Three Skills for Overcoming Depression

 

“Courage is fear that has said its prayers.” Author, Regina Brett

The legal profession and those who shape it devote plenty of time to the practical side of being a lawyer; the nuts-and-bolts of how to do, for example, a Will and Estate.  Precious little time, however, is spent on teaching lawyers how to maneuver skillfully through their lives not just as professionals, but as people. 

Three years ago, when I first went public with my depression, I suggested to a Bar Association director that we put on a half-day Continuing Legal Education Seminar on Depression.  She looked at me oddly — as if her face were about to crumble — and said “Who in the world is going to show up for that.” With some trepidation, I went forward expecting twenty people – over 125 showed up.  Lawyers are hungry for meaning in their lives and want direction from other people in the business. 

Ideally, every young lawyer should be paired with a mentor, a wise elder of the law.  Lacking that, few lawyers have examples of how to deal with the profession in a healthy and meaningful manner.  Is it any wonder then that lawyers suffer from depression at twice the rate of the average citizen? 

We live in a profession where people endure a real pain, trauma and meaninglessness in the hope that it will get better “someday” in the indeterminate future.  That someday may come sooner than later in the form of early retirement forced by burnout, unforeseen illness or some sort of divine intervention.  I don’t see this as pessimistic, but as realistic.  My goal is to wake lawyers up to the real costs of approaching their vocation with only nut-and-bolts in their tool chest.  We are not crude machines in need of tune-ups.  We are living beings in need of emotional and spiritual sustenance.

Depression is a type of half-living; we go to work, raise our children, sip lattes, do wheelies on our mountain bikes or grill steaks on the grill.  But there is something vital within us always yearning just below the surface, something that seeks expression in our lives. Perhaps the situation wouldn’t be so dire for the legal profession if our time as lawyers were just okay – a manageable amount of stress, decent interactions with people and fair wages.  But it isn’t okay; it’s completely out of balance: too much stress, combative interactions and wages, albeit much higher than the average American worker, that exacts a tremendous toll on our brains and bodies.

Is there any hope, any way out of this legal conundrum?  I think there is because I have seen it happen in my own life, and in the lives of scores of other lawyers.  For most – including me—the pain decibels have to be jacked up pretty high for us to conclude that change is better than living one’s life this way. 

Carl Jung, a former protégé of Sigmund Freud, offers us a great deal of wisdom for dealing with our modern day psyche.  He never preached a “top ten” ways to overcome depression, but some of his essential wisdom can be summarized for the modern reader.  In dealing with melancholy, he said that there were three essential steps that we need to take – and no one else can take them for us.

In his book “Why Good People Do Bad Things,” James Hollis, a student of Jung, writes:

“To gain the positive values arising from the “landfill” we call the Shadow [i.e. to learn the painful lessons that depression is trying to teach us], we have to wrestle with Jung’s suggestion that to be a full , we have to know what we want, and do it.  Knowing what we want, really, takes a lot of sorting.  And living what we find, really, takes a lot of courage and endurance.  In reflecting on the task of therapy, Jung once noted that it can only bring us insight.  Then, he said, come the moral qualities of our character – courage to face what must be faced, and then to take the leap, and the endurance to stick it out until we arrive at the place intended for us from the beginning. So much of our lives have been lived through reflexive adaptations [unexamined emotional habits grounded in our past], so knowing what we really want is difficult, and then scary, but it feels right when we live it, as were meant to do.”

Here’s a great presentation by Dr. Hollis about finding a meaningful path in life.

Insight

Most of us are, at best, barely aware of things we do and why we do them.  Many stuck in the muck of depression are doing things that actually encourage their distress without knowing they are doing so.  As Richard O’Connor, Ph.D., points out, “Depressives keep doing the things they’ve always done because they don’t know how to do anything else.”  They’ve become experts at “depressing.”

 Insight means that we begin to see the causes of our distress and our role in perpetuating it.  As Dr. O’Connor has said: “We aren’t to blame for depression, but we are responsible for getting better.”  To fulfill that responsibility, we need to develop ideas of what and how to do things differently in our lives and we can only do that when we have some insight into why things are going so wrong.  Absent this, we will continue to drift; to be a sort of unhappy ghost in the world.

We can become educated, in a dialogue with our therapist, about the origins of our depression and the old wounds that we will need to revisit in order to heal.  It’s in the safety of a therapist’s office where we learn to stop blaming others and – perhaps a bigger problem for depressives – ourselves.  Blaming ourselves is replaced by the recognition that bad things did happen to us as children that were not our fault.  In fact, much of our negative thinking and painful emotions were learned and endured here.  They don’t go away – we carry them into hood.  Numerous studies have concluded that one of the major indicators for onset depression is trauma, neglect or abuse during childhood.  Blaming others is replaced by the recognition that this just keeps us stuck and resentful.

