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The cure for unhappiness is happiness, I don’t care what anyone says – Elizabeth McCraken

Most folks describe depression as a weight they carry around: dumbbells lodged in their pockets that drag them down body, mind and soul into a stinking swamp.

There’s no humor in this bayou; no levity, no sense of the sweet exuberance life can bring. Instead, there’s a collapsing inward, an inertia in which we can’t imagine . . . well . . . anything good happening to us.

We have a yearning to be free of depression; a deep desire to cut our losses and spit in its eye.  It has cost us enough heartache – no more, we think.  We pine for a way out of it, but sometimes don’t know the way.

But if we are to recover, we need to think about a different kind of life for ourselves.  One where we take the “UP” to happiness escalator instead of the “DOWN” one to depression.

Imagining a Life without Depression

Envisioning freedom is part of the journey out of the dark woods.  So often, depressives imagine a future with uninterrupted bouts of depression.  This sorrow is what leads so many to a state of hopelessness. We need, with the help of wise others, to begin to imagine what our life would look like without depression and walk, step by step, that way. 

I used to say to my therapist when depressed, “Why am I being punished?”  It was as if I had done something “bad” and was a “bad person” (though I didn’t know and couldn’t articulate whatever that was) and now the Karmic Universe was going to dish out the punishment I thought I surely deserved. 

As depression author Dorothy Rowe writes,“Depression is a prison where you are both the suffering prisoner and the cruel jailer.”  Start to see, just a little bit at a time, that depression is not just happening to you.  It’s an inside job too. This took me years to learn. Our thoughts and style of thinking help create and sustain depression.  When we feed it with negative ruminations, it grows larger – like an algae plume. Withhold this noxious nourishment — and it can, slowly, wither away or at least become more manageable. 

Happiness Skills Can Help

Before even imagine the promised land of happiness, however, we may need medication to lift the more onerous physical symptoms of depression to give us enough focus and energy. No doubt, antidepressants aren’t the only way to do this.  Many have accomplished the same results with exercise, nutrition and/or psychotherapy.

In her book, The How of Happiness, Sonja Lyubomirsky, Ph.D., writes:

“Even the most the most severely depressed individuals can improve by doing a simple daily happiness-increasing exercise such as taking time to recall three things that went well each day.  Although the exercises are not designed to ‘cure’ depression, if you are depressed, trying one or more of these activities affords a strong chance of lightening the burden and darkness of depression and producing positive feelings.”

We can also look back further than just what went right on a particular day to increase our sense of happiness.  There is a powerful connection between how we view our past and present day happiness says Rick Nubert, Ph.D. In a study of 750 people, he found that highly extraverted people are happier with their lives because they tend to hold a positive, nostalgic view of the past and are less likely to have negative thoughts and regrets than their neurotic counterparts.  Howell says that while it may be difficult to change one’s personality to being an extrovert, he found that savoring happy memories or reframing past painful experiences in a positive light could be effective ways for people to increase their life satisfaction.

Other ideas offered up by Dr. Lyubomirsky include avoiding overthinking – a big problem for lawyers: “Very happy people have the capacity – even during trying times – to absorb themselves in an engaging activity, stay busy, and have fun.  To practice this strategy, pick a distracting, attention-grabbing activity that has compelled you in the past and do it when you notice yourself dwelling [on the bad stuff and your problems]”.  Check out her other ideas in her blog.

You deserve to be happy.  You don’t have to keep riding the down escalator.  While going up to the second floor, just wink and wave at your depression as it goes down into the bargain basement.

 

Stressed and Depressed Guys in Blue Suits

Beneath the body armor of their pin-striped suits, male lawyers carry a terrible burden. Corrosive levels of stress bombard them and they’re expected to pony up and take it by fellow lawyers and judges — and themselves. There is a serious disconnect between the conversations going on inside their heads about how they really feel about their inner turmoil and the ways they present themselves to their busy world as competent, confident and glacial under pressure.

Studies show that lawyers suffer from elevated rates of stress and depression —  more than double the rates found in the general population. There are some physiological and psychological clues as to why this is so for men in the legal profession.

A new study finds that stressed men have diminished activity in brain regions responsible for understanding other’s feelings.  The study concludes that under stress, men tend to withdraw socially while women seek emotional support.  Recently, I was preparing for a trial scheduled to go on a Monday.   I had worked hard the whole weekend and was cranky and exhausted.  Sunday afternoon, my wife asked if I felt okay and whether I was stressed.  I shrugged off her question and said that I really didn’t want to talk about it. 

Yet in times when my wife is stressed, she turns to me for support and encouragement – and she’s a lawyer too.  As a man in the legal profession, I expect myself to just bear it and soldier on through the mud of litigation.  If you can’t take it, you can’t cut it goes the mindset in the legal culture.  As if there were no middle ground, no way to express this sense of free-floating anxiety.  As if it was all that simple.

There was an interesting article in yesterday’s ABA Journal, “Lawyers under Stress are Critical, Cautious and Distant, Personality Test Shows.” The tests, administered to 1800 lawyers at big firms, were conducted in collaboration with Hogan Assessment Systems, found that, on average, the lawyers:

• Generally do not seem to have a strong need for public recognition, although there is a subset of lawyers who seem to crave recognition and notoriety.

• Tend to deal with others in a direct and matter-of-fact way, but may come across as cold, critical and argumentative.

