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.

One of Matt’s friend’s wrote this sympathy section of the funeral notice:

“He was brilliant, authentic and loyal. Matt encompassed qualities that undeniably made him stand out from the crowd, and loved by many. But what I admired most about Matt was his unconditional love for his family. He had immense respect for his parents, and a strong bond with his three siblings. Matt spent a lot of time with his family, and whenever I was with the Benedict family, I felt a great amount of love, appreciation, and support for one another.”

Matt reportedly suffered with depression.

Shocking. Sad beyond words. But I will try to offer a few.

Earlier in my legal career, I occupied an office on the 16th floor of the Liberty Building for five years. Hearing about Matt’s death, brought back images from those days.

This suicide hits home for me.

As a lawyer who has suffered from major depression for almost 20 years, I never had suicidal ideations. However, I could see how someone going through depression could think about suicide. The pain of depression can be that horrible.

There is a stigma attached to disclosing to anyone you have depression. But to say that you have suicidal thoughts would be, for must with depression, unheard of.  I feared others would think me “crazy” or ready for a stay in a mental institution.  The reality is, as most who have gone through major depression understand, that this happens.  That’s why it is listed as one of the nine symptoms of major depression. One study reports that approximately 10% of those with depression have had suicidal thoughts and/or plans.

Fortunately for me, my thoughts never went beyond that. I never planned or attempted suicide. But I know others who have. Most survived; a few did not.

A few years, I recall sitting at my desk at my law office.  It was around noon.  I had too much work to grab lunch.  I got a text from a fellow lawyer and friend.  He was a highly successful insurance defense trial lawyer. And also, a member of the depression support group I started for lawyers ten years ago.

I sometimes ignore texts.

Thank God, I didn’t brush off this one.

Dear Dan,

By the time you read this, I will be dead. You can find my body in my law office.  My car is parked in the City lot on the 5th floor.  Thanks, Steve.

I immediately called 911. The police found my friend unconscious in his office following a drug overdose. His stomach was pumped, and he survived.

Talking to my friend later, he said that he had convinced himself that the pain of living another day with depression was worse than the pain of killing himself.

It’s tough to understand this – if you’ve never been through major depression.

David Foster Wallace, the author of the best-selling book “Infinite Jest,” who later committed himself after suffering from depression for years, writes:

“The so-called ‘psychotically depressed’ person who tries to kill herself doesn’t do so out of quote ‘hopelessness’ or any abstract conviction that life’s assets and debits do not square. And surely not because death seems suddenly appealing. The person in whom its invisible agony reaches a certain unendurable level will kill herself the same way a trapped person will eventually jump from the window of a burning high-rise. The variable here is the other terror, the fire’s flames: when the flames get close enough, falling to death becomes the slightly less terrible of two terrors.”

The Depression-Suicide Connection

Approximately 25 million Americans suffer from depression each year. It is the leading cause of disability in the U.S. and globally, where some 350 million people are afflicted.

Although the vast majority of people who have depression do not die by suicide, having major depression does increase suicide risk compared to people without depression.

According to a 2018 Center for Disease Control report, suicides are on the rise in this country.

The Washington Post, reporting on the release of the study, noted that 54% of those who died by suicide had no diagnosed mental health condition.

But Joshua Gordon, director of the National Institute of Mental Health, said that statistic must be viewed in context.

“When you do a psychological autopsy and go and look carefully at medical records and talk to family members of the victims,” he said, “90 percent will have evidence of a mental health condition.” That indicates a large portion weren’t diagnosed, “which suggests to me that they’re not getting the help they need.”

Depression is among the most treatable of psychiatric illnesses. Between 80 percent and 90 percent of people with depression respond positively to treatment, and almost all patients gain some relief from their symptoms. But first, depression has to be recognized.

But according to the organization Mental Health America, 30% to 70% of suicide victims suffer from major depression or bipolar (manic-depressive) disorder.

Some facts on suicide in this country from 2017 (the latest data available):

  • Suicide was the 10th leading cause of death in the U.S.
  • More people died by suicide (47,173) than homicide.
  • There we approximately 1,400,000 suicide attempts.
  • White males accounted for 69.7% of suicide deaths.
  • On average, there are 129 suicides per day in this country.
  • 40% of persons who complete suicide have made a previous attempt
  • Nine of out ten people who attempt suicide and survive, do not go on to complete suicide at a later date.
  • Each suicide intimately affects at least six other people (estimated). In 2013, it was estimated that one in every 63 Americans became a suicide-loss survivor.

High Rates of Depression in Law School Contribute to Suicides

The specific details of what led this bright, talented young man to jump are unknown.

But what we do know is that his suicide is far from an isolated incident in the legal profession.

A 2016 survey of 3000 law students revealed that 17% had screened positive for depression, and 21% reported they had seriously thought about suicide in their lifetimes. 6% said, they had seriously thought of suicide within the past twelve months.