We shouldn’t give ourselves license to remain stuck in our childhoods and abdicate our responsibility in the here and now to create a healthy life. Our responsibility is to find a way to empower ourselves so that we can get on with living a fulfilling –instead of futile—life.

Courage

Once we get insight, we need to then act on it. Jung suggests that this isn’t something a therapist can give you. It’s your job to leave that one hour session and go out into the world and experiment with your newly found knowledge. In short, you will need courage.

Too often, people achieve hard-fought insight, but then their recovery doesn’t go very far because they don’t put their wisdom into action.  In my experience, action can be stressful because it involves stepping out of depression’s cave (a dark cave, yes, but also cozy in its own destructive sort of way) and risking new behaviors or feeling emotions long suppressed.   We can even feel great shame – a sense of cowardice—if we don’t change because in some sense, we feel we now “know better.”  

Pilot Amelia Earhart once wrote: “Courage is the price that life exacts for granting peace.”  We are never at peace until we act in congruity with our inner truth.

I’ve have talked to hundreds of lawyers across the country who say that they “have to” stay a lawyer, as if it is a form of servitude that was somehow imposed on them.  This seems to me a variation of depression’s theme that they are helpless.  This is not to suggest and I’m unsympathetic or unrealistic about the very real impediments to change.  What I am saying is that such impediments are given way too much power over our lives.  They become heinous bogeymen that we’re afraid to confront.   We give them so much power, that we remain stuck and depressed in our relationship to them.  We think of our fears as “reality” and our dreams for a different life as flat-out .

The fact is it may not be your law job that is depressing; you may be bringing your depressive way of being into the job.  It might be true that you’d be just as depressed if you were a librarian or sang in a country western band.  

I am not suggesting any answers on this score.  I am suggesting the living of questions to untangle this Gordian knot:  Why am I choosing to remain in the job I am in?  What behaviors support my depression while at work?  Am I willing to take some chances, even small ones, to move my life in a different direction? 

You will need courage, my friend, to act on the insights you’ve gained and not let these precious seeds die in the ground.

Sometimes music can get themes across when words aren’t enough.  The other day, my ear inclined towards this powerful piece of bluesy jazz music by artist Lizz Wright.  Watch this video of her belting out her song “You Can Fly”. 

Endurance

Once we have got it together, it has to stay together.  Episodic starts and stops just won’t do in the long run.  We need to be determined for our recovery and personal growth to continue.  We can get lazy or reckless about this.  We just don’t want to put in the time to exercise, or think that it really doesn’t matter if we don’t go to therapy.  It does my friend.  I’ve learned the hard way.  Everything counts. 

We will all have peaks in valleys in this journey.  The important part is not to stop.  It took us a while to fall into depression, and it will take us a while to get out of it.  By pressing on, we grow in stature because it is a courageous journey.  Novelist William Faulkner once wrote: I believe that men and women will not merely endure.  They will prevail.  They are immortal, not because they alone among creatures have an inexhaustible voice, but because they have a soul, a spirit capable of compassion and sacrifice and endurance.”

Goals, Depression & Work

I find the great thing in this world is not so much where we stand, as in what direction we are moving — Oliver Wendell Holmes.

There are different concerns at different stages of one’s depression journey.  Lawyers who are in the throes of it, perhaps for the first time, need education about what depression is, understanding, medication, support and psychotherapy.  After they’ve started to feel better, they’ll need to turn their focus to their livelihood and how they’ll work at it in a way, hopefully, which takes into account their mental health so as prevent and/or mitigate any future depression.  Richard O’Connor, Ph.D., author of the best-selling book, Undoing Depression, has this interesting insight about depressives in the workplace:

“Sometimes when I have spoken to business organizations, I have surprised them by advocating for hiring the depressed; but aside from taking more sick days than others, depressed people can be the best employees.  We’re [Dr. O’Connor has long struggled with depression] good at being responsible.  We are good soldiers, honest and industrious.  We have high standards and want to do any job well.  We have too much guilt to pad our hours or take home office supplies.  Treat us decently, and we’ll be grateful and loyal.  Unfortunately for the depressed individual, however, we discount these virtues and have a difficult time enjoying the world of work.”

I think that’s a great insight because overcompensating, even if it makes us miserable, can make us great workers.  God knows lawyers have high standards.  In essence, many of these people don’t fundamentally value themselves. They may fervently chase other measures of success – money, power and status.  Yet, inside, they often feel broken, sad, stressed or depressed.  Here’s what Dr. O’Connor said in an interview I had with in New York City about a depressive’s need to value him/herself:

We tend to think of lawyers as colossal egos bent on being Masters of the Universe; and there probably a good chunk of those people out there — who I never could stand anyway.  But, in my experience, there are many accomplished lawyers who suffer from depression who are of different ilk; “good soldiers” who bust their asses and don’t give themselves much, if any, credit.

