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Depression Leverage Points

Depression Leverage Points

| On 17, Nov 2019

Darrell Mann

From Matt Haig’s book, ‘Reasons To Stay Alive’ (Reference 1):

We have a project looking at Post-Traumatic Stress Disorder (PTSD) at the moment. The Director of the National Institute of Mental Health and the Department of Veterans Affairs in the US predicts that 70 percent of soldiers who return from combat in Afghanistan and Iraq, many of whom suffer from depression and PTSD, will not seek treatment in either the military health care system or the V.A. hospitals. Suicide in the Army has reached epidemic proportions. There have been more than 18 mass shootings on military bases since 2008. The combination of these forces on the civilian public mental health system have been described by the director of NIMH as “the gathering of a storm” and are seen by clinicians as approaching catastrophic levels. In concert with this dire prognosis it is entirely appropriate to factor in the extremely long delays at the V.A. hospitals and the epidemic problems they have with inadequate staff. In previous years, the U.S. Army has not given the attention to mental health as it might have warranted. Early approaches included low performance vehicles such as labelling those who sought care as “weak” and negatively stigmatizing cognitive health intervention. Soldiers perceived as “marginally productive” were given a medical discharge or early release. Most commanders simply adopted a hands-off need-help-seek-help approach and the results of which was nearly zero compliance. Today the Army is investing in grossly impersonal online and telephone crisis lines or worse, pre-disposed testing–the result of which could be used to kick soldiers out of the military.

A U.S. Circuit Court of Appeals recently found the Department of Veterans Affairs mental health care system to be unconstitutional because it violated solders’ constitutional rights to health care. V.A. hospitals are woefully understaffed with the adequate number of technicians and clinician staff needed to treat its population. By its own predictions, 70 percent of soldiers returning home for Iraq and Afghanistan theaters will not seek care at V.A. hospitals even though an increasing number of them suffer from PTSD and TBI injuries. Currently there is a present need for 28,000 mental health professionals in V.A. medical facilities; and this goal cannot be realistically attained for at least another 10 years! Over the course of the next ten years the present problems and delays at the V.A. hospitals will be exacerbated exponentially.

The subject is new to us. But it didn’t take long to be shocked by the poor quality of not just treatment options for PTSD sufferers, but also the thinking around the subject. The entire healthcare sector, it could be argued, is still reeling over recent revelations that PTSD and depression are not about ‘imbalances of chemicals in the brain’ that are best treated with chemicals to ‘right’ the balance (Reference 2). Or, at least the chemical-providing pharmaceutical industry is. One of the blinding flashes of the obvious from the Reference 2 world-shaker is that people become depressed when their life circumstances are depressing. Key word: circumstances. Plural. Some circumstances are more important than others, but, when we’re dealing with complex situations – and with depression we surely are – it is not so much the circumstances that are important as the relationships between them.

With that in mind, we thought we’d have a go at turning the two Matt Haig lists into a pair of Perception Maps. Admittedly, it would have been better to actually get the man himself to map the ‘leads to’ relationships, but nevertheless, the answers appear to be insightful in their own right.

Here’s the ‘things that make me feel worse’ map:

Figure 1: Matt Haig ‘Things-That-Make-Me-Worse’ Perception Map

The map contains three vicious cycle loops. This is what they look like:

Figure 2: Matt Haig Three ‘Things-That-Make-Me-Worse’ Vicious Cycles

Assuming these three vicious cycles are representative – again, in the ideal world we get the person making the list to do their own leads-to analysis – they offer up three important clues regarding how to either break out of downward spirals (or avoid them altogether): don’t allow yourself to sit for too long, don’t spend too much time away from loved ones and avoid Facebook.

The Facebook downward-spiral is one that seems to be increasingly common. Mark Zuckerberg wants people to engage with Facebook in order to feel connected, but all you tend to see when you get there is a surfeit of inauthentic ‘liking’ and people that aren’t actually listening to what you’re saying. If you’re famous like Matt Haig, I imagine the level of inauthenticity increases exponentially. You go on Facebook to make you feel better and end up drowning in shallowness.

And then, on the other side of the story, here’s the ‘things that make me better’ perception map:

Figure 3: Matt Haig ‘Things-That-Make-Me-Better’ Perception Map

Quite a different map this time, with lots of items all leading to ‘knowing I have things that work for me’, and two virtuous cycle loops:

Figure 4: Matt Haig ‘Things-That-Make-Me-Better’ Virtuous Cycle

With virtuous loops, the key is finding things that trigger and cause the things in those loops to happen. The loop on the left seems to be all about using writing as a means of absorbing yourself in something (i.e. creating a flow state), while the one on the right is consistent with a story from Reference 2 that I’ve been using a lot recently to describe some of the subtle but profound differences between the East and the West: tell someone from the West to spend a couple of weeks doing whatever they want to make themselves happy, and at the end of the time they will be unhappier than before they started. Conduct the same experiment with someone from the East and they will end up happier. The difference? The Easterner will have spent their two weeks doing things to make other people happy, and the Westerner will have spent the two weeks doing things to make themselves happier.

Whether there’s something general in our version of Matt Haig’s two perception maps is debatable. What seems in far less debate however, is the use of the Perception Mapping process to help individuals turn a list of things that make them feel better and a list of things that make them feel worse into something that lets them see what their personal vicious and virtuous cycles are seems like a really simple way to enable people to help themselves. And, maybe, if they felt comfortable doing it, and people could be encouraged to share their pictures with others, we might get a one-plus-one-is-way-greater-than-two multiplier effect. And learn – if TRIZ tells us anything – that rather than being millions of different vicious and virtuous cycles there are actually only a very small number. Then we might really be on to something.


    1. Haig, M., ‘Reasons To Stay Alive’, Canongate Books Ltd., 2015.
    2. Hari, J., ‘Lost Connections: Uncovering The Real Causes Of Depression And The Unexpected Solutions’, Bloomsbury Circus, 2018.