Blogger Therese Borchard writes, “I have always felt terribly guilty about these thoughts. They are a source of great shame for me because I know I am so very blessed. Every day I scribble plenty of things in my gratitude journal. Intellectually I register all things considered good and I thank God for them, but the emotion is inaccessible. I see my ten-year-old hold a lemonade stand with tips going to the SPCA and I smile, but the joy is not there. And the more I try to force it, the faster it escapes.” Read the rest of her blog.
I’m Dan Lukasik from Lawyerswithdepression.com. Today’s guest is Dr. Margaret Wehrenberg. Dr. Wehrenberg is a clinical psychologist in Naperville, Illinois. She is the author of six books on the treatment of anxiety and depression published by W.W. Norton, including, “The Ten Best-Ever Depression Management Techniques: Understanding How Your Brain Makes You Depressed and What You Can Do to Change It” and “Anxiety + Depression: Effective Treatment of the Big Two Co-Occurring Disorders.” An international trainer of mental health professionals, Dr. Wehrenberg coaches people with anxiety via the internet and phone. She’s a frequent contributor to the award-winning magazine, Psychotherapy Networker and she blogs on depression for the magazine Psychology Today.
What is the difference between sadness and depression and why do people confuse the two so often?
Because depression comprises sadness. Sadness is a response to a specific situation in which we usually have some kind of loss. The loss of a self-esteem, a loss of a loved one, the loss of a desired goal. Depression is really more about the energy – whether it’s mental energy or physical energy – to make an effective response. So, sadness is an appropriate and transient emotion, but depression sticks around and affects all of our daily behaviors and interactions.
What causes depression? Sadness, as you say, is an appropriate response to loss. What is depression a response to? What are the causes of depression?
Over the course of my career, I’ve developed the idea that there are four potential causes to depression. This comes from working with people for forty years; it comes from reading a lot of research.
The first part is genetics. You are born with a brain that is going to tend toward depression because of the function of neurotransmitters in your brain. It’s a genetic predisposition towards depression. With poor self-care, poor nutrition, you may end up stimulating or starting that feeling of low energy, of low interest in the world around you. Then if you pull back from the world around you, now you start to have fewer experiences that keep you interested in the world.
Another possible and probable cause is with people who are experiencing situational stress that goes on, and on, and on. That could be the stress of not being able to earn enough money, and you’ve got two jobs, and kids, and a life filled with stress. It could be the stress that comes on while caring for someone in your family circle who’s got a disability, or a chronic illness; that increases with severity over time. So, you’re stuck in stress, and you deplete yourself. And you can become depressed.
The state of the depression is a lot like the state of being sick. If you had the flu, you wouldn’t feel like sitting around eating and drinking; you wouldn’t feel like playing a round of tennis. If somebody says, “Let’s watch a really interesting T.V. show” and you say, “No, I want to go to sleep instead,” that’s pulling back from the world is healing. People have the same feeling when they’re depressed, but those feelings don’t lead toward healing because they’re persistent.
Two other causes that people would certainly be aware of are trauma or coming from early childhood adversity where early in your childhood you were not treated well, you were neglected, had some other abusive situation, and those two very difficult situations can lead people to function in a depressed way.
Let’s talk about the issue of stigma. As a person who’s had depression for the past 15 years, it’s something that I’ve had to deal with. Why is there so much stigma surrounding depression?
Part of it is because we have this mentality in this country that you should be able to pull yourself up by your bootstraps. And we look at people who are low energy, who aren’t completing tasks, and we judge them as doing it on purpose. People who aren’t depressed are of the impression that you could just decide to do it differently.
I was speaking with a 21-year old client of mine the other day who said, “I can’t make myself do the work, and I hate it that I am that lazy.” So, he judges himself as lazy, even though it’s the depression that’s robbing him of energy and mental tenacity. So, even depression sufferers judge themselves to be wrong, lazy, and bad and believe they should do better. So, I think the cultural expectation that you should be more productive. Also, people don’t see it as the medical problem it is. It’s just that it’s not a very “visible” medical problem.
In the past 40 years or so that you’ve been a therapist and have treated people with depression, what have you observed about the rate of depression in our country and our understanding of it?
I think the rate of depression, everybody would agree, is growing. More and more people are suffering depression.
There are different reasons why when we look at this.
Culturally, one of them is that American culture is a highly stressed culture. But it’s stress not over life and death, but that’s certainly the case for many living in poverty who have to worry where their next meal is coming from, but usually, what we look at is the stress of always needing to be more, to do more, to get more status and money. That’s not a very good way to feel good about yourself because there’s a limit, a human limit of time, a limit of money, a limit of talent or ability, a limit to resources or access to achievement.
