The Neuroscience of Depression: An Interview with Dr. Alex Korb

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The following is an edited transcript of the podcast recorded interview with Dr. Alex Korb.  This transcript has not been reviewed and is not a word-by-word rendering of the entire interview.

Hi, I’m Dan Lukasik from lawyerswithdepression.com. Today’s guest is Dr. Alex Korb.  Dr. Korb is a neuroscientist, writer, and coach.  He’s studied the brain for over fifteen years, attending Brown University as an undergraduate and earning his Ph.D. in neuroscience from UCLA. He has over a dozen peer-reviewed journal articles on depression and is also the author of the book, The Upward Spiral: Using Neuroscience to Reverse the Course of Depression One Small Change at a Time. Interesting, he’s also coached the UCLA Women’s Ultimate Freesbie team for twelve seasons and is a three-time winner for Ultimate Coach of the Year.  His expertise extends into leadership and motivation, stress and anxiety, mindfulness, physical fitness, and even standup comedy. Welcome to the show.

What’s Up? Gratitude and Depression

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When first squashed by clinical depression years ago, some told me to think of all the things I had to be thankful for – as if this would cure my “blues.”

But I didn’t have the blues. I didn’t just feel “sad.”  I had an illness.  I had entered a long, dark tunnel.  I didn’t see a glimmer of light at the end of it.  I wandered in it for years before things got better.  At some point, I saw an end, of sorts, in sight.  I exited that tunnel and felt the warming sun of life reinvigorating my body. I knew I was going to be okay.

It was only after having exiting the tunnel that I was capable of even thinking about gratitude.  But now it’s an important part of my “Depression Toolkit”: things I do to keep what sufferer Winston Churchill called “the black dog” at bay.

Listen to the podcast of my interview with Rabbi Mark Gellman

Lawyer Fight-Or-Flight And Its Connection To Depression

Lawyers are control freaks.  Okay, maybe they have to be. There’s is so much going on that they actually do have to control things to be good at their jobs.  But it creates a grind of perpetual stress; every day, all-out stress seizures to control of events and people that are all too often uncontrollable leaving them depleted by the constant firing of their bodies’ fight-or-flight reaction.

We all learned in high school biology about the fight-or-flight response; a binary system of survival that kept our hairy, grunting ancestors alive in prehistoric times when meandering about the Sarengeti plains.  This lighting quick response evolved to make us scamper from threats we could outrun and brawl with ones we couldn’t.

Today’s’ lawyers are embedded with the same nervous system their Neanderthal ancestors had 30,000 years ago.  When they’re threatened on the job, their heart rate fires, breathing becomes shallower to divert oxygen to muscles and stress chemicals are dumped into their bodies.  This all happens automatically, before they’ve even had a chance to think about it.  And it happens even when they’re not being chased by a ravenous cougar or fighting a loin clothed adversary.

When our body’s stress response is triggered, it does not know the difference between true physical threats to our physical survival and psychological threats to our sense of self.  Think about how much our hearts pounds in a contentious deposition, for example.  Our bodies, unable to actually physically run or fist fight in the office, surge with stress hormones as if we were in a bloody life-or-death battle for control of that deposition with a dastardly adversary.

For lawyers prone to anxiety and depression, the daily surges of the stress hormone cortisol are particularly troublesome because of its impact on the hippocampus and the amygdala in the brain.

The hippocampus is that part of the brain that remembers details and helps you put incoming information into context.  It is without emotions, registering and storing details of events, functioning like a Joe Friday from Dragnet:  “Just the facts, mam.”

The amygdala is the brain’s early warning system and is a major cause in genetically depressed moods and negative thinking. It acts as an importance meter, registering tone and intensity and tells your brain instantly if it should prepare for trouble.  It scans the environment looking for danger.

Too much cortisol, over too long a period of a time, can cause depression and result in actual changes to the brain.

