Lawyer Casey Berman at Leavelawbehind encourages lawyers to keep these three t hings in mind as they endeavor to cultivate courage and motivation in the face of anxiety and doubt. Read the Blog
Read this powerful story of a husband who experiences his wife’s descent into major depression and hospitalization. Read the Blog
The American Medical Association has recommended that depression be added to the list of factors associated with heart disease including obesity, diabetes, high blood pressure and smoking. Read the News
“Trail Therapy” is a moving mini documentary about Steve Fugate, a 64-year-old who raises awareness of depression and suicide by walking across the country with a sign that reads: “LOVE LIFE.” Read the Story
According to one expert, it’s time to seek treatment when your depression is moderate, and makes it difficult to function on a daily basis. Read the Blog
Among the lawyers whom I have known, it occurs to me that the only ones I’ve liked have had bouts of depression. So when Dan Lukasik, lawyer and depression sufferer, invited me to write a piece for his lawyerswithdepression.com, I gladly agreed.
In Surviving America’s Depression Epidemic, I explain how depression is neither a character defect nor a biochemical defect but a “strategy” for shutting down overwhelming pain. Given the level of pain in the lives of many lawyers, it does not surprise me that of 104 occupations surveyed by John Hopkins researchers, lawyers were the most likely to suffer depression, 3.6 times more likely than average.
Lawyers all too routinely experience the pain of injustice, the pain of the ugly side of human nature and the pain of money. For a sensitive soul, these pains can become insufferable. Some depressed lawyers, in confidence, tell me about another pain: interacting with soulless colleagues who maintain a “life-is-good” grin on their face as they swim through the day unmoved by the misery that surrounds them.
Many historians consider one depressed lawyer, Abraham Lincoln, to be the greatest U.S. president because of his critical thinking, wisdom and compassion. According to Joshua Wolf Shenk’s Lincoln’s Melancholy, the evidence is strong that by today’s standards Lincoln would have been diagnosed with major depression. Support for this thesis rests not simply on the famous Lincoln quote, “I am now the most miserable man living”; and goes beyond the observation of Lincoln by his longtime law partner William Herndon that, “gloom and sadness were his predominant state.” Shenk reports that Lincoln actually suffered two major breakdowns, which included suicidal statements that frightened friends enough to form a suicide watch. Lincoln’s propensity for gloom was widely known during his lifetime, but in an era when a dark temperament was viewed as neither a character defect nor a biochemical defect, it actually helped Lincoln politically more than it hurt him. Shenk points out that Lincoln’s depression, “seemed not a matter of shame but an intriguing aspect of his character, and indeed an aspect of his grand nature.”
In contrast, after depression was medicalized, George McGovern’s 1972 vice presidential running mate Thomas Eagleton was shoved off the ticket because of his history of medical treatment for depression. This calls into question the contention that diseasing depression destigmatizes it.
Despite billions of dollars spent attempting to establish biochemical markers for depression, no such markers exist. This is why depression continues to be diagnosed via symptom checklists, not with lab tests, brain scans or any other biochemical means. And recently, psychiatry officialdom discarded the serotonin deficiency explanation of depression.
Is there a better model for both understanding and overcoming depression? There exists a great deal of research showing that depression is highly associated with overwhelming pain including the pains of loneliness, a miserable marriage, childhood trauma, poverty, unemployment, physical incapacitation and a variety of significant hurts and losses. Instead of viewing depression as either a character defect or a biochemical defect, depression is better seen as a strategy for shutting down overwhelming pain. Similar to the shutdown strategy of substance abuse, depression can also get out of hand and become a compulsion (a behavior not freely chosen).
Compulsive shutdown strategies such as depression not only shut down pain but can shut down our entire being. Hence the classic symptoms of depression: shutdown of energy; shutdown of the ability to experience pleasure including the shutdown of sex drive; shutdown of cognitive functions such as attention, memory and concentration; and sometimes complete shutdown and immobilization.