• Tend to be self-critical and temperamental but are also self-aware, open to feedback, and emotionally expressive.

• Are most attracted to environments that emphasize quality and are less commercially focused than professionals in other industries.

• Tend to value education and educational activities.

While these stress-related problems don’t necessarily cause male depression, they are additional risk factors for those are predisposed to it.

Terrence Real, author of the book “I Don’t Want to Talk about It,” makes an important point about how men deal with their melancholy: for every male who discloses his depression and gets treatment, there are four others who are able to hide it and won’t get help. He writes:

“Covert male depression has three main domains: self-medication, isolation and lashing out. Self-medication may be drinking, drugging, womanizing and even watching excessive amounts of television. Some forms of self-medication are tolerated by our culture so it is hard to get across that what these men are doing is stabilizing depression.

A covertly depressed man will isolate himself and withdraw from intimacy with his partner, his kids, his friends. He can’t afford to be intimate with others because he is desperately trying not to be intimate with himself.

Lashing out can mean violence and domestic abuse. Untreated depression may be an integral part of many male batterers.”

Men drive their pain deeper into the well of their being to avoid dealing with it, to avoid facing the fact that they feel overburdened and, perhaps, afraid.  Alone at the bottom, there is darkness with no ladder out.  Many of them will need an escape rope dropped into them by other caring people, if they are lucky to have such people in their lives.  They feel odd and alone; like they are the only man alive with this problem.

In fact, depression is a secret pain at the core of many men’s lives, and one that goes largely undiagnosed and untreated. Watch the trailer of the recent documentary “Men Get Depression” which aired on PBS:

What Men Can Do About Stress

Check out this stress blog by therapist, Elizabeth Scott.

We all know exercise is important to controlling our stress levels. The problem isn’t that we don’t know that. The problem is that we don’t do it.  Hook up with a trainer at your local gym.  It’s is a relatively cheap way to motivate you to exercise. It also makes you accountable to someone and it’s painful to the pocketbook if you blow it off – must trainers charge you for no-shows! Here’s a great blog about managing stress with exercise and a good diet from a personal trainer.  Also check out the book Spark: The Revolutionary New Science of Exercise and the Brain which has three great sections about stress, anxiety and depression and what happens to the human body when we work out. I do use a trainer and it has had a dramatic impact on stress loads I carry.

For a quick fix, check this web article “Eight Immediate Stress-Busters.”

Read an article I wrote for lawyers in December, 2008 edition of Trial Magazine, “The Connection between Stress, Anxiety and Depression.” It is a companion to Dr. Andrew Benjamn’s wise advice, “Reclaim Your Life, Reclaim Your Practice.”

What Men Can Do About Depression

Read Terrence Real’s book because it’s important for all of us to learn about depression from a male perspective.  Also check out the website Mid-Life Men which offers stories from guys about their depression experiences.

Have your wife read Is He Depressed or What? Many women ask themselves this question every day wondering whether their husband or boyfriend’s short temper, tendency to withdraw, and mysterious physical complaints might be indications of some deeper psychological issue. The book offers an overview of the ways men typically express signs of depression. It provides strategies they can use for improving communication, dealing with relationship complications, and coping with men’s physical symptoms related to depression, such as insomnia and sexual dysfunction.

Above all, the book helps your spouse avoid becoming lost in your depression. By paying attention to their own needs, they can best preserve their well-being and peace of mind—and so are able to offer the most support to you.  I often suggest that men buy this book for their wives rather than ask their wives to go out and buy it.  This demonstrates that you are in this together, that you care about her feelings and that you want her to understand.

Get help.  Therapy is not scary and you don’t have to go it alone. Therapy will help you to feel better by having someone to talk with.  Check out this article where a therapist answers seven questions about how therapy works and what to expect. It is something productive you can do about your stress, anxiety and depression and it can help you to develop some better coping skills.  If you are concerned about being seen, many therapists have early morning or late evening hours. You also tell them that you have a concern about being seen by fellow attorneys or judges and request that he or she not schedule you at a time when that therapist may be treating someone you don’t want to see.

Men, you can’t handle exorbitant levels of stress and depression on your own.  It’s not shameful to get help.

Springing Out of Depression

 

Spring has returned. The Earth is like a child that knows poems. – Rainer Maria Rilke.

Spring is a time of renewal. If we follow nature’s lead, it’s a time for rebirth.  During the long nights of winter, depression can have a vise-like grip around our throats.  The increasing sunlight and warmth seem to make this black dog recede back into the shadows.

Spring cleaning is a perennial happening in this country; people tossing out and cleaning up in every zip code imaginable.  This feels good because it gets our bodies moving, we feel productive and somehow lighter.  Depressives have a lot of dross in their drawers; layers of junk strewn haphazardly throughout the pockets of their days.

Today, I’m cleaning out that most sacrosanct of male domains – my garage.  Laugh you may, but I really enjoy it.  I love the productivity of it all, the manual labor that gets things done without relying on my ability to think and analyze problems.  It seems to bring my life back into some sort of momentary harmony; a clarity where there used to be only the mildew of depression. 

It puts me back in contact with nature, with the fresh air that blows and the ground where life is murmuring and waiting to come forth.  Novelist Margaret Atwood writes, “In Spring, at the end of the day, you should smell like dirt.”   I don’t know about you, but that’s my plan for the day.

