Dan's Blog Archives - Page 7 of 17 - Lawyers With Depression

Building Your Depression Toolkit

One study found that as many as eighty-percent of all people in this country that suffer from clinical depression don’t get any treatment.

Given that depression is the leading cause of disability in the U.S. and that over 20 million people are afflicted with it, that’s a lot of people – about 16 million.

However, many of the law students, lawyers and judges with depression that I’ve met tell me that they don’t need to be told to get help because there are already getting it. They’re already in therapy, taking medication or both. They get it. They know that depression is an illness and they have to deal with it.
Some of them have been coping with it for a very long time. I call these people “depression veterans”. I have met many such veterans and their courage and determination to recover and stay well inspires me.

As I wrote in a prior blog, these people are really my “heroes”.

I also have met many in the legal biz who say they’re at the end of their rope. They’ve been in and out of therapy over the years with little or negligible improvement in their depression. Others have started and stopped a number of antidepressant and/or other mood stabilizing medications tired of to little impact on the mood and too many side effects. But the depression always returns for them.

For most of them, it’s not a relapse into major depression. Rather, a mild or moderate depression interspersed with fatigue, a lack of pleasure and a glum outlook on life. What they are experiencing is a fact about depression and its course. That it often a chronic and life-long illness for those so afflicted.
Then there are many who go through long stretches of feeling pretty well most of the time, but still have pockets of depression.

I put myself in this camp.

Most days, my depression, on a scale of “1” through “10” is a 1 or 2, if it’s present at all. If it gets worse, it’s less often, not as strong and has a much shorter duration is much shorter – maybe a 3 or 4. This seems to be especially so during the dark days of winter.

What worked for me to reign in the beast of depression was a change in lifestyle, which included regular therapy, medication, a support group, prayer and exercise. While there is no one thing that is a panacea for depression sufferers, I am convinced that such the positive changes have a direct, lasting an significant alleviation of depression’s worst symptoms.

To make a lifestyle change, I develop a depression “toolkit”. A game plan that I’ve pretty much stuck to for a number of years. The value of such a toolkit is that it provides a map for us to stay on course. It gives us a sense of structure and a sense of hope.

If you thinking about how to really recover from depression stay healthy, it’s important to come up with your own depression toolkit. There are lots of ways to go about it. The two best examples of depression toolkits I’ve found come from the University at Michigan’s Depression Center and the Depression and Bipolar Support Alliance.

So pick up your pen and start building your own toolbox today.

18 Tips on How to Start a Depression Support Group

I started a depression support group seven years ago. It’s one of the most meaningful things I’ve ever done. We started out with ten people. It met once a month. Over time, it evolved into every-other week. We now gather once a week. I’ve been asked many times about how to start a depression support group. Here are a few pointers to help you get going. They’re in no particular order of importance.

1. Be clear about what a support group is

A support group is a regular gathering of folks suffering from depression who share their struggles with fellow sufferers to gain insight, strength and hope. These meetings are less structured and more open-ended and the content doesn’t come from a mental health professional. In constrast, group therapy is more structured, focused on teaching, and has a clear outcome that the group is trying to reach. They’re led by a therapist.

2. Picking a place

I suggest you seek out a place to meet at a school, college, church, community center, library or other free space in your community. I guess you could have it in your home. I have never done that. I don’t know anyone else who has. In my view, the problem with this spot is that you must be prepared to have it there every single time. It may put a lot of responsibility on you. What happens if you’re sick or on vacation and can’t host the gathering? I also don’t suggest rotating the location of the meetings to different members’ homes. This doesn’t work because it becomes just too complicated for people to remember where the meeting is being held. Pick one place and stick with it.

3. Determine a schedule

With the help of initial support-group members, decide how often to meet and for how long. For example, every two weeks for 60 to 90 minutes. My experience has been not to fiddle with the day and time you ultimately pick. Members in my group know, come hell or high water, meetings start at 12:30 sharp and end at 1:30 every single Friday. They need not think about it. If they miss some meetings, they’re not left hanging about when the next meeting is.