I was doing a walk-a-talk with a friend of mine [a real non-lawyer type] recently in Central Park in New York City.  I stopped to munch on some peanuts that were a real disappointment. He was baffled when I told him I didn’t feel that I’d accomplished much in my professional life.  “You were just named to that that publication, ‘The Best Lawyers in America’. For Christ’s sake, count your blessings!” 

It wasn’t that I didn’t want to take credit.  It was because I couldn’t — I just didn’t know how to.   And, as Dr. O’Connor said, not taking credit doesn’t often have much to do with our professional success, but it has a lot to do with our satisfaction with our jobs.

There are emotional bridges that connect us to various aspects of ourselves and our environment. For depressives, there often isn’t an east-bound bridge connecting their good work to their emotional selves. Others may slap them on the back and plaques may parade across their office wall.  No matter, there’s still a disconnection; a sense that their accomplishments were an accident or a recent run of Lady Luck.  They often have a sense that they’ll be found out; that all of their success is a put-on.  They think they’re imposters who truly don’t deserve such accolades – especially from any genuine place inside of them. No matter how distorted this vision is, they’ll insist that it’s true till the cows come home.  I know because I’ve banged these drums a few times over the years. 

Then there’s the other bridge pointing west-bound.  It connects their goof-ups, mistakes and bad decisions to themselves. You see, lawyers have an exaggerated sense of responsibility for bad things and an underdeveloped sense of ownership for the good stuff they do. This take on life isn’t about taking responsibility for our mistakes.  Rather, it’s the toxic self-impugning; the inner critic run amok spraying bullets from an AK-47 at our self-esteem.

I’ve come to learn that feeling a sense of satisfaction and pride in my work because of my efforts is a skill that I have to work at – and I’ve come a long way.  One of the ways I’ve chosen to do this is by setting goals. For many years, like all lawyers, I swam upstream into the time currents of my day.  I didn’t have to set goals about when to get things done because the Court, my firm and other various incendiary devices did that for me. Finishing a set of interrogatories or successfully arguing a Summary Judgment motion, wasn’t a goal that I set for myself – it was simply another deadline in a litany of other deadlines.

Setting goals for ourselves that we’ve personally reflected upon is important step for those who wish to recover from depression.  It counters the sense of hopelessness and the confusing lack of direction characteristic of a depressive’s attempts to navigate through life.  Goals give us a Garmin for our game.

Even though setting goals would be a healthy thing for someone with depression to work at, they often don’t.  Again, Dr. O’Connor:

“Depressed people, pessimistic [a hallmark of lawyers thinking style] and lacking confidence, tend to avoid setting goals as a way to protect themselves from disappointment.  They don’t realize that the absence of goals leads to a completely different and frequently worse set of problems.  Even if you miss your target, you grow and benefit from the practice of productive activity.  But depressed people, who don’t trust their ability to adapt to bad news and hence avoid setting conscious goals, find lives that lack direction.  Your goal becomes just getting through another day.  In the depths of depression, that may be all you can manage, but it doesn’t take you anywhere.” 

Or, as the great Indian Chief Seneca once wrote: “Our plans miscarry because they have no aim.  When a man does not know what harbor he is making for, no wind is the right wind.”

Setting simple, realistic and concrete goals improve both our performance of the activity and our actual experience of it.  My Catholic take on it from Mother Teresa helps me put this in the context of my part-time faith:  “We can’t do great things; only small things with great love.” 

Work isn’t just about what is thrown at us by our jobs.  It’s also about the passion we bring to it. In this vein, it’s not just the immediate task before us that hooks us, but how we’ve set it up in our own minds.  Again, Dr. O’Connor:

“Making a commitment [to a goal] focuses our attention on where we want to go and helps us focus our thinking on getting there.  People feel happier as they progress toward their goals; they have a sense of involvement, they feel productive and useful, and they give themselves ego strokes for being good and industrious.  Because we’re so adaptable, however, those good feelings don’t necessarily last once we’ve got to where we are going.  We have to make a deliberate effort to savor and appreciate our achievements.”

The key words are deliberate effort.  The word “deliberate” comes from the Latin word “deliberates” which means to weigh carefully.  It requires us to reflect on our course of action and think about what actually works and what doesn’t for us on the job.

In my experience, depressives are often lacking the goal-setting skills they need to be happy and content in their work lives.  What’s the consequence of not setting goals is a sense of meaninglessness; ennui that won’t go away.  Depressed lawyers have an inner dialogue that goes something like this: “I have all this paperwork to get to today, but I have to be in court all morning.  And . . . oh shit!!  I forgot to call the judge back on that motion.” And so it goes as these worrisome thoughts pour out of our noggins.  We’re just jumping around putting out fires and surviving our days.  Is it really any wonder that we draw little or no satisfaction from our work with this approach? 