Yes, Spring is a time of change; a transition from the hibernation of winter.  It’s a good time to go back to the drawing boards of our lives and look at what is and isn’t working for us; what is and is not contributing to our depression.  If something works, keep it; if not, chuck it. 

Springtime is a great time not only to clean out garages, but also our minds that get gooey with too much depressive thinking.  Too often, depressives are immobilized by . . . well, depression.  Because they think that they can’t get anything done, they . . . get nothing done.  That sort of thinking needs to be tossed to the curb along with the rest of the trash.

Depression seems to add 50 pounds of psychic weight to our bodies.  We drag ourselves around the block like a broken wagon, never feeling that we have enough energy to do anything.  Yet, it is profoundly true, that energy begets energy in this corner of the Universe; hence, my assault on the garage.  

Depression is hard-headed and stupid. For some reason, this thought pops into my head as I watch my dog Sherman chewing on an old toy, slobber running down his brownish coat.  

Depression can make you feel like that best thing for you to do is sit on the couch and watch Brady Bunch reruns while sucking down a Coke.  But what’s really needed to make you feel better is movement.

That’s why I’ll be hanging out in my garage today.  It’s such a simple thing to do.  No game changer in the grand scheme of things.  Just an ordinary thing, in an ordinary life, that makes me feel great.

                                       

Newsweek Gets It Wrong: The Debate About Antidepressants

I yearned to get better; I told myself I was getting better.  In fact, the depression was still there, like a powerful undertow.  Sometimes it grabbed me, yanked me under; other times, I swam free. – Author, Tracy Thompson.

One study estimates that 19% – – or about 200,000 of this country’s 1 million lawyers – – suffer from depression.  This isn’t just some statistic; this is about people – folks who happen to be lawyers for one reason or another.

Just what are these people supposed to do about their depression?  Many if not most law students, lawyers and judges that I know have taken or are currently taking antidepressant medications. And they seem to be in the majority of people in this country who do so.

The ranks of the medicated are swelling.  The number of Americans taking antidepressants doubled in a decade, from 13.3 million in 1996 to 27 million in 2005. One in ten Americans are prescribed these drugs making them the most prescribed medications in the country.  By comparison, 18 million people take Lipitor for high cholesterol. 

The biggest reason lawyers take these drugs?  Like everyone else, they’re hoping want to feel better, but equally if not more importantly, attorneys want to return to their pre-depression levels of productivity at work.  A profession that doesn’t suffer fools well and demands a lot out of mere mortals.

But is medication effective in treating depression and achieving this objective?

Late last week, I was walking down an icy sidewalk minding my own business.  I could see the usual cast of characters in my peripheral field of vision; clusters of lawyers yucking it up on their way back from lunch, a judge lost in his own thoughts and a corporate lawyer I know (not particularly well) who once told me privately that he takes antidepressants, his lawyer wife  did as well and  five other lawyers in his firm did.  I guess he felt comfortable telling me this because of my public disclosure about my own struggles.  I often feel like a priest in a confessional; I hear about lawyers most private of struggles.  Then, like such disclosures never happened, the curtain is opened and we each walk our own ways.

Walking by a newsstand late last week, I noticed the current cover story of Newsweek Magazine which read, “Antidepressants Don’t Work:  The Debate Over the Nation’s Most Popular Pills”.  The large print seemed to stick a proverbial finger in modern psychiatry’s eyeball and toss the question –along with people who suffer with depression- up in the air. 

The article focused on a recent study which concluded antidepressants essentially worked no better than placebos (sugar pills).  Oh, just great, I thought. What am I, who have taken medication for the past eight years, supposed to do now?  Start popping M & M’s instead of Cymbalta?

The writer of the Newsweek piece concluded

“If placebos can make people feel better, then depression can be treated without drugs that come with serious side effects, not to mentions costs.”

This conclusion is the latest in a long line of recent books leading the charge against the use of medication to treat depression. Charles Barber, in his book Comfortably Numb: How Psychiatry is Medicating a Nation, argues that antidepressants are doled out like Halloween candy in this society.  The motive: the big money made by the pharmaceutical industry.  This is an appealing take because Big Pharma is commonly portrayed as the villains in the popular press; guys in black hats and white lab coats stuffing greenbacks into their pockets.

In an article written for Salon, Barber wrote:

“One has to wonder:  Are we really that miserable?  Manipulated might be a better word for the miserable.  If we were to pick one factor that explains the dramatically increased number of antidepressants that now runs through our collective bloodstreams, it would be direct-to-consumer advertising, otherwise known as television commercials for drugs.” This point is well taken, but not surprising.  Pharmaceutical companies are in the business of making money.  Does such a motive make Lipitor any less effective?  Should commercials about it deter us from taking this drug?  I don’t so.

In fairness to Newsweek, they ran an accompanying piece which tried to give the other side of the coin.  It was penned by psychiatrist, Robert Klitzman who framed the question about the study’s conclusions in this way:

“What should we make of the [study]?  First, some facts: antidepressants have been shown to work for serious major depression.  Most evidence shows they are effective for dysthymia: milder but chronic depression that continues for two years or longer.  The question is whether they work for milder depression that may be shorter or less intense.  That’s important, since major depression affects almost one out of five people [in this country] at some point in their lives.  And most people with depression do not have severe forms of it.”

