Undoing Depression in Lawyers

There’s some interesting research to suggest that happy people view the world through certain comforting illusions, while depressed people see things more realistically. [i] For instance, the illusion of control. You can take a random sample of people and sit them in front of a video monitor with a joy stick, and tell them their joy stick is controlling the action of the game on the screen. (But the point of experiment is that it actually doesn’t). Depressed people will soon turn to the lab assistant and complain that their joy stick isn’t hooked up correctly. Normal people, on the other hand, will go on happily playing the game for quite some time.

I think this explains a lot about why lawyers are so prone to depression. Because of their experience with the law, most attorneys have lost their rose-colored glasses some time ago. (Or else they never had them and chose the law as a career because it suited their personality). Attorneys know that life is hard, and doesn’t play fair. They’re trained to look for every conceivable thing that could go wrong in any scenario, and they rarely are able to leave that attitude at the office.  They see the worst in people (sometimes they see the best, but that’s rare). They tend to be strivers and individualists, not wanting to rely on others for support. They have high expectations of success, but they often find that when they’ve attained success, they have no one to play with, and have forgotten how to enjoy themselves anyway.

All this makes it hard for attorneys to get help with their depression. They tend not to recognize it as such; they just think it’s stress, or burn out, or life. They don’t expect that anyone is going to be able to help. Most of my attorney-patients have contacted me because their relationships are falling apart, but they don’t see that it’s depression that makes them such a lousy partner – tense, irritable, critical, joyless, tired all of the time, relying on alcohol or other drugs. If they’d gotten help for the depression a couple of years previously, their spouse wouldn’t be moving out now. The truth about depression is that it not only makes you feel horrible, it wrecks your life. And that’s why I wrote the book, Undoing Depression, in the first place. I was running an outpatient clinic, and grew exasperated with seeing the people whose lives wouldn’t have been so ruined if they had got some help when they first needed it –  before they alienated their children and spouse, got fired, went into debt, developed a substance abuse problem, etc. I thought there was a need for an intelligent self-help book, one that points out all the bad habits that depression engenders and which, in a vicious circle, keeps reenforcing the disease. But the truth is that self-help isn’t nearly enough for most depression sufferers. It’s as if you stepped over an invisible cliff, and you can’t find your way back doing what you normally do, because that’s what led you over the cliff in the first place. Depression is the original mind/body disease; your physical brain is damaged because of the stress in your mind, and you’re unlikely to undo that damage without help.

Depression is highly treatable, but if you want a lasting recovery you have to change your life. The ugly fact is that depression is very likely to reoccur. If you had one episode of major depression, chances are 50:50 that you’ll have another; if you have three episodes, it’s 10:1 you’ll have more. But you can improve those odds if you get good professional help, with medication and with talk therapy. We won’t put your rose-colored glasses back on, but we can help you see how negative thinking and the negative acting is contributing to your disease.

[i]  See for example, Shelly Taylor: Positive Illusions; and Julie Noren: The Positive Power of Negative Thinking.

Richard O’Connor, Ph.D., is the author of two noteworthy books, Undoing Perpetual Stress: The Missing Connection Between Depression, Anxiety, and 21st Century Illness andUndoing Depression: What Therapy Doesn’t Teach You and Medication Can’t Give You. He is a practicing psychotherapist with offices in New York City and Canaan, Connecticut.  He has suffered from clinical depression and is a member of a depression support group.

 

The Dark Side of Antidepressants

As I’ve intimated, drug industry research on the newer antidepressants has been manipulated to maximize positive results and minimize the downside. Here’s one example: the original research that got FDA approval and set off the craze for these drugs had very low standards, which were not revealed to the public.

ht_cymbalta_100818_ms

They were generally two- or three-month trials, very short over the lifetime course of depression, and the definition of cure was simply no longer meeting all the criteria for major depression. You might still be feeling suicidal and wracked with guilt, but if your sleeping had improved, as far as the FDA was concerned, the drug had demonstrated its effectiveness. Then there was the fact that in all these trials the drugs proved only slightly better than placebo—in most cases, about 40 percent of people got better with a sugar pill, and about 50-60 percent improved with an SSRI. Added to that is the fact that many of these studies stacked the deck by excluding people who were most responsive to placebo.

