Amiram Elwork Archives - Lawyers With Depression

The Heart of the Matter: Lawyers, Anger, and Depression

I’ve felt plenty of anger over my twenty-five years as a litigator.

Sometimes, and thank God they were few and far between, I would blow up at opposing counsel or a client. More often, my anger would sometimes simmer just below the surface. This is an all too common reality for today’s lawyer. “By definition, the adversarial system is conflict-ridden, and conflict creates certain types of emotions like anger, guilt, and fear, which causes stress, says Amiram Elwork, Ph.D. author of the book, Stress Management for Lawyers: How to Increase Personal & Professional Satisfaction.

According to Chicago litigator, Shawn Wood, the “nature of civil litigation involves two lawyers (often Type A personalities) squaring off against one another under circumstances where there will be a winner and a loser, and part of each lawyer’s job will be to capitalize on any possible error in judgment that the other side makes.” I really don’t buy into this completely. Many lawyers that I know aren’t “Type A” personalities. They are usually hard working and successful. But, it can take a tremendous toll on their mental and physical health. They struggle with the simmering variety of anger.

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Is it Lawyer Depression or Burnout? Telling the Difference

Burnout is nature’s way of telling you, you’ve been going through the motions, your soul has departed; you’re a zombie, a member of the walking dead, a sleepwalker. False optimism is like administrating stimulants to an exhausted nervous system. – Sam Keen

Sitting across from Tom, a lawyer for the past 15 years, I was struck by his ashen face. Before he said a word, before I asked him how his practice had been going, his slumped shoulders spoke volumes about a good man weighed down. As we spoke over coffee, he asked if I thought he was suffering from the “Big D” – depression.

As we spoke, he asked if I thought he was suffering from the “Big D” – Depression.

“No, I don’t think so, Tom. You seem pretty burn-out, though,” I said.

According to an ABA Journal article, lawyers facing increasing pressure to “value engineer” their services have adopted a “better-cheaper-faster” approach to practicing law because that’s what their clients are demanding.

This is one of the conclusions contained in a recent report on the future of the legal profession prepared by The New York Bar Association.

“Consumers have become more suspicious of institutions,” the report says, and clients are less willing to take their lawyer’s advice at face value and more willing to sue when they are unhappy. Technology is also changing client demands.

“Electronic communication has fueled a culture in which clients want more legal information, answers on the spot, and lawyers who can interpret, rather than simply provide, information,” the report says.The result is more specialization and an emphasis on ability to deliver higher quality services at a lower cost and in less time.”

This was certainly true in Tom’s case. There were no limits to the demands put on him – by both others and himself – to be better, cheaper, and run faster. As if he were a machine. He hunkered down into a survival mode, had little positive energy to invest in himself or his family and ultimately burned out like a meteorite entering the earth’s atmosphere.

Just Perfect

Burnout isn’t just a consequence of trying to keep up with an insane schedule. It’s also fueled by a common personality trait found in many lawyers: perfectionism.

Author of the book Stress Management for Lawyers: How to Increase Personal & Professional Satisfaction in the Law, Amiram Elwork, Ph.D. writes:

“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.”

“My clients are perfectionists,” says Alden Cass, a therapist to both corporate attorneys and men on Wall Street. “They have very rigid ideals in terms of win-lose,” he continues. “Their expectations of success are through the roof, and when their reality doesn’t match up with their expectations, it leads to burnout—they leave no room for error or failure at all in their formula.”

Out of Sync With Core Values

Elwork opines that “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.”

My friend Tom is in this boat. He works for an insurance defense firm. He’s a compassionate man who tries his best to be a good person. The culture of his firm, however, tells him to “hammer” personal injury victims at their depositions and trials. He hates to do this but doesn’t know what else to do. He has a family to support after all. He feels stuck at his job.

He suspects other lawyers at his firm are burned out, but doesn’t really know what a burned out lawyer looks like.

There are, however, telltale signs.

Burnout’s 10 Milestones

Over-commitment (always in motion)
Inadequate breaks and rest (continuous client involvement)
Idealistic standards
Constant low-grade stress (occasionally interrupted by crisis!)
Lack of help and assistance
Chronic fatigue from pushing oneself (“hitting the wall”)
Strong sense of responsibility, even when others “dropped the ball”
Guilty feelings about missing church events/activities
Heavy job and family responsibilities/expectations
Inability (or strong reluctance) to say no

Similarities Between Depression and Burnout

While they share some similarities, there are some important differences between the two conditions.

Both depressed and burnout sufferers show symptoms of withdrawal and fatigue.

