Guest Articles

Editor’s Note:  David Rosen, M.D. is a McMillan Professor of Analytical Psychology, Humanities in Medicine and of Psychiatry & Behavioral Science at Texas A&M University. He is a Psychiatrist and Jungian Analyst and is also the author Transforming Depression.

Long ago Abraham Lincoln was helped to overcome his suicidal depression by his law partner, John Stuart. In Lincoln’s day there were no medications or psychotherapy so he relied on the friendship and support of his friend and colleague. Later, leading up to his Presidency, Lincoln became weller than well. He was transforming his depression and healing his soul. His antidepressants were laughter (humor is divine), prayer, endurance and creativity (he wrote his own speeches and his depression with its burning rage fueled his creative work). Lincoln’s transformation involved death of his false self and rebirth of his true self. He committed egocide (his old self-destructive ego died or was killed off) and he was reborn. He then was able to realize his personal myth and the true purpose of his life goals.
Egocide is something Buddhists have known about for hundreds of years. Egocide leads to continued life, whereas suicide is literally a dead end. The innovative therapeutic approach of egocide and transformation evolved out of research I carried out with survivors of jumps off the Golden Gate Bridge. These survivors told me that their self-destructive identities or egos died when they leaped to end their lives. They all told of a Higher Power or Force that took over and they survived. No one ought to survive, as it’s 255 feet above the water and when you land it’s like hitting concrete at 75 m.p.h. The fact that these individuals survived seems miraculous. They all told of a new identity, the true self, emerging after yielding to something larger than themselves.

In one of the interviews I was told “Dr. Rosen, you don’t understand. The part of me that wanted to commit suicide, that drove me to the Golden Gate Bridge, and wrote a suicide note in the parking lot, died. I walked out onto the bridge and jumped off, but I survived.” So he went through what William James called a religious experience. His old self-destructive ego died. It wasn’t a failed suicide, for that does not convey what really transpired.

I had to find a word for what happened so I ended up calling it “egocide,” since the ego identity that wanted to kill him died. He then went through a death-rebirth experience. It’s like any religious conversion, according to William James in The Varieties of Religious Experience. Every religious experience has a prodromal syndrome that is like psychotic suicidal depression. Afterwards, the person is filled with joy and has purpose and meaning. Everything goes to the opposite of the way it was before.

In my book, Transforming Depression (2002), after reviewing depression and suicide I outline a therapeutic model of egocide and transformation as well as describe four actual cases. In my lecture we will cover this material and I will focus on one case briefly. In the workshop, participants will write about a time when they were depressed or wanted to kill themselves and then do active imagination and end up with a creative, artistic product about their experience, such as a mandala.

Analysis means to break up or break apart and in the process a metamorphosis or real change takes place. The terms “talked to death” and “analyzed to death” are metaphors to emphasize the concept of egocide and both phrases mean killing a part of the ego. Of course, we don’t like to do that in the west. But if you say, “analyze to death” the part of you that wants to kill you; most people can grasp such a concept. It is not the entire ego that you want to kill. It is just the part, the negative self-destructive ego, which wants to kill you. It’s holographic, that is, the part equals the whole and the process heralds a death-rebirth experience. I use the therapeutic alliance with the patient to work with the healthy, positive part of the ego.

Egocide is killing the ego. However, because of the holographic model, when you analyze to death the part that wants to kill you the ego does temporarily die. Depressed and suicidal people feel dead inside. The dying part is making them feel dead, but they are alive. They want to kill themselves, but the therapist helps them analyze to death that self-destructive part. Often my patients have to leave work or school, since they are temporarily unable to function. They would have killed themselves, but now they are not going to die, because it is symbolic. They’re analyzing to death the suicidal ego and a transformation is occurring.

Some patients who are not able to function are placed on disability for three months. I call this suicidal crisis, a “soul attack”, and like patients with a “heart attack” they are not able to work for a period of time. It is a parallel problem because in a heart attack a part of the heart dies and a regeneration process takes place; As in a soul attack when a part of the psyche dies and then there is a rebirth of the true self. Some refuse to go into a psychiatric hospital and I’ve had a few patients stay at a monastery. Naturally they have to see a local therapist and I am in contact with both during this early phase of treatment. For example, a patient once contacted me when he was driving around in his car with a gun. He asked, “Why shouldn’t I kill myself, Doc?” I saw him, after he gave up his gun to a trusted brother but he refused to go into a hospital. He ended up going to a monastery and staying there for several months. He was on medication and saw a therapist there. When he came back, he had gone through egocide and transformation. He also went through a religious conversion and his new positive ego identity was secondary to the Self.

Patients are encouraged to be open and engage in an inner creative process, like the second part of the title of my book, “Healing The Soul Through Creativity”. Creativity is essential because when you break up that false self, that negative self-destructive ego dies and it frees up a lot of energy that must be used as fuel for creativity. This patient chose the creative art of ceramics that he had learned at the monastery. Now he is a master ceramicist and has a kiln attached to his house. He talks about clay in spiritual terms. When he uses the wheel, which is like a mandala, he can tell if he is in balance, because the symmetry of the bowl or plate informs him.

Active imagination is like Hegel’s idea of thesis, antithesis and synthesis. The synthesis, the third principle, is the transcendent function. The patient starts out by meditating in order to relax and get the ego out of the way so that what is in the unconscious can become conscious. It is a creative process and through the synthesis of conscious and unconscious an artistic product emerges. The patient chooses some creative art form, such as ceramics, painting, dance, writing or composing music. It has to result in an artistic product, that is, something of substance.

In Let Your Life Speak (2000) Parker Palmer outlines a surrender to depression in his 4th Chapter “All the Way Down,” when he seeks psychotherapy and comes out a better person. In his transformation Parker describes a death of his “false self” and the birth of his “true self.” Another noteworthy account of an experience of suicidal depression is the late William Styron’s memoir, Darkness Visible (1990). Before I wrote the 1st edition of Transforming Depression (1993), I corresponded with Styron after sending him my manuscript. I asked him if he had gone through egocide and transformation and he responded in the affirmative.

As illustrated in my book, Transforming Depression, the case of Sharon was difficult because she had a borderline personality disorder, was suicidally depressed, an alcoholic and she suffered from anorexia nervosa. The first thing I had to do was to help her become neurotic, that is, to have a strong enough ego to go through the three stages of egocide and transformation. You cannot really do this unless you have enough ego strength to go deeper. A lot of the initial therapy is designed to build up positive ego and help the patient find his or her true self. The patient’s authentic self, is affirmed by supporting the patient’s strengths and unique qualities. This includes homework of determining what they like and do not like about themselves which leads to their true self and false self.