Subsequent studies, with larger groups over longer periods of time, have shown about the same disappointing results. The STAR*D study, with a large sample of real-world patients, without excluding placebo responders, found that about 50 percent of patients had a significant response to medication, but only about 30 percent met the researchers’ definition of remission. During follow-up, a significant number of patients relapsed. Overall, the recovery rate was only slightly better than chance alone. STAR*D was sponsored by the National Institute of Mental Health and should be considered relatively free of drug company influence.

prozac_180

The withdrawal problems with SSRIs have also been minimized. There can be significant withdrawal problems when you stop taking SSRIs—“SSRI Withdrawal Syndrome”—including extreme anxiety, skin crawling, confusion, GI distress, insomnia, and agitation. For some individuals these symptoms are excruciating. I had a patient who went through weeks of pure hell—fever, nausea, chills, extreme depression, and the certainty she was losing her mind—going off a pill I had encouraged her to take. The best advice is to discontinue any of these medications by tapering off slowly and under a physician’s care.

Last but not least, there are worries that antidepressants interfere with emotional vitality. One study of non-depressed volunteers found that taking an SSRI for only a week interfered with their ability to read facial expressions, especially of anger and fear. Another study of normal volunteers found that four weeks of Paxil significantly reduced their ability to feel sad or angry when appropriate. A group of patients who were experiencing sexual side effects also developed significantly less ability to cry or care about others’ feelings. They also lost erotic dreaming, surprise, creativity, anger, and ability to express their feelings.

Therapists who take SSRIs themselves were very disturbed by these findings, wondering if it meant they were losing their ability to be empathic; many of us have stopped medications as a result. I know a musician who tried Lexapro for his social anxiety and asthma. He noticed that he stopped getting chills and goose bumps when he was really moved by music. When he stopped Lexapro, he was able to get goose bumps again. He felt that he had also lost some of his ability to immerse himself in the music. Another male patient, who was prone to picking up girls for one-night stands, reported that with Paxil he stopped feeling guilty. At least he recognized this was a problem.

Listening-to-Prozac

It seems quite possible that SSRIs (and other antidepressants, for all I know) get some of their effect from an overall emotional blunting, especially of negative feelings. Their use may make us temporarily a little shallow or insensitive. As far back as Listening to Prozac (1993), Peter Kramer was advancing the theory that people with depression may be especially sensitive to signs of rejection, and that SSRIs helped them cope better. This is one of the reasons why I’m so against the use of antidepressants by people without severe depression who simply want to feel better. They may worry less, but it can damage their relationships, reduce their enthusiasm, make them more shallow and unrealistically complacent. This may be why, in this age of stress, so many people are using antidepressants—the drugs can help people put up with things they should not put up with.

Bottom line on SSRIs? Depression is a serious illness, and these are serious medications. No one should ever take them lightly. They definitely can do harm, but the harm depression can do can be much worse. If you have a severe depression, you owe it to yourself to give medication a genuine try. But it needs to be part of a balanced plan that includes good psychotherapy and a lot of self-care. One thing medication can do is let you have the energy or hope to follow through.

By Richard O’Connor, Ph.D.

Dr. O’Connor is the author of the best-selling books, Undoing Depression and Undoing Perpectual Stress: The Missing Connection Between Anxiety, Depression and 21st Century illness.

Undoing Depression in Lawyers

There’s some interesting research to suggest that happy people view the world through certain comforting illusions, while depressed people see things more realistically. [i] For instance, the illusion of control. You can take a random sample of people and sit them in front of a video monitor with a joystick, and tell them their joystick is controlling the action of the game on the screen. (But the point of experiment is that it actually doesn’t). Depressed people will soon turn to the lab assistant and complain that their joystick isn’t hooked up correctly. Normal people, on the other hand, will go on happily playing the game for quite some time.

I think this explains a lot about why lawyers are so prone to depression. Because of their experience with the law, most attorneys have lost their rose-colored glasses some time ago. (Or else they never had them and chose the law as a career because it suited their personality). Attorneys know that life is hard, and doesn’t play fair. They’re trained to look for every conceivable thing that could go wrong in any scenario, and they rarely are able to leave that attitude at the office.  They see the worst in people (sometimes they see the best, but that’s rare). They tend to be strivers and individualists, not wanting to rely on others for support. They have high expectations of success, but they often find that when they’ve attained success, they have no one to play with, and have forgotten how to enjoy themselves anyway.