In modern industrial societies, immobilization is terrifying because it can lead to poverty, homelessness and institutionalization, so the fear of immobilization is quite rational. This fear is painful, and so we may use depression or other shutdown strategies to suppress it. Thus we have a vicious cycle: pain, a shutdown strategy such as depression resulting in immobilization, a fear of immobilization and more depression to shut down that painful fear. A major reason why I wrote Surviving America’s Depression Epidemic was to provide a way out of that vicious cycle.
One problem for critically-thinking lawyers is that critical thinking is associated with depression. Studies show that moderately depressed people are more accurate in their assessments of an often painful reality than are non-depressed people.
There’s more bad news for critical thinkers. Critical thinking can make it more difficult for standard psychiatric treatments to work. To the extent that one knows the truth about depression treatments—that no treatment, including antidepressants, has been proven to be much more effective than a placebo— it makes it more difficult to have faith in treatment. This lack of faith makes it more difficult for treatment to “work.”
In reflecting on the empirical research on depression: my work with depressed people; biographies and memoirs of people who have experienced depression; and my own personal experience with demoralization, immobilization and despair, it is difficult to deny the power of what scientists call “the placebo effect” —which is more commonly called “belief” and “faith.” If one has faith in the efficacy of a treatment or approach, one’s likelihood of overcoming depression increases. Lincoln, for example, came to have faith in humor and meaningfulness, which were two powerful antidepressants for him.
Many Lincoln biographers note that Lincoln told jokes and funny stories as a political tool to both disarm and connect, but Lincoln also used humor as an antidote for depression. Lincoln said, “If it were not for these stories—jokes –jests, I should die; they give vent—are the vents of my moods and gloom.”
Lincoln also discovered the antidepressant power of meaningfulness. Though Lincoln shared with other politicians the trait of ambition, he also wanted his life to have genuine meaning, which he found first in attempting to stop the spread of slavery and then, when the political climate changed, in his Emancipation Proclamation.
Can meaningfulness provide lifesaving morale? In Man’s Search for Meaning, Viktor Frankl describes a harrowing tale of his physical, psychological and spiritual survival in Nazi concentration camps. Frankl states that in the concentration camps, “The thought of suicide was entertained by nearly everyone.” Frankl discusses the therapy he provided for two men who seriously talked about suicide: “In both cases it was a question of getting them to realize that life was still expecting something from them.” For one man, it was a child waiting in a foreign country, and for the other, a scientist, lifesaving meaning was a series of books that no one but he could complete.
I wrote Surviving America’s Depression Epidemic for critical thinkers who are pained by the injustices and dehumanization of modern society, some of whom become depressed and are failed by standard psychiatric treatments. While critical thinkers are more likely to experience depression and less likely, from my experience, to be helped by standard psychiatric treatments, the good news is that there are—in addition to humor and meaningfulness— other solutions for a depressed critical thinker with a soul.
Editor’s Note: Bruce E. Levine, Ph.D., is a clinical psychologist and has been in private practice in Cincinnati, Ohio since 1985. Dr. Levine’s most recent book is Surviving America’s Depression Epidemic: How to Find Morale, Energy, and Community in a World Gone Crazy. Dr. Levine lectures, provides workshops and is a regular contributor to numerous magazines. www.brucelevine.net.
Years ago, 1997 to be exact, I was thinking about writing an article for a lawyer’s magazine about my experiences with depression while practicing law. I had lunch with a good friend of mine, Bob, who at that time worked in a large litigation firm in New York City. Since then, Bob has become a federal judge and remains a dear friend.
After we had ordered, I told Bob about my idea to write the article. He sat quietly and listened, looking down at his salad as I spoke. Finally, he said, “Dan, this is an awful idea. While noble, why would you expose yourself to the insults some people are going to hurl your way.” We spoke at length and I finally told my dear friend that I was going to write the article anyway.
For the first few years after that initial talk, Bob would call me regularly and check in, “How’s it going, Dan? Is everything all right?” I so appreciated Bob’s loving concern. More importantly, however, something began to change in our relationship. Bob eventually disclosed to me that he had had a episode of major depression some years ago and had tried to commit suicide.
