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.

The Fog of Depression

In the early stages of dealing with depression, one of the more difficult aspects was trouble sleeping. At its worst, I would wake up at 3:30 every night and drive to an all-night coffee shop.  I would sit there like a block of cement and let the steam of the coffee wash over my face.  Looking out the large windows, the empty streets mirrored my own profound loneliness.  I didn’t know or understand why this had happened to me.  What had I done to deserve such misery?

Eventually, the sun came up. All I could think of was how I was going to do my job while feeling so bone weary and depressed.  Those days were tough.  They didn’t last forever, though.  What turned the tide was that I discovered that I had sleep apnea, a serious sleep disorder in which your brain wakes up during the night thus preventing a restorative night’s rest.  People with apnea are sometimes misdiagnosed with depression.  It’s important if you are having problems with fatigue and sleep to be evaluated by a sleep disorder specialist.   Watch this video of a man who suffered from sleep apnea and how he got help.

There are many people, like me, who have both sleep apnea and a sleep disorder caused by depression.  This is so because the causes of sleep apnea are not the same as the causes of a sleep problem associated with depression.  Thus, treatment and resolution of an apnea problem will not fix your sleep problems if you are also suffering from clinical depression.  Apnea is usually found in individuals with low muscle tone and soft tissue around the airway (e.g. due to obesity), and structural features that give rise to a narrowed airway. The cause of sleep disturbance because of depression is more complicated.

Our sleep patterns are dictated by the circadian rhythms in our bodies.  There is a body clock located in our hypothalamus of our brains which controls how we sleep and feel.  The center creates daily signals or rhythms that govern when our hormones and neurotransmitters are released – two critical elements in depression.  Antidepressants target neurotransmitters and hormones.

Due to problems with our circadian rhythms during depression, our sleep cycle does not function properly and we feel sleepiness in the daytime and will be awake at night.  My own experience is that the type of antidepressant you are on may be helping or hurting your ability to sleep.  You may need to change antidepressants (or the dosage). Alternatively, you may need to supplement your antidepressant with another medication that will help you to sleep.  I know many who are doing this and it helps them to sleep well.

Finally, there are a number of prompts or small behaviors that you can employ to let your body and mind know that it’s time to sleep.  This can be important because sleep disturbance is just not about biology, but also psychology.  Depressives ruminate and they do it at the worst of times:  when trying to fall asleep.  There are several things you can do to get ready for sleep.  Just don’t leave it to chance that you might sleep well.  Be pro-active and recognize the critical importance of a good night’s sleep in helping you to recover from depression.

Depression and our bodies

Working as a lawyer and struggling with clinical depression is a tough.  I know, because I deal with both every day.  In a peculiar sense, it is really like having two full-time jobs that absorb all of our time.  As we know, the daily demands and stress of our jobs as lawyers are often unremitting:  Deadlines to meet, phone calls to return, and that motion to argue in Court the next morning.  We often feel that others who aren’t lawyers really don’t understand us and our work because they haven’t “walked in my shoes.”

The “job” of being depressed seems to parallel my experience as a lawyer.  A common experience of feeling depressed is feeling alone and isolated.  When people who care about us reach out to help, there are times we push them away out of a sense of bitterness thinking:  “You really don’t know what it’s like to be a lawyer”.

Yet, there may come a time when we might want to begin seeing depression and our vocation as lawyers a little differently.  Not as two jobs, but really one.  The one job is finding a way to take care of ourselves.  Mother Teresa  once said that what God expects of humanity is that we be “a loving presence to one another.”  Taking that further, I would suggest what God equally expects is for us to be a loving presence to ourselves.

In any law firm, the barometric pressure of stress rises and falls frequently. Consequently, we often find it difficult to be a “loving presence” to ourselves:  to eat well, exercise, get enough sleep, and nurture a support structure of good friends.  The gale-force winds of stress, burnout and depression can begin blowing and disconnect us even from this basic agenda.  Yet, if we are to regain our health in the midst of depression, we must return to these basic concerns because depression afflicts our minds and our bodies.  Our physical state –our precious bodies – get hammered by the unremitting punishment that depression dishes out.  I have often described it to friends as “wet cement running through my veins.”

The biochemical imbalance that is so often a part of depression affects every part of our physical makeup: our eating, our weight, our energy level, and our ability to sleep.  How can we realistically hope to “feel better,” to regain the healthy ground that depression has knocked us off, if we don’t offer a loving presence to our tired and afflicted bodies left unbalanced, weak, and fatigued in depression’s wake?