When I talk to depressed lawyers about this and suggest that they think about their goals and what they really want to achieve, you would have thought that I asked them to jump off the Brooklyn Bridge: “Are you kidding?  You want me to spend time thinking about my goals?  When the hell do I have time to do that?  I have no time during work and then when I get home I either want to (a) forget about my day and enjoy my family, (b) pass out on the couch and forget about everything in front of the T.V. or (c) do anything that doesn’t involve thinking about my job.

There’s no problem in using these ways to decompress after a day’s warfare at the office.  But if these activities, albeit pleasurable, avoid the important questions raised by work, and our connection to it, we may to rebalance the tires.

In my next blog, I will address some practical ways lawyers can set goals and draw pleasure from accomplishing them in their everyday work lives.

One Nation Under Medication

Clinical depression’s analogy to illnesses like heart disease or diabetes has been helpful to de-stigmatize it in our society.  It is a physical illness, regardless of its causes, and requires medical care and treatment.  But, in a very real sense, it’s much more than that.

Heart disease and diabetes do not affect our minds, personalities and emotional worlds like clinical depression.  Taking antidepressant medication, unlike other meds to open sinus congestion or plaque-filled arteries, changes how we see ourselves as well as how others see us.

Much about what drives how we feel about taking medication is driven by stigma; the dark cloud of shame which says that we’re weak or somehow “bad” for taking such drugs.  This nonsense continues despite the fact that 350 million people suffer from depression worldwide and that it’s the leading cause of disability on the planet.

In the book Undoing Depression, Dr. Richard O’Connor captures some of the irony of stigma:

“If [all of the statistics] are true, if depression is as dangerous and prevalent as I’m saying, you may well ask: Where’s the big national foundation leading the battle against depression?  Where’s the Jerry Lewis Telethon and the Annual Run for Depression?  Little black ribbons for everyone to wear?”

Looking back on my journey with medication, it was a rough ride but one in which I am glad I took.  I have been on medication for the past eight years and it controls my depression.  I don’t think that it’s the only reason why I’ve gotten better; I’ve done a lot of healthy stuff to recover too (e.g. psychotherapy, exercise and change in my diet).  But, at least for me, medication brought about a profound stability that I might not have otherwise achieved.

The fact that medication helped me and continues to do so doesn’t mean I don’t have my fair share of ambivalence about taking them; on the contrary.  Besides the unknown long-term effects on our brains from using these potent concoctions, there is also a change of identity that takes place when we start using them.

I sometimes miss the old, pre-antidepressant Dan that was wired and edgy.  When anxiety and depression really lit up  my nervous system, it was as if too much wattage was flowing through the power grid of my body.  The medication seemed to calm things down and even things out.  As I grew calmer, I was able to think through things more clearly – especially my depressive thought habits.  But there’s a struggle which waxes and wanes within me, even as I give the medication its due, about whether becoming a medicated person has been a good thing entirely. 

In his book, “Is It Me or My Meds?” Boston College Professor, David A. Karp writes:

“[P]eople’s self-esteem and sense of integrity are deeply connected to their ability to control their personal problems  The people I spoke with had difficulty accepting the idea that emotional illnesses are no different from physiological problems such as heart disease or diabetes.  It may be comforting to hear that antidepressant medications correct chemical imbalances in the brain just as insulin controls diabetes.  But most of those I interviewed assigned different meanings to mental and physical conditions. When asked directly, they affirmed that psychiatric drugs are far more likely than other medications to make them feel bad about themselves . . . .”

There is no doubt in my mind that we become different people on these drugs; there is the pre-antidepressant person and the post-antidepressant person.

In an article Dr. Karp wrote for the Lawyers With Depression website, he writes:

“While direct-to-consumer advertising has likely fostered an easier acceptance of these pills, most of the people I interviewed who suffer from major depression embark on a psychiatric drug career with great reluctance.  Typically my respondents turn to medications only when desperation leaves them without alternatives. 

This is understandable in terms of the identity line that one crosses by seeing a doctor, or seeing a diagnosis of depression and filling the prescription for anti-depressants.  One person poignantly expressed her identity dilemma by saying that, ‘When I swallowed that first pill I swallowed my will.’  Beginning a regimen of psychiatric medications is part of the traumatic transformation from person to patient; from being a merely troubled person to someone who has mental illness.  Crossing that boundary is hardly an easy step to take.”

I think Dr. Karp captures a good deal of the angst that goes along with taking meds.  Most people I know who take them can identify with what he says.  There is often a sense of shame attached with taking medication because we feel that we should be able to kick depression’s ass all by our sweet old selves.  What that blows up and we are left stumbling on depression’s playing field, we often turn to medication.  In my own life, I felt shame for a period of time.  But as my understanding of depression grew, I knew I didn’t have anything to be ashamed of.  It wasn’t my fault that I had depression, but it was my responsibility to get better.  Medication was part of that for me.

