Stigma Archives - Lawyers With Depression

Judges and Depression

Loneliness is the most terrible poverty — Mother Teresa

I’ve written a lot on stress, anxiety and depression in the legal profession, but not about the judiciary. There has been much commentary, research and Law Journal articles about what ails law students and attorneys — but not about judges.

I guess that’s not surprising. In my work over the past four years, I have spoken with scores of judges from all over the country. It’s a noble, important calling in life. But it’s also very stressful, demanding and . . . lonely.

Here’s a clip from the new documentary A Terrible Melancholy: Depression in the Legal Profession. My good friend Judge Michael Miller talks about the loneliness of being a judge:

Isolation, Loneliness & the Judiciary

In an article for Judicature magazine, psychiatrist Isaiah Zimmerman culled through twenty years of notes he accumulated from treating state and federal judges. Here are the voices of the judges in their own words:

“Before becoming a judge, I had no idea or warning, of how isolating it would be.”

“Except for those very close, old friends, you cannot relax socially.”

“Judging is the most isolating and lonely of callings.”

“The isolation is gradual. Most of your friends are lawyers, and you can’t carry on with them as before.”

“When you become a judge, you lose your first name!”

“It was the isolation that I was not prepared for.”

“After all these years on the bench, the isolation is my major disappointment.”

“The Chief Judge warned me: ‘You’re entering a monastery when you join this circuit.’”

“I live and work in a space capsule – alone with stacks of paper.”

“Your circle of friends certainly becomes smaller.”

“Once you get on the appellate bench, you become anonymous.”

These weren’t isolated comments or small pockets of pedestrian sadness. Dr. Zimmerman notes that about 70% of the judges he interviewed came up with these observations on their own.

There are several things that contribute to a sense of judicial loneliness. The Code of Judicial Conduct imposes restrictions on judicial behavior both in and out of the courtroom. Judges must avoid the appearance of impropriety and thus must be cautious and keep an appropriate distance and bearing at social and bar events. There are good reasons to have these restrictions, but if a judge isn’t careful to live a balanced life, they can help trigger a profound sense of lonesomeness.

Loneliness isn’t just emotionally painful; it’s also dangerous to your health on multiple levels. According to an article by psychologist, Hara Estroff Marano, writes:

“Evidence has been growing that when our need for social relationships are not met, we fall apart mentally and even physically. There are effects on the brain and on the body. Some effects work subtly, through the exposure of multiple body systems to excess amounts of stress hormones. Yet the effects are distinct enough to be measured over time, so that unmet social needs take a serious toll on health, eroding our arteries, creating high blood pressure, and even undermining learning and memory.”

Given the pressures and isolation of the job, judges need to recognize the dangers associated with loneliness: unhappiness, discontent, health problems and perhaps . . . depression.

Judges and Depression

Judges are supposed to be problem solvers in black robes; not human beings with psychological problems of their own.

Given the position that judges occupy in our society, the stigma around disclosure to others –and perhaps getting treatment for clinical depression — is much, much greater.

One psychiatrist I know who treats judges told me that judges request very early or very late weekday or weekend appointments. Moreover, they ask not to be scheduled before or after another lawyer or judge and pay in cash so as not to attract attention or leave a paper trail.

For the first ten years of my career, much of my practice was spent litigating cases in state and federal courts in New York City. One of my best friends from those days is now a judge. When I decided to go public with my depression four years ago by writing an article for Trial magazine, my friend called me for dinner to catch up on things. He wanted to know how I was feeling and expressed concern about my plans to go public about my depression.

“Dan, why can’t you write the article anonymously,” the judge said. “But that’s the problem, isn’t it?” I replied. “Why should I have to write such an article anonymously? What do I have to be ashamed of? Depression is an illness no different than diabetes or heart disease. Would I write an article about those illnesses . . . anonymously?”

We kept in contact with dinners and phone calls over the next four years, but over time our conversations centered less on my depression and well-being and more on his. You see, my friend the judge disclosed to me that he was suffering from depression and had tried to commit suicide some years before.