It seems to me that my willingness to speak frankly about my depression gave Bob permission to speak about his.
Unfortunately, talking about depression is not easy for most men. They have lots of trouble coming to terms with depression, even when they get treatment. All the more so if they’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.
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. They may try to hide that their 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 of 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 can help them and they can get better.
In his book “What Happy People Know,” Dan Baker argues that you can’t be in a state of appreciation and fear, or anxiety, at the same time. “During active appreciation,” Baker writes, “the threatening messages from your amygdala [fear center of the brain] and the anxious instincts of your brainstem are cut off, suddenly and surely, from access to your brain’s neocortex, where they can fester, replicate themselves, and turn your stream of thoughts into a cold river of dread. It is a fact of neurology that the brain cannot be in a state of appreciation and a state of fear at the same time. The two states may alternate, but are mutually exclusive.” Other studies have also highlighted how gratitude can buffer you from the blues, promote optimism, and, in general, make you feel peachy.
However, I do hereby swear that it is possible to be grateful and depressed.
For example, I’ve articulated on several posts that I have been in a depressed cycle for about nine months. I have good days, and I’m able to write my blogs, do a little publicity, arrange play dates for the kids, and help with their homework. But I have, for three seasons now, woken up with that nausea in my stomach and the familiar dread that most depressives feel in the morning, of wondering how I’ll make it through the day with what I call “dark vision.”
Today I woke up incredibly grateful for my husband. By the time I got downstairs, he was brewing Godiva chocolate coffee and had the table set for breakfast. He was making the kids’ lunches and making sure our son had his lacrosse stick for practice afterward. I was grateful for my kids: for the creative and sarcastic one who left a poster for me last night that read “I love Daddy more than you,” and for the other one who has a beautiful, sensitive soul and the discipline and determination to–in my opinion anyway–succeed at whatever he wants to do in life. For my family I am incredibly grateful.
However, if learned this afternoon that tomorrow would be my last day on earth, I would be immensely relieved.
I know that seems wrong … that I could be grateful and want to die at the same time. But I guess it’s the difference between a physiological pain–a quiet desperation, or a plea for relief–and the virtues of love, commitment, and appreciation. Professor of Psychiatry Peter Kramer explains this quandary best when he says, “Depression is not a perspective. It is a disease.”
A Beyond Blue reader caused me to think about this. On the combox of my post, “Never Place a Period Where God Has Placed a Comma,” she wrote:
I know how hard it is to fight for sanity when your brain chemistry is askew. However, I sometimes feel you don’t realize how lucky you are. Perhaps I’ve missed posts regarding the blessings in your life, but you have a husband who loves you and supports you and two children, a boy and a girl even. The people you’ve loved, the people who’ve loved you, the joy and heartaches you’ve shared … relationships are where it’s at.
She’s absolutely right. I have so much to be grateful for. And if I haven’t articulated that enough in my blogs, I’m remiss. However, expressing the anguish of depression doesn’t mean I’m not grateful. The love I have for my husband and my kids can’t and won’t stop the pain of depression. And considering that 30,000 Americans kill themselves every year, I would imagine that I’m not alone in saying that. Good and healthy relationships are certainly buffers against depression and anxiety and can aid us in our recovery. But gratitude and appreciation can’t interrupt my mood disorder any more than they can relieve the pain of arthritis.
If I sound defensive, I guess it’s because I used to beat myself up over and over again for not being grateful enough to stop a depressive cycle. And based on my mail from readers, I know that is the case with lots of folks. So, while I continue to record all my blessings in my mood journal each day and say them aloud right before dinner and at bedtime with the kids, I now know that gratitude is a separate animal to my depression, and that sometimes confusing the two, especially while in a depressive cycle, can do more harm than good.
So I take note of my blessings. I thank God many times throughout the day. But if, at the end of my prayer, I’m still depressed … well, that’s okay. Because, as Kramer says, depression isn’t a perspective. It’s a disease.