Physician John Ratey writes in his best-selling book Spark:

“Chronic depression causes structural changes to the brain.  Research has showed that depressed patients had measurable changes in the amygdala and the hippocampus, crucial players in the stress response.  We knew the amygdala was central to our emotional life, but they also found that the memory center was also involved in stress and depression.  High levels of the stress hormone cortisol kill neurons in the hippocampus.  If you put a neuron in a petri dish and flood it with cortisol, its vital connections to other cells retract.  Fewer synapses develop and the dendrites wither.  This causes a communication breakdown, which, in the hippocampus of a depressed brain, could partly explain why it gets locked into thinking negative thoughts – it’s recycling a negative memory, perhaps because it can’t branch out to form alternative connections.  At the same time, MRI shows that new nerve cells are born every day in the hippocampus and possibly the prefrontal cortex – two areas shriveled in depression.  Now we see depression as a physical alteration of the brain’s emotional circuitry.

Norepinephrine, dopamine, and serotonin are essential messengers that ferry information across the synapse, but without enough good connections in place, these neurotransmitters can only do so much.  As far as the brain is concerned, its job is to transfer information and constantly rewire itself to help us adapt and survive.  In depression, it seems that in certain areas, the brain’s ability to adapt grinds to a halt.  The shutdown in depression is a shutdown of learning at the cellular level.  Not only is the brain locked into a negative loop of self-hate, but it all loses the flexibility to work its way out of the hole.”

In the privacy of their offices or in anonymous phone calls, I’ve heard many lawyers with depression tell me they hate themselves.  They hate themselves because they’re stuck in depression and spinning their wheels.  Rather than see this predicament as something that can be explained as an illness going on in their brain, they mercilessly punish themselves and feel they’re weak and lazy.

In his book Undoing Perpetual Stress: The Missing Connection between Depression, Anxiety, and 21st Century Illness, Dr Richard O’Connor writes:

“For an overwhelming number of people today, the result of the vicious circle of perpetual stress is a state of permanent malfunction: dissatisfied, irritable, overwhelmed and hopeless, out of control, frightened, physically run down and in pain.  For want of a better term, this is what I call the “Perpetual Stress Response.” Overwhelmed by too many stress hormones in our system, our cells close down receptor sites to try to compensate; but that just makes the endocrine system pump out even more stress hormones.  Continually bathed in neurotransmitters telling us there is constant danger.  And our brains become rewired by stress, our neural circuitry restricted to firing along preconditioned pathways, so that we are literally unable to think of new solutions, unable to come up with creative responses.”

Anxiety and depression are terrible coping mechanisms.  If so, why do lawyers in such large numbers suffer from these maladies?  Because they don’t know what else to do and don’t realize the damage they’re doing to their bodies and minds by living with the fight-or-flight furnace turned on high all day long.

So what is a depressed lawyer to make of all of this?  Like recovery from any illness, awareness goes along way.  For many with depression, it will take a long time and periods of suffering, to see, to truly see, that anxiety and depression don’t work as coping mechanisms and that they have to learn better ways in which to run their lives to help their brains.

In my next blog, I’ll explore what we can do about this situation.

Finding Our Way in the Law

It’s in the darkness of men’s eyes that  they get lost – Black Elk

Graduating from law school is both exciting and frightening at the same time.  There’s a real itch to put our knowledge into action, to be a bona fide “attorney at law” and to start making some dough instead of spending it on tuition and books. On the other hand, we really don’t know a lot about the application of legal theory to legal combat, may have a heap of debt and pray that our first stab at competency doesn’t land us face first on the courthouse steps. 

Beyond all of these pragmatic concerns is the meatier matter of living a life in the law that matters; a life in accord with our inner core of what we truly value in life.  As author Studs Turkel once wrote:

“Work is about a daily search for meaning as well as daily bread, for recognition as well as cash, for astonishment rather than torpor, in short for a sort of life, rather than a Monday-to-Friday sort of dying.”

Lawyers, young and old alike, find it difficult to live out their values in the workplace, to search for “meaning as well as daily bread.”  There are challenges and compromises, some more difficult than others.  For example, we may really value spending time with our family.  But as the demands of our career mount, we become untethered from this life-giving sustenance as we spend more and more time toiling at the office.

