Editor’s Note: LWD creator Dan Lukasik recently sat down with New York City psychologist, LWD guest writer andLiving With Depression author Deborah Serani for a conversation about depression in the legal profession.
Dan Lukasik: Deb, let’s start out by telling us a little about yourself and your background.
Deborah Serani: I’m a psychologist and I practice in New York. I became a psychologist because I had a very bad experience as a young teenager with depression. Unaware of what depression was or how to detect it, I descended into a Major Depressive Episode when I was a 19 year old college student. Hopeless and suicidal, I nearly took my life with a handgun. Luckily, my attempt was interrupted, and swift medical help was sought. I found a psychologist who helped release me from the grip of my unshakable sadness and taught me about the mood disorder called unipolar depression. Not only did psychotherapy save my life, it inspired me to become a student of its practice. It was good that I studied many years as a psychologist and learned about mental illness in all its forms, because the second time I had a Major Depressive Episode in my 30’s, I was better prepared. Now in full remission, I use my personal experiences with depression to inform my clinical work. This dual approach gives me a unique perspective because not only do I know what it’s like to diagnose and treat depression…I know what it’s like to live with it too.
Lukasik: And you’ve recently written a new book?
Serani: Yes. I took my personal and professional experiences and wrote a book calledLiving with Depression and wanted to highlight how a person can successfully live with depression. It’s my hope that anyone who reads it will find it meaningful.
Lukasik: I think that’s interesting what you said about learning to live with depression because in my own experience as lawyer with depression, people would often ask me, five or ten years after I’d been diagnosed with major depression, ‘So you’re over it’ or ‘you’ve taken a pill and you should be over it?’ I think it’s interesting that you use the phrase ‘living with depression’. Can you tell us a little bit more about what you mean by that phrase?
Serani: Anyone who has a chronic illness needs to learn how to live well in spite of it. If you’re one of the 40% who’s had just one depressive episode and have never encountered or had to deal with symptoms, that’s a wonderful thing. But, most individuals who have a mood disorder, particularly depression, live with it on a chronic basis. I think it’s so important to learn to live with your illness, how to manage it and how to find and build a life that’s meaningful and not let the illness define you. So that’s essentially what I mean.
Lukasik: That is so encouraging and hopeful to all of us who live with depression that, it can, in fact, be managed both medically and psychologically. Is that your experience in your therapy practice?
Serani: Yes. In my professional experience I’ve worked with people who have done very, very well with talk therapy alone. I’ve had other individuals that chose not to work with me and just went with medication. And then I’ve also worked with a third group, those who’ve done medication and talk therapy. So there’s many, many ways that people can find management. Research says that the best approach is medication and talk therapy, but I always encourage people to find their own way… and listen to their own voices for what works best for them.
Lukasik: In my experience over the years working with lawyers with depression, some people are resistant to talk therapy and some people are resistant to taking medication.
Lukasik: Why, in your experience, would someone who has depression be resistant to taking medication? What kind of things have they told you about why they feel that way?
Serani: There’s still this stigma that’s attached to mental illness. Despite the fact that research shows us that depression is a neurobiological illness, many people whodon’t want the social blemish that comes taking medication. There’s this feeling of embarrassment about needing to take medication. Or shame in having the illness. Or maybe they feel that they should be able to work this through on their own without the means of any type of medical support or even talk therapy. They should just kind of shake it off somehow. It’s always so troubling for me to hear things like that, but I know that, essentially, it’s part of their own acceptance of their illness. There are some people who remain in denial for a very long time. I always keep the door open and say, ‘I wish you well, but should you have difficulty coping, you know where I am.’ Some people do return. They come back saying, ‘You know, I kind of get it. I can’t be embarrassed. I realize now that I can’t do this on my own.’ It’s like me saying I want to change my brown eyes to blue eyes and I can just will it to happen. So, I think there’s a lot of social stigma and I think there’s a lot of personal shame. It’s so great that websites, like yours, self-help books, and grassroots movements are out there educating individuals to know what the real story is, what the struggles are and how to overcome them.
Lukasik: In your experience, say somebody does come to you for treatment for depression and maybe they’re a little bit over their own denial or maybe a little bit more accepting and they need help. Are there any problems with folks with their significant others, spouses, family, friends or co-workers?
Serani: Generally, I’d have to say that by the time somebody comes to my office, they’ve often been encouraged by someone else to make the appointment. I sometimes get phone calls from spouses who say ‘I want to bring my husband in’, ‘I want to bring my wife in’. Generally speaking, most people with depression have people who are very loving, worried and concerned about them.
What happens thereafter, as the person starts to improve and get better, is the worry of whether or not to disclose their current mental health situation. It almost sounds like I’m talking in a conflicting way from a moment ago. Society still hasn’t allowed individuals to fully come out and talk about their illness so it’s important to be wise and thoughtful about with whom you may and may not share your current situation with.
I’m my own boss. I have my own practice. I don’t have to worry about some social fallout of losing my job. Essentially, it’s easier for me to be outspoken about living with depression, because I don’t have too much to lose. But there are many individuals that may need to keep certain issues close-to-the-vest. Society still views a person with mental illness as impulsive, dangerous…even violent, unpredictable or unsafe. It’s almost as if we still have such a long way to go to help educate the general public. So, to answer your question, I think acceptance of chronic illness takes on a unique trajectory. Each person has to uniquely look at their situation and decide how to move forward be it with family, friends or co-workers.
