Dallas DA Sets Ethical Example with Depression Treatment

The website, Law360 reports: “When Dallas County’s district attorney took a leave of absence to treat serious depression — a problem that affects attorneys in disproportionate numbers to the general population — she faced calls for resignation, but experts say getting treatment and ensuring that any clients are taken care of is the ethical thing to do.” Read the News

From One Lawyer to Another: Simple Steps Lawyers Can Take to Deal with Depression

Since you are reading a website about lawyers and depression, you are probably wondering whether you are suffering from depression, or what to do about it. You’re in good company. It is estimated that 1 in 10 members of the public suffer from depression; among lawyers the rate is 3.6 times higher. That would make it likely that about 1 in 3 lawyers are suffering from depression.

I am one of those lawyers (so, two of you are off the hook—you’re welcome). There are many articles covering the symptoms of depression. (See, e.g., this NIMH list.) If you even think you are suffering from depression: GET PROFESSIONAL HELP. At first, I refused to admit to myself that I needed help. I told myself that I could muscle my way through. It was a trap: while my higher consciousness assured myself that I could handle it all, my depression kicked in when it was time to get things done. “By the time you are sick enough to recognize that you have a problem, your ability to engage in accurate self-evaluation is significantly impaired.”

My particular form of depression involved feeling as if I was in a daze, as if I was not in control of my actions, as if someone else were running my life. I did not respond to client calls, I did not get work done until the last minute (if at all), I missed court appearances, I forgot to pay bills, I failed to monitor my trust account. I am doing much better now thanks to the help of many including our host Mr. Lukasik.

The problem—well, one of the problems—for lawyers suffering depression is that they cannot let their mental condition interfere with their ethical and legal duty to their clients. A.B.A. Model Rules of Professional Conduct Rule 1.1 requires that a lawyer “provide competent representation to a client.” And Rule 1.16(a)(2) states:

(a) Except as stated in paragraph (c), a lawyer shall not represent a client or, where representation has commenced, shall withdraw from the representation of a client if: . . . .

(2) the lawyer’s physical or mental condition materially impairs the lawyer’s ability to represent the client.

I don’t think the A.B.A. expects one-third of the lawyers to immediately stop representing their clients. Depression does not mean that you cannot ably represent your clients; but depression is also no excuse for failing in your duties. What I address in this article are some actions you can immediately take that I hope will help you keep up with your responsibilities while you seek professional assistance.

The Matrix. The science-fiction metaphor of The Matrix (what is the Matrix?) helped me understand depression. The brain functions at a level that we are not always consciously aware of. Sometimes we can override our instincts; sometimes we cannot. Think of yawning, or sneezing. When you are depressed, the Matrix has you. To deal with the immediate impact of depression, you must get out of the control of the Matrix.

Make a list, work the list. Making a list of what you need to do puts your higher consciousness in charge. Rumination is controlled by the Matrix; the list is outside. Work the list. It should be as specific as you can make it: Not “write the brief” but “write section I of the brief.” Give yourself a time estimate, start a stopwatch, and do the work. This should be no big deal: you bill by the minute, you can plan by the minute too. Don’t just think, “I ought to do X.” Writing it down is important.

You won’t necessarily get the work done in the time allotted; that’s OK. Lawyers are aggressive perfectionist. Your inner mind likes specific achievable goals. When the time is up, look at the list and chose something to do next. It could be continuing to do what you are already doing. Write down a new time goal and get at it.

There were times when my focus waned. I tried to recognize what was happening and do something physical. Give yourself a defined short respite: Stand up, walk around, talk to someone, hide in the bathroom, whatever. When the time is up, get back to the list.

Existential problems. Sometimes the consequences of (in)actions are just too dire:  failing to file an Answer, missing a court appearance. If the list idea is not working perfectly to save you from existential dangers, get someone else involved. Ask someone you trust outside your workplace to contact you every day, ask you whether your list and your calendar cover everything that needs to be done, and ask you whether you are doing what’s on the list.

You need to be brutally honest with your friend and yourself. If not have not done what needs to be done, you should articulate your next steps as specifically as possible. Not, “I’ll do this tomorrow,” but “I’ll do this at 8:00 a.m. tomorrow.” This takes a good friend.

Adjust your body. Changes in your diet, exercise and social climate may improve your mood. Depression is not a “mood.” But good mood will help address how to get through the days, weeks and months without screwing up your client’s and your lives.