A few years, I was contacted by the Dave Nee Foundation to give a speech at its annual fundraiser in New York City. The foundation was founded by friends of Dave following his suicide during his third-year of law school at Fordham. It was an amazing event with over 150 people there to support the foundation’s mission to educate others about depression and suicide in law schools and the legal profession.  I met Dave’s friends and family. They were all gracious, welcoming, and smiling.

It came time for my short time.  The room darkened and I stepped up to the dais.  A spot light shone on me and it was difficult to make out the faces of people in the audience as I spoke – except one.  Near the stage was Dave’s mother. I looked at her. Here face crumbled into grief.  It was a powerful moment I will never forget. Though I never met Dave, he is a big reason why I continue to give speeches on depression.

The High Rate of Lawyer Depression

High rates of depression rise following graduation from law school.

A 2016 survey of almost 13,000 practicing lawyers and judges, found the following:

  • 28 % of lawyers reported experiencing depression within the past 12 months, compared 1% for the general population.
  • 46% reported they had encountered a problem with depression over the course of their legal careers.
  • 5% reported having had suicidal thoughts at some point in their legal career.
  • 19% experienced anxiety.
  • In terms of career prevalence, 61% reported concerns with anxiety at some point in their career, and 46% reported concerns with depression.
  • Mental health concerns often co-occur with alcohol use disorders and our study reveals significantly higher levels of depression, anxiety, and stress among those screening positive for problematic alcohol use.

Lawyers rank 5th in incidence of suicide by occupation.

Patrick Krill, a lawyer and mental health consultant, wrote Why Are Lawyers Prone to Suicide? for CNN:

“Despite whatever preconceptions or judgments, many people may have of lawyers and the work they do, there are facts about the practice of law that can’t be denied: It’s tougher than most people think and frequently less fulfilling than they would ever believe.

The psychologist Rollo May famously defined depression as “the inability to construct a future.” And, unfortunately for many attorneys who define their existence by a hard-earned membership in the legal profession, the powerful despair they experience when that profession overwhelms and demoralizes them doesn’t leave them much psychological real estate for constructing a future they can believe in.

Not a future where the practice of law will be what they hoped for, not a future where their lives will have balance and joy, and not a future where their relationships will bring fulfillment and their stresses will seem manageable. They just can’t see it. Unable or unwilling to extract themselves from the psychological, financial and personal mire they never would have expected years of hard work and discipline to bring them, many lawyers then find themselves sinking into a funk, a bottle or a grave.”

A few years ago, I spoke at a conference put on by the Cincinnati Bar Association on depression in the legal profession.  There were about 60 lawyers in attendance.  A few days after the event, I was contacted by another speaker who informed me that one of the attendees had died by suicide.  It took my breath away.  His name was Ken Jamison, a highly successful lawyer and beloved member of his legal community.  His friend and then law partner, Tabitha Hochscheid, Esq., wrote a deeply personal blog about Ken for my website. Here, in part, is her moving tribute:

“I’ll always miss Ken Jameson. The courage and commitment he showed to his clients, his family and those of us in business with him is something I admire. However, his suffering in silence has left me and his other colleagues with regrets as to what we could have done to help. In the end, however, Ken could not give himself permission to be less than perfect and eventually, felt those in his life were better off without him. It is truly a sad ending to a beautiful life that could have been prevented. My hope in sharing Ken’s story is that there will be greater recognition of depression and the despair that can accompany and that it will help someone struggling with these issues. As for Ken, I hope he has found the peace that life did not provide.”

What can we do?

Learn about the symptoms of depression and possible warning signs for suicide.

Depression is a significant risk factor for suicide. The deep despair and hopelessness that goes along with depression can make suicide feel like the only way to escape the pain. If you have a loved one with depression, take any suicidal talk or behavior seriously and watch for the warning signs:

  1. Talking about killing or harming one’s self
  2. Expressing strong feelings of hopelessness or being trapped
  3. An unusual preoccupation with death or dying
  4. Acting recklessly, as if they have a death wish (e.g., speeding through red lights)
  5. Calling or visiting people to say goodbye
  6. Getting affairs in order (giving away prized possessions, tying up loose ends)
  7. Saying things like “Everyone would be better off without me” or “I want out”
  8. A sudden switch from being extremely depressed to acting calm and happy

According to the Mayo Clinic, the first step is to find out whether the person is in danger of acting on suicidal feelings. Be sensitive, but ask direct questions, such as:

  • How are you coping with what’s been happening in your life?
  • Do you ever feel like just giving up?
  • Are you thinking about dying?
  • Are you thinking about hurting yourself?
  • Are you thinking about suicide?
  • Have you ever thought about suicide before, or tried to harm yourself before?
  • Have you thought about how or when you’d do it?
  • Do you have access to weapons or things that can be used as weapons to harm yourself?

Asking about suicidal thoughts or feelings won’t push someone into doing something self-destructive. In fact, offering an opportunity to talk about feelings may reduce the risk of acting on suicidal feelings.