The response to Newsweek’s take on the study was sharp and quick.  In an Op-Ed in the New York Times, Judith Warner wrote this biting retort:

“Happy pills don’t work, the story quickly became, even though, boiled down to that headline, it was neither startling nor particularly true. Yet in all the excitement about ‘startling’ news and ‘sugar pills,’ a more nuanced and truer story about mental health care in America was all but lost.  The story begins to take shape when you consider what the new study actually said:  Antidepressants do work for very severely depressed people, as well as for those whose mild depression is chronic (dsythymia). However, the researchers found, the pills don’t work for people who aren’t really depressed – people with short-term, minor depression whose problems tend to get better on their own.  For many of them, it’s often been observed, merely participating in a drug trial (with its accompanying conversation, education, and emphasis on self-care) can be anti-depressant enough.”

As the article also points out, most people receiving antidepressants aren’t getting them from well-trained psychiatrists, but family doctors who don’t screen well for depression. One wonders how much training they get on  how to probably diagnose depression and whether they can keep up on all the research on the topic.  The result: we are, in some sense, an overmedicated nation; a country too quick to give sad or unhappy people pills that they shouldn’t be taking and don’t need. 

That conclusion, however, does not mean that these medications don’t work for many (though not all) people suffering from true clinical depression.  My take is that a family doctor who treats urinary tract infections and constipation shouldn’t be doling out Lexapro to a patient that he has spent 5 minutes with. Perhaps the problem isn’t just pharmaceutical companys bent on making a quick buck, but family doctors under managed care who don’t have any time to spend with patients and don’t know much about depression and the various medications used to treat it.

People feel ashamed and stigmatized by going to psychiatrists, but it could be a game-changer for many:  either you don’t have depression and shouldn’t be on medication or you do and you could finally get relief from some of depression’s more devastating symptoms.

There is no doubt that exercise, psychotherapy and some form of community and support will help people whether they are suffering from some transitory upset/sadness in their life (by the way, this helps people with depression too). However, for many people afflicted with clinical depression, it’s unlikely that they will have a real shot at containing or overcoming their depression without short-term or long-term use of medication. They won’t be able to muster the energy, commitment and motivation to engage in the other healthy stuff; to go for a walk, to work out their distorted and negative self-beliefs about themselves with a good therapist or join a support group.

Depression has a terrible undertow; its riptides are often unforgiving.  We need as many weapons in our arsenal to deal with it. People with transitory sadness or disappointments don’t need to become patients; they need to connect with other people or change their lives – maybe both.  Therapy or just working it out by themselves with supportive friends and family may be all they need.

Law and the Human Condition

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Many people who went to law school didn’t have a burning passion to be a lawyer.  They did so because they didn’t know what else to do with their undergraduate degrees.  Some went on to find and embrace their calling as lawyers, some did not.  Some have left the profession.  Most have not. 

Those who haven’t left, but think of doing so – sometimes daily – are legion.  Forbes Magazine reported that a full 38 percent of attorneys say they somewhat regret their career choice.  Additionally, Harvard Law School counselors estimate that 20% to 30% of active attorneys are considering another career. 

I recently bumped into the Valedictorian of my law school class.  She told me she had chucked her law career awhile ago, went back to school and was now an elementary school teacher.  She had gone from power suit blues to L.L. Bean greens.  When I told other lawyer pals about this, they weren’t shocked – they envied her. 

Recently, I had lunch with a contract lawyer at the Oyster Bar in New York City.  He had come from a long line of lawyers and judges in his family who encouraged him to go to law school.  After graduating from Harvard Law School, he worked seven years at a large Manhattan firm.  As we slurped our Clam Chowder, he told me that he didn’t know one person that was happy being a lawyer.   That if they could get out, they would.  Now it may be that misery loves company, but let’s be honest:  there are a lot of unhappy folks out there.  Lawyers walk the halls of justice and corridors of power – or maybe just look out of a Starbucks window – and wonder why they just can’t turn things around and just feel happy.

I don’t think job dissatisfaction is unique to lawyers; it’s the daily fare for most Americans. A recent MSNBC article read:  “Americans hate their jobs more than ever in the past 20 years with fewer than half saying they are satisfied.”  People, deep down, feel broken and vulnerable, but just have to keep going in order to survive in this tough economic climate.

My friend and psychologist, Richard O’Connor, in his book, Undoing Perpetual Stress, captures the daily plight of the average American struggling to make to make it:

“Here is where I leave trying to explain physiology [how stress and depression affect the brain] and turn to something I know about – life as it’s lived in the USA.  I get to hear all about it from my patients, a wonderful cross-section – aging Yankees, rising Yuppies, farm and factory workers, teens and seniors.  Most people are living with, I think, a fear of fear.  There is a sense that something is fundamentally wrong with the way we are living our lives, but a reluctance to look closely at that.  We know deeply that we’re in serious trouble, but we live our daily lives as if everything is fine, whistling past the graveyard.  We try to purchase inner peace, knowing perfectly well that’s impossible, but not seeing an alternative.  Or we tell ourselves that someone will figure out what’s wrong someday, and until then we’ll just have to wait.  Or we’ll simply live our lives later.  Or we may believe for a while in the latest fad – a political leader, a spiritual leader, a self-help guru.  We try to follow what the fad tells us, but it usually doesn’t do much for our troubles, so we give up and try to forget again.”