If you want to know more about my work, and the therapeutic model of egocide and transformation, please read the 3rd edition, and most up to date versionTransforming Depression (2002). This book tells the in-depth stories of two women and two men who suffer from suicidal depression and have very difficult journeys. However, they opt for the arduous but transforming path of egocide. These individuals were chosen, because I felt many people would be able to relate to their stories. Issues of depression, despair, meaninglessness, hopelessness and suicide are endemic in our society, and these four cases involve all of these issues plus sexual abuse, abandonment, problems with alcohol and adoption.

Transforming Depression tracks the metamorphosis of their meaninglessness and demoralization into meaning, hope and the morale-enhancing unfolding of their personal myths. It reflects the courage to be. This book offers people from all walks of life an alternative to depression and suicide via the path of egocide and transformation: a journey of suffering encompassing symbolic death and new life.Transforming Depression is a guide for despairing individuals who are attempting to survive dark nights of the soul.

I think Jung put it best when he said that the world hangs by a thread, and that it is on the verge of destroying itself. It is as Martin Buber’s implies, it is imperative for individuals to heal themselves first, as he said, “Everything depends on inner change: when this has taken place, and only then, does the world change”. From research that we have done at Texas A&M University, when hope, spiritual meaning and healthy humility increase, anxiety and depression decrease. Also we have found that drawing mandalas is healing, particularly when individuals focus on love and joy. Once realized in individuals, this can be realized on a larger scale in communities, nations, and the world.

Editor’s Note:  Dr. Livingston was born in Memphis, Tennessee and raised in upstate New York. He attended the U.S. Military Academy and upon graduation as an infantry officr and trained as a parachutist and an Army Ranger. He served for two years in the 82nd Airborne Division before atending medical school at Johns Hopkins from which he graduated in 1967. He interned at Walter Reed General Hospital before volunteering for Vietnam where he served as the Regimental Surgeon for the 11th Armored Cavalry Regiment. He was awarded the Bronze Star for valor. While in Vietnam he registered a public protest against the war and subsequently left the army.

He trained in adult and child psychiatry at Johns Hopkins. He is a parent twice bereaved and his first book, Only Spring, described the death from leukemia of his six year old son. He is the author of the recent bestseller, Too Soon Old, Too Late Smart, which is now in its sixth printing. He has been published in a variety of magazines and newspapers including The Readers Digest, the San Francisco Examiner, the Washington Post and the Baltimore Sun. He is the father of four grown children andlives with his wife Claire in Columbia, MD where he continues to practice psychiatry.
People often come to me asking for medication. They are tired of their sad mood, fatigue, and loss of interest in things that previously gave them pleasure. They are having trouble sleeping or they sleep all the time; their appetites are absent or excessive. They are irritable and their memories are shot. Often they wish they were dead. They have trouble remembering what it is to be happy.

I listen to their stories. Each one is, of course, different, but there are certain recurrent themes: Others in their families have lived similarly discouraged lives. The relationships in which they now find themselves are either full of conflict or “low temperature,” with little passion or intimacy. Their days are routine: unsatisfying jobs, few friends, lots of boredom. They feel cut off from the pleasures enjoyed by others.

Here is what I tell them: The good news is that we have effective treatments for the symptoms of depression; the bad news is that medication will not make you happy. Happiness is not simply the absence of despair. It is an affirmative state in which our lives have both meaning and pleasure.

So medication alone is seldom enough. People also need to look at the way they are living with an eye to change. We are always talking about what we want, what we intend. These are dreams and wishes and are of little value in changing our mood. We are not what we think, or what we say, or how we feel. We are what we do. Conversely, in judging other people we need to pay attention not to what they promise but to how they behave. This simple rule could prevent much of the pain and misunderstanding that infect human relationships. “When all is said and done, more is said than done.” We are drowning in words, many of which turn out to be lies we tell ourselves or others. How many times do we have to feel betrayed and surprised at the disconnect between people’s words and their actions before we learn to pay more attention to the latter than the former? Most of the heartbreak that life contains is a result of ignoring the reality that past behavior is the most reliable predictor of future behavior.

Woody Allen famously said that “Eighty percent of life is showing up.” We demonstrate courage in the numberless small ways in which we meet our obligations or reach out to try new things that might improve our lives. Many of us are afraid of risk and prefer the bland, the predictable, and the repetitive. This explains the overwhelming the overwhelming sense of boredom that is a defining characteristic of our age. The frantic attempts to overcome this ennui take the form of a thirst for entertainment and stimulation that is, in the end, devoid of meaning. It is the answer to the question “Why?” that weighs most heavily upon us. Why are we here? Why do we choose the lives we do? Why bother? The despairing answer is contained in a popular bumper sticker: “Whatever.”

In general we get, not what we deserve, but what we expect. Ask a successful hitter in baseball about what he thinks will happen when he steps to the plate and you will hear something like, “I’m taking that thing downtown!” If you point out that the best hitters in the game make an out two of three times they bat, any good player will say, “Yeah, but this is my time.”

The three components of happiness are something to do, someone to love, and something to look forward to. Think about it. If we have useful work, sustaining relationships, and the promise of pleasure, it is hard to be unhappy. I use the term “work” to encompass any activity, paid or unpaid, that gives us a feeling of personal significance. If we have a compelling avocation that lends to meaning in our lives, that is our work. It is a tribute to the diversity of life that people can find pleasure and meaning in pursing mediocrity on the golf course or at the bridge table. Think about the traffic problems if we all liked the same thing.

Much is made of the presumed difficulty in defining “love.” Because the basis for the feeling itself is mysterious (Why do I love this person and not someone else?), it is assumed that words cannot encompass what it means to love another. How about this definition? We love someone when the importance of his or her needs and desires rises to the level of our own. In the best of cases, of course, our concern for the welfare of another exceeds, or becomes indistinguishable from, what we want for ourselves. An operational question I use to help people determine if they really love someone is, “Would you take a bullet for this person?” This may seem an extreme standard, since few of us are required to confront such a sacrifice and none of us can say with certainty what we would do if our desire for self- preservation collided with our love for another. But just imagining the situation can clarify the nature of our attachments.

The number of people we would consider sacrificing ourselves to save is very limited: our children, certainly; our spouse or other “loved one,” maybe. But if we cannot contemplate this gift, how can we pretend that we love them? More commonly, feelings of love or the lack of it are noticeable in all the mundane ways we show that someone matters to us, especially in the amount and quality of the time we are willing to give them.

The point is that love is demonstrated behaviorally. Once again we define who we are and who and what we care about, not by what we promise, but by what we do. I constantly redirect people’s attention to this. We are a verbal species, much given to the use of words to explain – and deceive. The worst deceptions, of course, are those we practice on ourselves. What we choose to believe is closely related to deeply felt needs—for example, the dream we all carry around inside of us of perfect love, unqualified acceptance of the sort available only from the good mother. This desire makes us vulnerable to the worst forms of self-deception and disillusionment, an indulgence of the hope that we have at last found the person who will endlessly love us exactly as we are.