Being a loving presence to our bodies is like being a loving parent.  We need to pause – and to have a support structure of people who remind us to pause – to ask ourselves what is good for our bodies.  My family doctor once told me that our bodies are like giant tape recorders that remember everything we have done to them.  Too little sleep, too much stress, not enough exercise tells our body that we simply don’t care and/or don’t have the time for it.  This pattern can have catastrophic consequences when depression hits because the body that we need to help us is not fully able to be our ally.  Because it has been ignored, it is of little help to fight depression and actually participates in it.  Anti-depressant medication can be a way, especially in the beginning, to begin to soothe our bodies, to calm our minds enough, so that we can begin thinking of how we are going to rebuild that loving relationship with our bodies.

One of my favorite parts of the Bible comes from the Old Testament, the Twenty Third Psalm.  To me, it speaks about the journey: “Yea, though I walk through the valley of the shadow of death, I will fear no evil; for You are with me; Your rod and Your staff, they comfort me.”  All humans must make this journey.  We must all “walk through the valley” of a life which is certain to have its victories and times of happiness, but also its stunning defeats and times of deep sorrow.  The shape of those victories and defeats take a particular form for lawyers.  Even more so for lawyers who struggle with  depression.  The valley can feel more like a deep trench with no way out.  Our bodies can feel buried in this trench with no light or air able to penetrate depression’s paralyzing weight.  Yet, there are steps each of us can take to begin our climb out of this hole.  In my experience, our bodies are like the ladders propped against the trench of depression.  The great Psalm tenderly says to us that we are not alone; God is there with us in the deepest darkness.  Yet, I would also suggest that our bodies are there for us also, waiting to assist us in our journey towards wholeness.

Recurrent Depression

There was a powerful article about one woman’s battle with life-long depression in last Sunday’s edition of The New York Times Magazine.

A Journey through Darkness

Depression, which she describes as a “thick black paste” and “the muck of bleakness”, can be a chronic and reoccurring condition for many sufferers (as it was for this woman).  The research bears this out.  Sixty percent of people who have had one episode of major depression will have a recurrence.  With each episode, the risk of recurrence increases from 60% to 70% after two episodes, to about 90% after three. Further, studies show that when symptoms continue, recurrent episodes can be longer and more severe, with less time between episodes.  Scientists have recently found that long-term treatment with antidepressants can be beneficial.

New Approach for Recurrent Depression

My view is that it is critical to cut depression off at the pass before it gets a foothold in our lives.  That is why I encourage lawyers who are in the midst of their first depressive episode to hit it with everything they’ve got:  medication, talk therapy, exercise, a spiritual practice and support groups.  If we do not, we run a significant risk of the depression returning.

As the old Japanese proverb goes, “Falls seven times, stand up eight.”  Winston Churchill, who suffered from depression his whole life, had a modern take on this ancient wisdom: “If you are going through hell, keep going.”  Take action, be determined and trust that you will get better.

Stress Depression Connection

At the beginning of my law career, I didn’t suffer from depression. But I did have trouble managing the stress of my practice. Over time, this constant stress developed into anxiety. I started feeling like I couldn’t control everything. I would go to bed fearing what problems and disasters were to confront me the next morning. After years of this, the pendulum swung. I went, more and more, from states of anxiety to states of depression. Why did this happen? It took me a long time to understand.

Depression develops because of a complex interplay of genes, neurochemistry, emotional history and personality. Recently, scientists have been focusing in on the connection between stress and anxiety and the role they play in producing and maintaining depression. This subject should be of great concern to lawyers who frequently report feeling stressed or burned out in their practices.

“Stress” is anything in our environment that knocks our bodies out of their homeostatic balance. The stress response is the physiological adaptations that ultimately reestablish balance. Most of the time, our bodies do adapt and a state of balance is restored. However, Dr. Robert Sapolsky, an expert on stress-related illnesses, warns: “If stress is chronic, repeated challenges may demand repeated bursts of vigilance. At some point, this vigilance becomes overgeneralized leading us to conclude that we must always be on guard – even in the absence of stress. And thus the realm of anxiety is entered.” For an excellent article which nicely summarizes his theories, see:

Robert Sapolsky Discusses Physiological Effects of Stress.

Stress went on too long in my own life as a litigator. I had, indeed, entered the realm of anxiety. For me, this anxiety felt like I had a coffee pot brewing twenty four-seven in my stomach. I became hypervigilant; each of the files on my desk felt like ticking time bombs about to go off. Over time, the litigation mountain became harder to climb as the anxiety persisted over a period of years.