If a friend or loved one is thinking about suicide, he or she needs professional help, even if suicide isn’t an immediate danger. Here’s what you can do.

Encourage the person to call a suicide hotline number. In the U.S., call the National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255) to reach a trained counselor. There is also a confidential online chat available.

Encourage the person to seek treatment. A suicidal or severely depressed person may not have the energy or motivation to find help. If the person doesn’t want to consult a doctor or mental health provider, suggest finding help from a support group, crisis center, faith community, teacher or another trusted person. You can offer support and advice — but remember that it’s not your job to substitute for a mental health provider.

Offer to help the person take steps to get assistance and support. For example, you can research treatment options, make phone calls and review insurance benefit information, or even offer to go with the person to an appointment.

Encourage the person to communicate with you. Someone who’s suicidal may be tempted to bottle up feelings because he or she feels ashamed, guilty, or embarrassed. Be supportive and understanding, and express your opinions without placing blame. Listen attentively and avoid interrupting.

Be respectful and acknowledge the person’s feelings. Don’t try to talk the person out of his or her feelings or express shock. Remember, even though someone who’s suicidal isn’t thinking logically, the emotions are real. Not respecting how the person feels can shut down communication.

Don’t be patronizing or judgmental. For example, don’t tell someone, “Things could be worse” or “You have everything to live for.” Instead, ask questions such as, “What’s causing you to feel so bad?” “What would make you feel better?” or “How can I help?”

Never promise to keep someone’s suicidal feelings a secret. Be understanding, but explain that you may not be able to keep such a promise if you think the person’s life is in danger. At that point, you have to get help.

Offer reassurance that things can get better. When someone is suicidal, it seems as if nothing will make things better. Reassure the person that with appropriate treatment, he or she can develop other ways to cope and can feel better about life again.

Encourage the person to avoid alcohol and drug use. Using drugs or alcohol may seem to ease the painful feelings, but ultimately, it makes things worse — it can lead to reckless behavior, or feeling more depressed. If the person can’t quit on his or her own, offer to help find treatment.

Remove potentially dangerous items from the person’s home, if possible. If you can, make sure the person doesn’t have items around that could be used for suicide — such as knives, razors, guns, or drugs. If the person takes a medication that could be used for overdose, encourage him or her to have someone safeguard it and give it as prescribed.

Take all signs of suicidal behavior seriously

If someone says he or she is thinking of suicide or behaves in a way that makes you think the person may be suicidal, don’t play it down or ignore the situation. Many people who kill themselves have expressed the intention at some point. You may worry that you’re overreacting, but the safety of your friend or loved one is most important. Don’t worry about straining your relationship when someone’s life is at stake.

You’re not responsible for preventing someone from taking his or her own life — but your intervention may help the person see that other options are available to stay safe and get treatment.

If someone is in immediate danger of committing suicide, call 911 immediately.

Other Resources

Each state has a Lawyers Assistance Program to provide law students and lawyers with confidential help regarding a mental health or addiction programs.  Here is a list of state LAP’s.

If you happen to live in the Buffalo, New York area, you can contact Crisis Service’s 24-Hour Crisis Hotline at (716) 834-3131. If you would like to become actively involved in the Western New York Community on this issue, contact Dr. Celia Spacone, Director of the Suicide Prevention Coalition of Erie County, at the same number.

Matt’s family has set up a fund where you can donate to their cause to “improve the lives of athletes that battle mental health issues.” This was a cause dear to Matt’s heart.  He was a star football player at Middlebury College. Go to their website, “Matthew Benedict’s One Last Goal,” to contribute.

By Daniel T. Lukasik, Esq.

Did Law School Bullying Contribute to a Recent Graduate’s Suicide?

The newest installment of The Struggle, a series of blogs examining the many challenges students face at law school, this sad story is a stark demonstration of the corrosive effects of stereotypes and stigma as two middle-aged, single mothers seek to navigate the rigors of law school in the midst of those who dismiss them because of their sex.  Read it here.

Depression Dominates Legal Industry, Starting at Law School

The Dave Nee Foundation reports that an average amount of students enter law school with depression, around 8-9 percent, but upon graduation, around 40 percent of law students will have depression. The leading cause of disability in the world and in the U.S. is depression. Some call depression an “epidemic,” which could very likely be accurate in the legal world.  Read the full article here.

Lets Stop Assuming People Know What Mental Health Is

One of the most important steps in overcoming the stigma surrounding mental illness lies in concretely defining terms that can serve as the basis for an honest discussion.  Ross Szabo, CEO of the Human Power Project, helps clear up some common misconceptions shrouding mental well being in his blog that coincides with the beginning of National Suicide Prevention Month.  Read his blog here.

My Struggle With Bipolar Depression and Dream to Go to Law School

I’ve struggled to write this blog, just like I’ve struggled to do most things for what amounts to a very long time now-so long that it feels like a lifetime and what came before only fragments of a not well remembered dream.  In actual temporal time, it’s only a few years of melancholy and moderately severe major depression. But in the life of the mind, there is an unbridgeable chasm between the person I am now, who I once was, and who I want to become.  I am so lost in my isolation that my only refuge is in turning inward; a strategy which offers no solace at all-only shame and regret.