When, therefore, someone purports to do so and says the words we so long to hear, it is not surprising that we might choose to ignore incongruent behaviors. When I hear someone say, “He does inconsiderate things, but I know he loves me,” I usually ask if it is possible to intentionally hurt someone we love. Would we do such a thing to ourselves? Can we love the truck that runs us over?

The other thing that true love requires of us is the courage to become totally vulnerable to another. The risks are obvious. Who has not had their heart lacerated by a mistake in judging the person to whom we gave this trust? Such wounds are the basis for much of the cynicism about love that pervades our relationships and produces the competitive games that frustrate our efforts to have faith in each other.

Other people alternate between the extremes of loneliness and self-deception. Somewhere in the middle lies our best chance for happiness. Finally, we are entitled to receive only that which we are prepared to give. This is why there is truth to the adage that we all get the marriage partners we deserve, and why most of our dissatisfactions with others reflect limitations in ourselves.

Editor’s Note: Bruce E. Levine, Ph.D., is a clinical psychologist and has been in private practice in Cincinnati, Ohio since 1985. Dr. Levine’s most recent book is Surviving America’s Depression Epidemic: How to Find Morale, Energy, and Community in a World Gone Crazy. Dr. Levine lectures, provides workshops and is a regular contributor to numerous magazines. www.brucelevine.net.

Among the lawyers whom I have known, it occurs to me that the only ones I’ve liked have had bouts of depression. So when Dan Lukasik, lawyer and depression sufferer, invited me to write a piece for his lawyerswithdepression.com, I gladly agreed.

In Surviving America’s Depression Epidemic, I explain how depression is neither a character defect nor a biochemical defect but a “strategy” for shutting down overwhelming pain. Given the level of pain in the lives of many lawyers, it does not surprise me that of 104 occupations surveyed by John Hopkins researchers, lawyers were the most likely to suffer depression, 3.6 times more likely than average.

Lawyers all too routinely experience the pain of injustice, the pain of the ugly side of human nature and the pain of money. For a sensitive soul, these pains can become insufferable. Some depressed lawyers, in confidence, tell me about another pain: interacting with soulless colleagues who maintain a “life-is-good” grin on their face as they swim through the day unmoved by the misery that surrounds them.

Many historians consider one depressed lawyer, Abraham Lincoln, to be the greatest U.S. president because of his critical thinking, wisdom and compassion. According to Joshua Wolf Shenk’s Lincoln’s Melancholy, the evidence is strong that by today’s standards Lincoln would have been diagnosed with major depression. Support for this thesis rests not simply on the famous Lincoln quote, “I am now the most miserable man living”; and goes beyond the observation of Lincoln by his longtime law partner William Herndon that, “gloom and sadness were his predominant state.” Shenk reports that Lincoln actually suffered two major breakdowns, which included suicidal statements that frightened friends enough to form a suicide watch.
Lincoln’s propensity for gloom was widely known during his lifetime, but in an era when a dark temperament was viewed as neither a character defect nor a biochemical defect, it actually helped Lincoln politically more than it hurt him. Shenk points out that Lincoln’s depression, “seemed not a matter of shame but an intriguing aspect of his character, and indeed an aspect of his grand nature.”

In contrast, after depression was medicalized, George McGovern’s 1972 vice presidential running mate Thomas Eagleton was shoved off the ticket because of his history of medical treatment for depression. This calls into question the contention that diseasing depression destigmatizes it.

Despite billions of dollars spent attempting to establish biochemical markers for depression, no such markers exist. This is why depression continues to be diagnosed via symptom checklists, not with lab tests, brain scans or any other biochemical means. And recently, psychiatry officialdom discarded the serotonin deficiency explanation of depression.

Is there a better model for both understanding and overcoming depression? There exists a great deal of research showing that depression is highly associated with overwhelming pain including the pains of loneliness, a miserable marriage, childhood trauma, poverty, unemployment, physical incapacitation and a variety of significant hurts and losses. Instead of viewing depression as either a character defect or a biochemical defect, depression is better seen as a strategy for shutting down overwhelming pain. Similar to the shutdown strategy of substance abuse, depression can also get out of hand and become a compulsion (a behavior not freely chosen).

Compulsive shutdown strategies such as depression not only shut down pain but can shut down our entire being. Hence the classic symptoms of depression: shutdown of energy; shutdown of the ability to experience pleasure including the shutdown of sex drive; shutdown of cognitive functions such as attention, memory and concentration; and sometimes complete shutdown and immobilization.

In modern industrial societies, immobilization is terrifying because it can lead to poverty, homelessness and institutionalization, so the fear of immobilization is quite rational. This fear is painful, and so we may use depression or other shutdown strategies to suppress it. Thus we have a vicious cycle: pain, a shutdown strategy such as depression resulting in immobilization, a fear of immobilization and more depression to shut down that painful fear. A major reason why I wrote Surviving America’s Depression Epidemic was to provide a way out of that vicious cycle.

One problem for critically-thinking lawyers is that critical thinking is associated with depression. Studies show that moderately depressed people are more accurate in their assessments of an often painful reality than are nondepressed people.

There’s more bad news for critical thinkers. Critical thinking can make it more difficult for standard psychiatric treatments to work. To the extent that one knows the truth about depression treatments—that no treatment, including antidepressants, has been proven to be much more effective than a placebo— it makes it more difficult to have faith in treatment. This lack of faith makes it more difficult for treatment to “work.”

In reflecting on the empirical research on depression: my work with depressed people; biographies and memoirs of people who have experienced depression; and my own personal experience with demoralization, immobilization and despair, it is difficult to deny the power of what scientists call “the placebo effect” —which is more commonly called “belief” and “faith.” If one has faith in the efficacy of a treatment or approach, one’s likelihood of overcoming depression increases. Lincoln, for example, came to have faith in humor and meaningfulness, which were two powerful antidepressants for him.

Many Lincoln biographers note that Lincoln told jokes and funny stories as a political tool to both disarm and connect, but Lincoln also used humor as an antidote for depression. Lincoln said, “If it were not for these stories—jokes –jests, I should die; they give vent—are the vents of my moods and gloom.”

Lincoln also discovered the antidepressant power of meaningfulness. Though Lincoln shared with other politicians the trait of ambition, he also wanted his life to have genuine meaning, which he found first in attempting to stop the spread of slavery and then, when the political climate changed, in his Emancipation Proclamation.

Can meaningfulness provide lifesaving morale? In Man’s Search for Meaning, Viktor Frankl describes a harrowing tale of his physical, psychological and spiritual survival in Nazi concentration camps. Frankl states that in the concentration camps, “The thought of suicide was entertained by nearly everyone.” Frankl discusses the therapy he provided for two men who seriously talked about suicide: “In both cases it was a question of getting them to realize that life was still expecting something from them.” For one man, it was a child waiting in a foreign country, and for the other, a scientist, lifesaving meaning was a series of books that no one but he could complete.