If others tend to come late to the meeting, always start it on time anyways. My experience is that people appreciate this. Everyone has busy schedules and other things to do. Meetings should be no less than once every two weeks because interest can wane if the group doesn’t meet often. If the meetings are too far apart, people forget each other’s stories.

4. Talk with your therapist

If you’re in therapy, talk with him or her about what you plan on doing and why. They know you well and can offer some suggestions. They’ve either run groups and/or been trained in how to do so. Get some ideas.

5. You don’t have to rebuild the wheel

Depression support groups happen everyday around the country. They’re run by various organizations such as the Depression and Bipolar Support Alliance. Check out their website to see where these groups meet in your community and go to a few to see how they function.

6. How Do I Find Support Group Members

You need to get the word out. Develop a flyer that briefly describes your group, where and when it meets, and contact information. You may also want to contact other support groups and ask if they can refer people to you or market your group on Facebook and other social networking sites. One thing I did was to write columns in my local paper about my own experiences with depression and the support group. This helped enormously. People connect with personal stories. It also helps people overcome the stigma of attending a meeting. If you’re comfortable with it, ask to speak at your local church or other social organizations you might be a part of. Another way to find members is to search for therapists who have offices within a 10-mile radius of where the meetings are going to be held. I’d send them flyers so that could refer people in need of support. Most therapists aren’t even aware of such groups. So educate them!

7. Have and opening and closing ritual

Early on, our group crafted an opening that we read before every meeting. I have typed out the opening we use at my group at the end of this blog. Towards the end of the meeting, I will say, “We’ve got about ten minutes left, is there anyone who hasn’t shared that would like to speak?” I’ll then conclude, “See you all next Friday at 1:30.” A consistent structure to the meetings helps a lot.

8. Arrange for refreshments.

Ask support-group members to take turns providing snacks and drinks if desired.

9. Create a confidential list-serve

It’s a good idea to get everyone’s email address to communicate with the group in the event of a meeting cancellation due to the weather or other problems. Sometimes, your usual location needs to be changed on a particular date because the building is closed for the holidays, etcetera. Send out an e-mail the day before the group meets to remind them there’s a gather the next day. People get busy and like these little pokes. I also forward onto members of group activities – sometimes we meet for dinner or breakfast. I also pass along depression blogs or news I’ve come across that might be interest. A confidential list-serve is easy to create. Check out this webpage about how to create a list-serve through Goggle. This is what I use. To make it confidential, I e-mail myself notices and blind copy the rest of the group. It works.

10. Leaders

A support group leader(s) is responsible for maintaining the structure of the group and keeping the group on topic. Leaders also set up meetings and clean up afterwards. They must be a bit assertive; if you are not comfortable being assertive, look for this quality in a co-leader.

11. Asking others to join the group – be sensitive to their concerns

Because of the stigma associated with depression, people are sometimes resistant to join a support group. They don’t know what to expect. “Will other people attending the group know me? Will this be embarrassing? Would this really help?” Then there are others who have attended other depression support group meetings and found them lacking. One of the most common things I hear is that many of the folks who attend these meeting aren’t working, are on disability and aren’t planning to go back into the work force. Let me be clear on this point: in no way am I criticizing people who are in this situation. In fact, I feel deep compassion for them. But for people who are in the workforce or those temporarily out of it who want to get back in, it isn’t always good fit. Be aware and sensitive to this issue. If I sense that people would like to come to the group, but are apprehensive, I meet them for coffee. Believe me, it helps to reassure them. Maybe a perspective member might not be a good fit for your group. If so, be honest with them and refer them to another.

