Editor’s Note:

As a psychiatrist in private practice for over 20 years, I’ve spent at least 20% of my 30,000 plus clinical hours treating attorneys with depression and anxiety disorders. The frequency of these problems with that population has been very troubling to me. What is it about the world lawyers inhabit that brings about depression at such a high rate? And what can you do to heal and stay well?

The legal system is based on a model of right and wrong, and win or lose. If you are an attorney, you are encouraged to work until you drop so you can rack up billable hours, to view emotional and mental challenge as a defense to be discredited, to see people as victims or perpetrators, and to deny that you are scared, overwhelmed, overworked or not up to the task at hand. You surely can’t let on that you are clinically depressed and need workplace accommodation.

The problem is, isolation fuels depression. All disconnection makes us ill, and connections heal us. But there is such stigma associated with admitting that you are ill, that you are urged to keep your suffering to yourself. Sadly, I have treated many lawyers who came to me in the aftermath of a colleague’s suicide. Routinely I have heard: "Why didn’t (s)he tell me (s)he was suffering? I wish I had known."

Here is another problem with the model you live. Self-esteem is tied with career success. Low self-esteem fuels depression. Your success is measured in how many cases you win, how many hours you work, and how much money you collect. It is really stressful to be worrying about being on the losing side of a case. And, given the law of averages, you will lose a case about half of the time. Furthermore, doing good work does not mean you will win. The legal system is not just! Losing means fewer claims, less money, less success . . . . and on the snowball grows.

As attorneys you are in a particularly challenging work environment and culture. Your system is set up for developing depression, and is a quagmire for healing from it and staying well. But there is hope! You can minimize your vulnerability and nurture yourself to wellness. I would like to how you how.

I use an integrative approach to the treatment of depression and anxiety that draws on ancient wisdom, and respects each individual’s capacity to choose the best combination of interventions for their own healing. I will share the model with you, and then highlight some steps and interventions you can use. We are all vulnerable to anxiety and depressive illness, although some of us have more genetic and environmental loading than others. Some of us will succumb to depression with less stress. But none of us are immune. Vulnerability to illness is not a flaw or a weakness. It’s not something to discredit or hide. It’s just a part of life. And treating depression successfully requires acceptance, compassion, humility, and flexibility, as well as an open-minded model that gives equal weight to all parts of you including your body, mind, and spirit. But what do I mean by that? Let’s define the body, mind, and spirit dimensions, and then explore the role and the genesis of treatment of depression. (You can learn more about this in my first book, There’s Always Help; There’s Always Hope.

The body dimension encompasses your biology, genetics, inborn personality characteristics, feelings, particular vulnerabilities, and diagnosable medical conditions. It is the realm modern medicine tends to be most comfortable with; it is the one that I learned the most about in medical school.

The mind or mindset encompasses your thoughts about yourself and others. It is dramatically affected by the models you are exposed to or taught, especially during your childhood or formative years. It includes your perfectionism, judgmental nature, self-concept and body image. It is the negative internal voice that criticizes your every move, as well as the encouraging internal cheerleader who says: Go for it! You can do it!

The mindset realm is the one most therapists are comfortable with; these therapists could be psychoanalysts, cognitive therapists, behaviorists, or just about any others who are not predominantly psycho-pharmacologists. It is the one that I learned the most about in my psychiatric residency training. It is the leg that is represented in self-help literature and on the covers of most popular magazines.

The spirit dimension concerns the meaningfulness and purpose of existence. It includes notions of a higher calling, one’s sense of connection to something bigger and grander than the self, and the belief that we are here to share our gifts to help and enrich one another. It may involve faith and a God, but it does not need to be confined to religious belief or practice. It is the experience of connection and oneness that unites all creatures, and the whole, which is infinitely greater than the sum of its parts.

This is the dimension that I have learned the most about in Hebrew day school as a child; and the ideas I contemplated during spiritual retreats and in solitude as I walked through the forests near my family’s home. It is the one most spoken of by spiritual leaders and their followers, and the one least visited by most physicians.

So how does this model relate to depression? Well, if you think back to my description of the body dimension, you will recognize that the diagnosis of major depression belongs in this category. Major depression is a common, serious medical illness with a high degree of morbidity and mortality. It is the result of a chemical or neurotransmitter imbalance in their brain. Its symptoms often remit when anti-depressant medicines are taken, and they often return when the medications are stopped.

Major depression is diagnosed when someone experiences a persistent depressed mood or a loss of interest or pleasure in usual activities for at least two weeks. It involves symptoms of significant weight loss or gain, insomnia or excessive sleeping, physical agitation or slowing of motion, excessive fatigue or loss of energy, feelings of worthlessness or guilt, impaired concentration and recurrent thoughts of death. It is a medical condition often treated by psychiatrists, and other primary care doctors, with medicines. It is the focus of much drug development by pharmaceutical companies and is subject of many symposia and educational programs offered to physicians.

Major depression could be seen as a biological, or body illness, plain and simple. Many doctors would say it is. They make this diagnosis, start their patients on medicine, and schedule follow-up medication checks. Many of their patients improve from this intervention.

