Depression as a Loss of Heart

This article was written by John Welwood, an American clinical psychologist, psychotherapist, teacher, and author, known for integrating psychological and spiritual concepts. He died in 2019. He wrote eight books, including Challenge of the Heart (1985), Journey of the Heart (1990), and Love and Awakening (1996). Trained in existential psychology, Welwood earned a Ph.D. in clinical psychology from the University of Chicago.

Depression is one of the most common problems in modern society. It appears in chronic low-grade forms that can drain a person’s energy and in more acute forms that can be completely debilitating. Our materialistic culture breeds depression by promoting distorted and unattainable goals for human life. And our commonly held psychological theories make it hard for people to make direct contact with depression as a living experience, by framing it as an objective “mental disorder” to be quickly eliminated. The current treatments of choice — drugs, cognitive restructuring, or behavioral retraining — are primarily technical, and often keep depression at arm’s length. However, in order to help people with depression, we must see how they create and maintain this state of mind in their moment-to-moment experience. This will help us understand depression not merely as an affliction, but as an opportunity to relate to one’s life situation more honestly and directly.

Treating Lawyers with Depression: One Psychologist’s Top 10 Tips

 

Here is an interview I did with Dr. Tyger Latham, a clinical psychologist and psychoanalyst in Washington, D.C. and the Commonwealth of Virginia. He received his Ph.D. George Washington University.

What is depression?

Depression is a mental health disorder that affects roughly 10 to 15 percent of the general population. According to the DSM, the manual used by psychiatrists and psychologists to diagnose depression, a person is diagnosed with depression if she/he experiences depressed mood, along with several other related symptoms, for a minimum of 2 weeks. Some of these other symptoms include: disrupted sleep; diminished energy; changes in appetite or weight; difficulties with concentration; restlessness or lethargy; feelings of guilt, worthless, and helplessness; and, in extreme cases, thoughts of death or suicide. This is the medical definition of depression. However, this definition fails to capture the experience of what it’s like to be depressed. I think Paul Simon has described depression best when he wrote: “Hiding in my room, safe within my womb, I touch no one and no one touches me. I am a rock, I am an island. And a rock feels no pain; and an island never cries.”

Have you treated many law students, lawyers and judges for it?

At any one time, I would say about a third of my practice is comprised of lawyers or law students, of which a large majority suffer from depression or some related mood disorder such as persistent depressive disorder or bipolar disorder.

Can you tell us what kind of issues concerning depression lawyers come to you for? (E.g. problems on job, marital)

As with all of my clients, I find that lawyers come to therapy for a myriad of reasons, including depression. In the case of lawyers, however, the practice of law often serves as a backdrop for their presenting concerns. I have yet to work with an attorney whose work was not adversely affected by their depression. In fact, many lawyers who are diagnosed with depression only become aware of it after it begins to affect their productivity. These lawyers might complain of being unable to concentrate; feeling indifferent or apathetic about their work; withdrawing from colleagues; or, in some cases, they talk with me about feeling burned-out or they might share fantasies of leaving the practice of law altogether. All of these symptoms can be associated with depression and when taken together they build a strong case for clinical depression.

Attorneys will often employ a number of coping strategies – some adaptive, others not-so-adaptive – to deal with their depression. Most attorneys are accustom to working long hours, so I often see many attorneys with depression pour themselves into their work as a way to escape. I’ve also worked with a number of attorneys who have resorted to alcohol and drugs as a way of managing their symptoms. While I wouldn’t say all attorneys who are depressed abuse alcohol and drugs, the majority of attorneys who abuse alcohol and drugs almost always suffer from some form of a mood disorder like depression, bipolar, or anxiety.