Lukasik: That’s interesting. I have talked previously about the high rate of lawyer depression. The national statistic for the general population is about 10% and for lawyers the studies show about 20% . Why do you think that’s true?
Serani: I think that it’s so very clear to the way a lawyer’s minds work: it’s a very black and white way of thinking. Because the way the justice system is designed, either you’re a winner or a loser. It can make somebody who’s prone to thinking in black and white terms to measure only the failures and to not see the successes. I also think that lawyering is a very difficult, difficult career. You’re dealing with people whose problems they, themselves, don’t even want to have. As a result, clients often look to externalize blame on others, rarely assuming responsibility for their own behaviors, which can be a heavy burden to deal with as an attorney. There is a great deal of pessimism in the field of law too. And research shows that individuals in high pressure jobs who tend to hold pessimistic views are prone to depression. I’ve seen many, many lawyers who struggle just with balancing career, pressure and pessimism.
Lukasik: And with regard to both men and women who are in the legal profession, is there any differences that you can see to how a man versus a woman lawyer may manifest depression or treat depression?”
Serani: Well I do see a difference in men and women. Women tend to be far more expressive in the sadness and melancholy or the hopeless and helplessness they encounter in their career. Often times, men come in and they’re very agitated and irritable, even short tempered. Their depressive symptoms are different. It’s really helpful when I share with men that the kind of irritable depression they experience is the body and mind’s way of saying ‘you just don’t have any more room.’ Essentially, they don’t have any more room because they’re struggling with depression. What therapy does is help the depressed individual learn how to problem-solve so they can find their way back to a healthier life. But there’s a very clear difference, at least in my practice, when I ‘m working with men and women. Men tend to be less expressive, I guess because of gender roles. Boys are not quite the talkers that girls are, but by the time men are done working with me, they’re very good talkers!
Lukasik: During presentations that I’ve done with lawyers groups before, there’s often a question and answer session at the end and one question that I am frequently asked and I would like your thought about is: “Does being a lawyer cause depression?” What do you think?
Serani: Actually, research shows that the field of law can promote depression for individuals who are called “negative thinkers.” Those who are negative thinkers are actually very good lawyers because they use this kind of analytical thinking to help with their cases. The good news is that they are very prepared for what could go wrong, but the bad news is that they tend to hold pessimistic attitudes. And it’s that negative kind of thinking that worsens depression.
Lukasik: It sounds like what you’re saying is that it’s almost necessary, almost a prerequisite, or a skill that lawyers really need to have? So why would that be a factor that would be a risk factor for a lawyer to develop depression?
Serani: When depression hits, it interferes with the positive thinking, problem solving, hopefulness areas of brain functioning. If you don’t see the positive outcomes, you start to go down that slippery slope of depression. Being able to think in black and white terms may be a great prerequisite for becoming an attorney, but it also raises the risk of developing depression. Law schools may want to set up programs or curriculum that can address the mental health aspects of practicing law. Interestingly, there are many lawyers who don’t struggle with depression. Studies show that these individuals tend to be less invested in the personal aspects of their clients and more emotionally invested in their own self interests. These lawyers have a protective layer of narcissism. I’m sure you know some of them!
Lukasik: Oh yes.
Serani: I know some of them too and it makes sense because it’s almost as if they have a built in Teflon. That whatever it is that they’re doing or working on in the adversarial system just rolls off them. They don’t use the negative self-talk are struggle with pessimism.
Lukasik: I think that’s a great way of you characterizing it…the Teflon…the lawyer who is like that it just rolls off…At some of these meetings that I’ve spoken at there’s a lot of people who’ve said, “Well you know it’s a tough profession. All of us are unhappy. But unhappiness is different than depression.” Why is that the case?
Serani: I tell a lot of people who come in that we call it “work” because it’s not “play”. It’s work. Now, many people find work difficult and unsatisfying. And one of the very first things I do in a session is determine if the person is really in the profession that suits their personality, suits their skill-set, and try to understand exactly what’s going on. Depression is quite different than unhappiness. All of us are unhappy from time to time. We can feel joy from time to time. But, depression is something that is so pervasive it cuts across most aspects of your life. It’s not just when you’re sitting in front of Judge Smith and Judge Smith is giving you a hard time…or you’re writing a motion and you just can’t fathom the thought of putting your pen to paper because you hate writing. Depression casts a long a dark shadow across the board. So when we’re talking about dealing with depression versus unhappiness, you’re right, it’s essential to clearly define what’s going on.
Lukasik: Well let’s get back to your book, “Living with Depression.” I want everybody to read this wonderful book. I have and I think it’d be an excellent resource for anybody struggling with depression but, in particular, lawyers. Can you give usthree things that you think would help somebody in the legal profession that has depression? What are some things that they can do to help themselves?
Serani: One of the first things to do is to recognize that what you’re dealing with is a real medical illness. That’s so important. The second thing is to start looking at your physical experience; and when I talk about that, I mean if you’re really struggling with sleeplessness and fatigue, you’ll need to address those issues. Once you deal with your physical symptoms, and your energy returns, you’ll move to the third thing, which is to start problem solving to lessen your depression. So it goes like this: Acknowledge what you have is real, be mindful of the physical symptoms of this chronic illness and then start using newly learned skills to help you find your way back to health.
Lukasik: Well those are good really excellent suggestions and Deborah I want to thank you very much for talking with me and reaching out to those lawyers who have depression. Thank you!
Serani: Thank you, Dan!