I think he felt he could trust me. Moreover, I think my disclosure gave him implicit permission to talk about his pain and struggles; a hurt only his therapist and wife knew of. He spoke of the loneliness of his job and how he missed the collegiality of his old large firm. But, he said that on the balance, he’d rather be a judge and didn’t regret his change in vocation; a move from the courtroom to the chamber. He liked his job, enjoyed the intellectual challenge and the chance to do justice.

The statistics on lawyer depression are deeply troubling. They suffer from depression at a rate twice that (20%) of the general population. As such, about 200,000 of this nation’s 1 million lawyers are struggling with depression right now. No studies have been done on judicial depression.

There are 1,774 federal level judges in the U.S. Were you to plug in the 20% depression rate we see with attorneys to the number of judges, approximately 350 judges across America are suffering from depression. Even though there haven’t been any studies of judicial depression, why would we expect the 20% rate to be any different than that found with attorneys?

I couldn’t find any statistics on how many state judges there are in the U.S. New York State has 1,250. Were you to plug in the 20% depression rate we see with attorneys to the number of these judges, approximately 250 of the Empire State’s judiciary are suffering from depression.

This isn’t sadness or burnout, but true clinical depression. Sometimes, we confuse being down in the dumps with depression. They’re really not the same thing – not even close. Here’s how psychologist Richard O’Connor, best-selling author of the book Undoing Depression, distinguishes it:

“Everyone knows what depression feels like. Everyone feels the blues at times. Sadness, disappointment, fatigue are normal parts of life. There is a connection between the blues and clinical depression, but the difference is like the difference between the sniffles and pneumonia.”

Nobody’s Perfect

Perfection is also an indicator for depression. In his article Even Judges Get the Blues, Judge Robert L. Childers writes:

“Because of the weight of public expectation, judges generally feel that they should be perfect. Not only do they feel that they should be fair, impartial, and make the right decision 100 percent of the time, but the public expects this of judges as well, as do the lawyers who practice before them. This can create undo pressure for judges and, consciously or unconsciously, keep judges from admitting or recognizing the signs of debilitating disease.”

In an article from the ABA Journal, Perfectionism, Psychic Batterning’ Among Reasons for Lawyer Depression, the piece states: “Lawyers [and judges] are taught to aim for perfection, to be aggressive and to be emotionally detached. They ‘intellectualize, rationalize and displace problems on others’ . . . . They don’t take direction particularly well. They tend to have to have fairly elaborate denial mechanisms. And they tend to challenge anything they’re told.” In another article from the ABA Journal, it notes that when combined with depression, perfectionism makes it harder for a person to seek help. And in the worst case scenario, leads to suicide.

Loneliness & Depression

Depression is a multifaceted illness that has several different causes – some genetic, some physical and some emotional. In the depths of my depression, I felt very alone – like I was trapped at the bottom of a dark well.

Many with depression isolate themselves because it’s painful to be around others. I would hang out at Starbucks and do my work. I didn’t want others I knew to engage me; I didn’t want others to see the pain I was desperately struggling with.

I’ve found that loneliness and depression often travel the same road. This creates a lot of problems because the two can feed off one another.

According to psychologist Dr. Reena Sommer:

“Depression is a problem that often accompanies loneliness. In many cases, depressive symptoms such as withdrawal, anxiety, lack of motivation and sadness mimic and mask the symptoms of loneliness. In these cases, people are often treated for depression without considering the possibility that loneliness may be a contributing and sustaining factor in their condition.”

Generally, the debilitating symptoms of depression can usually be managed with antidepressant medication. But when the underlying loneliness is ignored or overlooked, the depressive-like symptoms will probably continue. Unless the reasons for loneliness and depression are separated out, it can easily turn into a ‘chicken and egg’ situation where depression leads to loneliness, and loneliness leads to depression.”