I wrote Surviving America’s Depression Epidemic for critical thinkers who are pained by the injustices and dehumanization of modern society, some of whom become depressed and are failed by standard psychiatric treatments. While critical thinkers are more likely to experience depression and less likely, from my experience, to be helped by standard psychiatric treatments, the good news is that there are—in addition to humor and meaningfulness— other solutions for a depressed critical thinker with a soul.

Editors Note: Dr. Amiram Elwork is a psychologist who specializes in working with the legal profession. He is the Director of the Law-Psychology Graduate Training Program at Widener University near Philadelphia, Pennsylvania, and the President of the Vorkell Group, a consulting firm that helps lawyers and their firms achieve “true success” through a number of products and services, including organizational consulting, individual coaching, surveys, seminars, retreats, books and articles. Among his many publications, are two books entitled Stress Management for Lawyers and Success Briefs for Lawyers.
When individual lawyers seek the help of a counselor, it is not unusual for the conversation to start with: “I have been thinking about quitting my job or law altogether, but I am not sure what I should go into.”  My usual advice on such matters is “slow down.  While quitting your job or the law may in fact be the right thing to do, given the risks and costs involved, these should be options to consider only after you truly understand what has happened to you.”

I give this advice because by the time many lawyers seek professional help, they are often “burned out.”  People who are experiencing burnout commonly want to make drastic decisions, but they are usually driven by desperation rather than inspiration.  Because their thinking often lacks clarity, I ask them to take some time to just ponder.

“Burnout” is a term used to describe professionals engaged in people-oriented services who are experiencing emotional exhaustion, depersonalization, and a reduced sense of accomplishment.  A typical symptom is feeling drained and unable to give to others, wishing that “they would all just go away.”  Sometimes this can result in callous, rude, and inappropriate responses toward clients, colleagues and staff.  The person may also feel inadequate and lacking in personal achievement and purpose.

It should be noted that although mental health professionals use the term “burnout” regularly, it is not an official mental health diagnosis.  However, people who are seriously “burned out” usually exhibit the symptoms of at least a mild form of depression (e.g., pessimism, sadness), which is a mental health disorder.  And so, it may be more accurate to think of “burnout” as a form of depression.

Causes

Although not all of the problems that lawyers encounter can be blamed on their line of work, the fact that they experience particularly high rates of burnout suggest that certain stressful characteristics of being an attorney must have at least a contributory effect.

The most stressful occupational demands of attorneys include: time pressures, work overload, competition, the need to keep up with a wide range of legal topics, balancing a personal life with professional obligations, and dealing with difficult people.  Another stressor relates to the fact that the American system of justice is highly adversarial.  Some lawyers also experience conflict and ambiguity about their roles, such as when they are forced to hurt people or to advocate for what they know are unjust results.

In addition to these external stressors, there are several personality characteristics among lawyers which may make them less prone to withstand the demands of their profession.  The most significant one is “perfectionism.”

Because law requires objective logical analysis and close attention to details, the legal profession attracts perfectionists.  These are people who live by the rule: “If I don’t do a perfect job in every detail, I will fail.”  Perfectionists tend to be workaholics who are often viewed as inflexible, uncomfortable with change, and obsessed with control but unconvinced that they have it.  Since perfection can’t be achieved, striving for it can cause constant dissatisfaction.

Another reason that some lawyers experience burnout is that their core values are not aligned with their own behaviors.  Sometimes this problem reflects an internal psychological conflict, whereas at other times it is a conflict between the lawyer’s values and those of the organization at which he or she works.  Either way, when what you do is in conflict with what you think you should be doing, that triggers chronic feelings of guilt and unhappiness.

Solutions

If you have experienced burnout for a long time or the symptoms are severe, it is best to seek professional help.  However, if the symptoms are not severe enough to warrant professional intervention, there are a number of self-help techniques that are worth trying.  All I can do here is to describe a few of them very briefly.

First, you must understand that the human stress response goes through a sequence of four events:

Stimulus > Thought > Emotion > Behavior

There is usually a triggering incident or stimulus that causes you to respond.  Your initial response comes in the form of a conscious or unconscious mental appraisal.  The thought causes an internal physiological response that results in one or more emotions.  The emotions drive your external behaviors.

Using this model, your first attempt should be to try to change the external environmental demands that cause you stress.  For example, if you are constantly being put under the stress of unreasonable deadlines, go to the person(s) involved and attempt to change the time lines.  Or, if you don’t have enough support in the office, ask for additional support.

One would think that such advice is obvious, but I find that too many lawyers don’t even try these simple steps because they suffer from the illusion that it is a sign of weakness to do so.  Their thought is that a “real lawyer can handle anything and that if I can’t take what is handed to me, I must not be good enough for this job.”  Typically, this sort of misguided logic is a sign that the lawyer is a “perfectionist.”

This brings us to the second level of intervention one should try, namely to reduce one’s level of perfectionism.  You do that by first becoming aware of how your perfectionism plays itself out on a daily basis, and then by interrupting your automatic thought patterns until you change them.

For example, let’s assume that you are a perfectionist and your senior managing partner asks you to take on a particularly difficult project (stimulus).  Furthermore, let us assume that you are given an unreasonable deadline (stimulus), given all of the other matters for which you are responsible.  Your initial reaction might be to think, “I have no choice.  I must take on this case.  I must accept this deadline.  To do otherwise would be to show that I am incompetent.”  In the eyes of perfectionist, being less than perfect or just plain human is a equivalent to being incompetent.

Inwardly, you might also be thinking: “If I don’t take this on without any hesitation, I will expose myself as being inferior.  I don’t want anyone to find out who the real me is – – that I’m just an imposter and that I am not as good as others think I am.”  Such thoughts will trigger emotions like fear of failure and rejection, as well as guilt.  As a result, your outward response will probably be to reflexively say “yes” and to take on the project without any hesitation.

These reactions create a vicious cycle.  Your inability to say “no” causes more stress because it creates an impossible workload and increases your chances of making sloppy mistakes.  It reduces your ability to have a personal life and eventually leads you to feel burned out.

In order to improve your predicament, you must start by becoming fully aware of types of thoughts and emotions outlined above and by slowing them down.  The best way to do this is to keep a daily log of them for two weeks and break all stressful experiences down into four elements: stimuli, thoughts, emotions and behaviors.

Once you are fully aware of your perfectionistic thoughts and emotions, you need to force yourself to begin interrupting them.  The problem is that because so many of our dysfunctional thoughts and emotions are products of years of repetition, they tend to be driven by an internal automatic pilot.  By continually interrupting such thoughts and emotions, however, it is possible to regain conscious control of them.  Once you have done this, you need to begin cross-examining the validity of your automatic thoughts and emotions and considering other choices.