My exercise regimen is simple: I take a 30-minute quick walk in the morning, enough to get my heart rate up. It is surprising what a positive effect this little bit of exertion has. My main dietary culprit is sugar. “People who suffer from depression are especially vulnerable to sugar’s evil power.” I find that exercise and diet go together: The more I exercised, the less craving I have for sugar.

As above, take the decision-making power out of the Matrix. Get an exercise buddy. Find a time for exercise (easier said than done, I know) and put in on your list / calendar. When I wake, I do not ask myself whether I should go for a walk; I say to myself, “time for my walk.” Put snack breaks into your schedule and have an apple or banana available.

Meditate. If you scoff at this, here is my challenge: close your eyes and think about nothing but your breathing for two straight minutes. Go ahead, I’ll wait. . . . . Not so easy, is it? Random thoughts kept jumping into your mind. You had an instinctual emotional reaction to these thoughts (anxiety, self-loathing, dread, etc.). The random thoughts and emotions are from your subconscious (the Matrix); where the depression lives. Do not battle the thoughts. When they happen, tell the thoughts that you will get back to them as soon as you are done meditating, and return to thinking about nothing but the breathing. (For you Matrix fans: the thoughts are spoons; you must realize that there is no spoon.)

When you meditate you are developing the skill to recognize your emotional reactions without succumbing to them. You can impress your therapist by referring to this as CBT: cognitive behavioral therapy. It takes practice, but just starting this routine will help immensely.

A day is 24 hours long—no more, no less. I cannot follow my own advice all of the time. I still eat cookies; I still get lost in my personal miasma. At the end of the day I tell myself, “that was today, I will follow the program tomorrow.” No recrimination; just observation. Try to avoid thinking on Tuesday that you have to “make up” for what you missed on Monday. Just do Tuesday.

These are stopgap measures. GETTING PROFESSIONAL HELP is the most important thing you can do. But in the meantime, I hope this helps you get you through the days ahead.

Mitchell Chyette graduated from the University at Michigan School of Law in 1979 and currently works in San Francisco, California.

 

Law Students, Depression & Suicide

In January 2014, CNN reported that lawyers are among the top five occupations associated with suicide. In the summer of 2014, just before the start of the law school academic year, a law professor from the University of Vermont died by suicide. Since then, in a period of eight months, the United States law school community has seen seven law student deaths from suicide. Approximately one suicide per month, and the actual number may be greater than what has been reported by the media and the law schools.

law classroom

In the painful days, weeks, and months after a suicide, family members and loved ones often are left with unanswered questions. Many times one of those questions or comments is some version of “I don’t understand why (s)/he did not just ask for help.”

A study published in the American Journal of Psychiatry, it was found that of people aged 35 and younger who died by suicide, only 15% had received mental health treatment within one month of their death by suicide and just 24% had received mental health treatment within one year of their suicide. The study also found that 23% of those who died by suicide who were under 35 visited a primary care doctor within one month of their death and 62% visited a primary care doctor within one year of their death.

While interpretation of statistics should be done with caution, the data suggests that young people at risk for suicide present more often to primary care physicians than mental health professionals. And while this perhaps speaks to the need to better train primary care physicians to recognize warning signs of suicide, it also begs the question just posed: why don’t people who are feeling suicidal reach out for help?

stressedstudents1

Based on feedback from law students who attended one of the Dave Nee Foundation’s Uncommon Counsel programs at 35 different schools in the 2013-2014 academic year, 64% agree or strongly agree with the statement that law students do not seek help when needed for fear of the professional consequences. One of our 2L attendees suggested: “…lobby the ABA and character and fitness people to recognize treatment for depression is a good thing, and that legal professionals are people too.” Another 1L attendee noted, “I think it is worthwhile to discuss the stigma associated with seeking mental health services, i.e. perception that s/he ‘can’t hack it’ is weak, thin-skinned, that you’re ‘unstable’ or ‘crazy’. Professional consequences of people knowing this about you, etc.”

While it is easy to point to the ABA and to other systems that may contribute to stigma, it is harder to see systemic change. It is easier to begin with individual change.  Here are some things that you can do beginning right now to help reduce the stigma associated with mental health treatment.