Turning It Around

While depression might not be our fault, it is our responsibility to get better. We need to start behaving and thinking in constructive ways. Here’s some food for thought:

Get help. You can’t handle this by yourself. It is a problem bigger than any individual person. The A. B.A. ‘s Commision on Lawyer Assistance Programs recently created a Judicial Assistance Initiative. Reach out to them and they can get you pointed in the right direction.
You may have to take antidepressant medication to help you. That’s okay. You may have a chemical imbalance that you need to address. For many, psychotherapy alone won’t help until they quieted down their somatic complaints — e.g. fatigue from sleep problems — so that they can have the energy and insight to work on their problems.
Whether you need medication or not, you will need to confront your negative thinking with a therapist. A lot of research suggests that cognitive behavioral therapy is a particularly effective form of treatment for depression. Interview a couple therapists before you settle on one.
Exercise. The value of exercise is widely known: It’s simply good for everybody. For a person with depression, it becomes not just about a healthy habit, but a critical behavior and habit – they absolutely need to work out. In his book Spark: The Revolutionary New Science of Exercise and the Brain, Harvard psychiatrist John Ratey devotes a chapter to the importance of exercise in alleviating depression. Please check this book out.
If you have a spiritual practice, do it. If you don’t, think about starting one. This could be anything from a formal meditation practice, going to Mass, or walking the woods. A lot of research suggests that people who have a spiritual practice do better with depression recovery. If you believe in God or a higher power (I am Catholic), 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, are very important pillars of recovery. Two books from my tradition include Seeing beyond Depression by Father Jean Vanier and Surviving Depression: A Catholic Approach by Sister Kathryn James Hermes. Also see the wonderful guest article she wrote for my website.
Get educated. Read some good books on the topic. As part of your education, learn about the powerful connection between stress, anxiety and depression. On this subject, I recommend Dr. Richard O’Connor’s Undong Perpetual Stress: The Missing Connection between Depression, Anxiety and 21st Century Illness. Dr. O’Connor suggests 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/or depression. Also see the article I wrote for Trial Magazine about the connection between stress, anxiety and depression. It is a companion piece to an excellent article written by Andrew Benjamin called “Reclaiming Your Practice.”
Build pleasure into your schedule. Judges, like all those in the legal profession, are busy and have the “I will get to it later” mentally – especially when it comes to things that are healthy pleasures. We have to jettison this approach to how we live our days. We must begin to take time – now – to enjoy pleasurable things and people. A hallmark of depression is the inability to feel happiness or joy. We need to create the space where we can experience and savor good experiences and feelings.
Practice mindfulness. In mindfulness meditation, we sit quietly, pay attention to our breath, and watch our thoughts float by in a stream of consciousness. Normally, we immediately react to our thoughts (e.g. “I am losing my mind with all of these deadlines”). With mindfulness practice, we can begin – slowly – to let the thoughts and feelings float by without reacting to them. If such an approach to depression seems far-fetched, read the best-selling book The Mindful Way through Depression: Freeing Yourself from Chronic Unhappiness, for an excellent primer on how you can incorporate mindfulness into your day.
Remember to be kind to yourself. It sounds so simple. I tell this to depressed lawyers and judges all the time and they usually look puzzled. They often admit that they have 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.” Such a simple refrain can help us. Depression is often built on poor mental, emotional and physical habits. We must learn to acknowledge that we are worthy of love from ourselves and others and that part of such love involves taking better care of ourselves.
Spend time outside and in nature. We humans forget that we are part of nature and the animal kingdom. We need fresh air and sunshine. Even more so when the darkness of winter strikes. If you live in a part of the country with long winters, load up on vitamin D and consider using a light box to help you.

If you or a judge you know might be suffering from loneliness and/or depression, please forward this article to them. Here’s a list of depression’s symptoms and a self-test from the Mayo Clinic.

Newsweek Gets It Wrong: The Debate About Antidepressants

I yearned to get better; I told myself I was getting better. In fact, the depression was still there, like a powerful undertow. Sometimes it grabbed me, yanked me under; other times, I swam free. – Author, Tracy Thompson.

One study estimates that 19% – – or about 200,000 of this country’s 1 million lawyers – – suffer from depression. This isn’t just some statistic; this is about people – folks who happen to be lawyers for one reason or another.

Just what are these people supposed to do about their depression? Many if not most law students, lawyers and judges that I know have taken or are currently taking antidepressant medications. And they seem to be in the majority of people in this country who do so.

