The Worrier Warrior: Working with Depression through Brain Training

Frank walked into my office and said, “I was in therapy for 15 years, know my ‘issues’ inside and out, but I’m still taking an anti-depressant and an anti-anxiety med when I have to do any major presentation at the firm.  It’s like my baseline is off.  It’s great for being a lawyer.  I’m always hyper-vigilant—looking out for the next danger, working very hard to stay on top of everything.  But when I get into bed at night, my mind is racing and I feel this sinking feeling.  Still, after all this therapy.  What can you do for me?”

Frank doesn’t have a motivation problem, or a lack of insight problem.  Frank has a brain problem.

Frank had come into my office after having done research into the benefits of neurofeedback for depression and anxiety.  I see clients like Frank everyday and I call them my “Worrier Warriors”.  Their nervous systems are in a state of ‘activation’ where the flight/fight/freeze brain is always in go-mode.  And he’s right—it serves a law firm well.  These brains are habitually trained to be on the watch for danger.  Add a good analytic mind to that mix and you’ll have a highly successful lawyer who protects his or her clients well, but at a high cost of health and happiness.

We’ve come a long way in our understanding of the brain and brain functioning in producing the symptoms we call anxiety and depression.  In the mental health field we used to think of them as ‘mind’ problems, but now we’ve come to understand that they are also brain problems.

We all know we are ‘creatures of habit’ but what that really means is that the brain is prone to habituated rather than fresh responses. The brain functions to be most efficient and effective in use of its energy to protect and maintain the body.  The flaw in this system design is that the brain becomes efficient by using cues to approximate the present situation and then uses an old response pattern, which leads to misperceptions of the present moment and less than appropriate responses.  We’ve all seen someone “lose it” and respond with an angry outburst when the situation warranted concern or a firm voice.

A dramatic and sad illustration of this principle is the war vet who comes home with Post Traumatic Stress Disorder (PTSD) from his years of service.  As a soldier he has been trained to respond to danger with ‘fight’ response.  But now he is home from the war and is walking down his hometown street when a car backfires.  The brain is habituated to “loud sound equals danger” and the vet’s brain goes into fight mode—yelling, pushes someone or becomes highly irritable and later starts a fight with a loved one.

An important piece of information to know about the part of the brain that operates the fight/flight response: it does not take orders from anyone.  It is a part of the brain that needs to be able to respond in milliseconds, so it doesn’t take in information from other, more rational and analytic parts of the brain.  As a result you could say to yourself, “I really shouldn’t get angry and fly off the handle.”  But the part of the brain that decides that action, acts without input from our rational, willful self.  It takes in sensory input and then makes a snap decision.

Why are lawyers so prone to anxiety, depression and anger outbursts?  Their brains are habituated to the flight/flight/freeze response (anger/anxiety/depression) response.  For whatever reason, and their could be many, they experienced a threat or threats at some point in their lives that were significant enough to habituate the brain to being in this activation mode.  A quick way to find out if you are is to ask yourself this question, and answer quickly without thinking:  Is the world a safe place?  If the answer is ‘no’ then chances are your brain is habituated to thinking that you are in danger when you aren’t.  It makes you a perfect candidate to become a lawyer where you always have to be thinking about what the risks are in any situation.  Or to be an ENT or an emergency room doctor.  Your brain is habituated to perceive risk.

Now what to do about this habituated brain?  Here are some tips:

  1. Breath.  Seriously.  The breath, slow and deep breathing are ways we can “tell” the brain that we are safe and it can go into a state of relaxation and regulation.  Slow deep breathing for 5 minutes where you work your way up to counting to 5 on the inhalation and 5 on the exhalation will do wonders to communicate to the brain to come out of flight/flight and into calm awareness (the state of a regulated and balanced brain.)
  2. Understand: Help yourself by having a good and clear conceptual understanding that your anxiety and depression and anger outbursts are a brain over-reacting, not an accurate assessment of the present moment’s situation.  Your brain is reading a newspaper that’s 20 years old and acting as if it’s the here-and-now news.
  3. Get exercise: I recently had a neurologist tell me that if the positive effects of exercise (increased heart rate 30 mins 5 times a week) were a drug, it would be considered a “miracle drug” and would generate billions of dollars a year in revenue.
  4. Get enough sleep.  Studies are now coming out showing the detrimental effects of chronic sleep deprivation—5 hours a night or less—on the development of chronic conditions.
  5. Train the brain with neurofeedback.  Neurofeedback trains the brain to optimize its functioning through allowing the brain to ‘see’ its unhelpful response patterns.  And the brain learns to use the present moment to decide it’s next action rather than using those old habitual response patterns.  As a result the trained brain sleeps better, is calmer, is better able to focus, and is more cheerful.  And as one client said, “I have the same problems, they just don’t get to me anymore.”

 

Natalie Baker, MA LMHC, works as a psychotherapist and neurofeedback trainer in private practice in New York City. http://www.neurofeedbackny.com

 

 

 

 

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.

Coming Out of Our Caves: Male Depression

Guys have lots of trouble coming to terms with depression. All the more so if you’re a lawyer. Lawyers aren’t supposed to have problems; we’re supposed to fix them. Most male lawyers I know would rather drop dead than admit that they have problem with depression. I guess the exception to this observation is when the wheels have fallen off for them. Then – and only then – do they recognize (hopefully) that they are suffering from depression and the toll that it is taking on their lives. The consequences for failing to recognize this basic fact can be serious (loss of productivity at work, sleep problems, etc.) or fatal (middle aged lawyers commit suicide at twice the rate of the national average).

Psychologist, Terrance Real, the author of the book, I Don’t Want to Talk About It: Overcoming the Secret Legacy of Male Depression, makes the observation that we don’t think of men as depressed. This is so because what we are really thinking about is “overt” depression and more women show signs of that – weeping, a willingness to discuss painful feelings, etc. Men suffer from “covert” depression that expresses itself in addiction, isolation, workaholism, isolation and increased irritability.

“Men are just as feelingful, just as relational, just as connected, just as dependent, just as needy, as women are. Men have been coerced since childhood to forego these relational qualities and skills and squeeze their sense of membership and self-esteem through performance. Girls are taught to filter their sense of self-worth through connection to others, and boys are taught to filter their sense of self-worth through performance. That’s a vulnerable foundation for one’s self-worth” notes Real in an interview.

The excellent website, Men Get Depression, says there are three distinctive signs of male depression:

Pain
Depression may show up as physical signs like constant headaches, stomach problems, or pain that doesn’t seem to be from other causes or that doesn’t respond to normal treatments.

Risk Taking
Sometimes, depressed men will start taking risks like dangerous sports, compulsive gambling, reckless driving, and casual sex.

Anger
Anger can show itself in different ways like road rage, having a short temper, being easily upset by criticism, and even violence.

So often, the first symptom that male lawyers notice that they are slipping is in the performance department. One of the symptoms of clinical depression is difficulty concentrating. This leads to problems in getting work out the door. We may try to hide that our work is slipping – ask for extensions, take much longer to do tasks that were simple and routine in the past. If the problem doesn’t go away, some will seek out help – usually through their family doctor (who distribute 80% of the prescriptions in this country for antidepressant medications). Some will go the extra step of seeing a therapist that they can talk with about their problems.

My therapist used to liken my depression to a caveman camping out in his cave. It took a lot to coax me out of there. Men need to come out of their caves into the light of day where the colors are brighter, others live who can help us and where we can finally feel the sun of being worthy without having to perform twenty-four seven in our legal careers.

Built by Staple Creative