Depressed individuals also show signs of hopelessness and disinterest. Severe depression can already alter the sleep-wake pattern of an individual thus triggering insomnia.
The most serious cases are those involving persons who possess some recurring thoughts about death. Those who experience a burnout are often accompanied by feelings of helplessness, self-doubt, and failure on top of the other feelings similarly experienced by depressed individuals.

Differences Between Depression and Burnout

Burnout is a state that is just induced by severe stress. Depression, on the other hand, is a clinical behavioral disorder affecting one’s mood. As such, it is, therefore, more appropriate to say that when you are having a burnout you are also at risk of experiencing or developing depression rather than the other way around.

Researchers have successfully found important physiological differences between people who suffer from burnout and those who suffer from depression: individuals suffering from burnout do not produce enough cortisol as if the body decided to go on strike. As a reversal, those who suffer from depression produce too much of it.
When one is suffering from depression, he or she is unable to attain or experience a state of pleasure. As a result, you often see depressed individuals shrouded in extreme sadness. Burnout sufferers look different because they feel overly exhausted to the point of doubting their own ability to carry out their regular activities of daily living. Severe burnouts may also lead one doubt his self-worth.
Depression is usually rooted upon a number of factors like when one is suffering from an incurable chronic disease or an extreme severance of relationship (death, breaking from a serious romantic relationship) with a very significant other. Depression has also been discovered to have some genetic predisposition and environmental roots. With regard to burnout, this condition is usually tied in with strains in work and high demand stresses of life in general.

A Strategy for Avoiding Burnout

It’s easier to avoid burnout in the first place than it is to overcome it. Here a handful of do-able strategies for escaping its clutches:

Rest, relax, recreate, renew. It’s the only avenue for sustaining us for the long haul.
Give something up before taking on a new commitment or responsibility. Don’t keep “adding floors” onto your already towering skyscraper of activities.
Learn to say no and to set up reasonable boundaries around your involvement. Specify the help you’ll need and the constraints on your time.
Set priorities and consult with your family. Service work occupies an essential role in our lives but must never take priority over family. Be willing to occasionally say no to low priority activities when they conflict with quality family time.
Get away from it all on a regular basis through hobbies, recreation, short “sabbaticals,” and sometimes just being a couch potato.
Listen to your body’s stress warning signals, such as headaches, backaches, dizziness, insomnia, and unexplainable fatigue.
Cut out the hurry and worry. Stress is the natural byproduct of trying to stuff 10 pounds of potatoes into a 5-pound bag. Do only what you reasonably can in the time available and with the resources available.
Consider changing jobs. Sometimes the only thing you can do is leave your job and seek employment at another firm.
Consider changing careers. Some lawyers tell me that they are “sick and tired of being sick and tired.” Being burned out has forced them to confront this decision. It can be done and there are many happy ex-lawyers out there.

Further reading —

The Happy Lawyer: Making a Good Life in the Law by Nancy Levit and Douglas Linder

The Reflective Counselor: Daily Meditations for Lawyers by F. Gregory Coffey and Maureen C. Kessler

Can’t Get No Satisfaction: Burnout – New York Magazine

Lawyer Burnout: Avoidable, Not Inevitable – ABA Journal

Knockout Burnout! – Attorney at Work

Copyright, Daniel T. Lukasik, 2016

Lawyer Burnout

Burnout is nature’s way of telling you, you’ve been going through the motions your soul has departed; you’re a zombie, a member of the walking dead, a sleepwalker. False optimism is like administrating stimulants to an exhausted nervous system. – Sam Keen

Sitting across from Tom, a lawyer for the past 15 years, I was struck by his ashen face. Before he even said a word, before I asked him how his practice was going, his slumped shoulders spoke volumes about a good man weighed down.

As we spoke over coffee at Starbucks, he asked if I thought he was suffering from clinical depression. I didn’t think so, I told him. I thought he was burnt out.

According to an article on burnout in the ABA Journal, lawyers facing increasing pressure to “value engineer” their services have adopted a “better-cheaper-faster” approach to practicing law because that’s what their clients are demanding.

This was certainly true in Tom’s case. There was no end, no limits to the demands put on him to be better, to be cheaper to run faster. As if he were a machine. He hunkered down into a survival mode, had little positive energy to invest in himself or his family and ultimately burned out like a meteorite entering the earth’s atmosphere.

Burnout isn’t just a consequence of trying to keep up with an insane schedule, however. It’s also about how lawyers actually think.

Author of the book Stress Management for Lawyers: How to Increase Personal & Professional Satisfaction in the Law, Amiram Elwork, PhD writes:

“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.