Yet, the symptoms of major depression include thoughts about the self and the universe. Doesn’t that mean the mind and spirit dimensions are involved as well? A depressed woman’s feeling of guilt reflects her belief that she is doing, or not doing, something she should be doing. A depressed man’s recurrent thoughts of death reflect his experience of hopelessness in the universe. The ideas may stem from his belief that the world would be better off without him or that he deserves to suffer. Excessive guilt and recurrent thoughts of death bring a diagnosis of major depression into the realm of mind and spirit. It is not purely a body illness at all.

In fact, some cognitive therapists would tell you that negative thoughts cause depression. They would say that a series of negative distortions of life experience, like pessimism or self-criticism, are learned and lead to a depressed mood. They approach the treatment of major depression quite differently from the typical physician. Rather than prescribe medications, they help patients to identify and modify the negative thoughts involved in the genesis and perpetuation of their particular depressions. This mindset view, and form of treatment, tends to be extremely effective for some depressed patients.

So, if medication or body treatment works, and cognitive therapy or mind treatment works, what about the spirit dimension in major depression?

It turns out that in reviewing some eighty studies that have been published during the last one hundred years, McCullough and Larson found that religious/spiritual factors were tied to decrease rates of clinical depression.*¹ Religious commitment reduces the risk of developing major depression. Furthermore, several studies have shown that people whose religious faith is a central motivating factor in their lives recover more quickly from depression than those who are not religious. Therapy with religious content that draws on the patient’s spiritual resources, hastens recovery whether or not the therapist is religious. Beyond religion, yoga, meditation, and other spiritual practices have been found to affect vulnerability to, and recovery from depression. Major depression is clearly a spirit illness, too.

So, major depression is a body, mind, and a spirit illness. Unfortunately, many doctors and therapists treat patients with major depression as if one dimension were the whole. They prescribe medication or psychotherapy. At times, they even recommend a combination of the two. However, it is extremely rare for them to include a spiritual approach in their treatment of depressed patients. A fully integrated model has not yet found its way into clinical training or practice. Even though it has been shown that engaging in a spiritual practice reduces the risk of developing major depression, and helps in its recovery, this aspect of wellness remains somewhat taboo. But it should not be!

I urge you to think broadly. The integrative model I’m describing can help you turn your life around. Perhaps you will adopt my approach. As a physician, I often prescribe medications to my patients suffering from major depression. But, I also involve them in psycho therapy to identify their particular vulnerabilities, and the precipitants to the onset of their depressions. We then develop coping mechanisms to minimize the likelihood of recurrent episodes.

But I don’t stop there. I offer hope, and my belief, that my patients are meant to recover. I point out their unique and wonderful gifts and, encourage them to stay in treatment long enough to arrive at a place of personal fulfillment. Patients often leave my care far more spiritually connected or religious (in their own religious heritage) than they were when we met.

So how should you apply this body-mind-spirit model to your own healing journey? I recommend addressing the dimensions in a specific order. First, identify and work with your biological pieces. Establish proper diagnoses. Accept your inborn vulnerabilities, strengths, feelings, gifts, and limitations. Don’t end up stuck in your attempt to heal because some of these necessary givens have not been appropriately addressed.

Second, identify and work with your mindset and attitudes - - your thoughts about yourself and others. Addressing these may involve discovering and resolving family issues. You may choose to enter therapy to deal with this dimension.

Third, nurture your spirit: your sense of purpose, value, and connection to something greater than yourself. You may find that active involvement in spiritual pursuits is difficult for you in the early stages of healing. Be patient. Begin to identify your spiritual needs, and the spiritual path that can further your recovery.

You will find more specific guidance and direction, in my second book, 10 Steps to Take Charge of your Emotional Life: Overcoming Anxiety, Distress, and Depression Through Whole-Person Healing. It’s a how-to book that you can use to put together a unique combination of interventions to overcome your particular challenge. I believe, in every fiber of my being, that you are equipped to sort out what suggestions make sense for you. But here are some take-home tips for you today.

Some folks heal us, while others unsettle us. Those who are loving, accepting, encouraging, upbeat, and optimistic are most apt to inspire us, and nurture our spirits. Those who are critical, negative, and pessimistic are most likely to destabilize us.

You may carry a silent dream for a long time. But until you give voice to your hope, it does not fully exist. And something which does not fully exist cannot be actualized. So, you must share your hopes, wishes, dreams, and prayers.

This is a biggy. There’s a reason we all know the expression, Rome wasn’t built in a day. We need to be reminded of the pace at which real change happens. When we are bothered by something, or wish things were otherwise, we want the situation to change overnight. I want what I want, and I want it now, we seem to be screaming inside. We are unrealistic and impatient. Although we may know that real growth, substantial change, or actual transformation takes a long time, we don’t really get that. We expect miracles, and often get down on ourselves when we fall short of our crazy ideas.

The more we visualize ourselves where we want to end up, the more likely we are to believe in our potential to get there.

With my love and blessing,
Eve A. Wood, M.D.
Clinical Associate Professor of Medicine
Program in Integrative Medicine at the University of Arizona
Author, There’s Always Help; There’s Always Hope,
10 Steps to Take Charge of Your Emotional Life,
The Stop Anxiety Now Kit and
What Am I Feeling, and What Does It Mean? Kit
Phone: 520-577-4659