The ranks of the medicated are swelling. The number of Americans taking antidepressants doubled in a decade, from 13.3 million in 1996 to 27 million in 2005. One in ten Americans are prescribed these drugs making them the most prescribed medications in the country. By comparison, 18 million people take Lipitor for high cholesterol.

The biggest reason lawyers take these drugs? Like everyone else, they’re hoping want to feel better, but equally if not more importantly, attorneys want to return to their pre-depression levels of productivity at work. A profession that doesn’t suffer fools well and demands a lot out of mere mortals.

But is medication effective in treating depression and achieving this objective?

Late last week, I was walking down an icy sidewalk minding my own business. I could see the usual cast of characters in my peripheral field of vision; clusters of lawyers yucking it up on their way back from lunch, a judge lost in his own thoughts and a corporate lawyer I know (not particularly well) who once told me privately that he takes antidepressants, his lawyer wife did as well and five other lawyers in his firm did. I guess he felt comfortable telling me this because of my public disclosure about my own struggles. I often feel like a priest in a confessional; I hear about lawyers most private of struggles. Then, like such disclosures never happened, the curtain is opened and we each walk our own ways.

Walking by a newsstand late last week, I noticed the current cover story of Newsweek Magazine which read, “Antidepressants Don’t Work: The Debate Over the Nation’s Most Popular Pills”. The large print seemed to stick a proverbial finger in modern psychiatry’s eyeball and toss the question –along with people who suffer with depression- up in the air.

The article focused on a recent study which concluded antidepressants essentially worked no better than placebos (sugar pills). Oh, just great, I thought. What am I, who have taken medication for the past eight years, supposed to do now? Start popping M & M’s instead of Cymbalta?

The writer of the Newsweek piece concluded

“If placebos can make people feel better, then depression can be treated without drugs that come with serious side effects, not to mentions costs.”

This conclusion is the latest in a long line of recent books leading the charge against the use of medication to treat depression. Charles Barber, in his book Comfortably Numb: How Psychiatry is Medicating a Nation, argues that antidepressants are doled out like Halloween candy in this society. The motive: the big money made by the pharmaceutical industry. This is an appealing take because Big Pharma is commonly portrayed as the villains in the popular press; guys in black hats and white lab coats stuffing greenbacks into their pockets.

In an article written for Salon, Barber wrote:

“One has to wonder: Are we really that miserable? Manipulated might be a better word for the miserable. If we were to pick one factor that explains the dramatically increased number of antidepressants that now runs through our collective bloodstreams, it would be direct-to-consumer advertising, otherwise known as television commercials for drugs.” This point is well taken, but not surprising. Pharmaceutical companies are in the business of making money. Does such a motive make Lipitor any less effective? Should commercials about it deter us from taking this drug? I don’t so.

In fairness to Newsweek, they ran an accompanying piece which tried to give the other side of the coin. It was penned by psychiatrist, Robert Klitzman who framed the question about the study’s conclusions in this way:

“What should we make of the [study]? First, some facts: antidepressants have been shown to work for serious major depression. Most evidence shows they are effective for dysthymia: milder but chronic depression that continues for two years or longer. The question is whether they work for milder depression that may be shorter or less intense. That’s important, since major depression affects almost one out of five people [in this country] at some point in their lives. And most people with depression do not have severe forms of it.”

The response to Newsweek’s take on the study was sharp and quick. In an Op-Ed in the New York Times, Judith Warner wrote this biting retort:

“Happy pills don’t work, the story quickly became, even though, boiled down to that headline, it was neither startling nor particularly true. Yet in all the excitement about ‘startling’ news and ‘sugar pills,’ a more nuanced and truer story about mental health care in America was all but lost. The story begins to take shape when you consider what the new study actually said: Antidepressants do work for very severely depressed people, as well as for those whose mild depression is chronic (dsythymia). However, the researchers found, the pills don’t work for people who aren’t really depressed – people with short-term, minor depression whose problems tend to get better on their own. For many of them, it’s often been observed, merely participating in a drug trial (with its accompanying conversation, education, and emphasis on self-care) can be anti-depressant enough.”