Following up on what you just said earlier, you talked about some possible causes of depression including genetics and family of origin issues. Now you’re talking about American culture and its connection to depression. What is the connection?
We have a culture that values productivity, money, and status, and not everybody can achieve goals of status or financial success and it gets depressing to see how valuable those seem to be in our country.
We don’t value something everybody can do. Like, be a person of good character. We value how much status you’ve got, which is very different.
Why did you write the book, “The Ten Best-Ever Depression Management Techniques?” It’s a great read. I recommend all my listeners and readers at lawyerswithdepression.com to pick it up.
I wrote it because I believe both consumers and therapists need ideas for what to do right now other than to investigate, in some more general way, a life history, what do you do today that will make you feel somewhat better, to start you moving out of the depression. I wanted to present as many practical ideas as I could that would help people start to lift out of depression with the help and advice of a therapist and also for the general public that could read this book and say, “Oh, there are things I can do that would make me feel better.” And they’re simple; they’re not complicated.
Can you share with our listeners some of the techniques you recommend in your book?
Let’s start with somebody with low energy. Almost everybody who is depressed is doing something even while they are depressed. Playing a game on their phone, watching T.V. or watching Netflix. They are doing something. Unless, they are sleeping, of course. But I want to use what you’re already doing to help motivate you to do something you think you should do. So, for example, I often see people with depression that aren’t doing good health care, they’re not doing good care of their environment, they are not doing dishes, they are not doing laundry, stuff like that. So if you just think about household stuff for a second, what I want my clients to do is to break down the task into its parts.
If you’re going to do laundry, the first thing you have to do is pick it up off the floor. So, I don’t want you to think, “Oh, I’ve got to get all the laundry done.” If you’re depressed, that won’t work. What I want you to do is think is, “All I have to do is pick up the dirty clothes in the family room and then I’m going to sit down for 15 minutes and do what I’m willing to do anyway – play a game on the phone, turn on Netflix. Set a timer for 15 minutes of enjoyment of your show and then when the timer goes off, you just get up and pick up the clothes off the floor of your bedroom. Little pieces, okay.
What we know about depression is those small accomplishments are perceived in the brain as positive and encouraging, and you start to feel, “Oh, I can do something for myself.” You begin to have just a little rise in your overall energy. If you can do that consistently, then pretty soon, you get the task of doing the laundry over with. It may take a few days, but it’s done. Then you have a positive self-appraisal. That’s what I’m going for, for example, with a very simple way to think about raising your energy through small increments.
So the small steps and small behaviors affect neurochemistry?
They do, indeed. Because when you take action and it has a positive outcome, you have just changed the level of the neurochemical called dopamine, which I call the “James Brown” of the brain. It’s the “I feel good,” when dopamine is released in your brain you feel better. We know that people who decide, “I am going to do this,” and do it, they get a rise in dopamine and change your neurochemistry.
I want to discuss your second book, “Anxiety + Depression: Effective Treatment of the Two Co-Occurring Disorders.” I struggle with both anxiety and depression with depression being the primary diagnosis. Many people I meet struggle with both. Why do the two co-occur together and sometimes not?
Very often, if you are looking at brain function and structure, what you see in people who have both anxiety and depression, which, by the way, is about fifty-percent of the time, is that people who have one, have the other. Often, the anxiety comes first, and it’s not treated well. There’s a neurochemical called serotonin which is related to something called rumination or you might think of it as “brooding.” When people brood, when they go over and over a failure or fear, they get stuck mentally. It raises anxiety because it’s hard to solve a problem that you’re just brooding about and it raises depression because you don’t feel like you’re moving very much in your behavior or your thinking. That’s a pretty simplistic statement. And people will say, yes, but there are far more theories about the underlying neurochemistry. That’s true, but the chemistry that relates to brooding is related to both anxiety and depression, the repetitive, negative thinking.
Regarding your history as a therapist treating people with anxiety and depression, are there some techniques that work better with anxiety versus depression? Or, do all these techniques work equally well with both conditions?
I think you have to look at the energy level. Some people with anxiety and also depression have a fair amount of energy to cope with the depressive quality of repetitive, negative thinking. And you use the energy of that anxious person to be more assertive with yourself to say, “I’m going to take charge of this.”
