Paying Attention to Our Depression

Depression isn’t just an illness.  It’s a messenger.

In his book, Unstuck, James Gordon, M.D., writes:

“Depression is not a disease, the end point of a pathological process.  It is a sign that our lives are out of balance, that we’re stuck.  It’s a wake-up call and the start of a journey that can help us become whole and happy, a journey that can change and transform our lives.  Healing depression and overcoming unhappiness mean dealing more effectively with stress; recovering physical and psychological balance; reclaiming parts of ourselves that we’ve ignored or suppressed: and appreciating the wholeness that has somehow slipped away from us, or that we have never really known”.

If we would but listen, we might find that our depression is trying to tell us something; important insights about our lives and the ways we live it that might be keeping us mired in a soupy gloom.

We often don’t heed our inner wisdom, but keep going full-speed ahead in the wrong direction anyway. Richard O’Connor, Ph.D. observed, “Depression is a vicious circle and we keep doing these destructive patterns because “we don’t how to do anything else.”

When we think of depression only as an illness, we oversimplify its causes and remedies.  No doubt, it has profound effects on our brains and bodies.  Surely, it runs in families and likely has a genetic component. But if it were only that, a blue pill would solve the problem.  And it doesn’t.

The pain of depression may be an impetus for sufferers to live a more authentic life.  Often people who suffer from depression are living from a wounded place within themselves.  Along the way, they learned that they weren’t “good” enough or were “bad people”.  As a consequence, they learned to hide their true needs and wants and live an inauthentic life; a life that may not work, but they don’t know how to change.

In this vein, folks can come to think of depression as some sort of punishment:  a recompense of some unknown sins from an undefined past.  Or, maybe the very real wrongs they may have committed are magnified, as they are prone to be in the mind of a depressive, by the process of generalization: a known cognitive trick of depression where we take a negative incident (e.g. “I lost this case”) and turn it into “Why am I such a failure?”

Depression doesn’t just happen to anyone. Rather, it is the accumulation of a lifetime of varying degrees of psychic pain suffered during a lifetime, often starting in early childhood.  In our early years, many learned that it was dangerous to live from a space of our true selves because of a parent who was an alcoholic, abusive or in some way emotional abusive or absent.

Ellen McGrath, Ph.D., writes:

“Scientists know that traumatic experiences such as child abuse and neglect change the chemistry and even the structure of the brain.  They sensitize the stress response system so that those who are abused become overly responsive to environmental pressures.  They shape wiring patterns in the brain and reset the sensitivity level of the machinery.   Eventually, even small degrees of stress provoke an outpouring of stress hormones, and these hormones in turn act directly on multiple sites to produce the behavioral symptoms of depression. They push the brain’s fear center into overdrive, churning out negative emotions that steer the depression’s severity and add a twist of anxiety”.

Our parents, acting out of their own wounded souls, unconsciously played out their unresolved pain with us during our childhood.  They did so because of their distorted way of seeing the world; a place that they found threatening, its problems unsolvable and against them at every turn.  This hardened them and led them to fail in life’s most important vocation: the nurturance of their own children.

I recall my mom saying to me as a child, “Well, what are you going to do?”  While one could say this was the innocuous lament of a middle-aged mother of 5 kids, later in life I learned it was mom’s worldview that there weren’t really solutions to life’s fundamental problems, that we are, at our core, helpless in the face of life’s thorny challenges. 

My mom suffered from undiagnosed and untreated depression for most of her life.  I now see how this passive, victimized way of seeing the world took root in my psyche as a young man.  And how hard I had to work to overcome it over the years; how I had to struggle to listen less to the inner voice and critic of my parents and incline my ears toward my true self which was always there waiting to be heard.

In Listening to Depression, psychologist, Lara Honos-Webb writes that depression is trying to tell us something: that we are on the wrong track in life.  In this sense, depression can be a teacher if we would only listen to it.

How can we come to see depression as a teacher?  Honos-Webb writes:

“Depression can be seen as a break-down in the service of offering the person an opportunity for a break-through.  In this way, depression can be a corrective feedback to a life with little reflection.  We only reflect on those things that break down in life.  For example, if life is going along smoothly you won’t spend time thinking about the meaning of life.  We tend to think deeply about life when something is not working.  When we identify a problem, we begin to reflect on what caused the problem and how to fix the problem.  If you are disconnected from your deepest feelings and impulses you may still manage to get through life without realizing it.”