12. Remember that it takes time to start and keep a group going

I have known other people who have felt the passion and courage to start groups only to see them fizzle out because of a lack of members or organization. That can be discouraging, no doubt. When I first started the group, I’d worry about how many people would come. For example, I’d be disappointed if 4 people came. I somehow felt like a failure (why can’t I get more people to come?) or a big success if 15 came (“Wow, this is great. People think this is important!”) But in the past seven years of running my group, I learned that numbers don’t count for much. It’s the quality and depth of sharing that counts. Some of the best meetings I’ve attended have been with small numbers of people. It allows more time for each person to share more details of their struggles that they otherwise may not been able to do in with a larger group setting because of time constraints. Commit to keep the group going for at least one year. It will have its ups and downs. You need to be persistent.

13. Remember to stay on topic.

You’ll notice some participants drift into other topics like buying a new car, gossip or recent things in the news. Help keep the group focused and on task. It’s a depression support group, plain and simple. The majority of people are there for that reason. It’s simply not fair to others who need the support to listen to others who want to talk about things other than their depression-related issues. If people want to talk about these issues, they can do so before or after the group.

14. Be careful not to let someone dominate the talk

This is a common and tricky problem I’ve had to deal with over the years. We address this in the opening ritual, but people need to be reminded of this for the benefit of the group. An individual member may sometimes need a bit more time to talk than usual. That’s okay. But if it becomes a chronic issue, take the person aside after the group and gently address it with them.

15. Share resources

Many people who come to groups have read books about depression that have “spoken” to them in a meaningful way. I’ve shared my own favorites in a blog, Dan’s Top Ten Depression Books. Group members can also create such a list and distribute it. From time to time, my group has also come up with a list of recommended therapists and psychiatrists in our area. Again, a very helpful thing for people who don’t have one or are thinking of switching (a very common issue).

16. Hire a therapist to attend the group

Our group has hired a therapist to facilitate our meetings during different times in our history. It’s absolutely not necessary to have successful group, but may be helpful. How to find one? Send out a letter to local counselors that you’re group is looking for one. How do you pay for it? Take up a collection from the group. For example, if you have 10 people (an ideal number of members for a support group, by the way, is 8 to 10 folks), ask that they each kick in $10 per group meeting to pay for the therapist. The psychologist in our group didn’t talk much during the meeting, except at the end. He would sum up some of the themes he heard and offer a few helpful tips and observations. I thought this worked well and was a real benefit to the group. You can also ask a local therapist to volunteer their time to this worthy effort.

17. Get trained as a peer support person.

There are different organizations that offer such training. Check out DBSA. Attend other depression support groups in your community to see how they run it.

18. Commit to confidentiality.

Make sure everyone in your group understands that what’s shared in the support group stays within the group. I can’t stress this issue strongly enough. People need to feel safe. Without that, the group just won’t succeed.

Ritual Opening for a depression support group

Welcome to the {insert group name] support group for people coping with depression.

Depression is a bio-psychosocial phenomenon meaning that it affects people in their biological, psychological, and social areas of daily function. Depression is a health problem that does not discriminate by gender, race, religion, occupation, or intellectual ability. It is not a moral weakness any more than asthma, diabetes, or hypertension are. But, similar to these other illnesses, depression is highly treatable and can be managed effectively. Interpersonal support is an important part of depression management.

This group is anonymous and confidential. Here is a forum to share your stresses and your experiences in coping with depression. We ask that group members suspend judgment of others, refrain from direct advice giving, and allow adequate time for all participants to share their respective stories.

We seek the serenity to accept the things we cannot change, the courage to change the things we can, and the wisdom to know the difference.

Have you ever taken part in a depression support group? What have your experiences been? Do you have any additions to this list that would help someone form a group? Please share.

Why It’s Important to Join a Depression Support Group

“What can I do to help my depression?”

Well, there are many things you go do, really: therapy, medication, etcetera, etcetera.

But one idea you might not have given much thought to: join a depression support group. There are many benefits. I have belonged to one for the past seven years. Here are some of my thoughts about why it’s good for you and how to find one.

Why It’s Good For You

One of the worst aspects of depression is the loneliness that sufferers endure. There are several reasons why this is so: they don’t feel up to being with other people, others simply don’t understand, or they feel a sense of shame and hide. While it may be a good idea to take “timeout” from others to enjoy some peace or not share with others that we have strong reason to believe won’t understand, these strategies are often maladaptive and only serve to maintain and/or fuel one’s depression. Here is a bit of hard-won wisdom I’ve learned: when I feel the worst is when I most need to be with other people and share.

