Monday, January 05, 2009
Semantics and Tests for Depression
In the comments section of a previous post , "Subjectivity and Objectivity of Symptoms", Anonymous (E) commented, "Aside from cognitive tests, there are tests also designed to measure affect (mood), motivation, feelings of hopelessness." This triggered a remembrance of times when I have done written tests for depression and anxiety and why I believe they may not be accurate in terms of assessing how depressed or anxious a person is.
I cannot remember all the tests all I have done, but I know I have taken the Beck Depression test, and I believe the anxiety test, along with numerous others. I believe these tests only reflects how the person doing them understands the question. Unless I, as a patient, interpret the question exactly as the person giving me the test the tester and the patient are talking about completely different things.
I have experienced a very good example of how the meaning of a question sullies the outcome, unless the 'tester' and 'testee' are understanding the meaning of the question in the same way:
A few years ago I went to a vocational testing facility for people with mental illnesses. I took a number of tests for both my mental health and my vocational interests. When the results came in the psychologist testing me wrote a summary of the results. Her summary started with the words, The results of [aqua's] tests are bizarre and unlikely...".
I remember very little about anything else written in the report because I was so distraught at being dismissed and being told that my results were "bizarre and unlikely. I was intensely upset and hurt, because I had answered the questions as carefully and as honestly as I could. I sat across from the psychologist and I asked her, "what EXACTLY about my answers made you say my results were bizarre and unlikely?"
This is how the conversation went:
Her: When the test asked you about personalities you answered, "I feel like I have more than one personality" That is unlikely.
Me: I do have more than one personality. There's sad aqua, exhilarated aqua, intensely angry aqua, anxious aqua etc.. When I switch into one of those moods it feels like my personality switches because when I am sad I avoid people, become unsociable, want to sleep all day. When I am high I am highly social, bubble and have tons of energy. I become a different person.
Her: That is not your personality.
Me:There was no description in the test about what a personality is or is not. I am a lay person, not a psychologist. How am I supposed to understand what the question intended to mean?
Her:Well, in another question we asked about suicidal thoughts. The choices were: "I don't think about dying, I think about dying, I wish I would die, I want to die". You said "I want to die". You have never attempted suicide so this answer is unlikely.
Me:I read the question and I thought carefully about how I feel. I have intense suicidal ideation. When I am having those thoughts it feels like I want to die. Why else am I having the thoughts? The thoughts are propelling me towards dying. I cannot understand they are only thoughts. It feels like "I want to die". I have been having those thoughts all the time. So, given I have the thoughts all the time, and that while I am having the thoughts I believe I want to die...I choose "I want to die"
The conversation just went downhill from there with her refusing to understand, or acknowledge that basically, how I answer the question, and how she perceives the answer, comes down to semantics. Unless her and I MEAN the same thing when we interpret and read the question, the test is useless. It tells her nothing about me and how I am feeling.
In order for the test to be accurate she would have to sit down and ask me what I meant when I chose: " I feel like I have more than one personality", or "I want to die". Then she would have to TRANSLATE my choices into her meaning.
This has happened to me before. My interpretation of these tests is different from their intent. Personally I prefer, and believe, the way Dr. X interviewed me when I first met him is much better at picking up the truth and the subtleties of my mood and my other mental health difficulties.
The first time we met he asked me questions. I answered them, and he asked me more questions to ensure he fully understood what I was saying. He actively listened to me. The way he "interviewed" me felt more like a conversation. It did not feel rote like so many of these interviews. It felt natural and I felt like he was really listening to me.
Maybe for some people the tests work, but I think for some of us, our true feelings get lost in the different ways we interpret the questions and give our answer, as compared what the questions and answers mean to the psychiatrist/psychologist performing the tests.