Therese Borchard is the author of Beyond Blue: Surviving Depression & Anxiety and Making the Most of Bad Genes and The Pocket Therapist: An Emotional Survival Kit. Subscribe to Beyond Blue, visit her website, or follow her on Twitter @thereseborchard.
One study found that as many as eighty-percent of all people in this country that suffer from depression don’t get any treatment.
Given that depression is the leading cause of disability in the U.S. and that over 20 million people are afflicted with it, that’s a lot of people – about 16 million.
However, many of the law students, lawyers and judges with depression that I’ve met tell me that they don’t need to be told to get help because there are already getting it. They’re already in therapy, taking medication or both. They get it. They know that depression is an illness and they have to deal with it.
Some of them have been coping with it for a very long time. I call these people “depression veterans”. I have met many such veterans and their courage and determination to recover and stay well inspires me. As I wrote in a prior blog, these people are really my “heroes”.
I also have met many in the legal biz who say they’re at the end of their rope. They’ve been in and out of therapy over the years with little or negligible improvement in their depression. Others have started and stopped a number of antidepressant and/or other mood stabilizing medications tired of to little impact on the mood and too many side effects. But the depression always returns for them.
For most of them, it’s not a relapse into major depression. Rather, a mild or moderate depression interspersed with fatigue, a lack of pleasure and a glum outlook on life. What they are experiencing is a fact about depression and its course. That it often a chronic and life-long illness for those so afflicted.
Then there are many who go through long stretches of feeling pretty well most of the time, but still have pockets of depression.
I put myself in this camp.
Most days, my depression, on a scale of “1” through “10” is a 1 or 2, if it’s present at all. If it gets worse, it’s less often, not as strong and has a much shorter duration is much shorter – maybe a 3 or 4. This seems to be especially so during the dark days of winter.
What worked for me to reign in the beast of depression was a change in life style, which included regular therapy, medication, a support group, prayer and exercise. While there is no one thing that is a panacea for depression sufferers, I am convinced that such the positive changes have a direct, lasting an significant alleviation of depression’s worst symptoms.
To make a lifestyle change, I develop a depression “toolkit”. A game plan that I’ve pretty much stuck to for a number of years. The value of such a toolkit is that it provides a map for us to stay on course. It gives us a sense of structure and a sense of hope.
If you thinking about how to really recover from depression stay healthy, it’s important to come up with your own depression toolkit. There are lots of ways to go about it. The two best examples of depression toolkits I’ve found come from the University at Michigan’s Depression Center and the Depression and Bipolar Support Alliance.
So pick up your pen and start building your own toolbox today.
Copyright 2014 by Daniel T. Lukasik
I made a new friend this week.
A lawyer from down south emailed me. He had found me through my website. He told me about some terrible and unexpected turns his life had taken recently which had plummeted him into a major depression.
I e-mailed him back and said that I would like to speak with him by phone.
I learned that his drop into the well of depression wasn’t his first experience with this terrible illness. He had gone through a bad episode twenty-five years ago, but since then nothing until his most recent crash.
During our thirty-minute talk, I felt the rawness of his pain in his voice. I recognized this sound all too well. It was the pain of depression.
He told me that the only respite he felt was when he fell asleep because it was only in this state of unconscious that he had some relief from the grinding wheels of depression.
I also learned that he was married, a father of four and had worked very hard for over twenty-five years as a lawyer. He was a Catholic who prayed often. He felt horrible about the pain and anxiety his depression had caused his wife and children. He told me that he felt comfortable talking with me because I was a lawyer and someone who had been through depression. As we talked, his voice became a little lighter and his tone a bit more optimistic.
I don’t attribute to anything I did.
Instead, I see it more as a testament to this central truth about life on earth: It is in sharing with one another our stories that we heal.
And I believe that we’re all called to be healers of one another.
And in listening to one another’s stories, we learn that suffering doesn’t have the final say.
And in this truth, we find hope.