For example, using the scenario outlined above, you might ask yourself the following questions: “Would it be possible for me to suggest that someone else take on this project given the other things I have on my plate?  Is it possible for me to delegate some of my other work to other attorneys?  Is it really true that if I legitimately can’t do everything, I must take on this work anyway or be labeled a failure?  Are my colleagues that unreasonable?  Isn’t it true that I am the one who is being unreasonable with myself?”

Of course, it is possible that the realistic and true answers to the questions just posed would suggest that your organizational culture is fully to blame for your stress and burnout – – that you are not imagining it and there is nothing you can do about it, except leave.  On the other hand, if perfectionism is responsible for much of your problem, then you should come to the realization that no matter where you go, you will still be you.  The stresses that perfectionism cause will emerge on any job.  Leaving your current job because you feel burned out may not be the long term answer to your problems after all.

Another intervention to try is to assess the extent to which your stress is caused by the fact that your work life is not in alignment with your values.  Some misalignments are caused by internally conflicted or mutual exclusive values (e.g. high ambition vs. family).  Other misalignments are created by the fact that there is a conflict between your values and the values of the organization for which you work (e.g. financial success at any cost versus ethical behavior).

If your value misalignments are internal, they must be resolved internally.  Again, leaving your job or the law will usually not resolve such conflicts.  If, on the other hand, your values conflict with those of your organization, then you are “a fish out of water” and a separation may be in order.

The interventions I have described are simple to comprehend, but they could be among the most difficult tasks you will ever undertake.  Rather than running from your job or the law altogether, they require you to examine the issues that cause you stress more deeply before making any major moves, and to consider less drastic changes.  You might still decide to leave your job or the law, but at least it will be for valid reasons.

Copyright Amiram Elwork.  This article is reprinted here with the permission of Dr. Elwork.  Dr. Elwork can be contacted at the Vorkell Group, 1422 Tanglewood Drive, North Wales, PA 19454.  Telephone (215) 661-9330.  E-mail aelwork@vorkell

Editor’s Note: Zindel V. Segal, Ph.D. is a clinical psychologist and Head of the Cognitive Behavior Therapy Unit at the Center for Addiction and Mental Health and Professor of Psychiatry at the University of Toronto, where he is also Head of the Psychotherapy Program. He is the co-author of The Mindful Way Through Depression: Freeing Yourself From Chronic Unhappiness

The clang of the meditation bells slowly faded into a silence punctuated by the sounds of bodies moving on chairs and cushions. It was our seventh session, and by now, group members were comfortable with just sitting and watching their breathing for 40 minutes, while all manners of thoughts, feelings and sensations came into their minds with a searching insistence. It hadn’t always been this way. Right at our first session, these folks had asked lots of questions and were unsure exactly how meditation was going to help them prevent depression from returning. Attending to sensations in their toes, or taking five minutes to eat a raisin and then discussing the experience, didn’t seem, even to the most adventurous in the room, to be close to what they needed. Nonetheless, they were learning firsthand about the powerful connection between attention and emotional balance. Each of the participants had suffered from depression in the past, but recognizing that it could easily return, had signed up for a program in which meditative practices featured predominantly.

In the late Sixties, meditation gained popularity as a vehicle for exploring altered states of consciousness and experience. Today’s therapeutic uses of meditation are orientated toward cultivating a particular form of awareness known as mindfulness. The practice of mindfulness originated in the meditation traditions of Asia has been part of Buddhist culture for millennia. Mindfulness describes a moment-by-moment, non-judgmental attending to experience without automatically reacting to what is being noticed. When mindful of ordinary activities such as eating, we may do things to deliberately keep our focus on the act itself, such as putting our spoon down between tasting and swallowing each mouthful of soup. Within the realm of emotion, we may note the presence of disturbing ideas or sensations, and be less drawn into responding with an habitual defense of outburst, sense of sleight or reflexive withdrawal.

Mindfulness, Cognitive Therapy and Mood Disorders

Over ten years ago, my colleagues, John Teasdale, Mark Williams and I adapted the teaching of mindfulness meditation for use in preventing depressive relapse. In our program, Mindfulness Based Cognitive Therapy, these practices are taught without a particular religious or philosophical belief orientation, as a basic awareness technique or a way of looking at things that anyone, no matter what their fate, could utilize. Participants attend eight weekly two-hour classes of between 10 to 12 people, in which the primary work is intensive training in mindfulness meditation as it relates to regulating thoughts and feelings.

Participants in MBCT practice mindfulness meditation through the body scan, mindful stretching, mindful walking, and alternating the focus of attention by shifting between mindfulness of the breath, the body, sounds and thoughts. And of formal practices that encourage close attending to common, seemingly mundane experiences are one way in which participants can apply mindfulness skills in their everyday lives (e.g., eating a meal mindfully, monitoring the physical sensations such as brushing one’s teeth, noticing how hard one grips the steering wheel while driving on the highway). Taken as a whole, the mindfulness practices in the program help participants take a wholly different approach to the endless cycles of mental strategizing that often drive depression’s return. They do so by helping us get back in touch with the full range of inner and outer resources for learning, growing, and healing, resources that they can access on a daily basis and may not even believe they have.

One vital inner resource that is often ignored is the body itself. When people get lost in thoughts or try and jettison their feelings, they pay very little attention to the physical sensations from their bodies. Yet, those sensations provide immediate feedback about what’s going on at an emotional and mental level. Group members explore this possibility by monitoring every day pleasant or unpleasant events, firstly noting body sensations that are present before going on to record their thoughts and feelings.

The cognitive therapy aspects of MBCT include psychoeducation about depressive symptoms and the dark thinking styles that often accompany them. To many participants, the only ‘legitimate’ symptoms of their depression are the ones that dysregulate them physically. If they have turned into harsh and critical judges of themselves or feel like giving up, somehow this is not seen in the same light. It is just a sign of their lack of mental toughness or character. Discussing this material helps participants acquaint themselves with the ‘territory of depression’ so that if they notice these changes occurring, then it will be easier to take action earlier.

The second cognitive therapy emphasis comes in helping participants to see their thoughts as creations of the mind and not as facts. Through simple exercises that emphasize the relationship between thinking and feeling and how certain roads bring with them familiar negative ruminations, participants developed the ability to dis-identify from their thoughts as reflections of themselves and see them as part of a larger ‘package’ of depression. Very often this recognition, almost saying to oneself, ‘Oh here comes another round of judgement’, for example, can help people take a step back from it without resorting to disputation or challenging. In cases where certain thoughts or beliefs still have a strong pull on awareness, participants practice questioning them with an attitude of investigation, curiosity and kindness.

Finally, all participants are provided with The Mindful Way Through Depression, the book that describes the program and contains a CD of guided meditations similar to the ones they practice in the class.