I admit that it’s hard to see depression’s value when in the thick of it, the swamp through which we slog with little relief.  But there’s much to be said for seeing depression not just as a disease, but as a messenger that our lives need to change for us to heal.

 

 

How Stress and Anxiety Become Depression

Lawyers suffer from depression at an alarming rate.  I am one of them.

I have been a litigator for more than 22 years, and I didn’t suffer depression in the beginning of my career. 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 the problems and disasters to confront me the next morning.  After years of this, the pendulum swung from states of anxiety to states of depression.  Why did this happen?  It took me a long time to understand.

Recently, scientists have been focusing on the connection between stress and anxiety and the role they play in triggering and maintaining depression.  This is something that should be of concern to all lawyers, who carry high stress loads in their law practices.

Too Much Stress Can Lead to Anxiety

“Stress” is anything in our environment that knocks our bodies out of their homeostatic balance.  Stress responses are the physiological adaptations that ultimately reestablish balance.  Most of the time, our bodies do adapt, and a state of balance is restored.  However, “if stress is chronic, repeated challenges may demand repeated bursts of vigilance,” warns Dr. Robert Sapolsky, an expert on stress-related illnesses and author of the best-selling book, Why Zebras Don’t Get Ulcers: An Updated Guide to Stress, Stress Related Diseases and Coping. “At some point, vigilance becomes over-generalized, 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,” writes Sapolsky.

About 20% of the population will experience some form of anxiety disorder at least once in their lifetime.  Studies show that law students and lawyers struggle with anxiety at twice that rate.

Anxiety and Depression

Stress went on too long in my life as a litigator.  I had, indeed, entered the realm of anxiety.  I felt like I had a coffee pot brewing 24/7 in my stomach.  I became hypervigilant; each file on my desk was like a ticking time bomb about to go off.  At some point, the anxiety made me dysfunctional, and I was unable to do as much as I had before.  I felt ashamed of this.  I denied it to myself and hid it from others, but the litigation mountain became harder and harder to climb as the anxiety persisted over a period of years.

Sapolsky writes, “If the chronic stress is insurmountable, it gives rise to helplessness. This response, like anxiety, can become generalized: A person can feel . . . at a loss, even in circumstances that [he or] she can actually master.”  Helplessness is one pillar of a depressive disorder that becomes a major issue for lawyers because we think of ourselves as invulnerable superheroes who are the helpers, not the ones in need of help.  Lawyers often don’t get help for their depression and feel ashamed if they do.     

Many lawyers do not appreciate the connection between their stress and anxiety and their risk for developing clinical depression.  But the occurrence of anxiety disorder with major depression is frequent; in fact, 60 percent of people with depression are also suffering from an anxiety disorder.

Maybe this connection helps explain studies that find such high rates of both anxiety and depression in the legal profession.

Depression “is stress that has gone on too long,” according to Dr. Richard O’Connor author of the book Undoing Perpetual Stress: The Missing Connection between Depression, Anxiety, and 21st Century Illness.  Many people with depression have problems dealing with stress because they aren’t “stress resilient,” writes O’Connor.  It’s not some central character flaw or weakness, but a complex interplay bewteen genetics and one’s experiences over a lifetime.

How our bodies and brains deal with stress and anxiety hasn’t changed much in the last 10,000 years.  This wonderful defense mechanism, which is wired into our nervous system, is called the fight-or-flight response.  When confronted with a threat – – whether real or perceived – – this response kicks in and initiates a sequence of nerve cell firing and chemicals like adrenaline, noradrenaline and cortisol that flood into our bloodstream and propel us into action to meet a threat.  This was an essential survival device for our ancestors who lived in the jungle and would have to flee beasts or fight foes trying to kill them.

Lawyers don’t fact these types of real life-or-death threats.  But they 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 we were being chased by a hungry lion.  Accordingly, the stress response can be set in motion by mere anticipation, and when humans chronically believe that a homeostatic challenge is imminent, they develop anxiety.

Over time, this chronic anxiety causes the release of too much fight-or-flight hormones.  Research has shown that prolonged release of too much cortisol damages areas of the brain that have been implicated in depression: the hippocampus (involved in learning and memory) and the amygdala (a fear processing hub deep in the brain).  Another area of the brain, the cingulate (an emotion-dampening center located near the front of the brain), in tandem with the amygdala, helps set the stage for depression.

