It would appear that I have identified a problem with your mood tracking app.
As you know (or you might not) three times a day, I am asked a series of questions then asked to rate my mood on a scale of 5 faces: very good, good, moderate, bad, very bad.
One of the questions that I am sometimes asked is, “Have you been thinking about death more often than usual?”
I always answer this question saying ‘no’ because it’s true: I do not think about death any more than I usually do, which is constantly, every day, all of the time.
Then it skips onto the next question. Then I choose my mood: bad or very bad, but sometimes I choose the ‘moderate’ face because it most resembles my own face.
This is the face for bad and very bad :(
This is the face for moderate :|
I don’t tend to wear my mouth in the shape of an ‘n’, my mouth is usually the shape of the moderate face, a thin line, unmoving. This is because I am sick and depressed and disillusioned and numb and smiling is difficult (but still easier than making an ‘n.’) ‘Moderate’ suggests my mood is okay when it is not okay, but the face looks more like mine so I click on it sometimes.
Also, I don’t like looking at the chart and seeing :( :( :( :( :( :( :( :( :( so I like to mix it up a bit with the occasional :|
:( :( :| :( :( :( :| :| :( :( see what I mean?
I’ve gone off on a tangent now. My apologies. (Next time your app asks me “Are you finding it hard to concentrate?” “Do you find that you’re losing focus?” or “Are you up to your daily tasks?” I will say ‘no’, based on this letter, then you will ask me how much this bothers me on a scale of ‘not at all’ to ‘extremely’ and I will tap on whichever word my thumb is hovering over at that precise moment in time because I am depressed and can’t focus and am not up to my tasks.)
The problem is your question about thinking about death. As previously mentioned, I always answer ‘no’ because I don’t think about death anymore than I usually do, because I don’t think I can actually think about death more than I usually do. It is the most. There cannot be more thoughts about death because there’s no more room. So I answer ‘no’ and then the app continues to ask me about my appetite or my sleep.
I wondered what the app would do if I said ‘yes I am thinking about death more than usual’ so one day I pressed ‘yes’ and was then asked some super serious questions about whether I have thoughts of ending my life (‘yes’) and whether I have a plan as to how I’d do it (‘yes’).
Then I was faced with a choice, given to me by the app: to either call a helpline, or text a family member or friend. I did not want to speak to anyone (I am scared of talking on the phone, part of my sickness) so I clicked ‘send text to someone.’ Up came a pre-written message, something along the lines of ‘I’m having a hard time, could really do with talking to someone.’ I realised that I have nobody to send this to, and if I did, I would not use those words. I quickly shut down the app before any form of unwanted SOS could be delivered.
So, the problem: your badly-worded question could cost someone their life, or prevent a life from being saved, if you prefer.
“Have you been thinking about death more often than usual?”
What is usual? What is usual for you? Thinking about death when you read a depressing headline, when one of your friends or family is sick, when you’re at a funeral – is that usual? Would any other thought of death outside of these circumstances be unusual? What about health workers and morticians who are faced with death all the time? “More often than usual.” “What is normal for the spider is chaos for the fly.”
A constant preoccupation with death is usual for me. It would highly unusual for me to not think about death. The day I stop obsessing over death is the day I die (ha!) Your question assumes that the user probably thinks about death very rarely and that suddenly thinking about death is a huge indicator of their mental health. Which may be true in some cases, but everyone is different, particularly those with mental disorders where one’s cognitive functioning has been affected. When I answer (honestly) saying ‘no I haven’t been thinking about death more than usual’ the app assumes that I am not thinking about death at all and deduces from this assumption that I am in no way suicidal.
And, as we all know, assumption is the mother of all fuckups.
Any person like me, mentally ill or chronically suicidal or a perpetual truth-teller or a pedant or a linguist or a writer or a thanatologist or anyone who takes things literally or all the above, who would answer that question honestly may subsequently be denied access to your helpful little emergency chat system based on their answer of ‘no more than usual’ in which ‘usual’ may well mean all of the time.
Please consider changing your question to read: Have you been thinking about death today?
If the user answers ‘no’ then that’s wonderful (I imagine). However, one may answer ‘yes’ because their cat just died or they may answer ‘yes’ because they’re thinking about the latest murder in their city or they may answer ‘yes’ because they’re reading a book in which an excellent character dies or they may answer ‘yes’ because it’s the anniversary of the death of a loved one or they may answer ‘yes’ because they’re walking past a cemetery or they may answer ‘yes’ because they want to end their own life.
I’m sure you can create some sort of system that allows you to provide the correct support based on the context of their answer. The next question, should they answer ‘yes’ to the prior, could enquire as to the nature of their thoughts on death, giving them multiple choice such as ‘death of loved one’ ‘recent experience with death’ ‘death in terms of religion or spirituality’ ‘afterlife’ ‘death from famine, war, poverty, disaster’ ‘mortality in general’ ‘my own death.’
But please don’t use vague indicators like ‘a lot’ or ‘more than usual’ or ‘somewhat more’ or ‘too often’ – the interpretations of these phrases are different for everyone. What is ‘a lot’? I suppose I think about death ‘a lot’ but a funeral director would probably argue with me on that. Perhaps everyone thinks about death as much as I do, except I say my thoughts out loud and let them consume me where others don’t. Who knows? There is no decided spectrum for how much thinking is too much thinking.
Also, the helpline you provide should be readily accessible, as opposed to only being available if the app just so happens to ask you the death question (sometimes it doesn’t ask for days) and if the user happens to answer the questions ‘correctly’ thereby ‘gaining entry’ to the helpline/support page.
I’m suicidal and answered the death question honestly by saying ‘no’ and your weekly report concluded that I am not suffering from depression, I am just ‘stressed’ and ‘tired’ despite my mood tracker graph looking like this: :( :( :( :( :( :| :( :( :| :( :| :| :( :( :( :| :(
Other than weirdly worded questions, you’re doing a smashing job. Thanks for being free to use as well – I would be livid if I had paid for an algorithm to misdiagnose me and then offer me no support.
aka ‘Not Depressed, just Low On Energy’
aka Princess Pedant xoxo
Comment added at a later date:
Since I am new to smartphones and apps and don’t understand how anything works, I have just discovered that the anonymous helpline is in fact accessible to app users at all times, available under the “settings” section. Soz, my bad…