All this makes it hard for attorneys to get help with their depression. They tend not to recognize it as such; they just think it’s stress, or burn out, or life. They don’t expect that anyone is going to be able to help. Most of my attorney-patients have contacted me because their relationships are falling apart, but they don’t see that it’s depression that makes them such a lousy partner – tense, irritable, critical, joyless, tired all of the time, relying on alcohol or other drugs. If they’d gotten help for the depression a couple of years previously, their spouse wouldn’t be moving out now. The truth about depression is that it not only makes you feel horrible, it wrecks your life. And that’s why I wrote the book, Undoing Depression, in the first place. I was running an outpatient clinic, and grew exasperated with seeing the people whose lives wouldn’t have been so ruined if they had got some help when they first needed it – before they alienated their children and spouse, got fired, went into debt, developed a substance abuse problem, etc. I thought there was a need for an intelligent self-help book, one that points out all the bad habits that depression engenders and which, in a vicious circle, keeps reinforcing the disease. But the truth is that self-help isn’t nearly enough for most depression sufferers. It’s as if you stepped over an invisible cliff, and you can’t find your way back doing what you normally do, because that’s what led you over the cliff in the first place. Depression is the original mind/body disease; your physical brain is damaged because of the stress in your mind, and you’re unlikely to undo that damage without help.

Depression is highly treatable, but if you want a lasting recovery you have to change your life. The ugly fact is that depression is very likely to reoccur. If you had one episode of major depression, chances are 50:50 that you’ll have another; if you have three episodes, it’s 10:1 you’ll have more. But you can improve those odds if you get good professional help, with medication and with talk therapy. We won’t put your rose-colored glasses back on, but we can help you see how negative thinking and the negative acting is contributing to your disease.

[i] See for example, Shelly Taylor: Positive Illusions; and Julie Noren: The Positive Power of Negative Thinking.

Richard O’Connor, Ph.D., is the author of two noteworthy books, Undoing Perpetual Stress: The Missing Connection Between Depression, Anxiety, and 21st Century Illness and Undoing Depression: What Therapy Doesn’t Teach You and Medication Can’t Give You. He is a practicing psychotherapist with offices in New York City and Canaan, Connecticut.  He has suffered from clinical depression and is a member of a depression support group.

 

Depression & Procrastination

Most people who are depressed have a hard time being productive. Work—and here I mean everything from paid employment to child-rearing and housekeeping to the kinds of “work” we assign ourselves, like reading a good book or planting a garden—is a chore to the depressed. It drains us, leaves us feeling as bad as before, physically worn out and emotionally depleted, instead of proud of ourselves and invigorated. Other people with depression seem to work very hard all the time, but there is little payoff for their efforts. As with so much of depression, there is a real chicken-or-egg question—is work so difficult because we’re depressed, or are we depressed in part because we can’t accomplish anything? And as with so many chicken-or-egg situations, we face a false dichotomy: the truth is, poor work habits and depression reinforce each other.

Depressed people tend to be great procrastinators. Procrastination means putting off for a later time what “should” be done now. The “should” may come from without, as with the teenager who dawdles over homework, or from within, as with me planting my garden. When it comes from without, it’s easy to see the rebelliousness that procrastination expresses. When it comes from within, it’s hard to see immediately what purpose procrastination serves—but it may serve many.

procrastination-meterProcrastinators have some big false assumptions about how work works. They assume that really productive people are always in a positive, energetic frame of mind that lets them jump right into piles of paper and quickly do what needs to be done, only emerging when the task is accomplished. On the contrary, motivation follows action instead of the other way around. When we make ourselves face the task ahead of us, it usually isn’t as bad as we think, and we begin to feel good about the progress we start making. Work comes first, and then comes the positive frame of mind. Closely allied to this misunderstanding about motivation is the idea that things should be easy. Depressed people assume that people who are good at work skills always feel confident and easily attain their goals; because they themselves don’t feel this way, they assume that they will never be successful. But again, most people who are really successful assume that there are going to be hard times, frustrations, and setbacks along the way. Knowing this in advance, they don’t get thrown for a loop and descend into self-blame whenever there’s a problem. If we wait until we feel completely prepared and feeling really motivated, we’ll spend a lot of our lives waiting. See my page on developing greater will power.