Lawyers need to learn better ways to deal with stress and anxiety to avoid the multiple triggers that can cause or exacerbate clinical depression.  Turning and facing those things that make us stressed and anxious, and doing something about it, gives us the best protection against depression.

My Desk, My Enemy: 6 Helpful Ways to Get Organized

I spend time – too much it – trying to keep my desk in check.

Like a taciturn child, it erupts with tantrums of disorganization. The fact that it’s a mess today seems unfair, as if a hole suddenly formed in the ceiling above me and dropped a cache of briefs, case opinions and half-used legal pads onto my workspace.

I shuffle the papers that lay before me. They look back at me.  Ten minutes go by.  I reshuffle everything all over again. Sound familiar?

Mind you, on the Clutter-o-Scale, my desk is only a 4 out of 10.  If so, why the grief?

Some of my angst comes from having trouble finding things.  But an equal measure comes from the sense that I should be more organized. We have made a religion out of organization in this country which has sprouted temples of crazed worship like The Container Store or Organize.com.  Maybe this growth industry is in reaction to how much stuff/junk/information we like or have to obtain and perpetually reorganize.  This mania has even spawned an inane reality T.V. show “Hoarders.”

Too many things compete for lawyers’ attention besides the usual culprits of returning phone calls, court appearances and last minute deadlines.  When you add a messy desk to an already stressed-out life, well, it becomes the enemy.

Desks are the pedestals of our productivity.  How we organize the stuff on them has a big effect on how well or if we get things done in a timely fashion.  But just as important as these practical concerns is the impact it has on our mental health.

What is your Organizational Style?

According to Kelly Lynn Anders in her book The Organized Lawyer, “Not everyone prioritizes about what the eye needs to feel relaxed. Some ideas work for some and not for others. That’s why it’s important to know your type.” She identifies four types of organizers:

Stackers organize by topic in stacks. They are visual and tactile and like to give the appearance of order. The busier these people are, the more stacks they have.

Spreaders are visual like stackers, but must be able to see everything they’re working on.

Free Spirits keep very few personal belongings around the work area. They like new ideas and keep reports, books, articles and magazines near.

Pack Rats have emotional ties to things. They like the feeling of fullness around them and like to tell stories about what’s in the office.

Which type are you?  She has a lot of useful suggestions, among them is color coding files. On her own desk, she keeps commonly used files close at hand. Because she identifies herself as a “stacker,” Anders avoids cabinets and other hidden spaces for her files.  “The reason I don’t have a lot of hidden storage is stackers have a tendency to squirrel things away,” she said. Check out some of her other suggestions at her website.

A Contrarian Point of View

Einstein considered his cluttered desk a help rather than a hindrance to his prodigious creativity.

While we don’t have his brain’s elephantine computing power, it’s worth considering that your desk mess might not be so bad after all.

Dr. Jay Brand, a psychology professor, argues that a squeaky clean desk doesn’t always equate with a productive employee. It can actually hinder personal efficiency because a person’s desk is an extension of his/her mind. That’s because our human memory has a limited capacity, or finite ‘cells’ available for storage and since most people do multiple things at once they almost immediately ramp their working memory to capacity. They need a place to park some of the information from their working memory into the environment and what more logical place than their desks?

According to Dr. Brand, “these cluttered desks that people use to store information from their working memory are called ‘cognitive artifacts’, and they expand a person’s capacity to think and utilize the environment”. He argues that companies with clean desk policies waste time by requiring workers to clean up their cognitive artifacts every night and re-clutter them the next morning. He points out that everyone has a different working style and piles can be organized topically, chronologically, or according to an individual system. As long as the pile means something to the person who made it, it is effective.

I’ve known plenty lawyers in this group.  But I ain’t one of them.  Maybe it has to do with my own depression over the years.  Or, as Kelly Anders suggests, it’s just my type that determines how I lay out the work space in front of me.

The Depressed Desk

When a lawyer has depression, motivation and organization are BIG problems.  A lack of energy blunts motivation.  We already know that it’s a good idea to keep our desk together, but there simply isn’t much neurochemical juice to get it done.    But, time or a court’s scheduling order waits for no one.  If we don’t keep the paperwork on the conveyor moving, we end up a casualty of our work days and add to the stress/anxiety/depression mix.