I feel so isolated. I suppose that is one of the hallmarks of mental illness – detachment – that it seems impossible to relate to anyone.  Furthermore, I’m not an attorney, just someone who has lived the hells and wonderful peaks of manic depression.  My exposure to the law is through my father, my uncles, my cousins, and Dan Lukasik.  I hope to go to law school one day, but I need to retake the LSAT first.  So why write a blog?  What good could it possibly do?  Hopefully, some of the sentiments I describe will resonate with you.  But hope is fickle; a thinly stitched veneer stretched tautly over an ever-widening mire of unfulfilled promise.  When I look back at what I hoped for, most of it has faded into the mists of time with barely even the trace of memory or, worse yet, has been completely buried beneath the scars of regret.

In the face of my futility, my stupidity, my selfishness, my demons, hope that I can one day return the love and support that has been given me has allowed me to trudge on, kept me from giving up.  Even if it flies in the face of all rational thinking, experience, and who you believe you are the sole advice I would deign to give is to no never give up hope that you can bring yourself to a better place and can make yourself into the person you wish to become.  Though there be no reason to believe, allow belief to inspire you all the same.

“I can only stand apart and sympathize/ For we are always what our situations hand us/ It’s either sadness or euphoria.”

The above is a stanza from Billy Joel’s song “Summer, Highland Falls” that has always resonated with me.  The song itself captures the sense of helplessness, at times even ironic apathy, I have felt towards a disease (or mental illness or whatever I should call it) that has allowed me to leap through the heights of “euphoria”, and to spiral down into the depths of suicidal depression, seemingly completely independent of any of the external aspects of my life.

I once told a friend that in the past three months I had had at least 45 “perfect days” (i.e., days that I could not imagine being any happier in), but that 45 was a conservative estimate and it was probably more.  I’ve also spent weeks on end consumed by vivid images of ways in which I could gruesomely kill myself.  And both of these emotions, which at the time feel so pervasive and all encompassing, occurred while living on the same college campus and surrounded by many of the same people.  So it’s hard not to “stand apart and sympathize” with the fact that regardless of daily accomplishments or minor setbacks, or even in the face of significant change, it doesn’t matter what you do.  That because of who you are, in a very intimate and fundamental sense, you are going to experience “either sadness or euphoria,” and you have little say in how intensely you are going to experience that emotion, or for how long (so let’s hope its euphoria, and it lasts forever).

This complete lack of control has always weighed on me as a moral failure because I’ve recognized what I consider the best version of myself-productive, engaged, intelligent, charming and yet, due to an inherent weakness, have been unable to maintain that persona consistently.

Instead I, and I would like to emphasize the contradiction and confusion surrounding a feeling at once of helplessness and simultaneously of complete responsibility for being who I am, have eventually always succumbed to periodic bouts of anxiety, negativity, and self-doubt.  These periods have always been characterized by an intense sense of isolation in which almost palpable barriers are restricting me from coming into touch with the people and events surrounding me while at the same time engaging/suppressing the most endearing aspects of who I would hope to be as a person.

There are two types of sadness which result from this frustration and alienation.

Painful Sadness

There is a horrible, painful sadness.  For me, this type of sadness is expressed through intense suicidal ideation-constant mental images meant to shock the senses into an acknowledgment of how base you are.  Brutal beatings, stabbings, gouging’s, hangings.  It consumes you until the idea is all there is and it takes every ounce of energy you have to beat it back.  And it breaks your heart to see someone you love not to be able to say that this is how you feel, and it’s not their fault, but you are worlds away and mired in a sadness/loathing that is impossible to understand for those who have not yet experienced it.  And they love you, so they are trying to understand, but, how could they?  And this breaks your heart even more.

Cleansing Sadness

And there is also a beautiful, cleansing sadness.  For me, this beautiful sadness feels more real than anything in the world.  When I have been at the height of mania-during the happiest times of my life, I have still felt intimately in tune with songs that deal with regret-juxtaposing the inadequacy of the self with the intrinsic sublimity of some other-which you have failed.

There is a powerlessness to this beautiful sadness, an inevitability.  It is real because it exists at the core of our most vulnerable selves, and therefore its expression comes out at a time when we are “most alive” and most in tune with our emotional intuition-when we are most ready to admit to and grasp on to that which we truly hope for and believe in.  This sadness is not manifested in horrifying suicidal ideations but rather in the awe-inspiring idea that we are not worthy of the wonderful phenomena we call life.  That we are ashamed of our ugliness amidst so much beauty and yet, in spite of our baseness, we have the opportunity to exist within as well as work towards some greater good.