Being with others is even more critical when you’re in pain. You need to communicate your distress and know that your “tribe” will listen and care. When this doesn’t happen, you feel alone, distressed and even abandoned. You wander in the wilderness of pain by yourself and endure it as best you can. But don’t you deserve better than that?

Having a place to admit and share your story

Andrew Solomon, author of the best-selling book The Noonday Demon: An Atlas of Depression, writes:

Depression is a disease of loneliness. Many untreated depressives lack friends because it saps the vitality that friendship requires and immures its victims in an impenetrable sheath, making it hard for them to speak or hear words of comfort. Worldly success does little to assuage that agony, as Robin Williams’ suicide makes clear. Love, both expressed and received, is helpful, not because it ameliorates the symptoms of depression (it does not), but because it gives people evidence that life may be worth living if they can only get better. It gives them a place to admit to their illness, and admitting it is the first step toward resolving it.

Besides the psychological salve that support can bring to the wounds of your loneliness, there are important physiological reasons for being part of a support group.

Positive experiences can also be used to soothe, balance, and even replace negative ones. When two things are held in the mind at the same time, they start to connect with each other. That’s one reason why talking about hard feelings with someone who’s supportive can be so healing: painful feelings and memories get infused with the comfort, encouragement, and closeness you experience with the other person. (Buddha’s Brain: The Practical Neuroscience of Happiness, Love & Wisdom, Rick Hanson, Ph.D. with Richard Mendius, M.D.)

I’ve talked to hundreds of folks about depression over the years and often found that a good chunk are resistant to joining a support group. They feel tired and unmotivated to do so or feel hopeless that anything, even this, will help their depression. They have to meet this resistance and push forward because as depression expert Richard O’Connor, Ph.D. once told me, “Depression isn’t your fault. But it is your responsibility to get better.” And a support group, together with treatment, is one of the best ways for you to take responsibility for getting and staying better.

Small steps are best. Before going to a group, get in touch with the contact person for the group and speak with them by phone, or, better yet, meet them for coffee to see if the group would be a good fit for you.

How to Find a Support Group

It isn’t as hard to find a support group as you may think. Here’s my list:

The Depression & Bipolar Support Alliance

The National Alliance for the Mental Ill

Anxiety and Depression Association of America

Mental Health America

If you are a lawyer, check in with your local and/or state ABA’s Lawyers Assistance Program.

If there isn’t a support group in your community, my next blog will address how to create one.

In Therapy With Jerry

These days, it’s no big deal to admit you have a therapist.

I’ve had the same therapist for seven years. His name is Jerry. He’s 74, Italian and grew up in the Bronx. I see him a few times a month, generally. In one-hour chunks of time. Sometimes, I come and there’s doesn’t seem to be much to say about why I started coming there in the first place – how to cope with my depression. Probably because I’ve gotten pretty good at dealing with it successfully over the years.

On occasion, we spend a fair amount of time talking about or catching up on his life. I know quite a bit about it: the death of his beautiful wife thirty years ago from cancer (she was also a psychologist), his heroic and loving raising of his two small children left without a mother, the political travails of being the head of the Department of Psychology at a local university and his views on parenthood, love, aging and mortality.

To me, he’s father I never had. My own dad died 33 years ago at age 56 from alcoholism . . . and a three pack a day habit of Camel unfiltered cigarettes (something he picked up in the Navy during WWII). Dad was tough in a brutal and mean way. Jerry is tough in a loving way. Compared to other therapists I’ve had, he’s practical rather than Pollyannaish, wise rather than wishy-washy. I love him and respect him. And he’s my dear friend.