In her book Get it Done When You’re Depressed, Julie Fast writes:

“Many people equate depression with the inability to work. In reality, the problem is often the inability to feel like working.  People who are depressed assume that their lack of motivation is a sign of weakness, and if they could just buck up a bit, they would be more productive. But waiting until you feel like doing something is the single biggest mistake you can make when you’re depressed and need to get things done.”

Yes, we need to start working in spite of our desire not to.  Dr. John Preston, in the same book, elaborates further:

“Depressed people find it very hard to ignite this self-generated action due, in large part, to decreased metabolic functioning in the frontal lobes of their brain, which are responsible for initiating behavior.  So if a person waits a long time and not only not accomplish the non-rewarding tasks but also miss out on the big projects that can bring big rewards.”

So it appears that folks who aren’t depressed and are motivated people have ramped up brain metabolism.  I’m envious.  Yet, there is something we can do about it.  As I’ve written about before, consistent exercise helps boost the happy chemicals in our brains, jacks up metabolism and improves our motivation and focus.  Moving is motivating.

We must outfox depression.  It would have us do nothing.  So we must do something.   When I apply this simple wisdom to my day, I’m always pleasantly surprised at how my feelings catch up with my doing and how my doing affects my feelings.

My experience during bogged down moods, was that I’d get most things done, but it would take lots of energy.  When I’d come home from work, I’d be spent.

Six Simple Solutions

I agree with an observation made by Leo Babauta on his blog Zen Habits: “The most important thing to remember is that you must have a system in place, and you must teach yourself to follow the system.  Otherwise, you just clean your desk, and it gets messy again”.

Here are a couple of tried and true tips that have helped me:

1.   Get rid of all those pens. Only keep three or four.  More than that, and there’s too much ink in your work space.  If you love pen, keep your stash at home.  I often troll the pen aisle at Office Max — strange, but true. So I know how difficult it is to part with them.

2.   Take home any books that you don’t use on a regular basis. It’s just more clutter and keeps you from easily putting your hands on the important stuff you need to do your job.

3.   Hide cords – these are like a floating octopi with tenticles that seemingly go everywhere.  Use twist-ties or coil your cords up.

4.   Only keep on your desk what you need for that day. Then section off your desk and workspace so that everything has a specific space.

5.   Have a dump day.  Take everything off your desk and out of your drawer and then put it in a big pile. Then, sort through what is garbage and what you really need throughout the workday.

6.   Schedule a date and time to clean your desk.  Ideally, at the end of a workday.  Weather permitting, do it on Friday’s around 4 so that I start my Monday fresh.

Finding Our Way in the Law

It’s in the darkness of men’s eyes that  they get lost – Black Elk

Graduating from law school is both exciting and frightening at the same time.  There’s a real itch to put our knowledge into action, to be a bona fide “attorney at law” and to start making some dough instead of spending it on tuition and books. On the other hand, we really don’t know a lot about the application of legal theory to legal combat, may have a heap of debt and pray that our first stab at competency doesn’t land us face first on the courthouse steps. 

Beyond all of these pragmatic concerns is the meatier matter of living a life in the law that matters; a life in accord with our inner core of what we truly value in life.  As author Studs Turkel once wrote:

“Work is about a daily search for meaning as well as daily bread, for recognition as well as cash, for astonishment rather than torpor, in short for a sort of life, rather than a Monday-to-Friday sort of dying.”

Lawyers, young and old alike, find it difficult to live out their values in the workplace, to search for “meaning as well as daily bread.”  There are challenges and compromises, some more difficult than others.  For example, we may really value spending time with our family.  But as the demands of our career mount, we become untethered from this life-giving sustenance as we spend more and more time toiling at the office.

Andrew Benjamin, Ph.D., J.D., a lead researcher in studies about the mental health of law students and lawyers, concludes that much of the dissatisfaction in the profession comes from a widening gap between the values we truly care about and the things we end up pursuing in in our jobs as lawyers.  This takes place over time and its effects are cumulative.  Many end up leaving the profession.  Or, if they stay, are mired in unhappiness, discontent and can’t see a way out.

