Rhapsody In Blue

 

“What we play is life.”

Louie Armstrong – trumpeter

Cruising home yesterday, in one of my typical melancholic moods despite a sunny and warmer than usual Buffalo afternoon, I scanned my radio searching for sonic riffs to complement my sad reflections about everything and nothing.

Lo and behold, I tuned on B.B. King – the king of the blues – playing, “Nobody Loves Me But my Mother and She Might be Jiving Too”  – an old favorite that I hadn’t heard in eons. 

This number wasn’t inspired by depression – but the pain of being lonely in the world.  Blues belter Mahalia Jackson said it best:  “Anybody singing the blues is in a deep pit yelling for help.”

We all respond to and resonate with music before we’re even able to speak; even in the womb.  Primal and outside the constriction of words, sentences and periods, music captures something elemental about our lives.  It can be celebratory, tragic or comical – sometimes all at the same time.

They’re  are a couple ways to think about our relationship any music, but especially woebegone music.  In it, we can find a sort of companionship and communion — a way to express our sorrow or despair.  When we’re alone, jumping on a blues train can remind us that we’re not alone.

But there’s a caveat about any sulking vibrations. When in a sliding mood, tuning into lugubrious music can drag our mood yet further down into a well of despair.  I think this is so because our low moods can and often do have a dramatic flair about them; something akin to the Greek’s tragedy plays or some of Shakespeare’s biggest theatrical downers.  When such sullen moods are mixed and stirred with, say, the song  “Save Me”  by Aimee Mann, you’ve got one glum saga stirring in your head – even though I love this song for its quirky intimacy. 

A songwriter’s layered lamentations about loss can make us ruminate, perhaps too much, about our losses in life — and everyone has them.

Depressed denizens need counterweights to balance out their negatively skewed thinking process.  This is difficult because they have a tendency to wrap themselves around a depressive identity – “I am my depression.”  In this blue world, why wouldn’t one gravitate towards somber songs?

The point isn’t that we need only listen to sweet lullabies ala “You are the sunshine of my life” to improve our mood.  I’m not being a killjoy who believes you have to turn off sad music to steel yourself against depression. Rather, what I’m preaching is a greater sensitivity to what we choose to do when feeling low – in this case what music we listen to.  Just be careful that the music gives you solace and not cause to fall into a deeper depressive funk.

Flying by the off ramp lost in my midlife musings, another car speeds up alongside me in a black Volkswagen Jetta.  I turn up the volume and B.B. King is belting it out to reach the back row. My windows are open and I look to my right.  The other driver, a young woman, looks at me with a quizzical expression. I can’t tell if she is irritated by my choice in music or whether she finds it, well, quaint and amusing.

She is blasting a new hip-hop tune from the Black Eyed Peas, “Imma Bee.”

She smiles coyly, perhaps a suggestion that I evolved not from the era which she inhabits, but from a forgotten epoch in time given my choice of music from . . . the Jurassic era.

Listening to Our Depression

Any dialogue about the warp and woof of depression should include something about its value in our lives. That sounds like a bugged out thing for me to say; all the more so when you consider that much of the national dialogue has been dominated by main stream medicine that tells us that depression is an illness – just like diabetes or heart disease.  I have, in fact, been part of this choir at different times.

Leading this charge is psychiatrist, Peter Kramer.  He’s the author the best-seller, Listening to Prozac and followed up recently with, Against Depression.  His conclusion is that we need an all out war, a full fledged armada, against depression which he maintains is “brain damage” which we must stop from occurring in the first place or progressing once it has gotten a foot-hold.  

I think Kramer’s arguments oversimplify the complex malady that is depression.  More than just a biological illness, depression is also a dying of one’s soul.  Indeed, one’s inner self – that which is most vital and true about us – is a casualty of depression.

What if by medicating our depression, or replacing its jagged thoughts with “clearer” or “more constructive thinking habits” (As defined by whom?), we are moved in the wrong direction?   What if medication doesn’t so much result in full remission (i.e. the goal of psychiatry) of depression as a “draw” with the gun-slinging opponent that our melancholy can seem like?

What if we’re not supposed to mute our depression with medication or straighten out our uneven thoughts with a flat iron?  What if we are killing the messenger?

In his book, The Swampland of the Soul, psychologist, James Hollis, sees depression less as a biological phenomenon, than as a psychological one.  Here’s his description of its causes:

“Depression can feel like a well with no bottom, but is a well with a bottom, though we may have to dive very deeply to find it.  Think of what the word means literally, to de-press, to press down.  What is “pressed down”?  Life’s energy, life’s intentionality, life’s teleology is pressed down, thwarted, denied, violated.  While the etiology of such pressing down may or may not be discernible, something in us colludes with it.  We might even say that the quantity and quality of the depression is a function of the quantity and quality of the life force which is being pressed down.  Life is warring against life, and we are the unwilling host.”