But what I also find that works very well with anxiety and depression together is to work on mindful awareness, to try to stay in the moment, not to try to predict a negative outcome, but rather to pull yourself into the moment. And mindfulness, which can be done by meditating to stay in the present moment, but you can also just keep pulling yourself back to this moment by saying to yourself, “What’s happening now?” This pulls you back from predicting negative outcomes and then getting upset about what might happen. If you stay in the now, you can say I can do this activity now, this action now, and all I have to worry about is now. And then you tend to get better outcomes. So, that’s good for both for anxiety and depression.
Anxiety is “I worry about the future; I fret about the past.” And depression includes, “I think the future will be grim.” So if you stay in the moment, you’re addressing both of them.
As a psychologist and therapist who’s worked with people with anxiety and depression for decades, tell us a little bit why a person struggling with depression and anxiety should see a psychologist, a therapist? What benefit could be obtained from seeing someone such as yourself and how does that work?
We know that medication, which is often people’s first choice, can be extremely helpful. But what I say to my clients is that medication can help you feel somewhat better, but it doesn’t teach you anything about managing your life. Psychotherapy, when it’s practical, when I’m looking at it through the “The Ten Best-Ever Depression Management Techniques,” what it’s teaching you is how to handle your negative mood, what to do when you don’t have energy. It’s teaching you behavior that will rewire your brain. It talks about how and why exercise and nutrition are important.
But also why taking even a small action on your behalf changes your neurochemistry. So, psychotherapy immediately affects brain function. But, you usually need a psychotherapist to give you ideas, help you find ideas of how you stop yourself, how you block yourself, and to help you find the most effective tools for you in your specific situation. A psychotherapist can be very helpful in teaching you how to get rid of these negative symptoms and feel better for life.
Dr. Wehrenberg, what’s the best way for our listeners and readers to get in contact with you?
Well, if you’re able to spell my name, you can look me up on Margaretwehrenberg.com. I work in Naperville, Illinois. But my website has my telephone contact and a link. And if you went to the Psychology Today magazine website, you can look at my blog on depression, and you would be able to contact me through there as well. I have a really good “Contact me” on my website.
On behalf of your listeners at Lawyerswithdepression.com., I want to take the time to thank you for this insightful interview. I think it’s going to help many people.
Thank you for having me. I appreciate it.
I am a lawyer, like many of you.
I also struggle with depression, like too many of you as well.
A new study by the American Bar Association and the Hazelden Betty Ford Foundation found that twenty-eight percent of over 12,825 practicing lawyers polled reported a problem with depression. This is over three times the rate found in the general population. When put in perspective, of the 1.2 million attorneys in this country, over 336,000 reported symptoms of clinical depression.
Levels of stress, anxiety, and problem drinking were also significant, with 23%, 19%, and 20.6% experiencing symptoms of stress, anxiety, and hazardous drinking, respectively.
“This is a mainstream problem in the legal profession,” said
An international research team says they have identified the physical source of depression in the brain in a new study. Investigators traced depression, one of the most common mental ailments in the world, to the lateral orbitofrontal cortex, the part of the brain responsible for a non-reward mechanism. According to the research team, this is likely the reason people living with depression often feel a sense of loss, disappointment, and low self-esteem. Read the rest of the News.
Tiffanie Verbeke writes: “Did you know that coping with depression improves with practice? I wish that depression checked prerequisites before working itself into someone’s brain. I want to know that I’ve met a checklist of skills that guarantees that I’m fully capable of coping with depression. Fortunately, coping skills can improve with practice, in which case I think that depression could almost be viewed as a sport. Athletes have basic skills that help them succeed, but they must practice smaller, more specific skills in order to improve their overall success at the sport.” The same goes for coping with depression. Read the rest of her blog.
Ashleigh-Rae Thomas blogs, “Depression, anxiety, PTSD, borderline, these are all diseases and disorders. You haven’t done anything wrong! It’s taken me a long time to realize too that I haven’t done anything wrong.When I was going through it, and if I’m being honest, I still am, I felt utterly alone. The symptoms of depression sometimes present themselves as flaws. I kept thinking if I adjusted my attitude or if I weren’t such a bad person then I would feel better.” Read the rest of her blog.
Ester Crain writes, “Feeling down in the dumps every so often is a normal part of life. But when you’re gripped by an unrelenting sadness or hopelessness that keeps you from going about your usual routine, it’s time to pay attention: it’s the hallmark sign of clinical depression, and an estimated 7% of adults will experience it, according to the National Institute of Mental Health.” Read the rest of her blog.