Procrastination can also help protect the depressed person’s precarious self-esteem. We can always tell ourselves we would have done it better if. . . . The paradigm is the college term paper rushed together in a furious all-nighter. The student protects himself from the risk of exposing his best work by never having the time to do it right. This allows him to protect his fantasied sense of himself as special and uniquely gifted. Procrastination is also a result of the depressed person’s tendency toward perfectionism, a crippling problem. Research has shown that the more perfectionistic a depressed person is, the worse his chances of recovery. Trying so hard to make every single little piece of a project perfect, we doom ourselves to disappointment and frustration.

broad_chain_closeup_c_wikimedia_org_There is a simple, useful process psychologists call chaining, or making one event depend on another event’s being accomplished first. You can make chains that help you get a lot of work done. I want to go play Tomb Raider on my computer, but I’m going to let that be my reward for first going through the outdated magazines. As I go through the pile, I find there’s one I really must renew my subscription to. Now I have to do that as well before I play Tomb Raider. Renewing that subscription reminds me that I have a stack of unpaid bills nagging at me. Maybe I can’t get the bills all paid, but I can take twenty minutes to get them organized and make a commitment to myself to pay them tomorrow. Now I can go play my computer game feeling a little less overwhelmed by events and a little more deserving of some time to goof off. As you get used to this practice, your chains can get longer and longer without getting burdensome.

Finally, there’s also the Irish way of overcoming procrastination. Confronted with a wall too high to climb, the Irishman throws his hat over it. Now he must find a way over the wall. If I have to paint a room, I’ll likely get the paint and start the first coat as soon as I can, disrupting the whole household in the process. That way I’m fully committed, and have to finish quickly.

Controlling procrastination is more like controlling eating or exercise than smoking or drinking; it’s impossible to never procrastinate. For one thing, often it’s not clear which of two is the most important activity. Study for the exam right now, or eat dinner and then study? Or eat dinner, take out the garbage, walk the dog, call a friend, check Facebook, and then study? But procrastination is a habit that can gradually be replaced by the habit of not putting things off.

Rita Emmett, in The Procrastinator’s Handbook, gives us Emmett’s Law: “The dread of doing a task uses up more time and energy than doing the task itself.” Here’s O’Connor’s corollary: “It’s amazing what you can accomplish when you finally get down to work.” So my first advice for overcoming procrastination is to glue your seat to the chair, ignore distractions, and work for five minutes. Then you can take a short break if you feel it’s necessary, but put in another five minutes after your break. The procrastinating impulse in your mindless self won’t respond to logical argument, but it may respond to a narrowing of focus. You’ll get in a groove, start feeling productive, and the impulse to procrastinate further will dwindle. If it doesn’t work today, try again tomorrow.

A second piece of advice: while you’re sitting glued to your chair, you’re not allowed to do anything other than the task you’re there for, no matter what attractive distraction might come to mind. You don’t have to work on your primary task, but you can’t do anything else. This can be torture, but it’s great mental discipline. You’ll quickly see how easily distracted you are, but you’re forced to develop the will power to withstand temptation. Eventually, you’ll get something constructive done.

Hold yourself to precommitments. No television (Internet, email) until I’ve worked for a half hour. If I get X done, I’ll reward myself with pizza tonight; otherwise it’s peanut butter. Be sure to keep these commitments reasonable and don’t set yourself up to fail. If you practice and get consistent at this, you can start to up the ante.

Business Finish LineProcrastinators don’t reward themselves for finishing. A drink with friends, a special dessert—things that normal people might do to celebrate an accomplishment—these things don’t occur to procrastinators (partly because they’re never satisfied with their results). But it’s important to practice these rituals because, in our minds, the pleasure that comes with the reward comes to be associated with doing a job well. In this way, work itself becomes more satisfying.

Clutter is highly associated with procrastination. Each of those extraneous items on your desk, workspace, or computer desktop is a distraction, a reminder of something else to do. Mental clutter works the same way; if you have a set of nagging chores, just making a list will help you focus on the present. The list will contain the nagging. Every time we are distracted, we lose efficiency. You can reduce your procrastination greatly by eliminating distracting cues.

