Sunday, August 20, 2006

Shiny Happy Hair Scale

I understand that ShrinkRap owes Shiny Happy Person a fair amount of money for the great idea of a hair-related mood scale. Well, here it is. In lieu of royalties I am offering this ready-to-use instrument for all those affective disorder researchers out there.

The hair scale is based in part on the Homeland Security threat levels. The lowest threat level has a blue color code and is represented by Miss Piggy with her luxurious, extravagant looping curls. Miss Piggy is in a great mood, as illustrated by her motto "I Rule!". The neutral threat level is yellow and is represented by a quizzical, placid monkey with gentle wisps of hairy optimism. He is euthymic and accepting: "I'm OK, You're OK". The highest threat level, the red level, is shown by Frizzled Cat. Frizzled Cat has been dunked in a vat of flea dip and and blow-dried to maximum intensity. Frizzled Cat will attack with little or no provocation. Don't even think about stopping to schmooze.

Women everywhere can now warn their husbands and boyfriends what to expect just by slapping one of these on their foreheads. Or wear it to work to warn away those annoying co-workers that it's time to go back to their cublicles.

Then I started thinking...I do this occasionally.

Wouldn't something like this be a great way to assess mood in preverbal children? After all, children learn to recognize faces and identify emotions long before they can put a name to them. Max is pretty good at identifying human emotions and he can't even talk much less write a novel. All we need is a nice range of simple iconic human facial expressions and we're set to do research in children's affective disorders. It would be much easier than the Kiddie-SADS. Then again, it's such a good idea it's probably already been done.

That got me thinking again. Twice in one day...I'm on a roll...

Why stop at preverbal children? If it's good to catch the disease process as early as possible, why not neonatal mood scales? The Shiny Happy Hair Scale has relevance here---I can see the NICU progress notes now: "S: 'Goo goo wah...' O: Patient has full head of wavy curls. A: Incipient mania P: Start lithium". I can see this incorporated into the Apgar score at birth. But again, why stop there? With digital video and facial recognition technology, why not search for in utero pathology on ultrasound? The Shiny Happy Hair Scale applied prenatally.

OK, so now I'm being facetious. This silly post is actually grounded in a serious point: At what point does an attempt at early disease recognition, particularly as it pertains to mental disorders, become impossible to validate? Without gold standard diagnostic technology we become increasingly reliant on external interpretation of subjective internal phenomena without any way of verifying these observations with the subjects themselves.

It's tough enough knowing what Max wants; I'm not even going to guess about that kid on the ultrasound.