As the article also points out, most people receiving antidepressants aren’t getting them from well-trained psychiatrists, but family doctors who don’t screen well for depression. One wonders how much training they get on how to probably diagnose depression and whether they can keep up on all the research on the topic. The result: we are, in some sense, an overmedicated nation; a country too quick to give sad or unhappy people pills that they shouldn’t be taking and don’t need.

That conclusion, however, does not mean that these medications don’t work for many (though not all) people suffering from true clinical depression. My take is that a family doctor who treats urinary tract infections and constipation shouldn’t be doling out Lexapro to a patient that he has spent 5 minutes with. Perhaps the problem isn’t just pharmaceutical companys bent on making a quick buck, but family doctors under managed care who don’t have any time to spend with patients and don’t know much about depression and the various medications used to treat it.

People feel ashamed and stigmatized by going to psychiatrists, but it could be a game-changer for many: either you don’t have depression and shouldn’t be on medication or you do and you could finally get relief from some of depression’s more devastating symptoms.

There is no doubt that exercise, psychotherapy and some form of community and support will help people whether they are suffering from some transitory upset/sadness in their life (by the way, this helps people with depression too). However, for many people afflicted with clinical depression, it’s unlikely that they will have a real shot at containing or overcoming their depression without short-term or long-term use of medication. They won’t be able to muster the energy, commitment and motivation to engage in the other healthy stuff; to go for a walk, to work out their distorted and negative self-beliefs about themselves with a good therapist or join a support group.

Depression has a terrible undertow; its riptides are often unforgiving. We need as many weapons in our arsenal to deal with it. People with transitory sadness or disappointments don’t need to become patients; they need to connect with other people or change their lives – maybe both. Therapy or just working it out by themselves with supportive friends and family may be all they need.

It’s Just Cancer – Get Over It.

bigstockphoto_Man_In_Depression_5432510

I arrived in New York City’s JFK Airport yesterday. My family and I are visiting friends over the weekend. While walking through the terminal, I saw a large advertisement from the Depression Is Real Coaliation. If you haven’t heard of this organization, check out their website. The ad read as follows:

YOU’D NEVER SAY, “IT’S JUST CANCER, GET OVER IT”. So why do some say that about depression?

When I first developed depression over seven years ago, at least five people told me to “get over” or “snap out of” it. Get over or snap out of “what” I often thought. I searched my mind for some frame of reference.

When people are too preoccupied with themselves and their problems, we have all thought or told them to end their narcissistic nonsense. “Life isn’t so bad. So stop complaining,” is our common refrain. We judge them to be selfish, inconsiderate or even burdensome. Yet, were such people suffering from a physical illness – say cancer, diabetes or heart disease – we would never imagine saying such a thing for fear of being thought cruel, rude or simply ignorant.

Sadly, all too often, people treat people with depression as if they don’t have an illness, but a problem of self-absorbtion. And for people who have experienced the Black Dog, they know exactly what I am talking about. Such comments make us doubt ourselves: “maybe I am just a complainer,” or “I’m just selfish.” But deep down, we may sense otherwise. If we do, we know that something is seriously amiss.

Critical comments from others made me feel like the accused. I imagined what must have been going through their minds: “You’re faking it. Now let’s get back to the business of practicing law.” They just didn’t seem to believe me. That didn’t believe that I had a chemical imbalance in my brain, that it wasn’t my fault and that this had made me sick – very sick.

In the beginning of my journey, I wanted everyone to understand me. I wanted them to just say, “It is okay, Dan. You have a medical illness and need treatment.” Sometimes this happened and sometimes it didn’t. When it didn’t, I felt hurt and even angry. I thought, “Just step in my shoes for an hour and you’ll know that what I’m experiencing is true.” We need to be careful who we choose to expect sympathy from. Make no mistake about it, we need allies when we are in a depression. Most often, it will come from other depressives who have “walked the walk,” people who have known and loved others with depression, or just big-hearted, everyday people.

