Depression and Hope in the Legal Profession

I am a lawyer, like many of you.

I also struggle with depression, like too many of you as well.

A new study by the American Bar Association and the Hazelden Betty Ford Foundation found that twenty-eight percent of over 12,825 practicing lawyers polled reported a problem with depression.  This is over three times the rate found in the general population. When put in perspective, of the 1.2 million attorneys in this country, over 336,000 reported symptoms of clinical depression.

Levels of stress, anxiety, and problem drinking were also significant, with 23%, 19%, and 20.6% experiencing symptoms of stress, anxiety, and hazardous drinking, respectively.

“This is a mainstream problem in the legal profession,” said

Breaking Bad Habits: You Can Do It

From The Washington Post, a story about Richard O’Connor, Ph.D.’s latest book, Rewire: Change Your Brain to Break Bad Habits, Overcome Addictions, Conquer Self-Destructive Behavior.  Read the News

10 Ways For Lawyers to Deal With Their Depression

A lawyer with depression used to call me once a month. He’d sometimes weep as he told me about the myriad of ways that his depression was disrupting his work and personal life.

I’d listen each time, for about fifteen minutes or so.  I thought I was helping him by offering a compassionate ear.

The conversation would always end with, “catch you later.” 

This went on for six months. 

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During our talks I’d make suggestions about things he could do to help himself.  It seemed to go in one ear and out the other. Despite all the pain in his life, absolutely nothing changed for him.

I finally got to the point where I said, “Bob, what are you willing to do to change your life?”  He seemed surprised by the question.  There was a long pause on the other end of the phone. 

He then said, “Catch you later.”  And he never called again.

Making a Choice to Change Things in Your Life

A hallmark of depression is that those afflicted feel that they have no choice: they victims of their depression and powerless to change it.  In the final analysis, that’s what happened with Bob and why things never changed for him.

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In her book, Listening to Depression:  How Understanding Your Pain Can Heal Your Life , psychologist, Lara Honos-Webb, takes a somewhat unique view.

She maintains that depression isn’t just as an “illness”, but as a wakeup call; a powerful warning that we have been traveling down paths in our lives that have been untrue to who we really and, as a result, have gotten sick because it.  She encourages us not to see depression as just a disease, but as an opportunity to change our lives.  There is something in us, she writes, if we would only listen, that is telling us that we are killing ourselves. 

But depressives, like my friend Bob, often don’t listen to the early warning signs.  So that inner voice just turns up the volume until we get sick with anxiety and depression – or heart disease, hypertension and cancer. 

I would like YOU to challenge a conclusion that you might have reached about yourself: that you can’t change.

I believe if you’re going to heal and grow, however, you’ll need to come to see life as a series of choices rather than inertia.  Richard O’Connor, Ph.D. once said, “While you’re not to blame for your depression, you are responsible for getting better.”

What old behaviors are you willing to change or what new behaviors are you willing to try to help you get better?

1.   Get help

You can’t handle this by yourself.  It’s not your fault.  It is a problem bigger than any individual person.  There are Lawyer Assistance Programs in most states that can get you started in the right direction, provide resources and help you with referrals.  Click here to search by state for a program nearest you.  While this advice sounds self-evident, believe me, it is not.  Recent statistics reveal that eighty percent of Americans don’t get any help for their depression.

2.   Maybe you have to take medication

That’s okay.  You may have a chemical imbalance that you need to address.  For many, psychotherapy won’t help until they quiet down their somatic complaints (e.g. extreme fatigue, sleep problems) so that they can have the energy and insight to work on their problems. However, “one size doesn’t fit all.”  Medication can – and is – over-proscribed.  I also have a problem with family physician diagnosing depression and recommending antidepressants.  In fact, such doctors write eighty percent of the scripts for antidepressants in this country.  Better idea:  go to be evaluated by a well-regarded psychiatrist who specializes in mental health. Check out HELPGUIDE.org, a not-for-profit organization, for a balanced overview of the pros and cons of medication.

3.   Negative Thinking

Whether you will need medication or not, you will need to confront your negative thinking with a therapist.  You really can’t do this effectively with friends or family alone.  A lot of research suggests that cognitive behavioral therapy is a particularly effective form of treatment for depression.  It teaches us that a large part of depression is made up of cognitive distortions.  One example is the all-or-nothing thinking approach.  Lawyers often think to themselves that they’re either “winners” or “losers” in the law. This is a distortion because the reality is that most lawyers both win and lose in their careers. Check out this excellent website article for a list of other cognitive distortions.  I recommend interviewing a couple of therapists before you settle on one.