Of course, personal computers and wireless communication have created many more temptations to procrastinate—games, Facebook updates, checking on the news. Tweets, cell phone calls, and instant messages constantly break our concentration. If we really want to focus on something, we have to remove temptation and prevent interruptions. If you work on your computer, turn off your Internet browser and make it difficult to get back on. Put the phone on silent. Multitasking is a myth.

By Richard O’Connor, Ph.D.

Dr. O’Connor is a therapist and best-selling author of the book Undoing Depression: What Therapy Can’t Teach You and Medication Can’t Give You.

 

Running on Empty

From the site Undoing Depression, Richard O’Connor, Ph.D. blogs that professionals frantically run from one success to another because they’re afraid some unnamed demon will catch up to them.  Read the Blog.

The Triumph of the Human Spirit – Folks Dealing with Depression

A hero is an ordinary person who finds the strength to persevere and endure in spite of overwhelming obstacles – Christopher Reeve.

I want to tell others about all the remarkable people I’ve known who’ve struggled with depression.  While they’re not paladins that ride into medieval battle swinging swords atop snorting mares, they fight a different kind of battle.  And one no less heroic.

Many of the best people I’ve been privileged to know struggle with depression every day.  While they don’t have shiny medals pinned on their lapels, there is an unmistakable strength in them – even if they don’t see it.  I know it’s real because I see and feel it – just like when I am in a grove of giant and majestic pines during a walk in the forest that must withstand the fury of a winter’s storm in January.

A Hero Steps Forward

Take Bob Antonioni. Bob’s story appeared in Esperanza magazine’s regular column, “Everyday Heroes”.  He had a budding political career in the Massachusetts State Senate and a law practice. Despite holding such a public position, Bob took the courageous step to disclose that he suffered from clinical depression in the hope of letting others know it was okay – there wasn’t anything to be ashamed of:

“Telling his story has become another tool to chip away at stigma. Yet he remembers his trepidation when he disclosed the truth in a November 2003 interview with a local newspaper.
‘I had misgivings,’ he admits, ‘but I guess I didn’t give people enough credit. All I heard were thank yous —the complete opposite of what I expected.’ In fact, Antonioni was re-elected twice after that. He retired from public office in 2009 to have more time for himself and his family, but continues to practice law and pursue his advocacy work.”

To me, it says something wonderful about the human spirit that against such a formidable foe as depression, people keep fighting to get better. And many triumph. Just like Bob.

The Black Dog

A few weeks ago in Canada’s Globe and Mail newspaper, there was a great piece, Ill to Power.  The article was about Winston Churchill’s life-long battle with depression written by the author of the new book, A First-rate Madness.  Here, he describes Churchill’s struggles:

“There is no doubt that he had severe periods of depression; he was open about it – calling it, following Samuel Johnson, his ‘Black Dog.’ Apparently his most severe bout of depression came in 1910, when he was, at about age 35, Home Secretary. Later in his life, he told his doctor, ‘For two or three years the light faded from the picture. I sat in the House of Commons, but black depression settled on me.’ He had thoughts of killing himself. ‘I don’t like standing near the edge of the platform when an express train is passing through’.”

Like Churchill, Abraham Lincoln struggled with major bouts of depression.  In the book Lincoln’s Melancholy: How Depression Fueled a President to Greatness, Lincoln writes about a cloud over him that every bit matches Churchill’s darkness:

“I am now the most miserable man living.  If what I feel were felt by the whole human race, there would not be one cheerful face left on earth”.

Lincoln, who many say was one of this country’s greatest heroes, apparently did not feel like one all the time.

Hard to Feel Like a Hero

Most people depression — in some fundamental sense –feel broken.  This conclusion is fueled by the depression itself – both biological (sleep, appetite, energy levels) and psychological (e.g. “Nobody really cares about me”, “I stink at my job” or “My depression will never end”).  But this brokenness isn’t just an “inside job” – crummy stuff they tell themselves about themselves.  Other people or events in a depressive’s daily orbit serve-up damaging assessments and innuendos about a depressed person’s behavior or personhood.

Others may tell them that they are letting them down at the office or not contributing enough to family responsibilities – yes, loved ones can get fed up with the depressed person’s withdrawal from the family, the inability to do chores he/she used to do and the depressed person’s sourpuss.  Or, they deny the immensity of the suffering of the depressive by minimizing it:  “Don’t worry, things will get better.  You’re just in a slump.” 