Psychiatrist, Ian Drever, M.D., blogs, “It’s one of those words that gets thrown around a lot, and we all think we know what it is to be depressed, but do we really? Rather than seeing depression as just a one-dimensional illness of low mood, I think it’s better viewed as a collection of features which affect both mind and body. Everyone’s precise mix will be unique to them, and will often vary from day to day — even from hour to hour.” Read the Blog
From the Storied Mind website, blogger John Folk-Williams writes, “With all the conflict about defining depression, it’s not surprising if you’re confused about what it is, where it comes from and how best to treat it. There may not be much disagreement or confusion about what it does to you. But there is a difference of opinion about whether those impacts are a good or bad influence in your life.” Read the Blog
Are you a lawyer suffering from depression? Do you know a colleague that struggles with it?
If so, you’re not alone.
A new landmark study conducted by the Hazelden Betty Ford Foundation and the American Bar Association Commission on Lawyer Assistance Programs published this February reveals that 21 percent of licensed, employed attorneys currently qualify as problem drinkers, 28 percent struggle with some level of clinical depression and 19 percent demonstrate symptoms of anxiety. Forty-six percent (46%) reported concerns with depression at some point in their legal careers.
When put in perspective, that means that of the 1.2 million lawyers in the U.S., 336,000 lawyers have struggled with some form of depression this past year. A staggering number when one considers the rate of depression in the general population is ten-percent.
WHAT IS DEPRESSION?
Depression can be mild, moderate or severe in intensity. According to the National Institute of Mental Health, symptoms include:
- Difficulty concentrating, remembering details, and making decisions;
- Fatigue and decreased energy;
- Feelings of guilt, worthlessness, and/or helplessness;
- Insomnia, early- morning wakefulness, or excessive sleeping;
- Irritability, restlessness;
- Loss of interest in activities or hobbies that were once pleasurable;
- Loss of pleasure in life;
- Overeating or appetite loss;
- Persistent sad, anxious or “empty” feelings; and
- Thoughts of suicide or suicide attempts.
Whether or not you’re clinically depressed can only be determined by a mental health professional. To be so deemed, you must have at least five of the above symptoms for at least two weeks.
But many people never get to the point of receiving such an evaluation or treatment because they or others see their symptoms as a “slump,” “sadness,” or even burnout. Perhaps a vacation will cure the blues, some say. Others take the tough love approach and tell the depressed lawyer to “snap out of it.” But none of this works.
The opposite of depression is not happiness, but vitality – the ability to experience a full range of emotions, including happiness, excitement, sadness, and grief. Depression is not an emotion itself; it’s the loss of feelings; a big heavy blanket that insulates you from the world yet hurts at the same time. It’s not sadness or grief, it’s an illness.
WHAT CAUSES DEPRESSION?
Depression has many causes: A genetic history of depression in one’s family, hormone imbalances, and biological differences, among others. Certain personality traits, such as low self-esteem, a pessimistic outlook, chronic stress at work or home, childhood trauma, drug or alcohol abuse and other risk factors increase the likelihood of developing or triggering depression.
Why do lawyers experience depression at higher rates?
According to Patrick Krill, J.D., LLM., director of the Hazelden Betty Ford Foundation’s Legal Professionals Program, just why lawyers have such sky-high rates of melancholy isn’t always easy to see:
(The) rampant and multidimensional stress of the profession is certainly a factor. And not surprisingly, there are also some personality traits common among lawyers – self-reliance, ambition, perfectionism and competitiveness – that aren’t always consistent with healthy coping skills and the type of emotional elasticity necessary to endure the unrelenting pressures and unexpected disappointments that a career in the law can bring.
One factor is a pessimistic outlook defined not in the colloquial sense (seeing the glass as half empty) but rather as the pessimistic explanatory style. These pessimists tend to attribute the causes of negative events as stable and global factors (“It’s going to last forever, and it’s going to undermine everything.”) The pessimist views bad events as pervasive, permanent, and uncontrollable while the optimist sees them as local, temporary and changeable. Pessimism is maladaptive in most endeavors.
But there is one glaring exception: Pessimists do better at law. Pessimism is seen as a plus among lawyers because seeing troubles as pervasive and permanent is a component of what the law profession deems prudent. A prudent perspective enables a good lawyer to see every conceivable snare and catastrophe that might occur in any transaction. The ability to anticipate the whole range of problems and betrayals that non-lawyers are blind to is highly adaptive for the practicing lawyer who can, by so doing, help his clients defend against these far-fetched eventualities. If you don’t have this prudence to begin with, then law school will seek to teach it to you. Unfortunately, though, a trait that makes you good at your profession does not always make you a happy human being.