4.   Exercise

The value of exercise is widely known:  It’s is simply good for everybody.  For a person with depression, it becomes not just about a healthy habit, but a critical choice.  In his book, Spark: The Revolutionary New Science of Exercise and the Brain, Harvard psychiatrist, Dr. John Ratey devotes a whole chapter to the importance of exercise in treating depression.  Please check this book out.  Also check out this short article from the Mayo Clinic about how exercise can help with the symptoms of anxiety and depression.

5.   Spirituality

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If you have a spiritual practice, do it.  If you don’t, think about starting one. This could include anything from a formal meditation practice, going to Mass or just taking a walk in the woods.  A lot of research suggests that people who do have a spiritual practice do better with depression.  If you believe in God or a higher power, you can avail yourself of help and support from Someone who is bigger than your depression.  If you do not believe in God, maybe you believe in some other form of spirituality you can tap into.  Spiritual growth and development, in my opinion, is an important pillar of recovery.

6.   Join a support group 

I started a lawyer support group in my community and it has been going strong for seven years.  Such groups can be invaluable in helping you to see that you are not alone and that others share in the very same struggle.  Contact a Lawyers Assistance Program in your state.  If you don’t feel comfortable being in a support group made up of lawyers, there are plenty of other routes to go.  Check out the website run by The Depression and Bipolar Support Alliance.  They run depression support groups meetings in all fifty states.

7.   Get educated

Read some good books on the topic of depression.  As part of your education, learn about the powerful connection between stress, anxiety and depression.  I recommend you read Dr. Richard O’Connor’s, Undoing Perpetual Stress:  The Missing Connection between Depression, Anxiety and 21st Century Illness.  Dr. O’Connor opines that depression is really about stress that has gone on too long.  The constant hammering away of stress hormones on the brain changes its neurochemistry.    This can and often does result in anxiety disorders and clinical depression.  I list a number of other great books on my website at Lawyers With Depression.  The site also offers guest articles, news, podcasts and helpful links for lawyers.

8.   Build pleasure into your schedule 

As busy lawyers, we have the “I will get to it later” mentality – especially when it comes to things that are healthy for us.   We have to jettison that approach.  We must begin to take time – NOW – to enjoy pleasurable things.  A hallmark of depression is the failure to feel happiness or joy.  We need to create the space where we experience and savor such feelings. 

 9.   Restructure your law practice

Nobody likes changes.  Lord knows, I don’t.  Yet this pointer falls into the category of “what are you willing to do?”  Maybe you will have to leave your job.  Is this stressful?  Yes.  Is it the end of the world?  No.  Maybe you will have to change careers.  I have spoken to many lawyers who haven’t been particularly happy with being a lawyer since day one.  But they kept doing it because they didn’t know what else to do, the legal profession paid a good buck, they didn’t want to seem like a failure, they were in debt, etc.  I am not trying to minimize these very real concerns.  However, your good health (as I learned the hard way) has got to reestablish itself as a top priority in your life.  I changed the nature and variety of my practice and am the better for it.  I do less litigation.  As a consequence, I have less stress, which has been long known to be a powerful trigger for depression.  It can be done.

10.   Practice mindfulness in your daily life

A lot of attention has been focused on the use of mindfulness lately as a way to help depression.  In mindfulness meditation, we sit quietly, pay attention to our breath and watch our thoughts float by in a stream of our consciousness.   We habitually react to our thoughts (e.g. “I will never get this brief done”).  In mindfulness meditation, we learn – slowly – to let the thoughts and feelings float by without reacting to them.  If such an approach to depression seems far-fetched, read the compelling book, The Mindful Way through Depression: Freeing Yourself from Chronic Unhappiness, for an excellent primer on how you can incorporate mindfulness into your day. Check out this article written for my website by one of the book’s authors.

In closing, I often tell lawyers to remember, to “be kind to yourself.”  When I say this they usually look puzzled – like many a judge who has listened to my oral arguments. They’ve rarely, if ever, thought about it and don’t know how to be kind to themselves.  I believe that it first begins with a conscious intention – “I am not going to treat myself poorly anymore.” 

Depression is often built upon poor mental/emotional and physical habits.  Such inner pain can bring people to the point where we they’ve had enough.  As one friend of mine said, “You get sick and tired of being sick and tired.”