I give a lot of speeches across the country to groups of lawyers about stress, anxiety and depression.  It’s always interesting how many contact me later and say that while they aren’t depressed per se, life isn’t going very well.  There have been plenty of times I’ve considered – or it’s been suggested to me – that I consider changing the name of my website from http://www.lawyerswithdepression.com/ to something like www.lawyersdealingwithalotofshit.com.  No, it’s not a real website so don’t click on it.  The point is that lawyers are stuck not only dealing with the high decibel life as a lawyer, but also the everyday crap that all Americans must try to handle everyday.

Dr. O’Connor helps us to understand the breadth of the problem for the average American:

“Then there are those without a diagnosis:  I can’t estimate the number who feel their lives are out of control because they can’t lose weight, they can’t stop procrastinating, they can’t get out of debt, they can’t speak up for themselves – “soft addictions,” bad habits that make them feel miserable and ashamed.  They are still others who are like the living dead – numb to their own existence, busy working, buying, doing – feeling vaguely empty but compelled to continue, too busy even to sit and look at their lives.  Their depression has grown on them so insidiously that it feels normal; they believe life stinks, and there’s nothing they can do about it.  And finally there are the rest of us, who still have to find confidence, connection, love, who have to raise children without guidance in a crazy world, often watch our parents lose their minds if they live long enough, and wonder about the meaning and importance of our lives.  Even those of us supposedly without emotional problems, there is still the nagging fear that we’re faking it, just making it up as we go along, and praying we don’t stumble.”

This quote isn’t meant to bum anyone out – okay maybe it’s a tad bit melancholic.  However, I would argue, not morose.  I think it’s a true picture of the dilemma that most people deal with everyday as they cross at the traffic light pounding out on their Blackberry’s, yell into the old cell phone above the din of traffic noise or wonder ten times a day where they’re going to find the energy to deal with it all.

What makes lawyers different from the average Joe (and Jane)? 

I would argue that there are a couple of things.  First, the adversarial nature of the profession:  unless you are into slugging it out everyday (unfortunately, I’ve had opponents who thrive on this), the law will wear you down physically and emotionally.  Second, it is a career that is made up – maybe to a degree that few others are – of the mentality that you’re either a “winner” or a “loser.”  Third, much of the public has a murmuring resentment or outright disdain for lawyers.

What to do about all of this?  On this score let it be clear that I am not speaking to you from the mountain top, but from the valley.  I struggle with these problems – and the potential antidotes – every day.  But, I will give it a whirl.

First, recognize that many people are in the same boat as you.  If you recognize that you are not alone in feeling the way you do, it can ease your burden.  Some of this stuff is just the human predicament.  Most people have a difficult time navigating through life.  Chalk it up as a part of the deal we all signed on for when we were born into this troubled world.

Second, change your thinking.  I call this the “stressed-out-lawyer” myth.  This doesn’t contradict what I’ve said earlier; the point is that lawyers compound their pain by telling themselves — at virtually every moment of the day —  how out of control they are.  These thoughts, which a mental commentary on reality, – just plain out don’t help.  We need to be more constructive in our thoughts.  You’ll have to make the effort on this one.

Third – and I will never tire of tooting this horn – exercise.  We can’t ever forget that we are essentially animals with high powered brains.  The law jacks up our bodies with all sorts of high voltage situations we must confront.  We must find a way to discharge this energy or it will wear our batteries out.  Your poor body is literally screaming out to you to get rid of the stress before it eats away at your health.  As the Nike commercials say, “Just Do It!”

10 Ways to Deal with Depression

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A lawyer with depression used to call me once a month.  He would tell me about the emotional problems in his life.  Many times, he cried.  This went on for a year.  I listened each time for about a hour and then the conversation would routinely end with, “catch you later.”  Yet, nothing changed for him.  At some point I said, “Bob, what are you willing to do to change your life?”  He seemed surprised by the question.  He never called back.  Perhaps a good starting place for you to think about healing, is what old behaviors are you willing to change or what new behaviors are you willing to try to help you get better?

In her book, Listening to Depression:  How Understanding Your Pain Can Heal Your Life , psychologist, Lara Honos-Webb, views depression not just as an “illness”, but as a wakeup call; a signal that we have been traveling down paths in our lives that have been unhealthy.  She encourages us not to see depression as just a disease, but as an opportunity to change our lives.  There is something in us, if we would only listen, that is telling us that we are killing ourselves. 

We often don’t listen.  So that voice turns up the volume until we get sick with anxiety and depression – or heart disease, hypertension and cancer. 

As lawyers, we are experts at looking at problems from an analytical angle.  When we turn that powerful lens on ourselves, seeking to “solve” our depression, it just doesn’t work.  That’s because much of our distorted thoughts and strategies that got us into trouble with depression, can’t get us out. 

After we have been diagnosed with depression, we can evade responsibility for our own recovery.   Some time ago, I was in a great deal of pain.  I told my therapist that my depression wasn’t going away despite my sincere efforts.   I felt punished by my depression.   He gently told me, “Dan, you haven’t done anything wrong.  You’re doing it to yourself.” 

This was a turning point for me in dealing with my depression.  When I stopped letting depression victimize me, I began to take responsibility for getting better and started behaving and thinking in more constructive ways.  That being said, what constructive steps can lawyers take to deal with their depression? 