We sense that their agenda isn’t so much about helping us get better, as it is about them their needs.  Why else would we feel so much crappier and lonely after such exchanges?  It isn’t as if their needs aren’t important, but shouldn’t our mental health be at least as important?

Then there is the cultural stigma – a cloud of ignorance, fear and misunderstanding – surrounding depression.  American culture tends to see depression as a moral or personal weakness; the “just-get-over-it” rants of a society that likes simplistic answers to complicated problems.  Dr. Richard O’Connor, in his book Undoing Depression, captures some the irony of how our society sees depression as different from – or maybe not as real as — other forms of illness:

“Where’s the big national foundation leading the battle against depression?  Where is the Jerry Lewis Telethon and the Annual Run for Depression? Little black ribbons for everyone to wear?  The obvious answer is the stigma associated with the disease. Too much of the public still views depression as a weakness or character flaw, and thinks we should pull ourselves up by our bootstraps. 

And all the hype about new antidepressant medications has only made things worse by suggesting that recovery is simply a matter of taking a pill.  Too many people with depression take the same attitude; we are ashamed of and embarrassed by having depression.  This is the cruelest part of the disease: we blame ourselves for being weak or lacking character instead of accepting that we have an illness, instead of realizing that our self-blame is a symptom of the disease.  And feeling that way, we don’t step forward and challenge unthinking people who reinforce those negative stereotypes.  So we stay hidden away, feeling miserable and yourselves for ourselves for our own misery”.

Renaming One’s Walk through Depression as Heroic

Why can’t we re-imagine our self-image in relationship to our depression in a more positive light?  Why can’t we think of our battles with depression as, in fact, heroic?  Instead of counting all of times that depression has gotten the better of us and knocked us to our knees, how about giving ourselves credit for all of the times that we have triumphed over depression (perhaps even in the simplest ways); the times that we have risen to the occasion in spite of our melancholy and the moments that we have looked depression in the eye and said, “no more.”  Make no mistake about it that takes gumption – lots of it!  And I’ve witnessed scores of people say “that’s enough.”  While talking back to depression isn’t a panacea, it may be a healtier way for us to cope rather than succumb to it.

Viewing yourself as a hero is a constructive and healing experience for people with depression.  It doesn’t deny that we struggle with it sometimes, but it more importantly doesn’t deny the power we actually do have over it and the courage it takes to deal with it to the best of our ability each day.

In his article “The Continuing Stigma of Depression” psychologist Jonathan Rottenberg writes about the stigma for those who have recovered from depression:

“My hunch is that the disease/defect model of depression, is unwittingly contributing to the ongoing stigma of depression.  Through the lens of the disease model, the legions of the formerly depressed are a “broken” people who need lifelong assistance.  I would like to see a more revolutionary public education approach, with campaigns that emphasize the unique strengths that are required to endure depression. Even if a person is helped by drugs or therapy, grappling with a severe depression requires enormous courage.  In many ways, a person who has emerged from the grip of depression has just passed the most severe of trials in the human experience.  If we acknowledge that surviving depression requires a special toughness, we will not see formerly depressed people as a broken legion, but as a resource who can teach us all something about overcoming adversity”. 

Things to Consider

 – Maybe we fall down 30 times a day, or maybe it’s just a stumble, but we have to regain our balance and get up.  As the old Zen saying goes, “fall down seven times — get up eight.”  That, my friends, is heroic. Just remember that when you fall and get up – YOU are that hero.

– We must remember that when we are in a depression, it isn’t easy to feel like a hero — just think of Honest Abe. But the depression will pass. So don’t be too hard on yourself if you don’t feel heroic all the time.

– We should not condemn ourselves when we are down, but pick ourselves up and remember that we are, truly, remarkable people. 

As writer Andrew Berstein once wrote:  “A hero has faced it all: he/she need not be undefeated, but he/she must be undaunted.”

 

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.

 

 

Our Struggle with Depression

 

Everyone has had a taste of what depression feels like. Everyone feels the blues at times. Sadness, disappointment, fatigue are normal parts of life. There is a connection between the blues and clinical depression, but the difference is like the difference between the sniffles and pneumonia – Richard O’Connor, Ph.D.

