The Complicated History of the Visual Analog Scale: Part 2

Gabi Schaffzin // Last month, I introduced the Visual Analog Scale and began to trace its history back through the 20th century. I ended with the suggestion that use of the VAS was made necessary by the ways in which pain trials changed in a post-Beecherian world. Pain researchers adopted the VAS from the world of psychology and psychiatry, where investigators used it to assess subjective states of patients: happiness, depression, etc. Where, however, did the psychologists and psychiatrists pick up this tool?

In a 1923 article in the Journal of Educational Psychology, Dr. Max Freyd wrote that:

Owing to the immense importance of ratings in psychological experimentation, both pure and applied, constructive effort should be directed toward improving the means whereby ratings are obtained. For many types of psychological phenomena ratings are the only practical equivalents of objective measurements, and this applies especially though not exclusively to introspective or verbal report data.

Freyd goes on to sing the praises of something called the Graphic Rating Scale—a 10 cm line without set delineations. In his article, he cites a 1922 piece of the same name and credits the Scott Company of Philadelphia with its creation. Per Donald Paterson, who helped develop the GRS, it was “a new method for securing the judgment of superiors on subordinates.”

More from Paterson:

The person who is making the judgment is freed from direct quantitative terms in making his decision of merit in any quality.… The person who is making the judgment can make as fine a discrimination of merit as he chooses. These two facts eliminate the restrictions on natural judgments which other ratings methods impose.

The Scott Company that Paterson worked with was also known as the Scott Company Engineers and Consultants in Industrial Personnel, with offices in Chicago, Dayton, and Philadelphia. Started by Walter D. Scott, who was eventually president of Northwestern University and also director of the new Bureau of Salesmanship at the Carnegie Institute of Technology, the Scott Company was a personnel and management consultancy.

Why is it important to draw this line from the tool used by your caretaker in the hospital back, through behavioral psychology to Max Freyd and on to Walter Scott, a Taylorist industrial psychologist who studied under Wilhelm Wundt? I want to answer this question not as a medical humanities scholar, but as a design historian. So much of graphic design history is about the flash and pizzaz, the bold lines, the world-altering typefaces, and, especially, the celebrity designers who brought us these things.

But here, the VAS is a designed visual tool that has immense influence on an individual level—that is, what and how many chemicals go in your body after that surgery—and on the population level—i.e., what drugs are even brought to market in the first place. And it was designed by a guy named Beardsly Ruml—a man described on Wikipedia as “a statistician, economist, philanthropist, planner, businessman, and man of affairs in the 1920s, 1930s, and 1940s.”

Am I, then, suggesting that had the Graphic Rating Scale been designed by a hot-shot designer, we might see a different outcome in the way pain science and treatment are understood today? Would design somehow have prevented the current opioid epidemic? 

Of course not. I am, however, arguing that there are no Beardsly Rumls in the graphic design history textbooks I’ve ever read—no Walter D. Scotts as part of the graphic design curricula I’ve learned or taught.

There is a certain banality to the design history of the VAS that obscures extremely critical relationships of power. Let’s go back to Donald Paterson and remember that the VAS is based on a designed “method for securing the judgment of superiors on subordinates.” Is your caretaker the superior here? Who is the subordinate? Is it you? Is it your pain? What sorts of transformations happen in the translation of your pain to a point on a 10 cm line?

Perhaps we should turn to science and technology studies to inform this design history. After all, so much of STS is predicated on a blueprint for interdisciplinarity, texts for taking on questions of historical epistemologies, and frameworks for understanding power at work. Rarely are these considerations a part of graphic design history, but they most certainly should be.

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