1.   Get help

You can’t handle this by yourself.  It’s not your fault.  It is a problem bigger than any individual person.  There are Lawyer Assistance Programs in most states that can get you started in the right direction, provide resources and help you with referrals.  Click here to search by state for a program nearest you.  While this advice sounds self-evident, believe me, it is not.  Recent statistics reveal that eighty percent of Americans don’t get any help for their depression.

2.   Maybe you have to take medication

That’s okay.  You may have a chemical imbalance which you need to address.  For many, psychotherapy won’t help until they quiet down there somatic complaints (e.g. extreme fatigue, sleep problems) so that they can have the energy and insight to work on their problems. However, “one size doesn’t fit all.”  Medication can – and is – over proscribed.  I also have a problem with family physician diagnosing depression and recommending antidepressants.  Eighty percent of the scripts for antidepressants in this country are written by such doctors.  Better idea:  go to be evaluated by a well-regarded psychiatrist who specializes in mental health and doesn’t also treat stomach upset, fungus on the feet and the flu.  For a fair and balanced review of the pros and cons of medication, check out HELPGUIDE.org, a not-for-profit organization.

3.   Negative Thinking

Whether you will need medication or not, you will need to confront your negative thinking with a therapist.  You really can’t do this effectively with friends or family alone.  A lot of research suggests that cognitive behavioral therapy is a particularly effective form of treatment for depression.  It teaches us that a large part of depression is made up of cognitive distortions.  One example is the all-or-nothing thinking approach.  Lawyers often think to themselves that they’re either “winners” or “losers” in the law. This is a distortion because the reality is that most lawyers both win and lose in their careers. Check out this excellent website article for a list of other cognitive distortions.  I recommend interviewing a couple of therapists before you settle on one.

4.   Exercise

The value of exercise is widely known:  It’s is simply good for everybody.  For a person with depression, it becomes not just about a healthy habit, but a critical choice.  In his book, Spark: The Revolutionary New Science of Exercise and the Brain, Harvard psychiatrist, Dr. John Ratey devotes a whole chapter to the importance of exercise in treating depression.  Please check this book out.  Also check out this short article from the Mayo Clinic about how exercise can help with the symptoms of anxiety and depression.

5.   Spirituality

If you have a spiritual practice, do it.  If you don’t, think about starting one. This could include anything from a formal meditation practice, going to Mass or just taking a walk in the woods.  A lot of research suggests that people who do have a spiritual practice do better with depression.  If you believe in God or a higher power, you can avail yourself of help and support from Someone who is bigger than your depression.  If you do not believe in God, maybe you believe in some other form of spirituality you can tap into.  Spiritual growth and development, in my opinion, is an important pillar of recovery.

6.   Join a support group 

I started a lawyer support group in my community and it has been going strong for two years.  Such groups can be invaluable in helping you to see that you are not alone and that others share in the very same struggle.  Contact a Lawyers Assistance Program in your state.  If you don’t feel comfortable being in a support group made up of lawyers, there are plenty of other routes to go.  Check out the website run by The Depression and Bipolar Support Alliance.  They run depression support groups meetings in all fifty states.

7.   Get educated

Read some good books on the topic of depression.  As part of your education, learn about the powerful connection between stress, anxiety and depression.  I recommend you read Dr. Richard O’Connor’s, Undoing Perpetual Stress:  The Missing Connection between Depression, Anxiety and 21st Century Illness.  Dr. O’Connor opines that depression is really about stress that has gone on too long.  The constant hammering away of stress hormones on the brain changes its neurochemistry.    This can and often does result in anxiety disorders and clinical depression.  I list a number of other great books on my website at Lawyers With Depression.  The site also offers guest articles, news, podcasts and helpful links for lawyers.

8.   Build pleasure into your schedule 

As busy lawyers, we have the “I will get to it later” mentality – especially when it comes to things that are healthy for us.   We have to jettison that approach.  We must begin to take time – NOW – to enjoy pleasurable things.  A hallmark of depression is the failure to feel happiness or joy.  We need to create the space where we experience and savor such feelings. 

 9.   Restructure your law practice

Nobody likes changes.  Lord knows, I don’t.  Yet this pointer falls into the category of “what are you willing to do?”  Maybe you will have to leave your job.  Is this stressful?  Yes.  Is it the end of the world?  No.  Maybe you will have to change careers.  I have spoken to many lawyers who haven’t been particularly happy with being a lawyer since day one.  But they kept doing it because they didn’t know what else to do, the legal profession paid a good buck, they didn’t want to seem like a failure, they were in debt, etc.  I am not trying to minimize these very real concerns.  However, your good health (as I learned the hard way) has got to reestablish itself as a top priority in your life.  I changed the nature and variety of my practice and am the better for it.  I do less litigation.  As a consequence, I have less stress which has been long known to be a powerful trigger for depression.  It can be done.

10.   Practice mindfulness in your daily life

A lot of attention has been focused on the use of mindfulness lately as a way to help depression.  In mindfulness meditation, we sit quietly, pay attention to our breath and watch our thoughts float by in a stream of our consciousness.   We habitually react to our thoughts (e.g. “I will never get this brief done”).  In mindfulness meditation, we learn – slowly – to let the thoughts and feelings float by without reacting to them.  If such an approach to depression seems far-fetched, read the compelling book, The Mindful Way through Depression: Freeing Yourself from Chronic Unhappiness, for an excellent primer on how you can incorporate mindfulness into your day. Check out this article written for my website by one of the book’s authors.

