation.

6) Righteous Indignation - I am very familiar with this state, one perceives oneself to have been wronged in some way - implying that you are in the right - & you are very angry about this. It's often made worse by the person/thing that has made you angry not acknowledging that you are right/have a point/deserve some respect. I feel this most days of working in the Cambodian Health Care system. Read any clinical blog as an example of righteous indignation - perhaps PTC - an epic journey is a good start. Clearly righteous indignation is a barrier to effective capacity building.

7) Anger - a score of 7) or more on the VAS for pain denotes severe pain requiring an opiate - Anger AKA Wrath is the psychological equivalent. It needs what ever 'opiate' works to dull it - shouting, crying, violence towards oneself or others, smoking, drinking, using class A drugs, extreme sports, exercise, dangerous driving - everyone has there own coping mechanism. Humour as a defence is a common mechanism for me which doesn't work so well, when I'm angry people laughing at me seems just to make me angrier!

8) Slow Burning Rage - prolonged anger results in this state of persistent rage, it is not good for ones health. Last weekend I spent most of it 8) on the VAS for anger, hence the creation of the above scale. I felt like I had transcended annoyance, frustration, agitation, irritation, vexation, righteous indignation & anger. I had a true sense of calmness - much like the eye of a storm - my moodscope score was even 79%, the highest it had been in months. But that's only because I had focused all my negative energy on one thing then put it on the back burner. The peptic ulcer/BP are doing nicely, thank you for asking.

9) Fury/Red mist - slow burning rage isn't sustainable & one can either slip back down the scale or progress to fury. Thankfully seeing the 'red mist' is not a common experience for me, however I have it in my genes. Seeing 'red' tends to be a family trait, various members of my family or their loved ones have lived in fear of a 'Wilson' in a fury. Sleeping with a hardback coffee table book on ones chest in fear of being stabbed, hiding in your room/garage/place of safety/panic room, wordlessly handing over a large glass of whisky - these are all well used coping mechanisms for the recipients of this fury. I really don't do it half as much as I'd like to but you never know given the current circumstances I could be entering a new phase of my life & how I manage anger.

10) Acceptance/Depression - people have choices, one can either reach a level of acceptance about the source of one's anger or failing this develop a huge sense of helplessness & hopelessness heralding the onset of depression. I believe it is quite possible to cycle between the two depending on the amount of sleep/food/drink one has had, also it is dependent on environmental factors such as temperature & humidity, public holidays & visits to a swimming pool.

Being angry isn't healthy and as a fellow VSO-er pointed out to me the Buddhist scriptures advise "breath in love, out anger". My glib response was - well I'm very good at the anger part. Her text reply was - no esther, you have a lot of love. And she is right of course - it's holding on to it that is proving to be the tricky part.




1 comment:

  1. Fascinating work Esther. Interesting, isn't it, that the very top of the scale seems to be marked by an absence of that red mist which was there at the '9' point? I think you're right that there's a degree of helplessness that kicks in when things go beyond meltdown. You may know about Martin Seligman's work on 'learned helplessness' but if you don't, it's worth Googling it. Many congratulations on your thorough approach to building your scale. Nice work.

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