To date, MBCT has been evaluated in three randomized clinical trials, each showing a significant protective advantage for patients receiving the treatment. Recently, the UK National Institute of Clinical Excellence (NICE) has recently endorsed MBCT as an effective treatment for prevention of relapse. Research has shown that people who have experienced multiple episodes of depression can reduce their chances that depression will return by 50 percent.

Editor’s Note:  Fr. Richard Rohr is a Franciscan priest in New Mexico Province and author of several books including Hope Against Darkness and From Wild Men to Wise Men:  Reflections on Male Spirituality.  He is the founder of the Center for Action and Spirituality in Albuquerque, New Mexico.  In his article, Father Rohr speaks to us directly about a spiritual approach for lawyers struggling with depression. 

 
One description of depression is that it is like the shapeless sagging of a rubber band that has been kept tight and taunt for too long.  When feelings have been strong, stressed, unprocessed, or held captive over a period of time, we just stop feeling altogether.  Persons and events no longer have the power to enliven us, we operate on a low level cruise control.  Usually we keep functioning, but there is no positive or creative affect toward persons and things, and even less toward ourselves.  We basically stop living our only life.

Many lawyers operate at this level , without even knowing that it is a kind of death.  They have learned to take it as normative and unchangeable.  Life is no longer enjoyable, and almost everything becomes another excuse to be upset, angry, aggressive, afraid or defensive.  We all know many people who live at this level.

But I would also like to describe another common source of depression that is less often addressed:  basic meaninglessness.  Religion, philosophy, and culture are supposed to address that foundational need.  But when religion or spirituality is largely in the head, mostly fear based, or merely moralistic, there is a huge vaccum in most people.  The soul and the spirit are not fed at this level.  I am afraid that it is the most common form of religion we now have in the West.  Such people, often very smart, have no beginning, middle or end to their life story, unless they totally create it for themselves like some kind of Nietzschean “ubermensch”.  This is inherently too big a task for one autonomous individual.

The “Is that all there is?” feeling overcomes most people in our culture somewhere in their mid to late forties, if they are at all typical.  If you are riding a fast track of  upward mobility, external success, and lots of control, you might be able to put it off for another decade.  But it is hardly worth it, because then the patterns of avoidance, depression, splitting off, a basic non-intimacy with one’s deepest life, are so entrenched, that it is very hard to emotionally and intellectually change without a lot of grace – – and a lot of “grit your teeth” and try to bear it.  We are largely unteachable at that point.

The grace, of course, will always be available, but often we have lost the recognition of it, the desire for it, the trust in it, and the ability to cooperate with it.  We do not even know there is such a thing as grace (Acts 19:3), and it is indeed an “it” instead of a Presence, a power and a possibility.  In fact, for an ego that has been in overdrive for forty years, the reception of grace will actually feel like a defeat, a humiliation, and a failure.  If “I” have been doing it all along, any “we” experience of union and cooperation with Another will actually feel like a loss of control and a loss of self importance.  It will be like switching from an eager breast stroke to a back float, and still having to assume that I can still get there.  That would be hard for any successful lawyer, and actually for any of us.

At this point, one’s overdeveloped faculties (rational mind, willpower and Yankee can do!) will have to give way to those that were left underdeveloped for the sake of what we call in men’s work “building our tower”.  What do I mean by those “underdeveloped faculties”?  Well, first of all, I should state that they are not just underdeveloped, they are actively rejected and denied as values at all.  I think that is why religion tended to speak at this process as “conversion”.  Because if it is authentic, it is a rather complete reversal (“convertere” in Latin) of previously held virtues and values.  Probably also why authentic religious conversion is rather rare.

Okay, here goes.  This is what changes.  Things like admitted powerlessness begin to be admired over claims to power, unknowing over knowing, living without resolution over demanding closure, giving instead of taking, waiting instead of performing, listening instead of talking, letting go instead of collecting and hoarding, empathy with instead of domination over.  The more traditional words that were used for these values were three:  “Faith”, “hope”, and “charity”.  What St. Paul says, “are the only things that last” (1 Corinthians 13:13).  I am sure he is right.  But, mind you, these are virtues that are only learned by many trials and many errors by the second half of life, at best.  In the first half, they actually do not make sense.  The trouble is that many lawyers  in our secular world are not moving to the second half of life.  They are becoming elderly but they are not elders.

We all know that one part of each of these equations had to be developed to be lawyers at all.  You would not have built any kind of tower unless you were powerful in some sense, had your facts, moved towards closure, and were normally much better at talking than listening.  You lived in one way, but you died in another.  Eventually that unintended death catches up with you.  There is a huge hole in the soul of manglers and it gnaws and longs to be filled.  It is another form of depression, but potentially a life changing one.  Please trust me when I say that this hole has immense energy and possibility hidden within it.  Maybe it is even the necessary vacuum to hold a new Infilling.

At first you will not know where to turn, especially if you have a good mind, and you are used to explaining everything and determining your own direction.  You have no practice at this different set of virtues.  To be honest, only God can lead at this point.  You had best give up, because all of your previous tools are useless and even counter- productive.  This is exactly why Bill Wilson made the first necessary step of Alcoholics Anonymous the absolute admission of “powerlessness”.  This is about as counter intuitive as you can get, or even seemingly non-rational (not irrational!).

So what am I proposing that you do?  Really not that much.  I am first of all trusting in your ability to hear some of what I just tried to say.  If you have persisted in reading this far, you are hearing me at some non-resistant level.  We call this the “contemplative mind”, where you turn off the need to be right or wrong, agree or disagree, and just let something work on you at whatever level of truth there is.  (Everything Belongs, Crossroad Press, 1999).   The Eastern religions would call it non-dual thinking.

Secondly, I would encourage you not to try too hard, no self-assertion because that will only deepen your addiction to your own way of doing life.  You will try to “convert” yourself by yourself, which is actually a oxymoron.  If you try to be heroic and superior, you will only get more of the same, but now disguised with a religious or moral sugarcoating.  Please trust me on this one, all great spirituality is about letting go.  YOU cannot do it.  IT is done unto you.”  (Luke 1:38 and 28:43).  You are always the allowing.  Someone else is winning at this point, and you are getting your first lesson in creative losing.

Thirdly, I would like you to forgive yourself for your life’s mistakes.  God never leads by guilt or by shaming people.  Take that as an absolute.  God always leads the soul by loving it at ever deeper levels, and if you want to be led, you absolutely must allow such unearned love.  Like all grace, it will feel like losing, not gaining, surrendering not taking, trusting not achieving, allowing instead of “making the case.”  Like all authentic conversion it will feel like dying (See John 12:24 or Old Adams’ Return, Crossroad, 2005), but it will really be living.  Fully, for the first time.  God does not love you if  you change, God loves you so that you can change.   God is not the rewarder and the punisher.  God is the energy itself.  More of a verb than a noun, according to the great mystics.