A New Year to Kick the Depression habit

 

For last year’s words belong to last year’s language and next year’s words await another voice.  And to make an end is to make a beginning – T.S. Eliot

With the New Year comes new choices; we can choose to leave behind ways of being in the world that cause and maintain our depression and embrace healthier and saner approaches to our days.  Or we can simply do nothing.

Why do lawyers with depression keep repeating behaviors that prevent them from feeling good about themselves? Why do they relentlessly drive, isolate and unmercifully think of themselves as the biggest piece of crap this side of the Mississippi? 

In his revised and updated book Undoing Depression: What Therapy Doesn’t Teach You and Medication Can’t Give You, Dr. Richard O’Connor offers this insight:  “People persist in self-destructive behavior because they don’t know how to do anything else. I’m convinced that the major reason why people with depression stay depressed despite therapy, medication, and support from loved ones is that we are simply unable to imagine an alternative.  We know how to ‘do’ depression.  We are experts at it.”

Lawyers can’t envision healthier alternatives because depression shuts down their capacity to creatively imagine themselves productively engaged in the world.  We simply have no reference point for that.  So we stay in our offices with the doors closed looking out the window as the birds fly by and one season changes into another.

Our brains love habits — even when they stink and hurt us.  It’s a more predictable way to go through life because we don’t have to rethink everything and change.  We become used to depressive habits as we cruise through life on auto-pilot.  Many lawyers with depression usually view their jobs as the sole source of their depression; surviving “it” becomes the focus of their lives.  They use depression habits at their jobs that might work for awhile, but at a very high cost to their physical and emotional well-being.  These aren’t stupid people; they just can’t imagine doing their jobs any differently.  As educatior Parker Palmer once wrote about his depression, “It wasn’t so much that I was in the darkness as I became the darkness.”

Dr. O’Connor writes:

 “We depressives become shaped by our disease as well; the skills that we develop with depression in a vain effort to save ourselves pain – skills like swallowing our anger, isolating ourselves, putting others first, being over-responsible – prevent our recovery.  We have to give up the depressed habits that keep us down and make us vulnerable to relapse.”

Deepak Chopra wrote: “A habit is a frozen interpretation from the past that is applied to the present.”  I think that’s why depression can have such a deadening sensation associated with it.  In a sense, depression warps our perceptions about events happening in real time and pulls us under the frozen river of our past.  People and events happening in real time trigger old interpretations of how life works.  Since most people with depression come from dysfunctional or abusive childhoods, a current conflict with others becomes a ride back to their traumatic past.

For me, this distortion has often revolved around anger.  I not alone on this one; how we handle anger is a big issue for most lawyers. As lawyer and psychologist Andy Benjamin wrote and studies have concluded, there is a strong connection between hostility and depression.  Anger seems to be situational, while hostility is an overarching and aggressive approach to life.  Anger that is repeatedly stuffed or inappropriately expressed becomes hostility.  Many lawyers don’t want to be assholes, but feel they have to do so to survive in the shark tank of the law.  Most lawyers I’ve known feel deeply conflicted about this and if they’ve had problems with depression, it just compounds it all.

In my childhood home, my alcoholic father had a volcanic temper – you knew to scram when you saw lava cresting at the rim.  I learned that anger was painful, “bad” and always unjustified.  As such, I used to avoid conflict and stuff my own anger because it was dangerous.  Instead, I became a people pleaser.  I developed exquisite antennae to read clients, colleagues, opposing counsel and judges’ reactions for any signs of aggression, anger or conflict.   I molded my behavior to their behavior rather than living out of a core of my own reality.  This distortion gave others too much power and myself too little.  It is, as psychologist James Hollis once wrote, an emotional conclusion in which we tell ourselves “the world is big and I am small.”  Most depressives think this way and feel overpowered by the events of their world and lapse into a state of helplessness.

As we enter a new year, let’s start leaving some depressive habits behind and embrace some new ones.  This will take work on your part.  No one is going to save you from your depression.  While you are not to blame for your depression, you are responsible for getting better.  Dr. O’Connor writes:

“Overcoming depression requires a new set of skills from us.  But now we are recognizing happiness is a skill, willpower is a skill, health is a skill, successful relationships require skills, emotional intelligence is a skill.  We know this because practice not only leads to improvement but also to changes in the brain.  This is a much more empowering and adaptive way of understanding life than assuming that these qualities are doled out form birth in fixed quantities and that there’s nothing we can do to change our fate.  The skills required to undo depression will permeate your entire life, and if you keep practicing, you can go far beyond mere recovery.”

Happy New Year!