In his book, Against Depression, psychiatrist, Peter Kramer, M.D., takes an unflinching account of the illness that is depression. Check out his Blog. Kramer cites a number of scientific studies linking depressive symptoms with abnormalities in the hippocampus and prefrontal cortex of the brain. Kramer also emphasizes that depression is more than a brain disease. “It is a neurologic, hematologic and cardiovascular disease. Overactivation of stress pathways causes a liability to clots and [heart] arrhythmias – and along or together, they predispose to heart attacks, silent strokes, disturbed mood and sudden death”, he wrote. Listen here to Dr. Kramer being interviewed by National Public Radio.

Richard O’Connor, Ph.D., author of the best-selling book, Undoing Depression: What Therapy Doesn’t Teach You and Medication Can’t Give You, makes clear why depression should be likened to other major medical illnesses:

“Heart disease is a good analogy to major depression. Heart disease is “caused” by a complex of factors, including a genetic predisposition, emotional factors like how we handle stress, and habits like diet and exercise. You don’t catch heart disease from an infection. You develop it gradually, over time, as plaque builds up in your arteries. Once you cross an invisible threshold marked by standards of blood pressure and cholesterol levels, you have heart disease . . . . Depression may be a similar threshold disease – genetic and biochemical factors may determine a different level of stress for each of us that, once reached, puts us over the edge into depression.”

It is critical to remember that depression isn’t your “fault.” However, it’s equally important to remember that it’s your responsibility. We must take responsibility to get better and stay that way. Yes, the critical judgments of others hurt. That’s why it is imperative to not go through this alone. Join a depression support group. They have also dealt with the judgments of others. There truly is strength in numbers.

The Weight of Advice

Each of us is a Dear Abby to the world. We dish out advice and opinions whether asked for or not; me included! Much of this is harmless; some necessary and kind. Then there’s the stuff we dole out without knowing what the hell we’re talking about. Where we should tread carefully, we plod along.

For better or for worse, there’s tremendous power in words. When we are vulnerable – as we are during a depression – the critical or misguided words of others take on the ring of gospel. Some may blame us for our depression in a ploy to get us to snap out of it. In one poll, 54% of Americans said that they thought of depression as a “moral weakness”.

Years ago, when I first told my four law partners that I was diagnosed with depression and would need to take time off, they sat there stunned. After a moment of awkward silence, one partner said, “What in the world do you have to be depressed about? You’ve got a great job, wife, family and friends. What do you need, a vacation?” This is an all too common response. His school of thought would argue that it was a lack of gratefulness that was at the root of my distress. Carried to its logical (or illogical) conclusion, we have control over our depressed state and if we only try harder by thinking positive thoughts, it will all go away.

In the book, Unholy Ghosts: Writers on Depression, author Susanna Kaysen says:

“The Failure of Will theory is popular with people who are not depressed. Get out and take your mind off yourself, they say. You’re too self-absorbed. This is just about the stupidest thing you can say to a depressed person, and it is said every day to depressed people all over this country. And if it isn’t that, it’s, Shut up and take your Prozac. These attitudes are contradictory. Conquer Your Depression and Everything Can Be Fixed by the Miracle of Science presuppose opposite explanations of the problem. One blames character, the other neurotransmitters. They are often thrown at the sufferer in sequence: Get out and do something, and if that doesn’t work, take pills. Sometimes they’re used simultaneously: You won’t take those pills because you don’t WANT to do anything about your depression, i.e. Failure of Will.”

These observations capture some of the angst – and yes, anger – of depressives. When I was struggling with other’s judgments about my depression, I thought, “What do I have to do to be worthy of their mercy?” In retrospect, it wasn’t a question of worthiness, but ignorance. Some people (friends, family and business associates) will never be able to overcome the inertia of their own ignorance. They’re not bad people. It’s just the way life is. And we have to learn to be okay with that. But then there are others. These precious souls – and there don’t have to be lots of them – who have our back. They truly want to understand and help. Mother Teresa was once asked by a hard-boiled reporter what God expects of humanity. I think the reporter expected some stock answer. Mother Teresa, in all her gracious dignity, said that all God really wants from us to be is a “loving presence” to one another. There are those in our lives who want to be that presence to us. Give them the chance to be that light.

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