This is one case you are not going to be able to win.  In fact, I am convinced that the Gospel of Jesus really is the hope of the world precisely because it totally levels the human playing field.  Now we win by losing, and if we are honest, we all have lost, failed, and been untrue at some levels (Romans 5:12).  That humiliating recognition is the hole in the soul that allows God to get in – – and ourselves to get out – – of ourselves.  Don’t miss such an entrance or exit.  It is the Big One.

Editor’s Note: Susan Daicoff is an Associate Professor of Law at Florida Coastal School of Law.  She is a lawyer and professional psychotherapist.  For the past decade, she has been researching and writing on the psychology of lawyers, lawyer personality, lawyer distress and dissatisfaction. She is the author of the book, Lawyer Know Thyself.

Why are so many lawyers depressed?  Larry Krieger and Ken Sheldon’s research indicates that the loss of one’s intrinsic values is responsible for the dramatic increase in depression and lowered sense of well being among law students seen in the first year of law school.  I often think of this at the “ski slope” graphic representation of the excellent Andy Benjamin, et al. studies done in the 1980’s and 1990’s on depression in law students.  Their data showed that depression among law student’s approximated that of the general population, pre-law school (with a prevalence of about 9-10%).  It rose to 32% by the end of the first year of law school, and rocketed to an amazing 40% by the third year of law school, never to return to pre-law school levels.  Across 0 to 78 years of practice, 17.8 to 19% of lawyers reported clinically significant levels of depression.  Now, either the pre-law students assessed two weeks before law school classes began with uncharacteristically “happy” at the top of their game, and thus tested out as less often depressed than they really were, or law school had significant, permanent, deleterious effects on those individuals.  Krieger and Sheldon’s work suggests the second conclusion – and points to the concomitant shift from an emphasis on intrinsic, internal values to extrinsic, external values, as the culprit.

What are extrinsic values?  In law school, my students quickly point out: “Grades!  Class rank, Law Review, Order of the Coif, Moot Court, that great summer clerkship at a silk stocking firm, a plum judicial clerkship, and the brass ring: a lucrative associate position with a crave-able large private practice firm.”  First-year associate salaries at these firms were reported to hit $160,000, for select graduates from select law schools (the National Jurith, January, 2008).  In comparison, the median gross starting salary of a lawyer at a non-profit public service organization is approximately $40,000 (from the National Association of Law Placement).  After law school graduation, my students usually claim: “money, cars, houses, boats” are extrinsic rewards; they now also include Martindale-Hubbell ratings as well as win-loss records.  Extrinsic rewards may also be intangible, such as the approbation of one’s classmates and professors, prestige, status, other’s regard and opinion, and reputation – anything from sources located outside of the individual.  If Krieger and Sheldon are correct, then identifying one’s intrinsic values, holding firm to them, and integrating them into one’s day-to-day law practice are the keys to inoculating one’s self against psychic distress and depression.

So, what are intrinsic values?  What is tricky about intrinsic rewards is often that they are often unique to each individual lawyer or law student; they are not “one-size-fits-all”, as are grades, jobs or salaries.  For some, it may be intrinsically satisfying to represent a client and give that person their “day in court”, uphold constitutional rights, craft a particularly good oral argument, craft a particularly competent legal documents, structure a complex corporate transaction, or negotiate the settlement of a legal dispute.  It may be feeling that we “make a difference” in someone’s life, help someone, or created a new business venture or saved someone money.

Beyond locating our intrinsic values, however, there is one more disturbing finding in the research on lawyer distress that should be addressed.  Reich in 1976 found that many pre-law students wished to be seen as competent, socially ascendant, and in control, but inwardly they felt awkward, anxious, cautious, and unsure.  He suggested that they may have chosen law as a career because it allows one to hide behind a professional mask of competence, leadership, and dominance, without having to expose those more tender feelings of discomfort and awkwardness in social situations.  It allows one to interact with clients, other lawyers, Judges, and other individuals in the course of one’s work at a comfortable professional distance and in a professional, defined “role” with clearly defined role expectations and obligations (even imposed by law in the form of the Lawyer’s Code of Ethics), without having to confront other people without the comfort of this professional role.  This might appear to reduce angst, anxiety, and discomfort.  However, interacting with people always at a professional distance can be isolating, lonely, and discouraging, ultimately leading to depression.  It can even discourage close relationships with other lawyers.  The end result is that this lawyer ends up isolated and alone, even surrounded by clients, assistants, other lawyers, paralegals and other law office personnel.  The very psychological dynamic that may have driven some individuals to chose law as a career may ultimately contribute to debilitating depression in those individuals, necessitating treatment and behavioral change.

Another relevant trade is perfectionism.  Dr. Amiram Elwork has written at length about this in his excellent book, Stress Management for Lawyers.  He notes that perfectionism is adapted and even rewarded in law school and the practice of law; however, it can lead to a way of thinking and behaving that ultimately leads to depression.  It can turn into the attitude of, “if I don’t do it perfectly, I’m no good, it’s no use, I should just give up” or “I have to do it perfectly and I can’t quit until it’s perfect” which can lead to workaholism and isolation.  If a situation or matter does not turn out as hoped for, the individual often blames himself or herself and believes that the reason is because he or she did not “work hard enough,” was “not well enough prepared,” “let something fall through the cracks,” and either “beat themselves up” or resolves to “work harder” next time, not acknowledging that not every matter can turn out as he or she would like to expect.  This perfectionism can lead to an over developed sense of control and responsibility, so that the individual believes that he or she is responsible for the outcomes of matter and situations over which he or she actually does not have complete control.  The belief is erroneous and causes and great deal of angst.  Here is it relevant to note that this angst can either be expressed as depression or irritability and anger, which are really two sides to the same coin.  It is often said in psychology circles that depression is “anger turned inwards” – one might in turn think of anger and irritability, emotions so often seen in private law firms, as depression turned outwards.

So, what are the solutions?  The research and commentary outlined above point to three issues:  (1) focus on your intrinsic values and what you might find intrinsically rewarding about your work, and integrate some element of those values and rewards into your day-to-day work – change your job only if necessary; (2) increase your EQ and interpersonal skills so that you are not anxious and uncomfortable being fully emotionally present in interpersonal situations, challenge yourself to drop your “mask”; (3) undergo cognitive restruction to get rid of imperfectionistic thoughts and behaviors that are setups for anger and depression.  Experts suggest that making the later two changes are sometimes difficult to do alone, that it often requires the assistance of peers or professionals to accomplish this task.  However, identifying your intrinsic values and beginning to incorporate them into your daily work is something that can be done right away.  Whatever changes are indicated, the payoff is worth it, as no profession is as stimulating and challenging as the law, in my opinion, and a career in the law that is satisfying is, indeed, the brass ring”.