In closing, I often tell lawyers to remember to be kind to themselves.  When I say this they usually look puzzled – like many a judge who has listened to my oral arguments. They’ve rarely, if ever, thought about it and don’t know how to be kind to themselves.  I believe that it first begins with a conscious intention – “I am not going to treat myself poorly anymore.”  Such a simple refrain can help us. 

Depression is often built upon poor mental/emotional and physical habits.  Our inner pain can bring us to the point where we have had enough.  It begins to dawn on us that we are worthy of love from ourselves and others and that part of such love involves taking care of ourselves.  I hope these suggestions help you on your path.

 

When Is My Depression Going to End?

I find writing about depression for lawyers a delicate balancing act.  On one hand, I don’t want to pull any punches about just how awful depression is or how adversely it can affect your life and career.  On the other hand, I want to offer hope and encouragement to those who are in the trenches and deal with it every day.  I will try to do both today.

I have been encouraged by some to write only “positive” articles about dealing with depression. But I just can’t do that. To not deal with the more troubling aspects of depression seems to me a form of denial.  The other day, I was at my local bookstore checking out the Self-Help section for any new titles on depression.  Some of the titles seemed like they were being pitched by used car salesmen:  “Overcome Your Depression in 30 Days!”  This doesn’t help the conversation about depression because it sets up ludicrous expectations in the minds of those who suffer from it and their loved ones about the speed of recovery.  For many with depression, they’re in it for the long haul.

One of the hardest parts about dealing with depression on a daily basis is its seemingly unpredictable nature:  When is it going to start again and how long will it last?

Elizabeth Wurtzel, author of the best-selling book, Prozac Nation, gets it right when she wrote:

“That’s the thing about depression.  A human being can survive almost anything, as long as she sees the end in sight.  But depression is so insidious, and it compounds daily, that it’s impossible to ever see the end.  The fog is like a cage without a key”.

Many, many lawyers go into a mode of survival waiting for a depression to end.  To me, the degree to which such a depression can create catastrophe in our lives as lawyers seems driven by the episode’s severity:  is it a tropical depression or a full blown hurricane?

If it a low to medium grade depression, tools like Cognitive Behavioral Therapy (“CBT”) are very helpful.  With CBT, we work in therapy to replace destructive, depressing, negative self-talk with positive, healthy and realistic self-talk.  The efficacy of this approach has been studied and documented using PET scans of the human brain.  Such scans show that an area in the frontal cortex (the thinking part of our brain) is hyperactive in depressives before CBT and then calmed down after successful CBT treatment.  This same area of the brain is activated when people do self-referencing [relating external events, particularly negative ones, to the self] and depressives do too much of this.  They spin around in a cycle of negative thoughts and try to use the cerebral cortex to snap out of their depression.  With CBT, they learn to decrease their self-reference to the things that are negative.  It’s a form of rehabilitation of the cortex where depressives learn to turn the volume down.

This is a critical skill for lawyers to develop.  According to psychologist, Martin Seligman, author of the best-selling book, “Authentic Happiness,”  lawyers are pessimists.  They develop thinking habits which see problems as permanent and intractable.  They also feel an overdeveloped sense of ownership or responsibility for such problems.  Optimists, on the contrary, see problems as temporary, solveable and not necessarily their “fault”.  The important point here is that optimism is a skill that can be developed and practiced. Read Seligman’s chapter, “Why Are Lawyers So Unhappy?”

If it is a deeper depressive episode, more like a trough of despair, CBT won’t work very well.  During such an episode, there is the sense that it’s never going to end.  Yet, this is the distorted voice of depression talking because for the majority of people with depression, IT DOES END.  The trick is to learn how best to weather the storm.

I find that when I am in a deeper depression, I need to go outside my mind and get into my body.  Consistently, the things that helped me the most were the following:

1.   It’s virtually impossible to feel depressed while exercising and even for a good period of time thereafter.  The problem, as most of us know, is getting to the gym or the park.  Behavioral prompts can help.  Always have your gym gear in your car.  Also, be realistic.  Remember that it takes at least 21 days to form a habit.  So, those first 21 days won’t be the easiest ones.  Tell your family and friends about the importance of exercise to you and have them support and remind you about this on a daily basis.

2.   Cut off any unnecessary negative input in your life during these times.  Don’t listen to any sad music, watch violent T.V. shows or read somber books.  This isn’t a forever type of deal.  Think of it more as a “timeout”.  Some people stop reading the newspaper during an episode as well.  Also, the time you’re not doing these activities gives you the time that you’ll need to exercise.

3.   See a massage therapist.  Touch has a powerful effect on the human body and is known to cause the release of endorphins (the feel-good chemicals).  It doesn’t involve any thinking on your part.  For busy lawyers, it’s a time to relax and receive something positive for the day.

Remember to be kind to yourself today.

