The Resilient Lawyer
by Harry Emmons, M.D.

Editor’s Note: Henry Emmons, M.D., is a consultant to seven Twin Cities area college counseling centers, as well as several other organizations, and is a popular workshop presenter. He is a past recipient of a Bush Medical Fellowship, which funded a sabbatical to study natural and mindfulness therapies in the practice of psychiatry. His first book, The Chemistry of Joy: A Three Step Program for Overcoming Depression Through Western Science and Eastern Wisdom, was published by Simon and Schuster in January of 2006.

One way to think of depression is as a breakdown in resilience. It is our nature to be resilient, to be flexible and adaptable, able to respond to challenge and loss while maintaining a degree of emotional balance. Yet today, more than ever, people in the U.S. and around the world are experiencing depression. Rates of depression have climbed 10% every decade since epidemiologists began to track mental illness a century ago. Already the leading cause of disability in the U.S., it is predicted by the World Health Organization that depression will be the greatest cause of disability worldwide by the year 2020. And the statistics on this website suggest that depression among lawyers is highest of all the professions, with nearly 25% of practicing lawyers suffering from this illness, and rates of suicide among male lawyers nearly double that of the general male population.

We can only speculate about why this is so, but I believe that lawyers get depressed for the same reasons as anyone does, and the higher numbers are due to facing more of the things that cause depression. Since I have treated many in your profession over 20 years in practice, and as my wife is a lawyer herself, I feel that I know some of the stresses and other factors that you go through. And they are significant. Another possibility for the high rates of depression is if there is still denial about the problem so that it isn’t addressed until depression really has a chance to take hold. Either way, I am honored to contribute to Lawyers with Depression, to help break down the stigma, move through any denial and discuss potential solutions. My professional interest is more and more focused upon helping people achieve full recovery from depression through natural means, and giving them the personal tools so that they can prevent it from returning. I want to give an idea of how such an approach might work.

I think that most people who make it though law school and establish themselves in the profession are actually more resilient than average. Ironically, being highly resilient to begin with can end up as a detriment if one does not listen to the clues that something is wrong. I have worked with many tough-minded professionals who have such capacity for work and such an ability to handle stress that they can literally go for years without addressing their unhappiness. But if it is allowed to go on, things will eventually break down. When they do, the most common response to depression is to take a medication. This can be a great support to one’s mood, even life-saving for some. But it is not a good idea to rely too heavily on medication, as its benefits tend not to last. Only about 30-40% of people on long-term medication continue to stay in remission. Unless one addresses the causes of depression, it has an unfortunate tendency to come back. That is why I think it is so important to take a truly integrative approach to this whole-person disease.

What are the causes of depression? I place them in three categories that I call “the enemies of joy”:

1. Physical imbalance and toxicity:
Genetics do play a role in who gets depressed, or how easily one succumbs to depression. But regardless of genetic vulnerability, there is much that one can do to keep the brain working well, balancing the delicate chemistry and activity so that one is more likely to stay resilient. The brain itself is a physical organ, even more elegant and complex than the heart. We fully recognize how important diet and lifestyle are to heart health. We must do that as well with the brain. For example, diet is the only means we have for getting the “raw materials” that the brain needs to stay chemically balanced. The most crucial elements are to get adequate amino acids (eating modest amounts of lean protein throughout the day), essential fatty acids (olive and flax oils, nuts, seeds and fatty fish) and the B-vitamins (colorful fruits and vegetables, whole grains and lean meats). It is also important to reduce nutritional stresses by lowering amounts of unhealthy fats, simple carbohydrates (sugar, white flour and high-fructose corn syrup) and neurotoxins (environmental pollutants, hormones and other endocrine disrupters).

We are made differently from one another, so we do not all have the same needs when it comes to diet, exercise and sleep. There is not a single prescriptive approach to lifestyle. But when it comes to long-term prevention of the physical side of depression, it is hard to do better than the advanced common sense of these three pillars of health. For a thorough discussion of different mind-body types and the lifestyle measures for each, refer to my book, The Chemistry of Joy. There are also several herbal and other alternative ways to improve brain chemistry and function outlined in the book.

I don’t think that lawyers do much worse than others in terms of eating well and exercising, though I do see many who are short on sleep. But I suspect that the primary reasons for the increased rates of depression among lawyers lie in the next two categories: stress and isolation.

2. The mind run rampant:
The clearest understanding of the human condition has come, for me, through a weaving together of western psychology with insights from Buddhist practice. I call this “the psychology of mindfulness”. One of its main principles is that the mind is really the source of our happiness or unhappiness, not the events of our lives. Whether we experience life as good or bad flows from the mind and its perceptions, judgments and degree of equanimity. Notice that this does not deny the existence of stress, loss or other bad things happening. Rather, it is how we respond to those things, as well as how we respond to that which is good, that largely determines how we feel.

In this way of thinking, it is not stress itself that is the problem. Under normal conditions, we are well suited to handle stresses and quickly recover from them. But life as a lawyer in the 21st century is hardly a normal condition. The human body is not meant to be under constant stress for a long time without periods of recovery. Yet that is the day-to-day experience of many in your profession. Why would one do this to oneself? Why overwork, or stay in jobs that are unfulfilling, or remain where there is a degree of hostility in the workplace? The answer is really more complex than this, but I believe that it boils down to one of two things: either you aren’t paying attention, or you feel that you have no choice. Each of these is rooted in the mind, and working with the mind can get the solution for them.