Professor Daicoff can be reached at (904) 680-7774 or via e-mail atsdaicoff@fcsl.com.

Editor’s Note:  Dr. Lara Honos-Webb is a clinical psychologist and author of the books Listening to Depression: How Understanding Your Pain Can Heal Your Life and The Gift of ADHD. She practices in Walnut Creek, California. You can visit her website at www.visionarysoul.com.

Why are lawyers so depressed these days? The rates of depression and substance abuse problems are skyrocketing according to recent media reports and research. This article will show you how depression can be seen as a break-down in the service of offering you an opportunity for a break-through. If depression offers corrective feedback to lawyers, what might it be telling you?

We only reflect on those things that break down in our life. For example, if life is going along smoothly you won’t spend time thinking about the meaning of life. You tend to think deeply about life when something is not working. When we identify a problem, we begin to reflect on what caused the problem and how to fix the problem. If you are disconnected from your deepest feelings and impulses you may still manage to get through life without realizing that your life is off track.

One of the defining features of depression is that it results in impairment in social and professional functioning. You may feel blue, begin to lose interest in some aspects of your life, but this will not be diagnosed as depression unless a marked impairment in day-to-day functioning is evident. It is this aspect of depression – – by definition an impairment – – that seems on the face of it most difficult to reconcile with the idea that depression is a gift.

But if you begin to open to the possibility that there was something fundamentally wrong with your level of functioning before your depression, only then does the idea of depression as a gift begin to make sense. A bread-down can become a gift when it is in the service of increasing reflection on your life which will lead to ask the fundamentally important questions:

• What is wrong with my life?
• What can I do to correct the problem?

When you listen to your depression, you can hear your life.

What do lawyers need to hear to heal their lives? One message might be that money is no substitute for meaning. Many lawyers chose the profession as a path toward material success. Great wealth offers opportunities for great joy and liberation from financial stressors. Depression may be telling you, “Now you’ve got the money, time to go for the meaning.” The problem with the rat race is that no one tells us where the finish line is. Depression may be telling you “nothing is missing, it’s time to enjoy my wealth.”

Other lawyers may find their financial success to be the proverbial “golden handcuffs.” You may have created a lifestyle that forces you to work around the clock to sustain it. In this case depression may be telling you to find some balance. Depression may force you to gain perspective. If your professional life becomes impaired, you may be forced to see that it might be better to scale back your spending so you can put more “life” in your lifestyle.

Many lawyers may find themselves depressed simply because they are far outside of their “sweet spot.” Your sweet spot is that place where your passion meets your purpose. The quickest way to heal your life and heal your depression, is to find your sweet spot and start moving toward it. A friend of mine learned she lived medicine after she graduated from Harvard Law School. She worked as a lawyer for the American Medical Association. Sometimes lawyers feel that by working with the underprivileged they are fulfilling their purpose. Don’t forget to put the “sweet” back in the sweet spot. This means you have to love what you do and do it because it enlivens you. If your work is a constant strain, it’s a signal that even if it’s a noble job – – it might not be for you. Depression is a call to break-through to a life of both passion and purpose. Take it as a signal you have some soul-searching to do to get closer to your sweet spot.

For more tips and tools about depression, visit http://www.visionarysoul.com. Sign up for Dr. Lara Honos-Webb’s free newsletter athttp://www.visionarysoul.com/newsletter.html. Learn how to translate your pain into your purpose with individual sessions http://www.visionarysoul/sessions.html.

Editor’s Note:  I have asked several leading psychologists to write a short article about their experiences with treating lawyers who suffer from depression.  One psychologist, Richard O’Connor, Ph.D., is the author of two noteworthy books, Undoing Perpetual Stress: The Missing Connection Between Depression, Anxiety, and 21st Century Illness andUndoing Depression: What Therapy Doesn’t Teach You and Medication Can’t Give You. He is a practicing psychotherapist with offices in New York City and Canaan, Connecticut.  He has suffered from clinical depression and is a member of a depression support group.

There’s some interesting research to suggest that happy people view the world through certain comforting illusions, while depressed people see things more realistically. [i] For instance, the illusion of control. You can take a random sample of people and sit them in front of a video monitor with a joy stick, and tell them their joy stick is controlling the action of the game on the screen. (But the point of experiment is that it actually doesn’t). Depressed people will soon turn to the lab assistant and complain that their joy stick isn’t hooked up correctly. Normal people, on the other hand, will go on happily playing the game for quite some time.

I think this explains a lot about why lawyers are so prone to depression. Because of their experience with the law, most attorneys have lost their rose-colored glasses some time ago. (Or else they never had them and chose the law as a career because it suited their personality). Attorneys know that life is hard, and doesn’t play fair. They’re trained to look for every conceivable thing that could go wrong in any scenario, and they rarely are able to leave that attitude at the office.  They see the worst in people (sometimes they see the best, but that’s rare). They tend to be strivers and individualists, not wanting to rely on others for support. They have high expectations of success, but they often find that when they’ve attained success, they have no one to play with, and have forgotten how to enjoy themselves anyway.

All this makes it hard for attorneys to get help with their depression. They tend not to recognize it as such; they just think it’s stress, or burn out, or life. They don’t expect that anyone is going to be able to help. Most of my attorney-patients have contacted me because their relationships are falling apart, but they don’t see that it’s depression that makes them such a lousy partner – tense, irritable, critical, joyless, tired all of the time, relying on alcohol or other drugs. If they’d gotten help for the depression a couple of years previously, their spouse wouldn’t be moving out now. The truth about depression is that it not only makes you feel horrible, it wrecks your life. And that’s why I wrote the book, Undoing Depression, in the first place. I was running an outpatient clinic, and grew exasperated with seeing the people whose lives wouldn’t have been so ruined if they had got some help when they first needed it –  before they alienated their children and spouse, got fired, went into debt, developed a substance abuse problem, etc. I thought there was a need for an intelligent self-help book, one that points out all the bad habits that depression engenders and which, in a vicious circle, keeps reenforcing the disease. But the truth is that self-help isn’t nearly enough for most depression sufferers. It’s as if you stepped over an invisible cliff, and you can’t find your way back doing what you normally do, because that’s what led you over the cliff in the first place. Depression is the original mind/body disease; your physical brain is damaged because of the stress in your mind, and you’re unlikely to undo that damage without help.

Depression is highly treatable, but if you want a lasting recovery you have to change your life. The ugly fact is that depression is very likely to reoccur. If you had one episode of major depression, chances are 50:50 that you’ll have another; if you have three episodes, it’s 10:1 you’ll have more. But you can improve those odds if you get good professional help, with medication and with talk therapy. We won’t put your rose-colored glasses back on, but we can help you see how negative thinking and the negative acting is contributing to your disease.

[i]  See for example, Shelly Taylor: Positive Illusions; and Julie Noren: The Positive Power of Negative Thinking.