Mania

In many senses, for me, the mania of bipolar has been synonymous with stripping away the debilitating fear and anxiety which were so constricting for so long, and a constant struggle has been not to glorify it.  My Mom is taking a wonderful self-help course entitled “Fearless Living” and those two words, again from my experience, imbibe what it means to be manic or hypo manic; imbued with amazing amounts of self-confidence and gratitude, it’s unbelievably easy to live a carefree, upbeat, happy-go-lucky lifestyle, all the while being extraordinarily productive.  Thus thinking in the binary can be dangerous-there is a natural tendency to see every aspect of the mania as better than every aspect of the depression.

However, beyond the fact that I have never been able to sustain mania, there is also a depth of feeling engendered by the sincere melancholy of depression that I have never encountered in the euphoric whirlwinds of mania.  And I think the small silver lining to what is a dark cloud is the depth of meaning such great sorrow can expose you to-in a way an almost redemptive suffering.  At the very least, though depression has taught me to hate myself many times over, it has also taught me to love life.  The sad beauty of such a self-effacing distinction, to hate your being while loving your existence, is something to be thankful for and, hopefully in time, something to build off of for the future.

I would like to close this blog with what have for me been some solid building blocks for sheltering myself from, coping with, and eventually recovering from depression.

Exercise

When there seems to be nowhere to turn and the prospect of getting through the day seems unbearable, working out and (especially) yoga exercises are blocks of time where you don’t have to interact with other people, can be totally in your head, and when you’re done you feel a little better physically, even if not mentally.  Really any small thing that you can do consistently and through which you can mark progress-I’m getting stronger, better endurance, or greater flexibility-is a wonderful way to establish extrinsic markers of success-I’m better at this than I was a few weeks ago, which, in turn, can catalyze good feelings about yourself as a person.

Think of something you’ve always wanted to do or be good at, and then identify manageable steps that you can take on a consistent basis that gradually takes you towards your goal.  Don’t say I need to be as good as someone else or make an arbitrary benchmark-rather say I want to get in better shape relative to how I am right now, so I’m going to run or go to yoga more often.  Or I’ve always wanted to know how to tie my flies, shuffle a deck of cards, play an instrument, or speak a foreign language, so I’m going to work on this task a few minutes each day as opposed to watching TV or surfing the web.

Taking little steps like these that are working towards longer goals, even if you are not aware of any specific professional or extrinsic benefits to achieving those goals, can be inherently rewarding in and of themselves.  If you’re better at an activity, any activity, then you were a few weeks ago, that can be one small thing that you feel good about, even as the rest of your world remains shrouded in darkness.  It can help motivate you to get through the day, can serve as a spring towards other “productive” behavior, and eventually be something you can hang your hat on.  However, it’s important not to beat yourself up after a day in which you failed to take your positive “step”-rather have a little self compassion and say tomorrow is a new day, and it’s not the end of the world, indeed its completely ok, that I wasn’t able to do anything “productive” today.

Finally, reading and writing can be extremely cathartic.  Reading great literature can give you an emotional connection to characters, ideas, and feelings during a time when you felt completely isolated and estranged from the outside world.  Fiction and non-fiction distract you from the constant stream of negative and self-critical thinking that can paralyze you.  And, in a way similar to the steps discussed above, finishing a book you’ve always wanted to read or one on a subject that you’ve wanted to know more about, can generate a (no matter how small) sense of accomplishment that, no matter how insidiously it attempts to, the depression cannot take away.

On the other hand, for me, writing is more of a risk.  I can be very critical of myself as a writer-a case in point is this blog which has been taxing at times-and sometimes end up feeling worse after sitting down to write.  At other times, writing has been akin to therapy in that it has helped me to sincerely articulate-in the best way I know how the complex matrix of emotions enmeshed within me.  Even if journaling or poetry don’t make sense to a single other person, the fact that they make sense to you can temporarily relieve part of the burden imposed by self-guilt and personal shame.  It can be an outlet for your anguish, space where you can be authentically yourself.  Sometimes, you can be so overwhelmed by your depressive thinking that you need some way to release that thinking-writing can be an effective way to do this.

In any case, don’t immediately sit down and assume that because of your depth of feeling you’re going to write the next great American novel.  Rather start with a paragraph or a poem.  It might end up being useless junk that you never look at again, and that’s ok, because part of what depression is, is a needless anguish and self-doubt that is inhibiting you in your quest to live a full life and should be discarded as soon as possible.  But amidst the uselessness you may stumble upon small snippets of truth-a rhyming couplet here, a few sentences there-that satisfactorily express for you one of the tragic and meaningful aspects of your condition (or symbolically the human condition more generally).  These small snippets are worth holding onto as they reflect the deeper truths embedded within a malaise that so often brings us to our knees and which, on sublimely rare occasions, reveals insights that one (I believe) can only obtain through suffering.