Dr. Benjamin found that approximately 20% of lawyers – about twice the national average – aren’t just unhappy; they’re suffering from clinical anxiety or depression. We aren’t talking about everyday stress, sadness, blues or categorical grumpiness.  We’re talking rubber to the road clinical anxiety and depression; devastating diseases that cause breakdowns in every area of one’s life.  Put in perspective, Benjamin’s studies suggest that a whopping 200,000 of this nation’s 1 million lawyers are struggling – some very badly.

Certainly a gap between our values and the way we live as lawyers doesn’t cause depression.  But it’s one of many factors that include a history of depression in one’s family and emotional abuse and/or neglect during one’s formative years that make a person prone to depression. 

Lawyers also seem to have a particularly fearsome type of stress overload; a jacked central nervous system fueled by the adversarial nature of the trade.  Modern science now knows that there is a powerful connection between chronic and remitting stress and the development of clinical depression.  As I wrote in “How Stress and Anxiety Become Depression,” chronic stress and anxiety causes the release of too many fight-or-flight hormones such as cortisol which damages areas of the brain that have been implicated in depression: the hippocampus (involved in learning and memory) and the amygdala (involved in how we perceive fear).

The point of all this sobering news isn’t to rain on anyone’s parade.  Law can and should be a noble calling and a satisfying way to make a living.  Rather, these warnings are meant to impart some thorny wisdom: living out your values and dreams are just as important as – to quote my brother Wally’s favorite expression, “carving out a living”.  Or, as Studs Terkel earlier surmised:  “. . . to have a sort of life, rather than a Monday-to-Friday sort of dying.”

It’s scary when you sense that you’ve wasted a lot of time doing a type of law – or law at all – that fails to connect with your deeper values.  Part of the fear is driven by the growing sense as we age that we don’t have forever – we are finite beings.  When we don’t know the way, can’t find path to move our outer life closer to our inner life, we can experience a sort of existential terror.  We may be sitting in a classroom, at court or just wandering downtown during our lunch break and a visceral sense that we yearn for something else will hit us.  How many of us quickly dismiss such thoughts as minor meanderings that aren’t worth our time.  But, these thoughts may keep coming.  Listen to them.  If we don’t, we may risk greater peril.

Gregg Levoy, author of Callings: Finding and Following an Authentic Life, talks about the dangers of not following the murmurs coming from within us all:

“Of course, most people won’t follow a calling until the fear of doing so is finally exceeded by the pain of not doing so – pain that we appear to have an appalling high threshold for. Eventually the prospect of emotional and financial turmoil, the disapproval of others and the various conniptions of change, can begin to seem preferable to the psychological death you are experiencing by staying put.  Those who refuse their passions and purposes in life, though, who are afraid of becoming what they perhaps already are – unhappy – won’t of course experience the unrest (or the joy) that usually accompanies the embrace of a calling.  Having attempted nothing, they haven’t failed, and they console themselves that if none of their dreams come true then at least neither will their nightmares.”

So remember your values and where they are trying to lead you.  That’s realistic.  Our values are not set in granite; they can and will change over time.  Yet the only tuning fork you will ultimately have is trying to build a solid bridge between who you really are and what you are in the real world.  We can and will hit choppy waters as we sail our ships in our careers.  There will be many temptations – money, power.  This story has been played out for millennia.  As you go through your career, watch the currents and stir your ship bravely, with integrity and passion.

As Apple founder Steve Jobs wrote:

“Your time is limited, so don’t waste it living someone else’s life.  Don’t be trapped by dogma – which is living with the results of other people’s thinking.  Don’t let the noise of other’s grievances drown out your own inner voice; and most important, have the courage to follow your heart and intuition.  They somehow already know what you truly want to become.  Everything else is secondary.”

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.

The $tress of Success

         

We avatars of the legal system, we hired guns who ride into town and shoot up saloons, measure our success by the notches on our dusty belts: Did I win or lose?  Or, perhaps more accurately, is it: Am I a winner or a loser? There is a thrill about winning and being successful, however we define it — but also a lot of stress.

Results, bottom-line bastards that they are, can spew toxic stress into our bodies like BP oil into the Gulf.  Many lawyers struggle to shut off their inner dialogue that pings between their ears as they lay awake at night and their family sleeps:  “Will I be successful tomorrow?  Will I bill enough hours this month?” We mash ourselves up like Idaho potatoes flopping around in our beds as the minutes click away on our L.E.D. alarm clocks.