Talk non-judgmentally with anyone you are concerned about:

  • It is OK to ask someone if they need help.
  • It is OK to ask someone if they are thinking about suicide, it will NOT give them the idea.
  • It is NOT OK to say “You are not thinking about suicide are you?” or “What do you have to be depressed about?”
  • It is OK to say, “I have noticed some changes in your behavior, is everything OK?”
  • It is OK to say “It sounds like you are experiencing depression, often times people with depression have suicidal thoughts, are you thinking about suicide?”

Be mindful of language:

  • The term “died by suicide” is preferable to “committed suicide” as the term “commit” has negative connotations.
  • Avoid talking about suicide attempts as “successful or unsuccessful”; there are more suicide attempts in a year than completed suicides.
  • When describing individuals with a mental health diagnosis, try not to define them by that diagnosis. Put the person first, “s/he is a person with bipolar disorder” not “s/he’s bipolar.”

Promote mental health care services:

  • We are encouraged regularly to get a physical exam annually; we are regularly tested for blood pressure, glucose, and BMI.  Why not promote a mental health check up?
  • Visit Screening for Mental Health to find out how to bring an online screening service to your place of employment.

For more tips on how to help someone or for ways you can be involved in reducing stigma please visit the Dave Nee Foundation’s website.

Memories_Dave

June of 2015 will be the 10th anniversary of Dave Nee’s suicide. Dave was a beloved and brilliant brother, friend, son, and student. The suicide of Dave Nee prompted his loved ones, friends, and family to honor Dave’s life and prevent deaths like his from happening again by establishing the Dave Nee Foundation. Ten years later, there is much that the Foundation has done to promote wellness, raises awareness about depression & anxiety, and to prevent suicide in the legal field via law school and state bar association presentations. We know that 97% of our Uncommon Counsel attendees agree or strongly agree that the information learned will help them to recognize the symptoms of depression. We know that 95% of our Uncommon Counsel attendees agree or strongly agree that as a result of the presentation they can identify three warning signs of suicide. Perhaps most importantly, we know that 97% of Uncommon Counsel attendees agree or strongly agree that they know what steps to take if they felt a law student was at risk for suicide. (All data based on 2013-2014 Uncommon Counsel program feedback.)

As much progress and impact we hope we have had, until there are NO news stories of lawyer and law student suicides, we will not be satisfied. We hope that our passion and commitment might inspire other stakeholders, perhaps more powerful ones, like the ABA, the NCBE, law school administrators, and Big Law firms, to take steps towards creating cultural change and help us to destigmatize getting help and treatment for mental health concerns in the legal profession.

By Katherine Bender

Upon graduating from Georgetown University as an English and Theology major, Katherine Bender began teaching at an independent Catholic secondary school for girls in Philadelphia. During this time, she became increasingly interested in the social concerns of young women and decided to pursue a degree in community counseling with a focus on women’s issues at the University of Scranton. After completing an internship providing individual counseling to undergraduate students at a residential college, as part of her Master’s degree in counseling, she began working as a full time mental health counselor for college students in Daytona Beach, Florida.

Recognizing that advocating for students with mental health issues in higher education would likely require a Ph.D., Kate began her doctoral work at Old Dominion University in January of 2011, focused her dissertation on research regarding college student suicide prevention, and in the summer of 2013, successfully completed her doctoral program. She now has a PhD in Counseling, Counselor Education & Supervision.

She joined the team at the Dave Nee Foundation as Programming Consultant in September of 2012 and became Programming Director in September 2013. In this role, she leads the Uncommon Counsel program and LawLifeline. She sees her role with the Dave Nee Foundation as an excellent way to continue to provide outreach services and to raise awareness about depression, anxiety, and suicide prevention for higher education students.

You can reach Kate by email at Kbender@daveneefoundation.org

 

 

Judges Struggling With Depression: More Common Than You Think

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, 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.

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.

26182281.JudgesChambers

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 eight 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,” my friend 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 eight 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.

gavel

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

Perfectionism 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.”

An article from the ABA JournalPerfectionism, Psychic Battering’ Among Reasons for Lawyer Depression, 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 for those on the bench:

  1. Get help.  You can’t handle this by yourself.  It is a problem bigger than any individual person.  The ABA’s Commision on Lawyer Assistance Programs created a Judicial Assistance Initiative.  Reach out to them and they can get you pointed in the right direction.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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 Undoing 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.
  7. 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.
  8. 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.
  9. 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 others and ourselves and that part of such love involves taking better care of ourselves.
  10. 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.

 

Built by Staple Creative