Anonymous

Further reading:

Bipolar Disorder Overview

Writing Your Way Out of Depression

The Bipolar Disorder Survival Guide: What You and Your Family Need to Know

Yoga for Depression: A Compassionate Guide to Relieve Suffering Through Yoga

The Bipolar II Disorder Workbook: Managing Recurring Depression, Hypomania, and Anxiety

Is Bipolar II Easier to Live With Than Bipolar I

 

SHUTDOWN: WHY PEOPLE WITH DEPRESSION FEEL SO NEGATIVE

Depression is a state of shutdown in which an individual’s psychological system shifts toward negative feeling states and diminishes the positive feeling states. The hallmark features of a depressive episode is a high negative mood state (characterized primarily in terms of depressed/demoralized/defeated/despairing feelings and secondarily in terms of anxiety, irritability/defensive hostility, and guilt/shame) and a diminished positive mood state (loss of interest, pleasure, energy, desire, and excitement).

Why do people get depressed? The primary reason people enter depressive shutdowns because they cannot obtain the necessary psychological nourishment needed to energize their behavioral investment system. Think of it as being akin to a state of starvation, only instead of physiological nutrition, the individual is lacking psychological nutrition. What is psychological nutrition? The fundamental principle that underlies psychological organization is that of behavioral investment. The psychological system is organized to direct mental energy and action toward investments that offer a return on those expenditures. When one is a getting a good return on one’s investments, then one feels fulfilled, energized and engaged. However, when one is not getting a good return, one begins to feel frustrated, anxious, irritable, or disappointed. If one cannot find an effective pathway for getting one’s needs met, one begins to enter into a state of psychological shutdown called depression.

So what are the core psychological needs that people have that need to be nourished? There are many different possible classification systems of needs (and motives and goals that people seek fulfillment around, see, e.g., here). I offer five categories here that overlap loosely with Maslow’s classic hierarchy of needs.

Safety and Security Needs. First and foremost, the psychological investment system is concerned with basic safety and survival. If one’s physical safety is chronically threatened, if one is in constant pain, if one is chronically hungry, and so forth, the attention of the system will largely be focused here.

The Base Pleasures. Good sex, tasty food, relaxing on a warm summer day on the beach after working hard. The “hedonic” pleasures serve as a fundamental reward and signal positive investments (at least in the short term). Good investment systems are generally characterized by meaningful effort and hard work toward a productive goal, followed by short periods of relaxing and enjoying the base pleasures.

Relational Needs. Our core psychosocial need is to be known and valued by important others. Most notably, this includes being known and valued by members of our family of origin, friends/peers, romantic partners, and community. Needs for relational value are reflective of one’s degree of social influence. And folks go about achieving social influence and relational value in different ways. For example, see here for power and achievement needs relative to belonging and intimacy needs.

Developmental Growth Needs. We can think about an individual’s psychological system as being akin to an investor’s portfolio. An investor has resources that have the potential for growth and loss. An investor with a diverse portfolio whose investments are growing in a way that is exceeding expectation is flourishing. The same is true for an individual. Each individual will have “personal projects” that are engagements they are involved in that afford opportunities for growth (hobbies, interests, creative and playful endeavors, meaningful work projects, etc.). If an individual is chronically stuck and not growing or is largely cutoff from their growth pathways, or is frequently failing to meet expectations, or is deeply investing in pathways based on extrinsic reasons that are not consistent with their underlying emotional/motivational needs (or intuitive sense of potential), then the investment system is vulnerable.

Existential/Transcendental/Virtuous Needs. Adult humans are meaning-making creatures that need to have a narrative for how their lives and personal projects make sense. As Victor Frankl notes in his timeless classic Man’s Search for Meaning, if they cannot place their suffering, personal projects, virtues and relationships in the context of a larger narrative that provides meaning, then they will be vulnerable to developing a nihilistic attitude, which is the belief that their lives or actions really don’t matter, because really nothing matters. A nihilistic narrative can undercut the emotional value that folks get from engaging in such projects, leading to existential crises or depressions.

Why do people have trouble getting their psychological needs met? Sometimes the answer is obvious. For example, consider the city of Aleppo in Syria. The people of that city have been completely brutalized and many folks there undoubtedly feel depressed. (As an interesting aside, it is worth noting that the field of psychiatry/clinical psychology is divided as to whether such individuals should be considered “clinically depressed”). In other obvious cases, folks get depressed because of chronic pain or illness, or death of a loved one or because they get addicted so substances that ruin their lives or because they are abused or isolated.

Other times the issue is much more complicated. Consider that there are many people that live in nice houses and seem to be surrounded by caring people and are achieving in their lives, yet they also get depressed. Indeed, despite the fact that we have more and more technology and more and more resources and control over our environment, we seem to be struggling more than ever with feelings of depression and anxiety. What is going on in these cases?