My friend Tom is also in this boat. He works for an insurance defense litigation firm. He’s a compassionate man who tries his best to be a good person. The culture of his firm tells him to “hammer” personal injury victims at their depositions and trials. He hates to do this, but doesn’t know what else to do. He has a family to support and feels stuck at his job.

He suspects other lawyers at his firm are burned out, but doesn’t really know what a burned out lawyer looks like. There are, however, telltale signs.

BURNOUT’S TEN MILESTONES

Over-commitment (always in motion)
Inadequate breaks and rest (continuous client involvement)
Idealistic standards
Constant low-grade stress (occasionally interrupted by crisis!)
Lack of help and assistance
Chronic fatigue from pushing oneself (“hitting the wall”)
Strong sense of responsibility, even when others “dropped the ball”
Guilty feelings about missing church events/activities
Heavy job and family responsibilities/expectations
Inability (or strong reluctance) to say no

DEPRESSION vs. BURNOUT SIMILARITIES

While they share some similarities, there are some important differences between the two conditions.

Both depressed and burnout sufferers show symptoms of withdrawal and fatigue.

Depressed individuals also show signs of hopelessness and disinterest. Severe depression can already alter the sleep-wake pattern of an individual thus triggering insomnia.
The most serious cases are those involving persons who possess some recurring thoughts about death. Those who experience a burnout are often accompanied by feelings of helplessness, self-doubt and failure on top of the other feelings similarly experienced by depressed individuals.

DEPRESSION vs. BURNOUT DIFFERENCES

Burnout is a state that is just induced by severe stress. Depression, on the other hand, is a clinical behavioral disorder affecting one’s mood. As such, it is therefore more appropriate to say that when you are having a burnout you are also at risk of experiencing or developing depression rather than the other way around.

Researchers have successfully found important physiological differences between people who suffer from burnout and those who suffer from depression: individuals suffering from burnout do not produce enough cortisol, as if the body decided to go on strike. As a reversal, those who suffer from depression produce too much of it.
When one is suffering from depression, he or she is unable to attain or experience a state of pleasure. As a result, you often see depressed individuals shrouded in extreme sadness. Burnout sufferers look different because they feel overly exhausted to the point of doubting their own ability to carry out their regular activities of daily living. Severe burnouts may also lead one doubt his self-worth.
Depression is usually rooted upon a number of factors like when one is suffering from an incurable chronic disease or an extreme severance of relationship (death, breaking from a serious romantic relationship) with a very significant other. Depression has also been discovered to have some genetic predisposition and environmental roots. With regard to burnout, this condition is usually tied in with strains in work and high demand stresses of life in general.

A STRATEGY FOR AVOIDING BURNOUT

It’s easier to avoid burnout in the first place than it is to overcome it. Here a handful of do-able strategies for escaping its clutches:

Rest, relax, recreate, renew. It’s the only avenue for sustaining us for the long haul.
Give something up before taking on a new commitment or responsibility. Don’t keep “adding floors” onto your already towering skyscraper of activities.
Learn to say no and to set up reasonable boundaries around your involvement. Specify the help you’ll need and the constraints on your time.
Set priorities and consult with your family. Service work occupies an essential role in our lives but must never take priority over family. Be willing to occasionally say no to low priority activities when they conflict with quality family time.
Get away from it all on a regular basis through hobbies, recreation, short “sabbaticals,” and sometimes just being a couch potato.
Listen to your body’s stress warning signals, such as headaches, backaches, dizziness, insomnia, and unexplainable fatigue.
Cut out the hurry and worry. Stress is the natural byproduct of trying to stuff 10 pounds of potatoes into a 5 pound bag. Do only what you reasonably can in the time available and with the resources available.
Consider changing jobs. Sometimes the only thing you can do is leave your job and seek employment at another firm.
Consider changing careers. Some lawyers tell me that they are “sick and tired of being sick and tired.” Being burned out has forced them to confront this decision. It can be done and there are many happy ex-lawyers out there.

Dan’s Top 10 Stress Books

Full Catastrophe Living

Based on Dr. Jon Kabat-Zinn’s renowned mindfulness-based stress reduction program, this book shows you how to use natural, medically proven methods to soothe and heal your body, mind, and spirit. The title? Oh, that’s from the classic book Zorba the Greek. Zorba is a Greek full of a salty zest for life. At one point, his intellectual benefactor asked him, “Zorba, are you married?” Zorba snorts, “Married? Wife, kids, house . . . the full catastrophe!” When all of our lives are pulled about by the catastrophe of daily living, we need mindfulness to ground us, we need the deep breathing and quiet to enrich the quiets place in all of us.