Unpacking Depression: An Interview with Psychologist Dr. Margaret Wehrenberg

Today’s guest is Dr. Margaret Wehrenberg. Dr. Wehrenberg is a clinical psychologist in Naperville, Illinois. She is the author of six books on the treatment of anxiety and depression published by W.W. Norton, including, “The Ten Best-Ever Depression Management Techniques: Understanding How Your Brain Makes You Depressed and What You Can Do to Change It” and “Anxiety + Depression: Effective Treatment of the Big Two Co-Occurring Disorders.” An international trainer of mental health professionals, Dr. Wehrenberg coaches people with anxiety via the internet and phone. She’s a frequent contributor to the award-winning magazine, Psychotherapy Networker and she blogs on depression for the magazine Psychology Today.

Dan:

What is the difference between sadness and depression and why do people confuse the two so often?

Dr. Wehrenberg:

Because depression comprises sadness. Sadness is a response to a specific situation in which we usually have some kind of loss. The loss of a self-esteem, a loss of a loved one, the loss of a desired goal. Depression is really more about the energy – whether it’s mental energy or physical energy – to make an effective response. So, sadness is an appropriate and transient emotion, but depression sticks around and affects all of our daily behaviors and interactions.

10 Quick Self-Care Tips for New Lawyers

This guest blog is written by attorney Joe Milowic, Director of Well-Being and Of Counsel at Quinn Emanuel Urquhart & Sullivan, LLP in New York City. Most of Joe’s advice applies not only to young associates but any lawyer who cares about living a mentally and physically well- balanced life. Joe is also a Founder of the Lawyers Depression Project (LDP), a grassroots project aimed at addressing depression and other mental health issues in the legal profession. Joe is a graduate of the Rutgers College of Engineering, with high honors, and its law school where he was Co-Valedictorian of his 2001 class. In 2018, Joe wrote an article for the New York Law Journal, “Quinn Emanuel Partner Suffers from Depression and He Wants Everyone to Know.”  which encouraged a national discussion on depression in the legal profession (Read “Joe Milowic’s Story of Depression Should Spur Renewed Focus on Lawyer Well-Being” from the NYLJ). In this article, Joe shares his tips for self-care to manage your mental health and well-being.

The Dark Side of Success: A Psychiatrist’s Exploration of Depression in the Legal Profession

By Joann Mundin, M.D.

There are significant effects of depression in the legal profession that are pervasive. Lawyer depression can have terrible personal and professional ripple effects for attorneys but also impacts clients, business partners, employees, and staff.

The general population is significantly affected by depression, with 17.3 million persons, or 7.1% of all adults in the US, reporting having experienced a major depressive episode in 2017. But, the proportion of depression among attorneys is considerably higher: according to ALM’s Mental Health and Substance Abuse Survey from 2020, 31.2% of the more than 3,800 respondents report having a depressive disorder. This indicates that compared to the ordinary US adult, lawyers have an approximately three-fold higher risk of developing depression.

Nevertheless, the stigma associated with mental illness keeps lawyers from getting help immediately. This can cause excessive and prolonged distress, making the problem worse over time.

Addressing Mental Health and Well-Being in Law Schools: An Interview with Law Professor Shailini George

Today’s guest is Shailini George, a law professor at Suffolk University Law School. Her scholarship is focused on law student and lawyer well-being, mindfulness, and the cognitive science of learning. She is the author of the recently released “Law Students Guide to Doing Well and Being Well,” and the co-author of “Mindful Lawyering, The Key to Creative Problem Solving.” She and fellow law professor Lisle Baker, will be teaching a new law school course at Suffolk this year, “Preparing for Professional Success.”

Professor George is highly involved in the National Legal Writing Community, having served on the board of the Association of Legal Writing Directors, the Executive Committee of the AALS Section on Legal Writing, Research and Reasoning, and his co-chaired the Diversity and Scholarship Committees of the Legal Writing Institute. Professor George was recently appointed to the Institute for well-being in-laws research and scholarship committee and is a member of the AALS balance section.