Law and the Human Condition

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Many people who went to law school didn’t have a burning passion to be a lawyer.  They did so because they didn’t know what else to do with their undergraduate degrees.  Some went on to find and embrace their calling as lawyers, some did not.  Some have left the profession.  Most have not. 

Those who haven’t left, but think of doing so – sometimes daily – are legion.  Forbes Magazine reported that a full 38 percent of attorneys say they somewhat regret their career choice.  Additionally, Harvard Law School counselors estimate that 20% to 30% of active attorneys are considering another career. 

I recently bumped into the Valedictorian of my law school class.  She told me she had chucked her law career awhile ago, went back to school and was now an elementary school teacher.  She had gone from power suit blues to L.L. Bean greens.  When I told other lawyer pals about this, they weren’t shocked – they envied her. 

Recently, I had lunch with a contract lawyer at the Oyster Bar in New York City.  He had come from a long line of lawyers and judges in his family who encouraged him to go to law school.  After graduating from Harvard Law School, he worked seven years at a large Manhattan firm.  As we slurped our Clam Chowder, he told me that he didn’t know one person that was happy being a lawyer.   That if they could get out, they would.  Now it may be that misery loves company, but let’s be honest:  there are a lot of unhappy folks out there.  Lawyers walk the halls of justice and corridors of power – or maybe just look out of a Starbucks window – and wonder why they just can’t turn things around and just feel happy.

I don’t think job dissatisfaction is unique to lawyers; it’s the daily fare for most Americans. A recent MSNBC article read:  “Americans hate their jobs more than ever in the past 20 years with fewer than half saying they are satisfied.”  People, deep down, feel broken and vulnerable, but just have to keep going in order to survive in this tough economic climate.

My friend and psychologist, Richard O’Connor, in his book, Undoing Perpetual Stress, captures the daily plight of the average American struggling to make to make it:

“Here is where I leave trying to explain physiology [how stress and depression affect the brain] and turn to something I know about – life as it’s lived in the USA.  I get to hear all about it from my patients, a wonderful cross-section – aging Yankees, rising Yuppies, farm and factory workers, teens and seniors.  Most people are living with, I think, a fear of fear.  There is a sense that something is fundamentally wrong with the way we are living our lives, but a reluctance to look closely at that.  We know deeply that we’re in serious trouble, but we live our daily lives as if everything is fine, whistling past the graveyard.  We try to purchase inner peace, knowing perfectly well that’s impossible, but not seeing an alternative.  Or we tell ourselves that someone will figure out what’s wrong someday, and until then we’ll just have to wait.  Or we’ll simply live our lives later.  Or we may believe for a while in the latest fad – a political leader, a spiritual leader, a self-help guru.  We try to follow what the fad tells us, but it usually doesn’t do much for our troubles, so we give up and try to forget again.”

I give a lot of speeches across the country to groups of lawyers about stress, anxiety and depression.  It’s always interesting how many contact me later and say that while they aren’t depressed per se, life isn’t going very well.  There have been plenty of times I’ve considered – or it’s been suggested to me – that I consider changing the name of my website from http://www.lawyerswithdepression.com/ to something like www.lawyersdealingwithalotofshit.com.  No, it’s not a real website so don’t click on it.  The point is that lawyers are stuck not only dealing with the high decibel life as a lawyer, but also the everyday crap that all Americans must try to handle everyday.

Dr. O’Connor helps us to understand the breadth of the problem for the average American:

“Then there are those without a diagnosis:  I can’t estimate the number who feel their lives are out of control because they can’t lose weight, they can’t stop procrastinating, they can’t get out of debt, they can’t speak up for themselves – “soft addictions,” bad habits that make them feel miserable and ashamed.  They are still others who are like the living dead – numb to their own existence, busy working, buying, doing – feeling vaguely empty but compelled to continue, too busy even to sit and look at their lives.  Their depression has grown on them so insidiously that it feels normal; they believe life stinks, and there’s nothing they can do about it.  And finally there are the rest of us, who still have to find confidence, connection, love, who have to raise children without guidance in a crazy world, often watch our parents lose their minds if they live long enough, and wonder about the meaning and importance of our lives.  Even those of us supposedly without emotional problems, there is still the nagging fear that we’re faking it, just making it up as we go along, and praying we don’t stumble.”

This quote isn’t meant to bum anyone out – okay maybe it’s a tad bit melancholic.  However, I would argue, not morose.  I think it’s a true picture of the dilemma that most people deal with everyday as they cross at the traffic light pounding out on their Blackberry’s, yell into the old cell phone above the din of traffic noise or wonder ten times a day where they’re going to find the energy to deal with it all.

What makes lawyers different from the average Joe (and Jane)? 