Years ago:  I am walking down a Manhattan street on a grey day.  I am feeling so sad; beyond somber and without any external point of reference. I looked up at the grey buildings. I suddenly have the sense that I am a building; a tower with a cracked foundation slowly falling to the pavement below.

I step into a church I don’t know.  I try to pull myself together. “Please God. I need your help.” I have to be in Court shortly. I look at my watch. My suit feels tight against my skin. I struggle to make the sadness more manageable, more contained.  I leave because I must, not because I feel any better; but because I am an adult and have to move through my day, no matter the volume of pain ringing in my ears.

The sadness from that day would end.  I would feel better.    But a pattern was developing, even then.  A pattern of how I would respond to sadness in my life, both past and present.

The Struggle to Break Free   

Some folks have given up hope that depression will ever leave them alone. They’re just hoping for more good days than bad.  When it’s a relatively good day, when life is in flow and not stuck in the muck of melancholy, there is happiness, or perhaps, relief.  The depression gods’ hurtiling thunderbolts have missed them this day. But when they’re in the thick of it, they fight their sadness.  It’s as if they’re pressing on the gas trying to escape their pain while depression has its foot on the brake.

Sadness is not Depression – though they are cousins

First, let’s be clear: sadness is not depression, but it may manifest as persistent sadness that can be a symptom of clinical depression. When I developed depression ten years ago, my sadness was accompanied by lots of crying for no particular reason.

Paradoxically, Dr. O’Connor, in his book, Undoing Depression , wrote that depression is often the absence of despondency:

“We confuse depression, sadness, and grief.  However, the opposite of depression is not happiness, but vitality – the ability to experience the full range of emotions, including happiness, excitement, sadness, and grief.  It’s not sadness or grief, it’s an illness.”

Maybe this is why we don’t see – we don’t see how we react to our own sadness because we’re stuck in the vortex of depression where everything, like the perimeter of a tornado, is thrown together.

This relationship between sadness is troublesome for a depressive.  This is so not because there is anything wrong with sadness – it’s a normal part of the human experience and gives our lives depth and pitch.  It’s the bass tone you hear when B.B. King plays the Blues. In my experience, sadness has a bittersweet quality to it. As the great novelist Herman Hesse once penned, “It was if all of the happiness, all of magic of this blissful hour had flowed together into these stirring, bittersweet tones and flown away, becoming temporary and temporary once more.”

The Brain Knows How we React to Sadness

A recent study revealed that the brain’s response to sadness can predict a relapse into depression.  Faced with sadness, the relapsing patients showed more activity in a frontal region of the brain, known as the medial prefrontal gyrus.  These responses were linked to higher rumination: the tendency to think obsessively about negative events.  Patients who didn’t relapse showed more activity in the rear part of the brain, which is responsible for processing visual information and is linked to greater feelings of self-acceptance and non-judgment of experience. 

According to Norman Farb, Ph.D., who did the study:  “For a person with a history of depression, using the frontal brain’s ability to analyze and interpret sadness may actually be an unhealthy reaction that can perpetuate the chronic cycle of depression.  These at-risk individuals might be better served by trying to accept and notice their feelings rather than explain and analyze them.”

We keep trying to find the source of our sadness like squinting to find the bucket that has fallen in the deep well.  We circumambulate the hole, peering into the darkness, but don’t see the flashlight nearby that can help.  We can’t see that our attempt to break down and explain our sadness to ourselves isn’t helping – it’s hurting us.

A New Relationship to Our Sadness

In his book The Mindful Path to Self-Compassion, Christopher Germer, Ph.D., writes:

“This is an opportunity to move from mental work to heart work.  Self-compassion has a distinctly nonintellectual and non-effortful feel to it. If we can find ourselves in the midst of suffering and acknowledge the depth of our struggle, the heart begins to soften automatically. We stop trying to feel better and instead discover sympathy for ourselves. We stop trying to feel better and instead discover sympathy for ourselves. We start caring for ourselves because we’re suffering.”

Don’t always try to figure out your depression. Give yourself a breather from solving it, this boulder of sorrow. Instead, see that you – yes, you – are worthy of compassion from yourself because you suffer. If you don’t know how to feel this compassion for yourself, isn’t it about time to try?

 

 

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.

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