The short answer is that I think the modern, fast-paced society is placing many new, unusual stressors on our emotional system. And I don’t think people have been well-educated about how to appropriately process negative feelings. People have been given much more freedom to acknowledge negative feelings than in past generations (read this story to see what I mean), but there has not been good education on how to learn and grow from such feelings (see here or here). What I see in my clinic is that individuals try to avoid negative feelings, and wish everything would just be fine. They often try to act publicly like everything is fine, but they have no idea how to maturely process and learn from their negative feelings. Instead, they enter into an intra-psychic battle with their negative feelings, often working to banish them, or criticize themselves out of their feelings or try to “stay positive”. This creates a powerful “split” in their psychological systems. Namely, their feeling system is sending one signal, their internal narrator is in conflict with that signal, and they are trying to publicly present a totally different image than their inner conflict. All of this sets the stage for a “neurotic breakdown”.

In addition, I see many parents who value their kids, but who do not know how to guide their children in processing negative feelings. Instead, too many have been caught up in “self-esteem nation” and act in an overprotective way, essentially communicating both that their kids are fragile and that others are responsible for keeping you happy. Another group teaches their kids to repress and minimize their feelings. I am not blaming parents here. The modern world is complicated and psychologists and psychiatrists have generally not done a great job being clear about the nature of emotions and relational needs.

At the societal level, we need to recognize both the dramatic changes the information technological revolution has brought to our world and how many of the institutions that provided guidance for the good life are breaking down. Religious systems have lost much of their authority. The political system has broken down into a polarized way. I think our educational system is broken in the way it assesses performance and fails to teach character values. Science often seems to characterize the world as an amoral, meaningless physical system. In other words, in terms of our existential/transcendental understanding, there seems little that supports the deep-seated need that many people have for true meaning making. So, we live in a fast-paced, high-stress world in which we are overloaded with choice, we regularly observe massive amounts of inequity in power and resources, we give lip service to negative feelings but often characterize them as disease states and provide very little real education about human emotions and needs, and institutions that provided deep meaning making systems have lost their authority.

The bottom line is that depression arises, in most cases, when people do not receive the necessary psychological nourishment from their investments. This arises because of brutal environments and injury from traumas, diminished capacities to meet growth expectations, intrapsychic and interpersonal conflict with important others. Unable to find a path forward folks shutdown and, unfortunately, getting depressed in modern society likely creates more problems than it solves. So folks get trapped in neurotic depressive cycles.

There is clearly no easy fix, as depression is a massive health problem. But I do believe there is much that can be done. We need (and can achieve) a much better shared understanding of human psychological needs and nourishment. We also need a clear recognition from institutions like the World Health Organization that depression emerges as a function of psychological malnourishment, rather than being brain disease stemming from neurological malfunctions.

My ultimate vision is for the development of a holistic meaning-making system that harmonizes the natural sciences, the social sciences, and the humanities in a way that affords an understanding of our human natures such that we can have a more effective guide toward fulfillment during these rapidly changing times.

Gregg Henriques, Ph.D., author of A New Unified Theory of Psychology, directs the Combined Clinical and School Psychology Doctoral Program at James Madison University. He is a licensed clinical psychologist with expertise in depressionsuicide, and the personality disorders. He has developed a new meta-theoretical system for psychology articulated in many professional journals and is now applying that system to researching well-being, personality, and social motivation, and he and his students are working on the development of a general system of psychotherapy. Henriques received his M.A. in Clinical/Community Psychology from UNC-Charlotte and his Ph.D. in clinical psychology from the University of Vermont. He also completed several years of post-doctoral training at the University of Pennsylvania under Aaron T. Beck exploring the effectiveness of various cognitive psychotherapy interventions for suicide and psychosis. Henriques teaches courses in personality theory, personality assessment, social psychology and integrative adult psychotherapy.

 

Depression and Suicide: A Catholic Perspective

As a psychiatrist, I had been aware, prior to his death, that Robin Williams struggled with a severe mood disorder – major depression and bipolar disorder, depending on the source of the reporting – along with related problems and drug dependence.

The vast majority of suicides are associated with some form of clinical depression, which in its more serious forms can be a sort of madness that drives people to despair – leading to a profound and painful sense of hopelessness and even delusional thinking about oneself, the world and the future.

I knew all of this, and yet this death still shocked and surprised me, as it shocked and surprised so many others. Williams seemed to be the consummate humorist, the funny man who would be just so much fun to be around. Unlike some comedians who trade only on irony and cutting humor, Williams appeared to us as a warm, big-hearted, endlessly fun, brilliantly quick, incredibly talented man. Though he was a celebrity, he was the kind of person that people felt like they knew – like the cousin, everyone just adores and hopes will show up at the family reunion.  Williams was the kind of guy that people wanted to be friends with, the kind of person that one wanted to invite to the party.

This is not the typical stereotype of mental illness, which why the typical stereotype must be relinquished: Quite simply, it is false.

Mental illness can afflict anyone, of any temperament and personality. In the wake of his death, the strange truth gradually began to sink in: In spite of outward appearances, Williams’ mind was afflicted by a devastating disorder that proved every bit as deadly as a heart attack or cancer. He suffered in ways that are difficult for most people to imagine.