The Suicide of a Law Student Hits Home

When people are suicidal, their thinking is paralyzed, their options appear spare or nonexistent, their mood is despairing, and hopelessness permeates their entire mental domain. The future cannot be separated from the present, and the present is painful beyond solace. ‘This is my last experiment,’ wrote a young chemist in his suicide note. ‘If there is any eternal torment worse than mine I’ll have to be shown.’ – Kay Redfield Jamison, M.D., “Night Falls Fast: Understanding Suicide”

A second-year law student at the University at Buffalo School of Law, Matthew Benedict, died by suicide earlier this week by leaping from the Liberty Building he had been clerking at according to the Buffalo News. Another account of Matt’s life and suicide was reported in The New York Law Journal.

Matt’s funeral is tomorrow. By all account’s he was a tremendous, loving, talented, bright young man.Matt was kind-hearted, passionate and driven.

Slogging Through the Swamp of Lawyer Depression With Dr. James Hollis

Here is my fascinating interview with Dr. James Hollis, psychoanalyst and author of several best-selling books including “Swampland of the Soul” and “What Matters Most: Living a More Considered Life.”

Dan:  What is depression?

Jim:   I think first of all we have to differentiate between depressions because it‘s a blanket term which is used to describe many different experiences, different contexts and different internalized experiences of people.  First of all, there is the kind of depression that is driven by biological sources and it is still a mystery as to how that works.  We know it affects a certain number of people in profound ways.   Second, there is reactive depression which is the experience of a person who has suffered loss and as we invest energy in a relationship or a situation and for whatever reason, that other is taken away from us, that energy that was attached to him will invert as depression.  Reactive depression is actually normal.

Do You Need To Take Medication For Your Depression?

Today’s guest post is by Dr. Eve Wood, a psychiatrist who treats patients struggling with depression, anxiety, burnout or extreme stress.

Do you find yourself wondering if you need to be on medications for depression, or hoping you can stop them? If so, you are not alone!

In 1980, Americans filled 30 million prescriptions for antidepressants, and in 2010, 30 years later, the number of prescriptions for antidepressants filled had risen to 264 million in a year!

What are we to make of this? Twenty eight percent of attorneys nationwide are struggling with depression! Why? And, what is to be done about it? In this short blog, I intend to highlight the relationship between stress, burnout, and “depression”, and the role of diagnosis, medical treatments, and other strategies. I encourage you to think broadly about what you can do to make your life better.

What is Depression?               

To be totally clear: We do not really know what depression is! We have a lot of theories, and can identify biological correlates, with some depressive symptoms. And, we do know that a small percentage of people suffer with an incapacitating illness that won’t quit. However, much of what is being called Depression today, is probably Burnout, or a normal response to abnormal stress!

While I am simplifying the diagnostic process a bit, I think you will appreciate the point. We diagnose Depression by establishing that you have a requisite number and type of symptoms, to meet the diagnostic criteria, as laid out in the DSM (Diagnostic and Statistical Manual). Over the course of the last 35 years, there have been 6 iterations of the DSM. As the book has gotten longer, and the number of diagnoses has progressively increased, the “illness” criteria has gotten too loose to be useful.

Before the printing of DSM III, the incidence of depression was quite low, prevalence rate of 1.2% in 1996. After the DSM III was released in 1980, a NIMH study found the prevalence of Depression had risen to 5%. After DSM III-R the prevalence rate had risen to 10 % of the adult population in the United States. And, the rate continues to rise.

In my 35 years in medicine, I have not seen the numbers of people with serious depression, true debilitating symptoms that no one could deny were life-threatening, change much. I have, however, seen a significant escalation in the numbers of people told they “have depression” and consequently get treated with medications.

Today, when you might be dealing burnout, exhaustion, disillusionment, or extreme worry, you are given a clinical diagnosis or two, and prescriptions. This strategy stops you from looking at the precipitants to your distress, and proactively identifying solutions. It also exposes you to “side-effects” or unnecessary risks.

But, Isn’t my Depression due to a Chemical Imbalance in my Brain?

Chances are pretty good you’ve been told that your depression is due to a chemical imbalance in your brain, and medications correct that abnormality. The problem is, all attempts to prove that theory have totally failed.

