A landmark study by the American Bar Association and the Hazelden Betty Ford Foundation depicts a profession troubled by problem drinking, depression, anxiety—and abiding fears about seeking help. In a pair of interviews, Joan Bibelhausen of LCL and study co-author Linda Albert discuss the findings and what the profession can do to address them. Read the News
Lawyer Jenna Cho writes, “Many lawyers view anxiety as a necessary part of life. It’s what fuels their motivation. And at the same time, it’s also an annoyance. This sort of unwelcomed feelings of anxiety, which frequently shows up coupled with other somatic complaints such as insomnia, backaches, headaches, etc somehow becomes an acceptable state of being.” Read her Blog
Lawyer Megan Zavieh writes, “My purpose is to encourage attorneys to stop buying into the “Superman complex” — the idea that nothing is going to hurt you — and consider the ramifications of not taking care of yourself.” Read her Blog
Lawyer Jennifer Alvey writes, “I’d be willing to bet more than 80% of you live with a Happy Horizon in your head. The Happy Horizon is the fantasy you use to convince yourself that all your angst over your job is just a temporary blip, rather than the actual contours of your daily existence.” Read her Blog
A new study reports that getting rejected hurts depressed people for longer due to a lack of a natural pain and stress-reducing chemical. Read the News
Elahe Izadi writes in The Washington Post, “Struggling with clinical depression can be especially challenging for people who don’t have strong support from loved ones. But having that kind of social support may end up discouraging some men from seeking out professional help, according to a new study.” Read the News
Check out these 20 great quotes on depression assembled by blogger, Therese Borchard. Read the Blog
Elizabeth Forbes writes, “There’s no such thing as ‘depression,’ called by sufferer Winston Churchill, ‘the black dog”. Instead, experts say, we should get in the habit of talking about ‘depressions’ just as we talk about infections or cancers.” Read her Blog
Some people who experience a single depressive episode will fully recover, never to experience another. (Sign us up for that, right?)
For about 40-60% of us, however, depression is a chronic illness that will come back. By the time most people get treatment, they have experienced multiple depressive episodes already.
Good news: with treatment, recurrences can be less severe, occur less frequently and not last as long.
So why does depression seem to rear its ugly head over and over again for most of us?
Saying you have depression is like saying you have a terrible headache, in that you have disabling symptoms, but it says nothing about the cause of those symptoms.
For instance, in the case of a headache, you may have a migraine, a tension headache, a stroke, a brain tumor, a concussion, or something else. The underlying cause informs the prognosis and treatment of your headache, whether it will come back and the best course of treatment.
With depression, we are just beginning to understand the underlying causes and contributors – which could be medical, neurological, psychological or social – many of which are ongoing and lead to a propensity for depressive episodes.
Depression has a genetic basis, but whether that’s because of biological differences in brain chemistry or temperament or something else, we don’t know yet.
We do know that people in stressful situations or lifestyles have more depressive episodes. This could be stress brought on by work, it could be relationship-related, a traumatic or neglectful childhood, or an unsafe living or work environment.
Recurrence can be caused by psychological makeup – much of which can be based in how we view ourselves, others and everyone’s place in the world. Studies have shown that psychotherapy can change this brain makeup to positively influence our outlook.
There’s still so much to learn about the disease. We need to recognize that for many, it’s a biopsychosocialspiritual illness with multiple contributing components that must all be addressed to create the highest likelihood for treatment to work.
Psychotherapy remains the most effective treatment for depression, and should be part of every patient’s plan for recovery.
Someone with chronic, disabling depression may also benefit from a comprehensive evaluation at a center that respects all contributors to the illness to treat the whole person in an individualized, comprehensive way. One place to do this is at The Retreat at Sheppard Pratt, which also specializes in treatment-resistant depression.
Depression is an intensely personal experience. When pursuing treatment, be sure that you are being understood, and obtaining the level of support you need. For some, particularly those working in a highly stressful environment, that could mean getting away for a short time to focus on recovery, even though it can be a tough decision to make. Be open to all levels of care.
It can be disheartening to realize that your depression will likely come back. Know that you’re not alone, as about 6.7% of the U.S. population have had at least one depressive episode in the past year.
Keep working on your recovery, talking about it to reduce stigma, and supporting those who are studying mental illness. One day, we will know more.
By Thomas Franklin, M.D., Medical Director, The Retreat at Sheppard Pratt
Dr. Thomas Franklin is the medical director of The Retreat at Sheppard Pratt. He is a clinical assistant professor of psychiatry at the University of Maryland School of Medicine and a candidate at the Washington Center for Psychoanalysis. He is Board Certified in Addiction Medicine and Psychiatry and has extensive experience in psychotherapy, psychopharmacology, and addictions and co-occurring disorders. Dr. Franklin previously served as medical director of Ruxton House, The Retreat’s transitional living program, before assuming the role of medical director of The Retreat in 2014.
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.
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