 

In the Beginning: Depression in Law Schools

Everything has a beginning:  the Cosmic Bang, the French Revolution and depression in the legal profession.

There is little doubt that for many, depression begins in law school. One study of law students found they suffered from depression at the same rate as the general population before entering law school. Just two months into the school year, however, their negative symptom levels had increased dramatically.  By the spring of their first year, 32% of the same law students were depressed. By the spring of their third year, the number had risen to 40%.  Two years after graduation, 17% of the students – about twice the rate of depression experienced by the general population – were still depressed.  Such elevated levels of depression have been corroborated by later studies.

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Plug in these stats and an estimated 30,000 to 60,000 of this country’s 150,000-law students struggle with depression at some point during their law school experience

Andy Benjamin, J.D., Ph.D., the lead researcher in the above study and others that have looked at law student and lawyer depression, wrote me recently:

Since the publication of our research about law student and lawyer depression, depression still runs rife for law students and practicing attorneys – nearly a third of all law students and lawyers suffer from depression.  The data to support this statement have been published since the early eighties when the studies were first conducted.  Several subsequent empirical studies have corroborated the grim findings up until 2010.  As the stress, competition, and adversarial nature of the profession have continued to take their toll, not surprisingly, the rates of depression have not changed.  Law students and lawyers remain at the greatest risk for succumbing to depression, more so for any other profession.  After nearly forty years of compelling evidence about the prevalence of the severity of depression for the legal profession of law, more meaningful systematic changes must be implemented throughout the professional acculturation process of law students and lawyers.

It’s difficult for the legal establishment to face all of this. William M. Treanor, immediate past dean of Fordham Law School, told The New York Law Journal “Depression is a very important issue that often gets swept to the side.  It’s a real concern and a problem in the legal profession. Studies indicate that it is common among law students and common among lawyers. Given that, it’s important to try to figure out ways to combat it and to let people know if they are suffering, they are not alone.”

As author Kathleen Norris wrote, “The religion of America is optimism and denial.”  We’re a nation of suck-it-uppers; a people who drive their inner pain deeper and deeper into themselves until they break. The denial of depression in the law is both institutional and individual.

In “The Institutional Denial About the Dark Side of Law School,” Florida State University Law Professor Lawrence Krieger wrote:

There is a wealth of which should be alarming information about the collective distress and unhappiness of our [law] students and the lawyers they become.  We appear to be practicing a sort of organizational denial because, given this information, it is remarkable that we are not openly addressing these problems among ourselves at faculty meetings, and in committees and without students in the context of courses and extracurricular programs.  The negative phenomena we ignore are visible to most of us and are confirmed by essentially unrebutted empirical evidence.

Attorney Andrew Sparkler, a friend of then fellow Fordham law student David Nee who suffered from depression (unbeknownst to his friends) and committed suicide in his third year of law school, observed, “To admit that you are depressed [in law school], to yourself or to others . . .  , is a weakness and if you’re in a shark tank of hyper-aggressive folks around you, you’d be hesitant to expose it because why would you fess up to anyone that you have a problem?” Sparkler, his friends and the Nee family started the Dave Nee Foundation to address law student depression and suicide.

It doesn’t get much better when one graduates and enters the job market.  A John Hopkins study looked at 104 occupations to determine which ones had the highest incidence of depression.  Lawyers topped the list and were found to suffer from depression at a rate of 3.6 times that of other profession studies.  Other studies have found that about 20 percent of all lawyers struggle with depression.

Plug in these stats and an estimated 200,000 of this country’s 1 million lawyers are hurting.

Obviously, something is really rotten in Denmark.

There have been several theories bantered about as to why law students suffer from such high rates of depression: pessimistic thinking styles taught in law school (“learning to think like a lawyer”), personality types that go to law school, a breakdown in inner values and the current nasty economy and stress to find and maintain a good job.  The New York Times ran an article, No Longer Their Golden Ticket, – I was interviewed for this one – which spoke about the stress and uncertainty that law school students’ face:

“[The] days of [high pay and full employment] are over. As the profession lurches through the worst economic slump in decades, with jobs and bonuses cut and the internal pressures to perform rising, associates do not just feel as if they are diving into the deep end, but rather, drowning.”

However, there has been pushback against the theory that law school even causes much psychic damage.