I would argue that there are a couple of things.  First, the adversarial nature of the profession:  unless you are into slugging it out everyday (unfortunately, I’ve had opponents who thrive on this), the law will wear you down physically and emotionally.  Second, it is a career that is made up – maybe to a degree that few others are – of the mentality that you’re either a “winner” or a “loser.”  Third, much of the public has a murmuring resentment or outright disdain for lawyers.

What to do about all of this?  On this score let it be clear that I am not speaking to you from the mountain top, but from the valley.  I struggle with these problems – and the potential antidotes – every day.  But, I will give it a whirl.

First, recognize that many people are in the same boat as you.  If you recognize that you are not alone in feeling the way you do, it can ease your burden.  Some of this stuff is just the human predicament.  Most people have a difficult time navigating through life.  Chalk it up as a part of the deal we all signed on for when we were born into this troubled world.

Second, change your thinking.  I call this the “stressed-out-lawyer” myth.  This doesn’t contradict what I’ve said earlier; the point is that lawyers compound their pain by telling themselves — at virtually every moment of the day —  how out of control they are.  These thoughts, which a mental commentary on reality, – just plain out don’t help.  We need to be more constructive in our thoughts.  You’ll have to make the effort on this one.

Third – and I will never tire of tooting this horn – exercise.  We can’t ever forget that we are essentially animals with high powered brains.  The law jacks up our bodies with all sorts of high voltage situations we must confront.  We must find a way to discharge this energy or it will wear our batteries out.  Your poor body is literally screaming out to you to get rid of the stress before it eats away at your health.  As the Nike commercials say, “Just Do It!”

It’s Just Cancer – Get Over It.

 

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I arrived in New York City’s JFK Airport yesterday.  My family and I are visiting friends over the weekend.  While walking through the terminal, I saw a large advertisement from the Depression Is Real Coaliation. If you haven’t heard of this organization, check out their website.  The ad read as follows:

YOU’D NEVER SAY, “IT’S JUST CANCER, GET OVER IT”.  So why do some say that about depression?

When I first developed depression over seven years ago, at least five people told me to “get over” or “snap out of” it.  Get over or snap out of “what” I often thought.  I searched my mind for some frame of reference.

When people are too preoccupied with themselves and their problems, we have all thought or told them to end their narcissistic nonsense.  “Life isn’t so bad.  So stop complaining,” is our common refrain.   We judge them to be selfish, inconsiderate or even burdensome. Yet, were such people suffering from a physical illness – say cancer, diabetes or heart disease – we would never imagine saying such a thing for fear of being thought cruel, rude or simply ignorant. 

Sadly, all too often, people treat people with depression as if they don’t have an illness, but a problem of self-absorbtion.   And for people who have experienced the Black Dog, they know exactly what I am talking about. Such comments make us doubt ourselves:  “maybe I am just a complainer,” or “I’m just selfish.”  But deep down, we may sense otherwise.  If we do, we know that something is seriously amiss.    

Critical comments from others made me feel like the accused.  I imagined what must have been going through their minds:  “You’re faking it.  Now let’s get back to the business of practicing law.” They just didn’t seem to believe me.  That didn’t believe that I had a chemical imbalance in my brain, that it wasn’t my fault and that this had made me sick – very sick.

In the beginning of my journey, I wanted everyone to understand me.  I wanted them to just say, “It is okay, Dan.  You have a medical illness and need treatment.”  Sometimes this happened and sometimes it didn’t.  When it didn’t, I felt hurt and even angry.  I thought, “Just step in my shoes for an hour and you’ll know that what I’m experiencing is true.”  We need to be careful who we choose to expect sympathy from.  Make no mistake about it, we need allies when we are in a depression.  Most often, it will come from other depressives who have “walked the walk,” people who have known and loved others with depression, or just big-hearted, everyday people.

In his book, Against Depression, psychiatrist, Peter Kramer, M.D., takes an unflinching account of the illness that is depression.  Check out his Blog.  Kramer cites a number of scientific studies linking depressive symptoms with abnormalities in the hippocampus and prefrontal cortex of the brain.  Kramer also emphasizes that depression is more than a brain disease.  “It is a neurologic, hematologic and cardiovascular disease.  Overactivation of stress pathways causes a liability to clots and [heart] arrhythmias – and along or together, they predispose to heart attacks, silent strokes, disturbed mood and sudden death”, he wrote.  Listen here to Dr. Kramer being interviewed by National Public Radio.

Richard O’Connor, Ph.D., author of the best-selling book, Undoing Depression: What Therapy Doesn’t Teach You and Medication Can’t Give You, makes clear why depression should be likened to other major medical illnesses:

“Heart disease is a good analogy to major depression.  Heart disease is “caused” by a complex of factors, including a genetic predisposition, emotional factors like how we handle stress, and habits like diet and exercise.  You don’t catch heart disease from an infection.  You develop it gradually, over time, as plaque builds up in your arteries.  Once you cross an invisible threshold marked by standards of blood pressure and cholesterol levels, you have heart disease . . . . Depression may be a similar threshold disease – genetic and biochemical factors may determine a different level of stress for each of us that, once reached, puts us over the edge into depression.”