The fallacy is reinforced by the names given to psychiatric medications. For instance, the term SSRI (selective serotonin reuptake inhibitor) was chosen to imply that the medication inhibits the uptake of a neurotransmitter and thus creates benefit. It originated when the pharmaceutical company SmithKline Beecham, was trying to distinguish its medication Paxil, from its competitor Prozac.

“SSRI” came out of their marketing department and was used to market a new “class” of drug, even though all antidepressants (new and old) have some impact on serotonin. And, we have no idea how significant that impact is! The term SSRI gives rise to cool pictures of neurons and chemicals which can be used to sell drugs.

Do Antidepressants Work?

Clinical trials of antidepressants show that only 1/3 of patients get better in 8 weeks. The other 2/3 respond in part or not at all! And, within 3 years, 75% of the responders have quit treatment, likely due to side effects, cost or diminishing efficacy.

In many studies of antidepressant effectiveness, drugs perform no better than placebo. And, several studies have found that the biggest predictor of response is you believe meds will help, and vice versa!

So, do pills work? At times, yes, and they even save lives. But, they don’t help most people consistently. And, other interventions might be just as good, or better tolerated. Examples with clear anti-depressant efficacy include improved work-life balance, therapy, specific breathing practices, yoga, mindfulness, light exposure, meditation, nutritional interventions, cognitive restructuring techniques, spiritual practice, time in nature and exercise.

What Should You About Medication?

You are probably wondering whether you should be on medicine. The answer is unique to you and your history. That said, here is what I have seen in 35 years of work with attorneys. Many of you are experiencing normal responses to extreme stress. While you have tremendous power to self-heal, rebound, and thrive when episodically stressed, you become depleted, and burned out when the pressures on you are continuous.

The symptoms of burnout; emotional exhaustion, interpersonal disengagement, and a low sense of meaningfulness and accomplishment are very similar to those of depression. And, interventions for burnout, often transform depression symptoms. Most of my clients stop, or massively reduce their medication need, as they tackle burnout, build resilience, decrease stress, and improve their lives.

In choosing your next steps, consider when you last felt well, and your attendant life circumstances. What was working, or gave you joy? Have medicines saved your life, or are you taking pills because you can’t seem to make your life work? Do you need training on techniques and tools to promote well-being, and minimize your need for medications?

If your life is not as you wish, you can change it! You are a gifted, capable person, as evidenced by how far you have come. You can learn evidence-based solutions, to transform what doesn’t work!

Dr. Eve A. Wood helps lawyers and judges dealing with depression, anxiety, burnout and extreme stress learn to transform their lives for well-being, joy and professional fulfillment. She offers practical, science-based programs and coaching that promote whole person healing, decrease stress and depletion, transform anxiety/depression and reduce reliance on medication.

 

 

 

 

 

Finding Meaning in the Legal Profession:An Interview with Dr James Hollis

This is my interview with psychoanalyst, James Hollis, Ph.D., author of the best-selling books, “What Matters Most: Living a More Considered Life,” and “Finding Meaning in the Second Half of Life: How to Finally, Really Grow Up

Dan:  What is depression?

Jim:   I think first of all we have to differentiate between depressions because it‘s a blanket term which is used to describe many different experiences, different contexts and different internalized experiences of people.  First of all, there is the kind of depression that is driven by biological sources and it is still a mystery as to how that works.  We know it affects a certain number of people in profound ways.   Second, there is reactive depression which is the experience of a person who has suffered loss and as we invest energy in a relationship or a situation and for whatever reason, that other is taken away from us, that energy that was attached to him will invert as depression.  Reactive depression is actually normal.

We would have to figure out where that fine line is and where it might cross over into something that was more than normal.  When we say that a person is grieving too long or it is affecting their lives so profoundly, that’s a judgment call, of course, but we do know people that have been sort of destroyed by reactive depression because they had attached so much of their identity to the other, whatever it might be: a position in life that they lost or a relationship that was important.

But I think none of us can avoid occasional reactive depressions because life is a series of attachments and losses.  Most commonly, when we think about depression, however,

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