 I wrote an article for Trial Magazine about the connection between stress, anxiety and depression.  Here’s a part of that article:

 “How our bodies and brains deal with stress and anxiety hasn’t changed much in the last 10,000 years.  A wonderful defense mechanism, which is wired into our nervous system, is called the fight-or-flight response.  When confronted with a threat – whether real or perceived – this response kicks in and floods our bodies with the powerful hormones cortisol and adrenaline, which propel us into action.  This was an essential survival device for our ancestors who lived in the jungle and would have to flee beasts or fight foes trying to kill them.

Lawyers don’t face these types of real life-or-death threats. But they 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 a hungry lion.  Over time, this chronic anxiety causes the release of too many fight-or-flight hormones.  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).”

Living in the jungle of our profession doesn’t involve warding off wooly mammoths, but it does involve a fight-or-flight from mental constructions in our heads:  the fear of missing a court ordered deadline can create panic in our nervous system every bit as real as a tangling with a beast that tried to kill our ancestors.

Lawyers are perfectionists and overachievers who are never content to give things their just their best try.  They believe in dumping large amounts of energy into each and every project. Such extraordinary efforts are stressful on our bodies and minds.  Yet, we know all of this, don’t we?  The truth is that many lawyers have already made the calculations in their heads and are willing to take the pounding for more dollars.  We come back to our abodes at the end of our days exhausted, peak at our mutual funds statements and turn on the T.V. too tired to think about the implications of living this type of life.

Lawyer Steve Keeva, in his piece Take Care of Yourself, wrote:

 “The dominant method of legal billing can, if you let it, subvert your ability ‘to claim a full and rich life   for yourself,’ as litigator John McShane put it.  Think about it. Billing by the hour is extraordinary in the way in which it so nakedly equates money with time.  It thereby offers no incentive at all to stop working. The taskmaster par excellence can reduce grown professionals to slavish piece workers.” 

When exploring the stress of success, we shouldn’t lose sight of the fact that depression happens in a context, a cultural milieu and a profession’s mores.  Too often, we put everything on the individual – her depressive thinking, his genetic makeup – as if depression in a person forms and takes place in a vacuum:  if it “takes a village to raise a child;” well, it takes a culture to create conditions for depression to develop.

We are social creatures that need support from our families, institutions and society.  These structures help mitigate stress and prevent depression.  Yet,  contemporary culture has largely failed us: the breakdown in families, the betrayal of cultural and political institutions, a grimy cynicism in people, vacuous and crass entertainment unmitigated consumerism and a legal profession which endorses the value of professionalism while lawyers say that levels of incivility between lawyers is at an all time high.  It’s become more of a business than a profession and calling, it’s become more mercenary in nature where lawyers forget that they are officers of the court and not just there to do the bidding of a well paying client.

Bruce Levine, Ph.D., author of the book Surviving America’s Depression Epidemic, writes about renowned psychoanalyst and social critic Eric Fromm’s commentary on the connection between our cultural values and depression.  Here is an excerpt from book about the dangers of a comsumerism driven culture:

“Fromm argued that the increase in depression in modern industrial societies is connected to their economic systems.  Financial success in modern in modern cultural societies is associated with heightened awareness of financial self-interest, resulting in greater self-absorption, which can increase the likelihood of depression; while a lack of financial interest in such an economic system results in deprivation and misery, which increases the likelihood for depression.  Thus, escaping depression in such a system means regularly taking actions based on financial self-interest while at the same time not drowning in self-absorption – no easy balancing act.

The idea that money and buying stuff and acquiring status = happiness isn’t treated for what it is – a paper thin myth.  Certainly, there’s nothing wrong with making money; buying things and wishing to obtain a certain level of success in our careers. It’s a healthy recognition of the limitations of our income and what it really can buy that makes all the difference and keeps us out of this downward spiral.

In the book The How of Happiness: A Scientific Approach to Getting the Life You Want, author Sonja Lyubomirsky, Ph.D., concludes:

 “One of the reasons for the failure of materialism to make us happier may be that even hen people finally attain their monetary goals; the achievement doesn’t translate into an increase into an increase in happiness. Also, materialism may distract people from relatively more meaningful and joyful aspects of their lives, such as nurturing their relationships with family and friends, enjoying the present, and contributing to their communities.  Finally, materialistic people have been found to hold unrealistically high expectations of what material things can do for them.  One father confided to me that he believed that purchasing a forty-tow-inch flat-panel TV would improve his relationship with his son.  It didn’t.