Dr. Sapolsky states: “If the chronic stress is insurmountable, it gives rise to helplessness. This response, like anxiety, can become generalized: a person can feel they are at a loss, even in circumstances that she can actually master.” Helplessness is a pillar of a depressive disorder. It becomes a major issue for lawyers because we aren’t supposed to experience periods of helplessness. We often think of ourselves as invulnerable super hero’s who are the helpers and not the ones in need of help. Accordingly, lawyers often don’t get help for their depression and feel ashamed if they do.

Many lawyers do not appreciate this connection between their stress and anxiety and the risks they pose for the development of clinical depression. Indeed, the presence of co-morbid anxiety disorders and major depression is frequent and, according to some studies, as high as 60 percent. Maybe this connection helps explain the studies which find such high rates of depression for lawyers. In many ways, we are too stressed and anxious too much of the time.

The human body was not designed for such punishment. Dr. Richard O’Connor, author of the best-selling book, Undoing Perpetual Stress: The Missing Connection Between Depression, Anxiety and 21st Century Illness states that depression “is stress that has gone on too long” and that many people with depression have problems dealing with stress because they are not “stress resilient”. Not because of some central character flaw or weakness. But because of a complex interplay between genetics and one’s experience over a lifetime. This interplay is played out daily for lawyers in how their bodies and brains deal with stress and anxiety.

Our bodies haven’t changed much in the last ten thousand years. We have a wonderful defense mechanism wired into our nervous system called the fight-or-flight response. Dr. Sapolsky, in his acclaimed book, Why Zebra’s Don’t Get Ulcers, walks us through the connection between this ancient defense mechanism and depression. When confronted with a threat – whether real or perceived – this response kicks in and floods our bodies with powerful hormones that propel us into action. This was an essential survival device for our ancestors who lived in the jungle and would have to flee beasts that were trying to eat them or fight foes that were trying to kill them.

Lawyers don’t face these types of real life-or-death threats. Instead, lawyers perceive life-or-death threats in their battles with opposing counsel while sitting in a deposition or sparring in the courtroom. Our bodies respond as if they were being chased by that hungry lion. Accordingly, the stress response can be set in motion not only by a concrete event but by mere anticipation. When humans chronically and erroneously believe that a homeostatic challenge is about to come, they develop anxiety.

Over time, this type of chronic anxiety causes the release of too much of the powerful fight-or-flight hormones, cortisol and adrenaline. Research has shown that prolonged release of cortisol damages areas of the brain that have been implicated in depression, the hippocampus (involved in learning and memory) and the amydala (involved in how we perceive fear).

If we don’t as litigators learn better ways to deal with stress and anxiety, we expose ourselves to multiple triggers that can cause and/or exacerbate clinical depression. It is in turning and facing those things which make us stressful and anxious that we provide ourselves with the best protection against depression.

 

Suicide

This is my first blog entry. I am the creator of the website Lawyers with Depression. I created it two years ago. I have been a lawyer for over twenty years and have suffered from depression for the past seven. I created the site to create a virtual home for lawyers all across America who struggle with depression. I went looking for such a home on my computer two years ago and couldn’t find one – – so I built one.

Since it was launched, I have heard from thousands of lawyers, judges and law students about their battles with depression. It is my hope that this blog will be a good supplement to the website. It will offer frequent commentary, thoughts, observations and insights about working as a lawyer and dealing with depression.

The launch of this blog starts on a very sad note indeed.I was interviewed for a piece in The National Law Journal which appeared today.

Reports of Suicides Point to Job Stress – The National Law Journal

The interview concerned the rash of lawyer suicides. I have known or spoken to many lawyers who have either thought about suicide or attempted it. Unfortunately, there are attorneys in my own community who took their lives when the pain got too deep.

One of them was a dashing man who taught me trial technique years ago. He was a pillar of our legal community and a person of integrity. After a string of stressful events, he slit his wrists in a bathtub. Why people commit suicide is a complicated question.

For an excellent discussion of the issue, the best book I have ever read is Night Falls Fast: Understanding Suicide by psychiatrist, Kay Redfield Jamison. What makes the book so compelling is Dr. Jamison’s own bipolar illness and past suicidal ideation.

As I said in the interview with The Journal, stress due to layoffs may explain a few of the recent deaths. But such stress is, most likely, only the most recent incident in a long line of stressful incidents for these poor people.

Stress, as I will discuss in future blogs, plays a major role in the creation of depression.

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