I recall when my mom died four years ago from brain cancer. While walking around the funeral home greeting people who had come to pay their respects, in walks Jerry. I didn’t expect it. But I was so happy to see him. I introduced him to my friends and family, people he had heard so much about in sessions. I didn’t introduce him as my therapist. Just, “This is my friend, Jerry.” And it rang so true.

I’m sure it was interesting for him to attach a face with a story and how they fit into the drama of my life.

Most people stay at wakes for fifteen minutes. Then say, “I’m sorry for your loss,” and leave and that’s okay – but not Jerry. He stayed by my side for a few hours. He was there for me. He didn’t have to be. The meter wasn’t running for his time. He was just being who he was since I met him: a loving and compassionate person full of integrity. In short, one of the finest people I’ve ever met.

It’s not to say that we haven’t had our differences. But they’ve been minor. Over time, not only have I come to appreciate the bounty of healing I’ve reaped in therapy with Jerry, but also it’s limitations. While we can make a lot of progress in an hour, it’s still just that – 60 minutes every other week of sharing ups and downs, problems and triumphs, and the sifting through and making sense of life. I wish we saw each other outside of therapy as friends. But maybe many patients feel this way. I wouldn’t be surprised.

Jerry is a man of science and rationality. He believes in Cognitive Behavioral Therapy in which depression sufferers heal when their dysfunctional thought patterns of depression are challenged and changed for the better.

There’s much to be said for this type of therapy. He’s challenged and helped me leave a lot of the thoughts that had fueled my depression behind in the dust: “I’m not good at anything,” “I’ll never get over this,” etcetera. I now think and believe, “You know, I pretty good at most things and superlative at some” and “I have and will get over it. This too shall pass.” I now believe in these takes on reality because he has helped me, as a wise guide, to do so with his characteristic wit, insight and humor.

When it comes to the spiritual, Jerry won’t go there. He’s a self-proclaimed agnostic at best. At first, this disappointed me. How could this loving and brilliant man not believe in God? But, I came to accept this as I had others in my life that didn’t believe in a God however he or she could have conceived him or her.

But I know this is true: regardless of what Jerry does or doesn’t believe, I know that a kind and loving God, the only one I can really believe in, loves and blesses Jerry just as Jerry does his clients in his own unmistakable way.

The 25 Paradoxes of Depression

1. You loathe the isolation of depression, but you avoid other people.

2. You want help, but you don’t always listen

3. The harder you fight it, the harder it gets

4. As soon as you think you’re well again, bang, it hits your harder than ever.

5. While other’s may see you as happy, successful from the outside, you see yourself as miserable, a loser and helpless

6. You believe there is a God, but you feel like an atheist.

7. You’ve been told a million times that exercise would help lift your mood, but chances are you don’t do it.

8. You’ve been told a million times that a better diet would lift your mood, but you don’t do it.

9. You intellectually might know the causes of your depression and what you could do to feel better, but it doesn’t improve your depression

10. You suspect that your high-stress job may be a significant factor causing or exacerbating your depression, but you can’t seem to find a way to leave it.

11. You do everything to beat your depression, therapy, medication, exercise, etc. and you still suffer from it.

12. There is more media coverage about depression being an illness, but most people don’t believe it is.

13. People with other types of diseases, cancer, heart disease, arthritis, elicit sympathy from others, but many people who suffer from depression do not.

14. Many people who take antidepressants know that it helps, but still quick taking them.

15. You feel like you have explained what it’s like to suffer from depression a hundred times to people, and they still don’t get it.

16. You may have been a person who has gotten things done in the past prior to your depression, but can’t get things done now.

17. You procrastinate a lot, even though you know it’s bad for you.

18. You know you love your family and friends, but don’t feel anything.

19. You have the means to get help and sense you need it, but don’t do anything to get it.

20. You have many things to be grateful for in your life, but don’t feel grateful for it.

21. Your depression suddenly lifts or returns through no effort of your own.

22. When you’re in a depression, you can’t remember a time when you haven’t been in one.

23. You’re a good person, but feel like a bad one.

24. You treat others’ well and forgive them, but can’t seem to treat yourself well.

25. You dismiss achievements in your life and feel that you didn’t deserve them, even though you feel others’ successes are well earned.