Why couldn’t Williams see himself as other saw him – as a person of immense gifts and talents, a man who stood at the pinnacle of achievement in the world of comedy and entertainment?

Why couldn’t he see himself as God saw him – as a beloved child, a human soul of immense worth, a person for whom Christ died?

This is the tragedy of depression, which is so often misunderstood by those who have not suffered its effects.

Novelist William Styron – whose memoir Darkness Visible represents one of the best first-person attempts to describe the experience of depression – complains that the very word “depression” is a pale and inadequate term for such a terrible affliction.  It is a pedestrian noun that typically represents a dip in the road or an economic downtown. Styron prefers the older term “melancholia,” which conjures images of a thick, black fog that descends on the mind and saps the body of all vitality.

Indeed, the title of his book – Darkness Visible – comes from John Milton’s description of hell in Paradise Lost. We’re not talking about hitting a rough patch in life or the everyday blues that we all experience from time to time. We are talking about a serious, potentially fatal, disorder of mind and brain.

Fortunately, in most cases, depression is amenable to treatment. Because the illness is complex – involving biological, psychological, social, relational and, in some cases, behavioral and spiritual factors – the treatment likewise can be complex. Medications may have a very important role, but so do psychotherapy, behavioral approaches, social support and spiritual direction.

In some cases, hospitalization may be necessary, especially when an afflicted individual is in the throes of suicidal thinking or when one’s functioning is so impaired from the illness that he or she has difficulty getting out of bed or engaging in daily activities. For the severely depressed, even brushing one’s teeth can seem like an almost impossibly difficult chore.

This level of impairment is often puzzling to outsiders – to the spouse or parent who is trying to help the loved one. Unlike cancer or a broken bone, the illness here is hidden from sight. But the functional impairments can be every bit as severe.

I recall one patient, a married Catholic woman with several children and grandchildren, who had suffered from both life-threatening breast cancer and from severe depression. She once told me that, if given the choice, she would choose cancer over the depression, since the depression caused her far more intense suffering. Though she had been cured of cancer, she tragically died by suicide a few years after she stopped seeing me for treatment.

Depression is neither laziness nor weakness of will, nor a manifestation of a character defect. It needs to be distinguished from spiritual states, such as what St. Ignatius described as spiritual desolation and what St. John of the Cross called the dark night of the soul.

Tragically, even with good efforts aimed at treatment, some cases of depression still lead to suicide – leaving devastated family members who struggle with loss, guilt, and confusion.

The Church teaches that suicide is a sin against love of God, love of oneself and love of neighbor.  On the other hand, the Church recognizes that an individual’s moral culpability for the act of suicide can be diminished by mental illness, as described in the Catechism: “Grave psychological disturbances, anguish or grave fear of hardship, suffering or torture can diminish the responsibility of the one committing suicide.”

The Catechism goes on to say: “We should not despair of the eternal salvation of persons who have taken their lives. By ways known to him alone, God can provide the opportunity for salutary repentance. The Church prays for persons who have taken their own lives.”

Robin Williams’ death – like the death of so many others by suicide who have suffered from severe mental illness – issued from an unsound mind afflicted by a devastating disorder. Depression affects not just a person’s moods and emotions; it also constricts a person’s thinking – often to the point where the person feels entirely trapped and cannot see any way out of his mental suffering. Depression can destroy a person’s capacity to reason clearly; it can severely impair his sound judgment, such that a person suffering in this way is liable to do things, which, when not depressed, he would never consider. Our Lord’s ministry was a ministry of healing, in imitation of Christ, we are called to be healers as well. Those who suffer from mental-health problems should not bear this cross alone. As Christians, we need to encounter them, to understand them and to bear their burdens with them.

We should begin with the premise that science and religion, reason and faith are in harmony. Our task is to integrate insights from all these sources – medicine, psychology, the Bible, and theology – in order to understand mental illness and to help others to recover from it. In cases where recovery proves difficult or impossible, we pray for the departed and never abandon those who still struggle.

Aaron Kheriaty, M.D., is associate professor of psychiatry and human behavior at the University of California-Irvine School of Medicine. He is the co-author with Msgr. John Cihak of The Catholic Guide to Depression.

Hope Counts: One Lawyer With Depression’s Testimony

I am a lawyer, as many of you.

I went to law school and passed the bar exam like 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 the study’s lead author, Patrick Krill, director of the Legal Professionals Program at the Hazelden Betty Ford Foundation, and a lawyer himself. “There needs to be

Dan’s Top 10 Video Picks on Depression

Films can teach us a lot about depression.  Not only can they provide information.  They can also move us emotionally by drawing us into the subject with interviews, animations, and other techniques that aren’t amenable to books.  Here are my favorite videos that address the topic of depression.

Living with Depression

I came across this short video recently.  And was very moved.  It captures, with sublime music and moving images of a young woman, her struggles with clinical depression and the loneliness she endures. Powerful. Over four million people have viewed it. Running time is 3 minutes and 22 seconds

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