Andrew Benjamin, Ph.D., J.D., a lead researcher in studies about the mental health of law students and lawyers, concludes that much of the dissatisfaction in the profession comes from a widening gap between the values we truly care about and the things we end up pursuing in in our jobs as lawyers.  This takes place over time and its effects are cumulative.  Many end up leaving the profession.  Or, if they stay, are mired in unhappiness, discontent and can’t see a way out.

Dr. Benjamin found that approximately 20% of lawyers – about twice the national average – aren’t just unhappy; they’re suffering from clinical anxiety or depression. We aren’t talking about everyday stress, sadness, blues or categorical grumpiness.  We’re talking rubber to the road clinical anxiety and depression; devastating diseases that cause breakdowns in every area of one’s life.  Put in perspective, Benjamin’s studies suggest that a whopping 200,000 of this nation’s 1 million lawyers are struggling – some very badly.

Certainly a gap between our values and the way we live as lawyers doesn’t cause depression.  But it’s one of many factors that include a history of depression in one’s family and emotional abuse and/or neglect during one’s formative years that make a person prone to depression. 

Lawyers also seem to have a particularly fearsome type of stress overload; a jacked central nervous system fueled by the adversarial nature of the trade.  Modern science now knows that there is a powerful connection between chronic and remitting stress and the development of clinical depression.  As I wrote in “How Stress and Anxiety Become Depression,” chronic stress and anxiety causes the release of too many fight-or-flight hormones such as cortisol which damages areas of the brain that have been implicated in depression: the hippocampus (involved in learning and memory) and the amygdala (involved in how we perceive fear).

The point of all this sobering news isn’t to rain on anyone’s parade.  Law can and should be a noble calling and a satisfying way to make a living.  Rather, these warnings are meant to impart some thorny wisdom: living out your values and dreams are just as important as – to quote my brother Wally’s favorite expression, “carving out a living”.  Or, as Studs Terkel earlier surmised:  “. . . to have a sort of life, rather than a Monday-to-Friday sort of dying.”

It’s scary when you sense that you’ve wasted a lot of time doing a type of law – or law at all – that fails to connect with your deeper values.  Part of the fear is driven by the growing sense as we age that we don’t have forever – we are finite beings.  When we don’t know the way, can’t find path to move our outer life closer to our inner life, we can experience a sort of existential terror.  We may be sitting in a classroom, at court or just wandering downtown during our lunch break and a visceral sense that we yearn for something else will hit us.  How many of us quickly dismiss such thoughts as minor meanderings that aren’t worth our time.  But, these thoughts may keep coming.  Listen to them.  If we don’t, we may risk greater peril.

Gregg Levoy, author of Callings: Finding and Following an Authentic Life, talks about the dangers of not following the murmurs coming from within us all:

“Of course, most people won’t follow a calling until the fear of doing so is finally exceeded by the pain of not doing so – pain that we appear to have an appalling high threshold for. Eventually the prospect of emotional and financial turmoil, the disapproval of others and the various conniptions of change, can begin to seem preferable to the psychological death you are experiencing by staying put.  Those who refuse their passions and purposes in life, though, who are afraid of becoming what they perhaps already are – unhappy – won’t of course experience the unrest (or the joy) that usually accompanies the embrace of a calling.  Having attempted nothing, they haven’t failed, and they console themselves that if none of their dreams come true then at least neither will their nightmares.”

So remember your values and where they are trying to lead you.  That’s realistic.  Our values are not set in granite; they can and will change over time.  Yet the only tuning fork you will ultimately have is trying to build a solid bridge between who you really are and what you are in the real world.  We can and will hit choppy waters as we sail our ships in our careers.  There will be many temptations – money, power.  This story has been played out for millennia.  As you go through your career, watch the currents and stir your ship bravely, with integrity and passion.

As Apple founder Steve Jobs wrote:

“Your time is limited, so don’t waste it living someone else’s life.  Don’t be trapped by dogma – which is living with the results of other people’s thinking.  Don’t let the noise of other’s grievances drown out your own inner voice; and most important, have the courage to follow your heart and intuition.  They somehow already know what you truly want to become.  Everything else is secondary.”

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