Copyright, 2014 by Daniel T. Lukasik

Batten Down the Hatches: Surviving a Depression Hurricane

I’ve always been fascinated by all sorts of weather calamities. But none holds my attention more than a hurricane. Though I’ve never been in one, I marvel at their power and size; spinning vortexes of blistering wind manipulated into different colors on The Weather Channel’s satellite video.

Many who are struck by major depression feel like they’re in a hurricane. They may have sailed in navigable waters much of their lives (the average age of onset of major depression is about 40). But then the skies darken. And the large swells begin. The winds go from buffeting to battering their ships of their lives. A type of emotional and neurochemical hurricane goes on in their brains and pulls apart their sense of self and neural connections needed to run their lives.

Just like a hurricane, major depression doesn’t last forever. It dissipates. The seas eventually calm. People come out of their of their deep troughs of sorrow. The average length of depression is about six months – sometimes shorter, sometimes longer.

The speed at which one recovers may be accelerated by treatment: especially medication and talk therapy. However, many people do not get help when they really need it. They don’t call the coast guard when they’re in trouble. They ignore the warnings, either dismissing it as “the blues” or maybe drinking too much or drugging themselves to blot out the pain.

To have a good shot at long-term recovery, it’s critical to not only get help but to recognize that this ongoing assistance will be part of a new way of life. The afflicted to develop and be persistent about self-care habits that go a long way to warding off future depressives episodes. Avoiding future outbreaks of depression is critical. And this is because mental health care experts know that the more depressions you have, the likelihood you’ll have ones in the future goes up dramatically. It is also usually highly recurrent, with at least 50% of those who recover from the first episode of depression having one or more additional episodes in their lifetime, and approximately 80% of those with a history of two episodes having another recurrence.

One of the best ways to get out of the eye of depression’s storm is a support group. They combat the stigma and loneliness that wrap around the bones of a depressed person. In such support, sufferers find a kinship. As Ernest Hemmingway once wrote, “He knew too what it was to live through a hurricane with the other people of the island and the bond that the hurricane made between all people who had been through it.” The bottom-line is that there’s strength in numbers. Check out the Depression and Bipolar Support Alliance’s website to find a support group near you.

So don’t get caught in the hurricane of depression. Get help. And once you recover, develop a strategy that you can and do stick with to stay well.

The Death of Robin Williams, Depression and Suicide

Our hearts are broken. This funny, kind and gentle man is gone. He, like the 30,000 other souls that commit suicide each year in this country, was struck down by depression.

Many people find it incomprehensible that someone so talented, beloved, good and wealthy could take his own life. One commenter from Fox, Sheppard Smith, (not surprising, I guess) called him a “coward.” What a cowardly thing to say from a man who has, most likely, never suffered from the grind of depression as Robin did. However, this commenter isn’t alone in his ignorance. One poll found that over forty percent of all Americans viewed depression as “a lack of willpower.”

Rather than cowardly, I believe Robin’s well-documented life-long battle with major depression and addiction was heroic. As someone who had lived in the trenches of major depression over the years and known hundreds of fellow soldiers like Robin, I feel that people who struggle with depression are my heroes.

Ironically, Christopher Reeve, Robin’s long-time friend who studied acting and roomed with him at Julliard, defined what a hero is:

“I think a hero is an ordinary individual who finds strength to persevere and endure in spite of overwhelming obstacles.”

Given his brilliance, fame and wealth, one could say that Robin was anything but “ordinary.” Yet, he was a flesh-and-blood human being, just like you and I, who suffered tremendously. And he, tragically, decided he just couldn’t take it anymore.

Until he committed suicide, he had somehow found the strength to persevere over the course of his life despite his poor mental health. I’m sure that there was many times that such perseverance involved pushing through the pain of depression on a daily if not moment-to-moment basis. The pain, known all too well by sufferers, must have been so dreadful that he was holding on by his fingertips.