In an article by University at Michigan Law Professor James White entitled Maiming the Cubs, he takes issue with Professor Krieger theory and argues that the law school experience does not “. . . cause permanent and irreversible change and that the ills of lawyers cannot be traced in any meaningful way to the stresses of the three years in law school.”  He concludes:

“I wonder, too, whether the anxiety and depression that we observe in some of our law students is the unavoidable consequence of the challenge of hard learning and of confronting the looming need to prepare to behave like a lawyer.  Soon after they come to law school, students must sense that however hard Contracts and Torts is, learning to be a successful practicing lawyer is harder, and that the road to success in the profession is even less clearly marked than the road to law school success.”

Sorry, I just don’t agree.

My take on law school depression

I think we must look at what makes people more vulnerable to depression before they enter law school – those 10% who already have depression or are at risk for developing it before they register for their first 1L class. For most, there is a genetic or family history of depression. Likewise, there is a history of family dysfunction: for example, alcoholism, physical and emotional abuse and/or neglect.   These folks bring those major risk factors into law school. It is my view that law school doesn’t cause depression; rather, it may be the straw that breaks the camel’s back for those who already have some risk for it. 

Pessimistic thinking and persistent stress , both powerful dynamics in law school, are known triggers for depression.  When these influences are mixed in with other pre-law school risk factors, law school creates a “perfect storm” for depression to happen.

We tend to mix up law student unhappiness and dissatisfaction with depression.

They’re not the same thing; not even close. Unhappiness and discontent are relatively transitory; other emotions aren’t pushed to the margins or extinguished. We are adaptable in response to our environment. We might feel stressed or exasperated by the law school grind, but everyone bumps up and down throughout their days.  We deal with our stress and balance ourselves out either with exercise, socializing or just by having stress resilient genes.  Not so with depression.  Richard O’Connor, Ph.D., in his best-selling book, Undoing Depression, writes:

“We confuse depression, sadness, and grief.  But the opposite of depression is not happiness, but vitality—the ability to experience a full range of emotion, including happiness, excitement, sadness, and grief.  Depression is not an emotion itself. It’s not sadness or grief, it’s an illness.  When we feel our worst, sad, self-absorbed, and helpless, we are experiencing what people with depression experience, but they don’t recover from those moods without help.”

There is also a biochemical poverty about depression; the scarcity of neurochemicals like serotonin and dopamine that wreck havoc in our brains and set the stage for depression.  As I wrote in Trial magazine about the connection between stress, anxiety and depression, the grind isn’t just about long hours in the office or law library cubicle, but the grinding up of our nervous systems.

We have a sense that such a lifestyle can be problematic to our happiness, but we’re willing to keep marching to that beat in the hope of later rewards (e.g. money, security, partnership). Yet, I can’t help but think that we’re dimly aware, if at all, of the risk we put ourselves in for major depression.

Besides the psychological-physiological links to depression, we live in a culture that breeds melancholy.  How could this not eek its way into the law school experience?

Maybe it’s the moral and spiritual bankruptcy of our times; the torpor of the imagination which fails to inspire our young people, to live an engaged and spirited life in the law, or the cynicism to think that such a life is even possible that worries me. Or, by the time young people get to law school, they’re so jaded by our consumer driven culture they just want the diploma to start making the big bucks. All of this contributes to depression, to a lonely society that undermines what it means to live a decent, healthy and happy life.

In 2008 the American Bar Association launched a Mental Health Initiative to address mental health problems on law school campuses.  See the Mental Health Toolkit for Student Bar Organizations and Administrators distributed as part of this effort.  Such initiatives’ involve mental health days (e.g. check out Marquette Law School) where they had out a document from Professor Krieger called The Hidden Sources of Law School Stress, “wellness” web pages on law school websites (e.g. check out the one at Harvard Law School) and referrals to a school’s counseling center (e.g. check out Cornell Law School).

While laudable, they’re an arm’s length effort to confronting such a deeply personal and painful human experience.  Moreover, it seems like any presentation on the issue of depression in law schools is limited to first year orientation. What about the second and third year students? Studies conclude that depression rates continue to rise into the second and third year.  If that’s true, what is being done to help these students?  Another query: Just how many of the people who speak at these programs are law students or lawyers who actually had or are currently suffering from depression and disclose it?  My hunch is few, if any.