 

 

 

 

 

 

 

 

 

 

 

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A Lawyer’s Heart

I’ve felt plenty of anger over my twenty years as a litigator.  Sometimes, and thank God they were few and far between, I would blow up at opposing counsel or a client.  More often, my anger would sometimes simmer just below the surface.  This is an all too common reality for today’s lawyer.  “By definition, the adversarial system is conflict-ridden, and conflict creates certain types of emotions like anger, guilt and fear, which causes stress, says Amiram Elwork, Ph.D. author of the book, Stress Management for Lawyers

According to Chicago litigator, Shawn Wood, the “nature of civil litigation involves two lawyers (often Type A personalities) squaring off against one another under circumstances where there will be a winner and a loser, and part of each lawyers job will be to capitalize on any possible error in judgment that the other side makes.”  I really don’t buy into this completely.  Many lawyers that I know aren’t “Type A” personalities.  They are usually hard working and successful.  But, it can take a tremendous toll on their mental and physical health.  They struggle with the simmering variety of anger.

Anger turned outward is hostility.  Such hostility can express itself in a number of ways for lawyers.  Andy Benjamin, Ph.D., both a lawyer and psychologist who treats lawyers with stress, anxiety and depression, describes hostility as an “array” of the following thoughts and behaviors: 

  • Holding persistent negative, hostile, or cynical thoughts during relationship interactions;
  • Chronic impatience;
  • Frequent irritability
  • Disconnecting from others due to an empathetic deficit (for example, being rigid in relationship interactions);
  • Suffering continual fatigue.

You could say most people have these problems in our hectic, stressful world.  “But lawyers are particularly susceptible to stress-related illnesses because of the unique interplay of the legal profession and lawyer personality” says the ABA Journal.  A study that followed University of North Carolina law students as lawyers for 30 years suggested that those with significantly elevated levels of hostility were more likely to have died prematurely from cardiovascular disease.

According to Jesse Stewart, assistant professor of psychology at Purdue University, depression and hostility commonly occur together.  When a person is both depressed and hostile, the traits interact in a complex way to elevate inflammatory proteins in the body.  The combination of hostility plus depression appears to be as dangerous a risk factor for heart disease as high blood pressure or even smoking.

Edward C. Suarez, Ph.D., of Duke University, says a recent study, “. . . suggests the possibility that men who are . . . hostile and exhibit depressive symptoms, even in the mild to moderate range, are at heightened risk for cardiac events.”  This is so because of the release of adrenaline during times of stress.  According to Dr. Cleaves M. Bennet, clinical professor of medicine at UCLA Medical Center,  “Adrenaline is the growth hormone for the heart muscle.  On the one hand, its good to have a big, strong heart, but at the same time that the heart is getting bigger and stronger, the arteries are narrowing to protect the tissue.”

Given the clear connection between lawyer hostility, depression and the heightened risk for a cardiac event, what can lawyers do about it?

First and foremost, they need to educate themselves about the connection between depression, hostility and heart disease. Most people don’t see the correlation. But, there’s no denying the science which makes the links. 

Second, because hostility creates stress in the body (i.e. the release of adrenaline and cortisol when the body goes into the fight or flight mode), it’s critical to discharge the stress through some form of exercise.  When I go through a good workout after a confrontational day, it’s as if I am wiping the slate clean.  I am discharging the stress that is causing so much trouble in my body and bringing it back into some kind of balance.  Exercise is really just a formalized form of the flight response to stress.  Our bodies want to step on the gas.  Listen to your body and let it run.

Third, you need to find out where your hostility is coming from.  Is it from problems in your personal life that you bring into your daily life as a lawyer?  If so, these need to be met and addressed.  Or, is it the other way around?  Is it the daily grind and confrontation at the office that you bring home?  It’s important to figure this out.  If opposing counsel is a jerk and elicits a hostile reaction from you, it might be time to learn (and, yes, it is a skill you can learn) different ways of being assertive without harming your heart and increasing your risk for depression.  If it is problems at home, identify them and if need be, go for counseling.

Fourth, learn to tell the difference between being assertive and being aggressive. For further reading on this topic, check out this article “Are you Assertive – or Aggressive?” and the article “Assertive, Not Aggressive.”  To help evaluate your own levels of perceived stress and associated health risks, visit the University at Pittsburgh Center’s Healthy Lifestyle Program Web site.

A Walk in the Park

During my depression, my world narrowed.  I just didn’t want to go anywhere.  My life was lived inside coffee shops, on the couch watching television, sitting in my office with the door closed.  There was something deadening about this.  In hindsight, I guess I felt that doing something else wouldn’t make a difference anyway.

I have learned over the years that nature is a powerful antidote to depression.  Being in nature does make a difference.  Maybe it’s because there is such power in nature.  It’s always in motion, isn’t it?  There isn’t any clinical depression in nature.  Humans evolved from the natural world, not from concrete and office towers.  One study found that a walk in a park or countryside reduced depression whereas walking in a shopping center or urban setting increased depression.  This summer, I am going to reconnect to nature by taking my daughter on nature walks.  During these times, I just want to let my incessant conversation with my depression go and let nature speak to me.

A favorite poem of mine, “Wild Geese”, by Mary Oliver, speaks to me of the beauty and healing power of the natural world:

You do not have to be good – You do not have to walk on your knees for a hundred miles through the desert, repenting.  You only have to let the soft animal of your body love what it loves.  Tell me about your despair, and I will tell you mine.  Meanwhile the world goes on.

Meanwhile the sun and the clear pebbles of the rain are moving across the landscapes, over the prairies and the deep trees, the mountains and the rivers.  Meanwhile the wild geese, high in the clean blue air, are heading home again.

Whoever you are, no matter how lonely, the world offers itself to your imagination, calls to you like the wild geese, harsh and exciting- over and over announcing your place in the family of things.

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