A loss of hope was at the bottom of Robin’s decision to end his life, a loss that no amount of love, support and guidance could assuage.

As Elizabeth Wurtzel wrote in Prozac Nation:

That’s the thing about depression: A human being can survive almost anything, as long as she sees the end in sight. But depression is so insidious, and it compounds daily, that it’s impossible to ever see the end.

Psychiatrist Kay Redfield Jamison, a professor at Georgetown University, herself a sufferer from depression, had this to say about suicide in her seminal book on the subject, Night Falls Fast:

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.

Rest in Peace, Robin. Thank you for all the gifts you freely gave to the world. Your suffering is over.

Summer On My Mind

I’m in Ottawa, Canada now. I’m on vacation with my family in this capital of Canada. It’s about a 5-hour drive from Buffalo, my hometown, and I’ve never been here before. It has a European sensibility with historical buildings everywhere.

And it’s been hot; steamy, lava-like hot. But having endured yet another merciless Buffalo winter where the bitter cold felt epoxied to my hands and feet, I can’t complain.

I’m an early riser, and I’m no different on vacation. Whatever town I’m in, the first place I look for is a Starbucks. Many Ottawans, however, seems to pooh-pooh that dark brew from Seattle. “Go organic and go local, man,” says my hotel concierge; a pasty, redheaded young man of maybe twenty-two who looked fifteen named, “Brad.”

So here I am at Bridgehead, a chain that you can only find in Ottawa, that serves “organic, fair-traded and freshly roasted” coffee. The interior of the place is decorated with IKEA furniture with giant windows letting in morning light muted by today’s grey, watercolored clouds.

I’ve been feeling pretty grateful, lately. Maybe it’s the summer sun or the cyclical nature of my moods, but I feel happy. Waking up this morning, my wife and daughter were still asleep. I just celebrated my 18^th year anniversary and my daughter is entering her sophomore year in high school. A few weeks ago, I received my 25-year pin from my bar association to commemorate my silver anniversary in the profession. My mom’s been gone four years and I’m 35-five years removed from my high school graduation. Check out the blog I wrote for my 30^th high school reunion.

I have a lot less hair, but I think a bit more wisdom. A piece in the New York Times took a stab at what wisdom is:

“They learn from previous negative experiences. They are able to step outside themselves and assess a troubling situation with calm reflection. They recast a crisis as a problem to be addressed, a puzzle to be solved. They take action in situations they can control and accept the inability to do so when matters are outside their control.”

Maybe. But the few people I’ve met in my life that I think wise, are more than that. They have warmth of heart; an appreciation of life despite its troubles and the occasional tragedies that everyone is sure to be struck with if one lives long enough.

Sitting here sipping my coffee in my middle-aged self, I don’t really know how wise I am. But I do know that I’ve had more than my share of blessings and good fortune to be wise enough to smile in appreciation on this summer’s day.

As Mark Twain wrote, “Wrinkles should merely indicate where the smiles have been.”

Here’s to more wrinkles.

The War In My Father’s Head

What a cruel thing is war; to separate and destroy families and friends, and mar the purest joys and happiness God has granted us in this world; to fill our hearts with hatred instead of love for our neighbors and to devastate the fair face of the earth. – Confederate General Robert E. Lee

Depression has many roots. Several of them anchored in the deep soil of our past.

I dug down into that ground last week. It was the 70^th anniversary of D-Day; America’s landing in Normandy and entry into World War II. Watching all the television tributes to these now old and fading veterans, I thought of my dad.

The Great War

My father enlisted in the Navy in 1944. He was 18 years old. He fought on a destroyer ship in the Pacific theater. He saw many of his young buddies meet horrible deaths.

The war not only took a devastating psychological toll on him, but also his family in the years that were to unfold. In a very real sense, my mom, my siblings and I were also casualties of that war that never ceased in my dad’s head.

While he died in 1981, he’s still on my mind some 33 years later. I’ve gone from a young man to middle-aged, from a teenager in college to a lawyer about to mark my twenty-fifth year in the profession. I can’t help but look back at him and our time together as father and son. To the man he was and the man I’ve become.