Tyger Latham, Ph.D., a psychologist in Washington, D.C., who treats many lawyers with depression, writes:
. . . I’ve come to recognize some common characteristics amongst those in the profession. Most, from my experience, tend to be “Type A’s” (i.e., highly ambitious and over-achieving individuals). They also have a tendency toward perfectionism, not just in their professional pursuits but in nearly every aspect of their lives. While this characteristic is not unique to the legal profession – nor is it necessarily a bad thing – when rigidly applied, it can be problematic. The propensity of many law students and attorneys to be perfectionistic can sometimes impede their ability to be flexible and accommodating, qualities that are important in so many non-legal domains.
WHAT YOU CAN DO ABOUT IT?
1. Join a Depression Support Group
You can (a) join or (b) start a support group in your community. These groups provide a place for the depressed to share their struggles and gain the encouragement and support they need to recover and remain well.
(a) Join a Group
A depression support group is not “group therapy”. The group is run by those who attend the meetings. To see if there’s a lawyer group in your community, go to the Commission on Lawyer Assistance Programs’ website to find such information. To see if there’s such a group in your city that isn’t lawyer specific, go to the Depression & Bipolar Support Alliance’s website at www.dbsa.org.
(b) Start a depression support group for lawyers in your legal community.
If there’s not one in your hometown or the ones’ you’ve attended aren’t a good fit, think about starting one yourself or with another friend or two.
Read my previous post, “18 Tips on How To Start a Depression Support Group“.
2. Get Educated
There are plenty of great websites to educate you about what depression is and the variety of ways it can be treated. A great resource can be found at the University of Michigan’s Depression Center website at www.depressioncenter.org.
Also, read my previous post, “Dan’s Top 10 Depression Books“.
3. Work with a Lawyer Life Coach
If you would wish to work one-on-one with a life coach, I offer such services at www.yourdepressioncoach.com. My practice is unique in that I am a fellow lawyer who has struggled with depression over the years while practicing law. I believe I can help you if you answer “yes” to any of the following questions:
- You need someone to listen with a sense of compassion. I am that person. I will care. I will be in your corner.
- You need a sense of structure at a time when life may seem pointless and meaningless. I can be an anchor for you, a safe port in a storm, a place to go and share your deepest struggles and concerns about home and work.
- You need someone to educate you about what depression and anxiety are and their symptoms and causes.
- You need guidance as you weave through the matrix of treatment options to find a plan that works for you.
- In addition to treating with a psychologist and/or psychiatrist, you find that you get more encouragement, insight, and support to help you keep moving forward.
- You suffer from anxiety and depression. If so, you’re far from alone. Studies show that as much as 60% of all people with depression also suffer from an anxiety disorder.
I will work with you on whatever specific problem most pressing to you. Here are some areas where depression and anxiety may be causing real pain and trouble in your life:
You need help getting things done at work. You’re falling behind and because of you’re the depression and/or anxiety. I can help by providing insight, support, and exercises to help you deal with this all too common and critical issue.
You want to leave your job. You’ve been coping with work-related depression and/or anxiety for some time and decided “enough is enough”. You want to make plans to transition to another job or career. I can help you develop your game plan to do so and hold you accountable for following through and take the necessary steps to make this a reality.
You’re a “Depression Veteran”. You might be further down the road in your recovery from depression and/or anxiety but still need help and encouragement. Or you’ve been struggling with off-and-on depression and/or anxiety for years. I will work with you to develop a program to make sure you do things that will help you recover and stay well. I will hold you accountable for actually following through with your program. I can help to motivate you to stick with a healthy game plan.
You are just plain unhappy. Many people, while not clinically depressed, are very unhappy with their lives. They have too much stress. Aren’t happy in their careers. Or don’t have a sense of meaning and purpose in their lives. The support and structure I provide for depression sufferers are easily transferable to getting to the heart of what’s causing your unhappiness. I will work with you to build a different set of skills and make different life choices to lead a happier and healthier life.
You need help explaining your depression to others. For loved ones and business associates that have never been through depression, it’s difficult for them to really understand your pain because they really don’t have a point of reference for psychic pain someone undergoes with clinical depression. They mistake it for “the blues” or everyday sadness, which it clearly is not. I can work with you to develop a language and actions that could help others understand. If you wish, I would also be happy to talk with others as your work to educate them about what depression is and ways that might be able to help and support you.
If you relate to any of these issues and think coaching might be a good fit for you, I offer a free twenty-minute consultation. You can contact me at www.yourdepressioncoach.com to schedule a meeting. I coach clients around the country via Skype and over the phone.
Copyright, 2016 by Daniel T. Lukasik, Esq.