Mathematics, measurement, and number—hardly a clinician exists who does not recoil upon their mentioning. Many clinicians, in the early stages of their education, purposefully found safety away from the hauntings of a rigorous scientific education in the hearth of the humanities.
Thus, when confronted again with the concept of number in the clinic, at least in the form of measurable treatment goals, they are encumbered by nausea or by some visceral and long forgotten allergy.
Of course, this depiction is an exaggeration. Not all mental health professionals are against numbers. Mathematics is not the enemy of the mental health clinician. Instead, just like all other domains of inquiry, it is its extension, its technology and empowerment.
There are two misconceptions that I will be touching upon specifically: that quantification and mathematics overly complicate things and that they are too reductive and fail to capture what is important.
On Complications and Simplifications
A common misconception is that quantitative methods and mathematics unnecessarily complicate things. Such an edifice of symbols, rules and operations can strike the senses of anyone unfamiliar with the subject as mysterious or insurmountable for the understanding.
A few quotations from Alfred North Whitehead’s “An Introduction to Mathematics” (1911) are helpful:
By relieving the brain of all unnecessary work, a good notation sets it free to concentrate on more advanced problems, and in effect increases… mental power… (43).
It is a profoundly erroneous truism, repeated by all copy-books and by eminent people when they are making speeches, that we should cultivate the habit of thinking of what we are doing. The precise opposite is the case. Civilization advances by extending the number of important operations which we can perform without thinking about them. Operations of thought are like cavalry charges in a battle — they are strictly limited in number, they require fresh horses and must only be made at decisive moments (45-46).
Quantification and mathematical operations do not complicate things, they do not increase the amount of mental energy necessary for any solving of problems; in fact, they simplify them. Numbers and math make the indigestible digestible.
In the mental health clinic, we do not yet make use of a number system in any rigorous and consistent fashion. Such a rigorous and generalized application has yet to be justified.
However, there are particular applications in mental health practice that are substantively cogent and deductively valid and could greatly simplify things. An example:
Assume that you have been a client who has been feeling unwell. You suspect that the client might be suffering from a mood disorder. After she discloses that she has been feeling very anxious for a month, and somewhat depressed, you ask for more information. Naturally, you ask her to rate her experiences and discuss changes in the severity of her experience.
“It is worse some mornings,” the client says, “my anxiety. I’d say it is pretty bad, but then it gets better. I would say it is moderate most days, but it gets worse at random times.”
Now, how are you, the provider, to better understand the client’s symptom of anxiety? By standard techniques, the clinician will continue to interview the client in order to access more dimensions of her experience as represented in words and expressions in that particular moment.
You might try to locate other factors associated with the anxiety. Over time, an assumption of ours is that more interviews, explorations and interventions will make pertinent connections clear, thus enabling the therapeutic alliance to develop and the client’s condition to improve.
Unsurprisingly, so much of this time is spent exploring the semantic dimensions of the client’s experience so that we can develop an understanding of her clinical disposition complete enough to warrant a diagnosis and case conceptualization.
Questions about the ordinal properties of their experiences, questions about contingent or possibly non-contingent cofactors, and so forth, in addition to any number of conjectures concerning their interrelationships, are an important starting point of any therapeutic alliance that continues throughout the entire process. It especially seems to dominate in the beginning.
In other words, there are numerous mental operations involved in a continuous assessment and reassessment that nevertheless produce only thematic and vague pieces of datum with questionable accuracy. We are left to ponder and sort out the client’s experience with words only, but with everything so ambiguous, we end up considering and considering and reconsidering, at least in theory.
Now, consider this simple fact: although the client’s experience of anxiety might not be able to be represented in all of its facets by a number system, some of its properties and associations are indeed susceptible to such modeling.
For instance, if a client experience’s anxiety, she does so throughout time. Time is measurable. Thus, the length of time that a symptom is experienced is measurable and the data that such measurements produce can have important meaning.
Moreover, even for the most immovable skeptics who believe with conviction that psychological phenomena are only categorical or qualitative in nature, and thereby are not quantitative, applications of proportions and probability theory enable the application of a quantitative analysis.
Even if I cannot numerically measure the severity of the client’s anxiety in any one moment, I can have her take note of whether or not she felt anxious at random moments and then determine the proportion of affirmative answers.
Regarding associated factors, any of the above forces in the data can then be analyzed, provided certain assumptions are fulfilled, for correlations with other reported phenomena.