It is critical to remember that depression isn’t your “fault.”  However, it’s equally important to remember that it’s your responsibility.  We must take responsibility to get better and stay that way.  Yes, the critical judgments of others hurt. That’s why it is imperative to not go through this alone.  Join a depression support group.  They have also dealt with the judgments of others.  There truly is strength in numbers.

Stress Depression Connection

At the beginning of my law career, I didn’t suffer from depression. 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 what problems and disasters were to confront me the next morning. After years of this, the pendulum swung. I went, more and more, from states of anxiety to states of depression. Why did this happen? It took me a long time to understand.

Depression develops because of a complex interplay of genes, neurochemistry, emotional history and personality. Recently, scientists have been focusing in on the connection between stress and anxiety and the role they play in producing and maintaining depression. This subject should be of great concern to lawyers who frequently report feeling stressed or burned out in their practices.

“Stress” is anything in our environment that knocks our bodies out of their homeostatic balance. The stress response is the physiological adaptations that ultimately reestablish balance. Most of the time, our bodies do adapt and a state of balance is restored. However, Dr. Robert Sapolsky, an expert on stress-related illnesses, warns: “If stress is chronic, repeated challenges may demand repeated bursts of vigilance. At some point, this vigilance becomes overgeneralized 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.” For an excellent article which nicely summarizes his theories, see:

Robert Sapolsky Discusses Physiological Effects of Stress.

Stress went on too long in my own life as a litigator. I had, indeed, entered the realm of anxiety. For me, this anxiety felt like I had a coffee pot brewing twenty four-seven in my stomach. I became hypervigilant; each of the files on my desk felt like ticking time bombs about to go off. Over time, the litigation mountain became harder to climb as the anxiety persisted over a period of years.

Dr. Sapolsky states: “If the chronic stress is insurmountable, it gives rise to helplessness. This response, like anxiety, can become generalized: a person can feel they are at a loss, even in circumstances that she can actually master.” Helplessness is a pillar of a depressive disorder. It becomes a major issue for lawyers because we aren’t supposed to experience periods of helplessness. We often think of ourselves as invulnerable super hero’s who are the helpers and not the ones in need of help. Accordingly, lawyers often don’t get help for their depression and feel ashamed if they do.

Many lawyers do not appreciate this connection between their stress and anxiety and the risks they pose for the development of clinical depression. Indeed, the presence of co-morbid anxiety disorders and major depression is frequent and, according to some studies, as high as 60 percent. Maybe this connection helps explain the studies which find such high rates of depression for lawyers. In many ways, we are too stressed and anxious too much of the time.

The human body was not designed for such punishment. Dr. Richard O’Connor, author of the best-selling book, Undoing Perpetual Stress: The Missing Connection Between Depression, Anxiety and 21st Century Illness states that depression “is stress that has gone on too long” and that many people with depression have problems dealing with stress because they are not “stress resilient”. Not because of some central character flaw or weakness. But because of a complex interplay between genetics and one’s experience over a lifetime. This interplay is played out daily for lawyers in how their bodies and brains deal with stress and anxiety.

Our bodies haven’t changed much in the last ten thousand years. We have a wonderful defense mechanism wired into our nervous system called the fight-or-flight response. Dr. Sapolsky, in his acclaimed book, Why Zebra’s Don’t Get Ulcers, walks us through the connection between this ancient defense mechanism and depression. When confronted with a threat – whether real or perceived – this response kicks in and floods our bodies with powerful hormones that propel us into action. This was an essential survival device for our ancestors who lived in the jungle and would have to flee beasts that were trying to eat them or fight foes that were trying to kill them.

Lawyers don’t face these types of real life-or-death threats. Instead, lawyers perceive life-or-death threats in their battles with opposing counsel while sitting in a deposition or sparring in the courtroom. Our bodies respond as if they were being chased by that hungry lion. Accordingly, the stress response can be set in motion not only by a concrete event but by mere anticipation. When humans chronically and erroneously believe that a homeostatic challenge is about to come, they develop anxiety.

Over time, this type of chronic anxiety causes the release of too much of the powerful fight-or-flight hormones, cortisol and adrenaline. Research has shown that prolonged release of cortisol damages areas of the brain that have been implicated in depression, the hippocampus (involved in learning and memory) and the amydala (involved in how we perceive fear).

If we don’t as litigators learn better ways to deal with stress and anxiety, we expose ourselves to multiple triggers that can cause and/or exacerbate clinical depression. It is in turning and facing those things which make us stressful and anxious that we provide ourselves with the best protection against depression.

 

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