Why Zebras Don’t Get Ulcers

Dr. Robert M. Sapolsky has chapters on how stress affects sleep and addiction, as well as new insights into anxiety and personality disorder and the impact of spirituality on managing stress.
As Sapolsky explains, most of us do not lie awake at night worrying about whether we have leprosy or malaria. Instead, the diseases we fear-and the ones that plague us now-are illnesses brought on by the slow accumulation of damage, such as heart disease and cancer. When we worry or experience stress, our body turns on the same physiological responses that an animal’s does, but we do not resolve conflict in the same way-through fighting or fleeing. Over time, this activation of a stress response makes us literally sick.

Buddha Brain

Jesus, Moses, the Buddha, and other great teachers were born with brains built essentially like anyone else’s, but used their minds to change their brains in ways that changed history. With the new breakthroughs in neuroscience, combined with the insights from thousands of years of contemplative practice, this book shows readers how to have greater emotional balance in turbulent times, as well as healthier relationships, more effective actions, and a deeper religious or spiritual practice. It’s full of practical tools and skills readers can use in daily life to tap the unused potential of the brain and rewire it over time for greater peace and well-being.

Spark

This book offers a fascinating investigation into the transformative effects of exercise on the brain, from the bestselling author and renowned psychiatrist John J. Ratey, MD. Did you know you can beat stress, lift your mood, fight memory loss, sharpen your intellect, and function better than ever simply by elevating your heart rate and breaking a sweat? The evidence is incontrovertible: Aerobic exercise physically remodels our brains for peak performance. This is one of the few books that got me off my ass and into the gym.

How to Train a Wild Elephant

This is a short book and easy to read. Jan Chozen Bays, M.D., a physician and Zen teacher, has developed a series of simple practices to help us cultivate mindfulness as we go about our ordinary, daily lives. Exercises include: taking three deep breaths before answering the phone, noticing and adjusting your posture throughout the day, eating mindfully, and leaving no trace of yourself after using the kitchen or bathroom. Each exercise is presented with tips on how to remind yourself and a short life lesson connected with it.

The Relaxation and Stress Reduction Workbook

This book details easy, step-by-step techniques for calming the body and mind in an increasingly overstimulated world. It’s based on the latest research, and draws from a variety of proven treatment methods, including progressive relaxation, autogenics, self-hypnosis, visualization, and mindfulness and acceptance therapy. In the first chapter, you’ll explore your own stress triggers and symptoms, and learn how to create a personal plan for stress reduction. Each chapter features a different method for relaxation and stress reduction, explains why the method works, and provides on-the-spot exercises you can do to apply that method when you feel stressed.

Stress-Proof Your Brain

Our brains have evolved powerful tools for coping with threats and danger-but in the face of modern stresses like information overload, money worries, and interpersonal conflicts, our survival reflexes can do more harm than good. To help you adapt your nervous system to the challenges of today’s world, neuropsychologist Dr. Rick Hanson presents Stress-Proof Your Brain. Join him to learn research-based techniques and meditations that will literally re-shape your brain to make you more resilient, confident, and peaceful, including: – How to replace your brain’s unhealthy reactions to stress with protective and self-nurturing responses- Techniques for using memory to soothe and release painful feelings of sadness, guilt, anxiety, inadequacy, or anger – Guided meditations for calming chronic worries, developing gratitude, building inner strength, and more.

Stress Proof Your Life

Stress proof your life is for people who struggle to find time for a shower, much less a bath. The ones who worry that stress is affecting their health and relationships. Or they would worry if they weren’t so knackered. Some people are really good at avoiding some stresses without realizing that they are slaves to another kind. Elisabeth Wilson looks at the sources – occupational, genetic and environmental – and reveals 52 brilliant techniques for creating a stress-free zone. When your batteries are blown and burnout is imminent these top tips can help you regain control.

Getting Things Done

If you’re like me, my biggest source of stress comes from the pressure to get lots of things done everyday.

In Getting Things Done, veteran coach and management consultant David Allen shares the methods for getting things done. Allen’s premise is simple: our productivity is directly proportional to our ability to relax. Only when our minds are clear and our thoughts are organized can we achieve effective productivity and unleash our creative potential* Apply the “do it, delegate it, defer it, drop it” rule to get your in-box to empty.

Upward Spiral

Lawyers help others but take very poor care of themselves. In their quest to max out their earning potential and afford the best material goods our economy has to offer, lawyers lead a narrow, grimly serious existence without emotional rewards. They work inhuman hours yet always feel pressured for time. Since they never stop, breathe, and relax, they are frequently tense, irritable and ready to bark. Author Harvey Hyman, himself a former trial lawyer, gives us the latest science, wit and wisdom in a book I highly recommend.