Why should that matter?  Because students need to hear it — they need to listen to someone in the trenches of a profession they’ll soon be entering.  Without such depression experiences, a speaker is like someone trying to enlighten someone about the dangers of smoking and cancer, but has never smoked. Wouldn’t it be a more powerful, credible and informative experience for students to listen to a law student and/or a practicing lawyer, who has depression and is willing to talk about it?

Instead, students are served up programs, usually offered up by well-meaning Dean or Vice-Deans of Student Affairs and therapists from a University’s Counseling Center. There’s a lump-it-all-together approach to it all.  I was asked a few years back, when I was just beginning my advocacy work, to give a brief, 15-minute talk on depression. The school trotted out a variety of people in fifteen minute increments to talk about stress, drinking, drugging and, eventually, depression. Speaking in that big first year classroom, I was reminded of the ancient Greek amphitheaters.  Many of the Greek dramas were tragedies.  And make no doubt about it, depression is a tragedy.

I was saddened by the whole charade, the paucity of imagination and effort that went into addressing such a critical problem; the let’s pool this list of mental ills together into a small program on “mental health.”  I sensed that the students failed to see how any of this was connected to them.  The sliver of time allocated to depression couldn’t help but leave the students with the impression that the school really didn’t take the problem that seriously.

Over 130 million people suffer from depression worldwide on a planet where it is the leading cause of disability. In our country, it’s also the leading cause of disability and some 20 million people are afflicted.  It’s been characterized as an “epidemic.”  If that’s true, what does that say about the higher rates of law student and lawyer depression?  Just what adjective could one use to describe the scope of the problem?

 Addressing Depression In Law School – Really

Here’s what can be done right now:

1. Law Schools – show the thirty minute documentary, “A Terrible Melancholy: Depression in the Legal Profession.”   Copies of the film on DVD are available form the Erie County Bar Association. A trailer of the film is on this website.

2. Have someone come in to speak to the students that are in the legal profession who has suffered from depression to reach these students.  Give it more than 15 minutes of your time and have programs for second and third year student on this critical topic.

3. Law Students – show up, watch the film and think long and hard about it.

Finally, I want to urge all of you reading this blog to write in and express your views about your law school experience, whether you’re in school now or it’s been thirty years.  There’s much to be gained by such sharing. Please write.

Further reading:

Todd David Peterson & Elizabeth Waters Peterson, Stemming the Tide of Law Student Depression: What Law Schools Need to Learn from the Science of Positive Psychology, 9 YALE JOURNAL OF HEALTH POLICY & ETHICS (Summer, 2009); Susan Daicoff, Lawyer Be Thyself: An Empirical Investigation of the Relationship Between the Ethic of Care, the Feeling Decision-making Preference, and Lawyer Well-being, 16 VIRGINIA JOURNAL OF SOCIAL POLICY & LAW (2008-2009); Patrick J. Schlitz, On Being a Happy, Healthy, and Ethical Member of an Unhappy, Unhealthy, and Unethical Profession, 52 VANDERBILT LAW REVIEW 871 (1999) and Depression and Anxiety in Law Students: Are We Part of the Problem and Can We Be Part of the Solution?, 8 JOURNAL OF LEGAL WRITING INSTITUTE 229 (2002).

 

 

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.

 

Lawyer Blues or Depression?

The opposite of depression is not happiness, but vitality – the ability to experience a full range of emotions, including happiness, excitement, sadness, and grief.  Depression is not an emotion itself; it’s the loss of feelings, a big heavy blanket that insulates you from the world yet hurts at the same time.  It’s not sadness or grief, it’s an illness. –Richard O’Connor, Ph.D.

I can spot sadness on lawyer’s face.  Like a craggy poker player reads dog-eared cards in a smoke-laden backroom bar, world-weary drooped eyelids, even on young lawyers, which suggests a great weight borne, a solemnity.  To others, their expressions may seem like a seasoned lawyer’s humorless, steely resolve. But, I know better.  Their faces a subtler shade of grey, the somber hue of a 1L’s textbook on Contracts.

Their humorous repartee among each other, if any, can be deeply cynical and sarcastic. It is a tough life for many in this boat; many dream, sadly, of a different life.  “Every man has his secret,” wrote the poet Henry Wadsworth Longfellow, “which the world knows not; and often times we call a man cold when he is only sad.”

It’s normal to “feel the blues”, a sadness that colors our lives from time to time like the reds of anger, the greens of envy.  Sadness is the price we pay to experience its opposite: happiness.  Carl Jung, a protégé of Sigmund Freud, wrote, “Even a happy life cannot be without a measure of darkness, and the word happy would lose its meaning if it were not balanced by sadness”.