The idea behind mindfulness is really simple: pay attention, and try not to critique, judge or figure things out. Just stay with your actual moment-to-moment experience. Sounds simple-but it’s not. Believe me, it is as hard for doctors to shut down their judging mind as it is for lawyers. Well, almost as hard. It is, after all, what we do. And there is a place for that type of thinking. If I am trying to understand a patient, make an accurate diagnosis and give an effective treatment plan, I want my entire rational mind to be engaged. I’m sure the same is true when you are advising a client or trying a case in court. The key is to be flexible and aware enough to know when to use the thinking mind, and when it is using you.

One’s state of mind and the emotions that accompany it depend largely upon what you practice from moment to moment. We are especially vulnerable when we feel besieged in some way, because then the mind tends to unconsciously rehearse thoughts that are detrimental to mood. We do this because we don’t realize we do it, or how it affects us, and we don’t know how to stop it. If we are not tending to it, the thinking mind under stress will automatically take us down a well-worn path that is a little different for each person but has the same destination: a place we call depression.

The good news here is that it does not take years of therapy or other sophisticated measures to counter this. What it does require is conscious attention and a bit of practice. What do you practice? You begin noticing your thoughts and feelings without judging them. This is a little tricky, because you want to attend to them lightly, not focusing on them too hard or for too long. You don’t want to fan the flames of an unpleasant emotion by giving it too much of your attention—that only makes it stronger.

If you have a feeling of anger or hostility, for example, there is a tendency to judge oneself for feeling that way. You may not be aware of having the thought, but it says something like “I shouldn’t feel this way. Good people don’t get hostile. I’m not a good person.” Instead, you just notice the feeling but know that it is transitory, and you notice the accompanying judgment and let it go. If you can be aware of it as it’s happening, you can choose to be kinder to yourself about it and drop the self-judgments.

A different reaction to anger that is just as troublesome is to give it more energy. You might think about the cause of your anger over and over, perhaps having a full argument in your mind with the person who made you angry. Or you might give expression to your anger, working yourself into a full state of rage that eventually gets directed at another, only making matters worse. This is not to say that one should never express anger or talk with someone with whom one is angry, but bringing awareness to it gives you more choices. Knowing that you are angry, you may choose to turn your attention toward it, let yourself consciously feel it. Where in your body does the feeling of anger reside? Notice how it ebbs and flows, how it moves around in the body. See what happens when you have your dispassionate attention on the feeling and choose to breathe into it, or soften the body around it.

These are but examples of how one might bring consciousness to the thoughts and feelings that so often precede or prolong a state of depression. It helps to have some guidance with a therapist skilled in mindfulness practice, or perhaps a meditation teacher knowledgeable about depression. And remember that depression is not all in your head. Getting more skilled at dealing with the troublesome thoughts and emotions helps everyone. But the physical side to depression must still be addressed in some way, be it medication, lifestyle measures or alternative therapies. And the soul or spirit are also part of being human and are strongly affected in depression.

3. The illusion of separation
Many people today feel themselves to be isolated or disconnected—to be separate. I call this an “illusion” because, in the largest sense, it is not true. Whether or not we see it or believe it, we are profoundly connected with one another and with a reality greater than ourselves. Yet that is not the day-to-day reality for so many in our culture, and indeed there has been a breakdown in many of the institutions (e.g. extended family, community, religion) that have traditionally given some protection against depression.

I have worked extensively with professionals of all types in retreats and other programs of personal renewal. I know that there is a strong sense of alienation today among many professionals, and lawyers certainly share in that. There are many reasons for this sense of disconnection, and I believe that working in a highly competitive, often-adversarial system may serve to heighten it.

Lawyers With Depression is doing something to break down that isolation. It is so important to pass through the barriers that depression wants to build around you. Creating communities must also be done in one’s daily life, and ideally in work life. If a job is stressful or depleting, I don’t believe it is sustainable over time unless there is a strong sense of community and support. And that should be found in the work setting itself. It may be up to you to create it, or if that is not possible in the place you now work, I would encourage you to look for a place where it does exist.

In the Resilience Training Program, which I designed for the recovery and prevention of depression, we place much of our attention on “cultivating a good heart”. To me that means that one can develop an internal state that makes it possible to go beyond not being depressed. There are few things more protective against depression than to feel really vital and alive. So we intentionally cultivate things like compassion, self-acceptance or generosity. We offer meditative practices meant to open the heart, create a sense of belonging and have some experience of the sacred. At the most profound level, we’re only human in community. We’re meant to be part of one another’s lives, and we need to share in each other’s humanity. It is the sense of connectedness that keeps us feeling most enlivened. And it’s not only connectedness to other humans that we need. We need, too, a link to the divine—and to a sense of the higher purpose of which we are a part.


BIOGRAPHY:
Henry Emmons, M.D., is a consultant to seven Twin Cities area college counseling centers, as well as several other organizations, and is a popular workshop presenter.  He is a past recipient of a Bush Medical Fellowship, which funded a sabbatical to study natural and mindfulness therapies in the practice of psychiatry.  He has created adult education programs through the University of Minnesota’s Center for Spirituality and Healing, including “A Year of Living Mindfully” and “The Inner Life of Healers: Programs of Renewal for Health Professionals”.  Dr. Emmons developed the Resilience Training Program at the Institute for Health and Healing at Abbott Northwestern Hospital in January, 2007.  This unique program integrates nutrition, exercise and the psychology of mindfulness to improve outcomes in the treatment of depression.

His essay “Insights on the Inner Life of Healers” was included in the book Living the Questions: Essays Inspired by the Work and Life of Parker J. Palmer (Jossey-Bass, 2005).  His first book, The Chemistry of Joy: A Three Step Program for Overcoming Depression Through Western Science and Eastern Wisdom, was published by Simon and Schuster in January of 2006.