Stress Management for Lawyers

When you practice law, stress comes with the territory. Such stressors as time pressures, work overload, conflict, and difficult people can rob you of a satisfying career and personal life. It doesn’t have to be that way, however. You can take effective action and this book, written specifically for lawyers, shows you how.

A Lawyer’s Heart

I’ve felt plenty of anger over my twenty years as a litigator. Sometimes, and thank God they were few and far between, I would blow up at opposing counsel or a client. More often, my anger would sometimes simmer just below the surface. This is an all too common reality for today’s lawyer. “By definition, the adversarial system is conflict-ridden, and conflict creates certain types of emotions like anger, guilt and fear, which causes stress, says Amiram Elwork, Ph.D. author of the book, Stress Management for Lawyers.

According to Chicago litigator, Shawn Wood, the “nature of civil litigation involves two lawyers (often Type A personalities) squaring off against one another under circumstances where there will be a winner and a loser, and part of each lawyers job will be to capitalize on any possible error in judgment that the other side makes.” I really don’t buy into this completely. Many lawyers that I know aren’t “Type A” personalities. They are usually hard working and successful. But, it can take a tremendous toll on their mental and physical health. They struggle with the simmering variety of anger.

Anger turned outward is hostility. Such hostility can express itself in a number of ways for lawyers. Andy Benjamin, Ph.D., both a lawyer and psychologist who treats lawyers with stress, anxiety and depression, describes hostility as an “array” of the following thoughts and behaviors:

Holding persistent negative, hostile, or cynical thoughts during relationship interactions;
Chronic impatience;
Frequent irritability
Disconnecting from others due to an empathetic deficit (for example, being rigid in relationship interactions);
Suffering continual fatigue.

You could say most people have these problems in our hectic, stressful world. “But lawyers are particularly susceptible to stress-related illnesses because of the unique interplay of the legal profession and lawyer personality” says the ABA Journal. A study that followed University of North Carolina law students as lawyers for 30 years suggested that those with significantly elevated levels of hostility were more likely to have died prematurely from cardiovascular disease.

According to Jesse Stewart, assistant professor of psychology at Purdue University, depression and hostility commonly occur together. When a person is both depressed and hostile, the traits interact in a complex way to elevate inflammatory proteins in the body. The combination of hostility plus depression appears to be as dangerous a risk factor for heart disease as high blood pressure or even smoking.

Edward C. Suarez, Ph.D., of Duke University, says a recent study, “. . . suggests the possibility that men who are . . . hostile and exhibit depressive symptoms, even in the mild to moderate range, are at heightened risk for cardiac events.” This is so because of the release of adrenaline during times of stress. According to Dr. Cleaves M. Bennet, clinical professor of medicine at UCLA Medical Center, “Adrenaline is the growth hormone for the heart muscle. On the one hand, its good to have a big, strong heart, but at the same time that the heart is getting bigger and stronger, the arteries are narrowing to protect the tissue.”

Given the clear connection between lawyer hostility, depression and the heightened risk for a cardiac event, what can lawyers do about it?

First and foremost, they need to educate themselves about the connection between depression, hostility and heart disease. Most people don’t see the correlation. But, there’s no denying the science which makes the links.

Second, because hostility creates stress in the body (i.e. the release of adrenaline and cortisol when the body goes into the fight or flight mode), it’s critical to discharge the stress through some form of exercise. When I go through a good workout after a confrontational day, it’s as if I am wiping the slate clean. I am discharging the stress that is causing so much trouble in my body and bringing it back into some kind of balance. Exercise is really just a formalized form of the flight response to stress. Our bodies want to step on the gas. Listen to your body and let it run.

Third, you need to find out where your hostility is coming from. Is it from problems in your personal life that you bring into your daily life as a lawyer? If so, these need to be met and addressed. Or, is it the other way around? Is it the daily grind and confrontation at the office that you bring home? It’s important to figure this out. If opposing counsel is a jerk and elicits a hostile reaction from you, it might be time to learn (and, yes, it is a skill you can learn) different ways of being assertive without harming your heart and increasing your risk for depression. If it is problems at home, identify them and if need be, go for counseling.

Fourth, learn to tell the difference between being assertive and being aggressive. For further reading on this topic, check out this article “Are you Assertive – or Aggressive?” and the article “Assertive, Not Aggressive.” To help evaluate your own levels of perceived stress and associated health risks, visit the University at Pittsburgh Center’s Healthy Lifestyle Program Web site.

Tag: Amiram Elwork

Is it Lawyer Depression or Burnout? Telling the Difference

Lawyer Burnout

Dan’s Top 10 Stress Books

A Lawyer’s Heart

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