Sadness

Sadness is not clinical depression – – not by a long shot – – because while sadness is an emotional response to a loss, depression is a loss of feeling; the absence of a wide array of emotions replaced by psychic pain.

There are two major differences between the blues and depression: the length of time the sadness endures and whether or not there are other symptoms associated with depression which are tagging along with the perpetual sadness. “I think the difference between just having the blues and depression lies in the symptoms,” said Raymond Crowe, M.D., UI professor of psychiatry. “If ‘the blues’ persist for more than a couple of weeks and are accompanied by trouble eating, difficulty sleeping, or suicidal thoughts, you should see someone.”

J.K. Rowling, the creator of that mischievous and bespectacled wizard Harry Potter, makes this distinction:

Depression is the most unpleasant thing I have ever experienced. . . . It is that absence of being able to envisage that you will ever be cheerful again. The absence of hope. That very deadened feeling, which is so very different from feeling sad. Sad hurts but it’s a healthy feeling. It is a necessary thing to feel. Depression is very different.

Psychiatrist Peter Kramer, author of Against Depression, underscores the point that depression is a serious illness and not ordinary sadness:

For the psychiatrist, then, depression becomes an intimate.  It is poor company.  Depression destroys families. It ruins careers. It ages patients prematurely. It attacks their memories and their general health. For us – for me – the truth that depression is a disease is unqualified.  Depression is debilitating, progressive and relentless in its downhill course, as tough and worthy opponent as any doctor might choose to combat.

It’s important to recognize the difference between sadness and depression because a suffering lawyer will not be able to resolve the depression by himself; talking it out with a group of work pals over some Old Milwaukee’s after work just won’t get to the bottom of the problem.  This person will need a mental health professional to help evaluate him to see if he has depression, and, if so, to get him the serious help he needs.

Others simply do not have a reference point for depression unless they have been through it before.  Have they known loss and sadness? Yes.  The deep psychic pain of depression?  No. So they misidentify a person with depressive symptoms as having the blues which can have severe consequences because the more people do so, the greater the isolation, the greater pit of desolation the depressive falls into because no one understands and because they do not understand, it becomes hard for them to seek out help.

This commingling of sadness and depression is confusing – – and dangerous.  This is so because a sufferer and those around him may underestimate the gravity of the situation: “Bob is just sad, going through a tough patch at the law office.  He’ll get over it.”

But, Bob might not.  He may get worse.  The depression may deepen.  He may need medication that he’ll never get. He may need to talk to a therapist to address the distorted thinking that goes on during a depression. He may need medication to lift himself out of the darkness. Absent such help and hope, he may commit suicide.  As much as 80% of suicides are committed by those struggling with depression and lawyers have much higher suicide rates than the general population.

Not only do others misunderstand and mislabel a depressed lawyer’s symptoms as regular sadness, the depressive himself often does not know what is going on inside him or herself.  He himself may be confused because while he knows what sadness is, he senses something bigger than sadness – – and much worse – – may be happening to him.  He senses something is deeply wrong, but might ignore the red flags, or symptoms of depression, because he doesn’t know what they mean. If he’s never experienced major depression before, he doesn’t know that they’re harbingers of something awful, a turbid wave about to hit his bow.

Grief

Grief, a close cousin of sadness, has several symptoms in common with major depression because its symptoms are more layered than everyday sadness: the sadness is accompanied by sleep problems and poor appetite, for example.

Another significant difference between the two is that grief tends to be trigger-related:  People that are grieving tend to feel better in situations where they have heart-felt support, but have their grief triggered by things that remind them of their deep loss such as their wedding anniversary which they no longer enjoy because their spouse has died.  Andrew Solomon sums it up best, “Grief is depression in proportion to circumstance; depression is grief out of proportion to circumstance.”

The reason for the differences between sadness and depression is because with the former we are dealing with a normal human emotion which is transitory – – it will change, subside and be replaced with other emotional experiences.  Depression is not transitory because it is an illness going on in the brain, a system unable to ward off serious psychic pain.

These losses are stressful, but not, in themselves, necessarily depressing in a clinical sense. Peter Kramer, M.D., writes:

Depression can be set off by a variety of stressors: sexual abuse, housing problems, illness in one’s child, and the other common problems you might imagine. To suggest that depression arises from loss is to skew the argument in the direction of the metaphor . . . , the one that likens apparent depression to ordinary bereavement. Likewise, “sadness” does not capture the essence of depression, which is a marked disruption of brain and mind characterized by painful apathy. Not only in degree but also in quality, sadness and depression are different.