Looking Back

I read a New York Times’ review of a book out about J.D. Salinger, author of The Catcher in the Rye. The article noted that Salinger, who served in the infantry during WWII in Europe, witnessed a lot of death and mayhem and struggled with depression his whole life:

“Salinger’s experiences during WWII heightened his sense of alienation. The war left him with deep psychological scars, branding ‘every aspect’ of his personality and reverberating through his writings. Salinger had suffered from depression for years, perhaps throughout his entire life, and was at times afflicted by episodes so intense that he could not relate to others.”

Like Salinger, my father came back from the war a broken man. He, too, would also have trouble relating to others. He had frequent nightmares. As children, we heard his screams behind our parent’s bedroom door. When he wasn’t raging, he was usually drunk. When he wasn’t angry and violent, he was depressed.

Dad survived his years of PTSD by drinking. Cheap beer and bottom shelf whiskey. He became a hard-core alcoholic. It gave him a brief respite from the demons shouting in his head. A sort of dying to a day of struggle in the hope that he would wake up the next day and all his pain would be gone.

Writer and hard-core drinker Charles Bukowski wrote about this type of dying,

“Drinking is an emotional thing. It joggles you out of the standardism of everyday life, out of everything being the same. It yanks you out of your body and your mind and throws you against the wall. I have the feeling that drinking is a form of suicide where you’re allowed to return to life and begin all over the next day. It’s like killing yourself, and then you’re reborn. I guess I’ve lived about ten or fifteen thousand lives now.”

A Final “I’m Sorry”

Dad ultimately died from too much drinking. Smoking three packs of Camel unfiltered cigarettes a day couldn’t have helped either. I was 19 when they diagnosed him with cancer. He would spend the last six weeks of his life in the hospital. He seemed unrepentant, never saying he was sorry for anything. Maybe he thought he didn’t deserve forgiveness. Or, maybe it was too frightening to think what our reaction would be.

But I remember one night that I went to visit him in the hospital towards the end. There wasn’t anyone else in the room. It was dim, but the lights near the nurses’ station cast enough light to see in the ill-defined shadows. Dad was awake when I got there. I pulled up a chair and sat next to his bed. I kissed his sweaty brow, but avoided looking into his eyes.

“Dad, just rest,” I said. He gave a weary nod. A little more time passed. It was quiet except for periodic announcements over the P.A. system. I was sure he was asleep.

Then, quite unexpectedly, I felt his hand stroking my back as I hunched over in my chair. I immediately knew it was his way of connecting beyond the words he couldn’t bring himself to say: “I love you and I’m sorry for everything.”

My favorite poet, Mary Oliver, remembers her long-deceased father in this moving poem:

My father, for example,

who was young once

and blue-eyed,

returns

on the darkest of nights

to the porch and knocks

wildly at the door,

and if I answer

I must be prepared

for his waxy face,

for his lower lip

swollen with bitterness.

And so, for a long time,

I did not answer,

but slept fitfully

between his hours of rapping.

But finally there came the night

when I rose out of my sheets

and stumbled down the hall.

The door fell open

and I knew I was saved

and could bear him,

pathetic and hollow,

with even the least of his dreams

frozen inside him,

and the meanness gone.

And I greeted him and asked him

into the house,

and lit the lamp,

and looked into his blank eyes

in which at last

I saw what a child must love,

I saw what love might have done

had we loved in time.

10 Ways For Lawyers to Deal With Their Depression

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

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

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

This went on for six months.

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

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

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

Making a Choice to Change Things in Your Life

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

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

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

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

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

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

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

1. Get help

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

2. Maybe you have to take medication

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

3. Negative Thinking

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

4. Exercise

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

5. Spirituality

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

6. Join a support group

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

7. Get educated

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

8. Build pleasure into your schedule

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

9. Restructure your law practice

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

10. Practice mindfulness in your daily life

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

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

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