A more spiritual take on the issue was penned by famed author and Trappist monk Thomas Merton.  In his classic work, No Man Is an Island, he writes:

 “One of the chief obstacles to a sense of wholeness in life is the selfish anxiety to get the most out of everything, to be a brilliant success in our own eyes and in the eyes of other men. We can only get rid of this anxiety by being content to miss something in almost everything we do. We cannot master everything, taste everything, understand everything, drains every experience to its last dregs. But if we have the courage to let almost everything else go, we will probably be able to retain the one thing necessary for us -whatever it may be. If we are too eager to have everything, we will almost certainly miss even the one thing we need.

Happiness consists in finding out precisely what the ‘one thing necessary’ may be, in our lives, and in gladly relinquishing all the rest. For then, by a divine paradox, we find that everything else is given us together with the one thing we needed.”

For Merton, that one thing was God.  For some of us with depression, this may be our touchstone as well; a center around which to slow down the centrifugal force of our spinning lives.  For the others, it may be our family or friends.  But whatever it is, it must ground us and bring out, as Abraham Lincoln once said, “The better angels of our nature.”

To lessen the stress in your life, and the risk for developing or exacerbating your depression, try these tips from your friend Dan:

1.   Fast for a few days from the radio in your car, the newspapers or fooling around on your Blackberry.  Take a time out.  Think of it as an experiment.  Lawyers complain that they’re stressed out only to dump more information and stimulation into their craniums at every few moment they have.  Lawyers already read and think enough for a living – give your nervous system a break for crying out loud.

2.   Hand in hand with the above, incorporate some slice of silence into your life.  It doesn’t have to be a monastic experience.  I wear a runner’s watch and do a ten to fifteen minute period of silence a day.  If you don’t do something like this, you know what you’re stuck with – too much noise.

3.   Start asking yourself some questions.  What toll on your mental and physical health is your drive to succeed exacting on your life?  Make an actual list, take it out every day and read it.  The purpose is to try to become more conscious of the actual cost of your career to you.  People tell me they don’t have the time to do this, but then spend hours researching whether to buy a Lexus or Audi.  The irony of it all.We love accumulating things and experiences in our society.  Instead of adding something into your life, what can you drop out of it that would make you feel better? 

4.   Read something that would nurture you as a person and dump the rest of the crap.  Read only one thing at a time.  Maybe a book of poetry or the biography of a heroic person. 

5.   Reconnect with the humorous, whether highbrow or sophomoric.  Plug into it and have a gut-busting hoot.

6.   Remember, that life isn’t a dress rehearsal.  The time you’re spending at your job is a segment of finite time that you’re given.  Once it’s spent, it’s spent.  No one tells you how to spend it, despite what you might have gotten yourself around to believing.   Remember, you choose.  My priest once said that on every gravestone there are two dates:  the date we were born and the date we died.  We don’t get to choose those dates.  But between those dates, is a dash line: “—.” That dash is our life and what we have done with it.  Resolve to be a person whose dash is driven by substance and not solely by success.  As Mark Twain once wrote, “Let your life sing so that upon your death, even the undertaker will weep.”

7.   The notion of “quality time” for oneself or others is largely bullshit.  Richard O’Connor, Ph.D. once said that to overcome depression we need to start investing in ourselves like we’re worth it: exercising, sleeping enough, etc.   No matter how you slice it, there is no small amount of “quality time” in which you can achieve these basic self-care routines.  The reality is you will need to take whatever amount of time it takes because YOU are worth it.

8.   If you are locked in the success matrix as a lawyer, remember that it doesn’t have to stay that way forever.  Realistically, your life won’t probably change tomorrow.  But it can begin to change in small way that can lead you in a healthier direction.

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.

 

Stress, Depression and Our Bodies

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Working as a lawyer and struggling with clinical depression is tough.  I know, because I deal with both every day.  In a peculiar sense, it’s 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 our 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 to find 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 chronic stress, burnout and depression, we must return to these basic concerns because these maladies afflict our minds and our bodies.  Our physical state -our precious bodies- gets hammered by the unremitting punishment which they dish out.  I have often described my depression 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, weakened 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.

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.

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