So, look at the nature of your pain and others.  Is it something you can relate to some loss?  If so, it’s probably sadness. If not and there are a few symptoms of depression, bereavement that will pass at some point after a major loss.  If not, the culprit is probably depression.

 

 

 

Dan’s Top Ten Depression Books

Undoing Depression – Richard O’Connor, Ph.D.

This is the best book I’ve read on depression.  Perhaps it’s more compelling than most books on this subject because Richard O’Connor, a therapist in New York City, has gone through major bouts of depression himself.  Depression has often been compared to heart disease; an illness fueled by complex and interrelated factors: genetic, biochemical, environmental.  In this book, O’Connor focuses on an additional factor often overlooked: our own habits. Unwittingly, we get good at depression.  This book teaches us how to replace depressive patterns with a new and more effective set of skills. We already know how to “do” depression. And we can learn how to “undo” it. With a truly holistic approach that synthesizes the best of the many schools of thought about this painful condition, this book offers new hope, and new life, for sufferers of depression.  Go to Dr. O’Connor’s website  

The Noonday Demon – Andrew Solomon

Winner of The National Book Award following its release a decade ago, this is a beautifully written book by depression sufferer, Andrew Solomon.  Drawing on his own struggles with the illness and interviews with fellow sufferers, doctors and scientists, policy makers and politicians, drug designers and philosophers, Solomon reveals the subtle complexities and sheer agony of the disease. With uncommon humanity, candor, wit, and erudition, he not only helps us understand depression, but also the human condition. Go to Andrew Solomon’s website to read a chapter

The Mindful Way through Depression – J. Mark Williams, Ph.D.

Mindfulness, a simple yet powerful way of paying attention to your most difficult emotions and life experiences, can help you break the cycle of chronic unhappiness once and for all.  It seems like every few days, there is a new book or article out on the power of mindfulness. Here, four uniquely qualified experts explain why our usual attempts to “think” our way out of a bad mood or just “snap out of it” lead us deeper into the downward spiral. Through insightful lessons drawn from both Eastern meditative traditions and cognitive therapy, they demonstrate how to sidestep the mental habits that lead to despair, including rumination and self-blame, so you can face life’s challenges with greater resilience. Jon Kabat-Zinn gently and encouragingly narrates the accompanying CD of guided meditations, making this a complete package for anyone seeking to regain a sense of hope and well-being.  Go to a review and summary of this book

Listening to Depression – Lara Honos-Webb, Ph.D.

I first read this book five years ago and was struck by its originality:  depression isn’t just a disease to be fixed with medication and therapy, but a warning signal that our lives are off track and needs to be healed.  In this sense, depression and its painful symptoms is a sort of unwelcome wisdom. Dr. Honos-Webb argues that we too often try to cut off or numb our feelings of depression instead of listening carefully to what they are telling us about our lives. Listening to Depression offers insightful ways to reframe depression as a gift that can help you transform your life for the better.  Go to an interview with Dr. Honos-Webb

Lincoln’s Melancholy – Joshua Wolf Shenk 

I am a little biased here.  I am a lawyer and Lincoln is my hero.  He not only was a great trial lawyer, but also struggled with depression his entire life. Giving shape to the deep depression that pervaded Lincoln’s adult life, Joshua Wolf Shenk’s Lincoln’s Melancholy reveals how this illness influenced both the president’s character and his leadership. Lincoln forged a hard path toward mental health from the time he was a young man. Shenk draws from historical record, interviews with Lincoln scholars, and contemporary research on depression to understand the nature of his unhappiness. In the process, he discovers that the President’s coping strategies—among them, a rich sense of humor and a tendency toward quiet reflection—ultimately helped him to lead the nation through its greatest turmoil.  Go to the author’s excellent website about the book

Unstuck: Your Guide to the Seven-Stage Journey Out of Depression – James S. Gordon, M.D.

One of our country’s most distinguished psychiatrists and a pioneer in integrative medicine, Dr. Gordon believes that depression is not an end point, a disease over which we have no control. 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, one that can change and transform our lives. Unstuck is a practical, easy to use guide explaining the seven stages of Dr. Gordon’s approach and the steps we can take to exert control over our own lives and find hope and happiness. Unstuck is designed for anyone who is suffering from depression, from mild subclinical depression (“the blues”) to its severest forms. Go to this PBS television intereview with Dr. Gordon

Unholy Ghosts: Writers on Depression – Nell Casey

The only book of its kind, Unholy Ghost is a unique collection of essays about depression that, in the spirit of noveliest William Styron’s Darkness Visible. Unlike any other memoir of depression, however, Unholy Ghost includes many voices and depicts the most complete portrait of the illness.  With an introduction by Dr. Kay Redfield Jamison, Unholy Ghost allows the bewildering experience of depression to be adequately and beautifully rendered. The twenty-two stories that make up this book will offer solace and enlightenment to all readers.  Go to an excerpt of the book

Depression is Contagious – Michael Yapko, Ph.D.

Dr. Yapko has identified the types of relationship patterns that lead to negative ways of thinking, feeling, and relating to others and culls from the latest findings in neuroscience, social psychology, epidemiology, and genetics to provide a practical, proven plan for developing the skills and insights you need to forge stronger, healthier social connections and enjoy an enriching, interconnected life. While commonly prescribed drugs address some of depression’s symptoms, they cannot change the social factors that cause and perpetuate the disorder. By treating a social condition as though it’s a disease, the problems compound rather than diminish. The foundation for recovery is to build a healthy social life based on understanding what to expect from our relationships, what we should give, and how to relate to and accept others — skills that have been neglected by modern society. Dr. Yapko’s groundbreaking plan of action — filled with skill-building emotional and mental exercises, anecdotes, and illuminating explanations.  Go to an article written by Dr. Yapko about his approach to treating depression

I Don’t Want to Talk About It – Terrence Real

Depression is a silent epidemic in men who hide their condition from family, friends, and themselves to avoid the stigma of depression’s “un-manliness.” Problems that we think of as typically male — difficulty with intimacy, workaholism, alcoholism, abusive behavior, and rage-are really attempts to escape depression. And these escape attempts only hurt the people men love and pass their condition on to their children. Real reveals how men can unearth their pain, heal themselves, restore relationships, and break the legacy of abuse. He mixes penetrating analysis with compelling tales of his patients and even his own experiences with depression as the son of a violent, depressed father and the father of two young sons. Go to a video of Terry talking about men and depression

What to Do When Someone You Love is Depressed – Mitch Golant and Susan Golant

There are few circumstances in life as hard and at the same time as important as being a friend to a person who is suffering from depression. What to Do When Someone You Love Is Depressed offers guidance to the friends and family of a depressed person on how to keep one’s own spirits up and at the same time do what is best to help a loved one get through a difficult time.  Read an excerpt here

HONORABLE MENTION

 The Zen Path through Depression – Philip Martin

Extremely accessible to people with little or no Zen experience as well as to longtime students of Buddhism, The Zen Path through Depression shows how the insights and exercises of Zen offer relief for those suffering from depression.  Read an excerpt here

Beyond Blue – Therese Borchard

In this part memoir/part self-help, Therese Borchard, who blogs about depression at her site, Beyond Blue, endears herself to the reader and then reduces even the most depressed to laughter as she provides a companion on the journey to recovery and the knowledge that the reader is not alone.  Go to her popular depression blog now

Get it Done When You’re Depressed –Julie A. Fast and John Preston, M.D.

When a depressed person can’t meet the expectations of society, the depression becomes worse and a vicious cycle begins. The goal of Getting Things Done When You’re Depressed is to break this cycle. Readers will learn how to prepare themselves mentally for working while depressed, how to structure their environment so they can work more easily, how to work with others and how to prevent depression. Go to an interview with the author

The 10 Best-Ever Depression Management Techniques – Margaret Wehrenberg, Ph.D.

What I like about this book is that it provides an overview of the some of the best techniques out there that scientists and therapist are using to help and heal people from depression. As Margaret Wehrenberg explains, you must first understand your brain. Drawing on cutting-edge neuroscience research presented in a reader-friendly way, Wehrenberg skillfully describes what happens in the brain of a depression sufferer and what specific techniques can be used to alter brain activity and control its range of disabling symptoms. Containing practical, take-charge tips from a seasoned clinician, this book presents the ten most effective strategies for moving from lethargy into action, taking charge of your brain, and breaking free from depression to find hope and happiness. Read an excerpt here

 

 

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