What is pushing down our life force as attorneys with depression?  Is it just the long hours, stress and adversarial nature of our craft?  No doubt such factors play a role, just like our biology and genetics. But clearly much of the foundation of adult onset depression has been layered, brick by brick, in our childhood experiences for it is here where we learn how much to value ourselves and others.  If we learn to value ourselves in a healthy way early on in life’s journey, there are fewer impediments in the future to de-press our life’s energy which is trying to express itself.

If we have grown up in a dysfunctional home, as the majority of adults with depression have, it will be much harder to feel good about ourselves and build a healthy life without depression.  This is so because we have learned to devalue our inner experiences and give too much weight to what others expect and think about our life’s value and future course.  After all, all parents are giants to small children.  In a child’s world of magical thinking, there is no way of filtering out parents’ toxic messages about a child; no way of seeing these voices as a reflection of the parent and not a child’s fledging sense of identity.

This was certainly the case with me.  My alcoholic father, who had gaping holes in his psyche and soul, couldn’t nurture himself let alone his five children.  The eldest of five children himself in an era of WWII veterans, his feelings were alien to him.  As time went by, he crumbled under the weight of his disease and growing awareness, on some level, that he was a failure at work and home.  My mother, an equally damaged person who grew up with an alcoholic father, never learned the basic law of reciprocity in love and nurturance. 

No wonder I ended up as a young man after a successful undergraduate career; without an internal sense of who I was or what I wanted to be.  Like many others without a deep relationship to self and my feelings, I “chose” the law because of one thing I could be sure of – it was a chance to serve others, be a professional and make money.  This is, to be sure, why many young people go into this strange business we call the legal profession.

I was estranged from something essential in me for many years, so powerful was the pushing down of my own inner instincts and life force.  I felt defined and limited by who I had been in my rocky childhood, whether I was aware of it or not.  I always felt a gnawing sense that something was missing – that piece turned out to be nothing less than my essential self. 

Dr. Hollis frames the developmental task before us after we have come to sense this elemental truth:

“The task implicit in this particular swampland is to become conscious enough to discern the difference between what has happened to us in the past and who we are in the present.  No one can move forward, psychologically, who cannot say, “I am not what happened to me: I am what I choose to become.”  Such a person can come to recognize that the early deficit was not inherent in the child, but the result of circumstances beyond the child’s control.  One can then begin to tap the energy for life that was previously walled off.”

And so begins the journey out of the well of depression for all of us.  We must learn to regain our inner authority – regardless of our biology.  This doesn’t mean one needs to quit the law – though some may need to do so to follow their true path.  It may be a more modest shift in perspective or a reshuffling of our life’s deck. 

Hollis has a great analogy that captures the value of modest changes.  He writes that steering our lives is like a pilot using his navigation instruments while flying.  A one degree shift here or there will determine where he ends up landing; in Africa or in Europe.  

In Listening to Depression, psychologist, Lara Honos-Webb writes that depression is trying to tell us something: that we are on the wrong track in life.  In this sense, depression can be a teacher if we would only listen to it. In one interview, she summarizes the five greatest gifts as follows:

–         It propels you on a search for the meaning of life

–         It’s nature way of pushing you out of your comfort zone. Depression reminds you that you are losing your life while not risking

–         It’s a breakdown in the service of offering you an opportunity for a breakthrough

–         It means it’s time to reclaim your power to author your own life

–         It alerts you when you have gotten off course and guides you towards self-healing.

How do we come to see these truths?  Honos-Webb says:

“Depression can be seen as a break-down in the service of offering the person an opportunity for a break-through.  In this way, depression can be a corrective feedback to a life with little reflection.  We only reflect on those things that break down in life.  For example, if life is going along smoothly you won’t spend time thinking about the meaning of life.  We 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 it.”

I admit that it’s hard to see depression’s value when in the thick of it, the swamp through which we slog without relief.  But there’s much to be said for seeing depression not just as a disease, but as a diminishment of self which makes our world too small.  We don’t have to keep colluding in our own victimization.  And remember this:

You are not what happened to you – You are what you choose to become.

Springing Out of Depression

 

Spring has returned. The Earth is like a child that knows poems. – Rainer Maria Rilke.

Spring is a time of renewal. If we follow nature’s lead, it’s a time for rebirth.  During the long nights of winter, depression can have a vise-like grip around our throats.  The increasing sunlight and warmth seem to make this black dog recede back into the shadows.

Spring cleaning is a perennial happening in this country; people tossing out and cleaning up in every zip code imaginable.  This feels good because it gets our bodies moving, we feel productive and somehow lighter.  Depressives have a lot of dross in their drawers; layers of junk strewn haphazardly throughout the pockets of their days.

Today, I’m cleaning out that most sacrosanct of male domains – my garage.  Laugh you may, but I really enjoy it.  I love the productivity of it all, the manual labor that gets things done without relying on my ability to think and analyze problems.  It seems to bring my life back into some sort of momentary harmony; a clarity where there used to be only the mildew of depression. 

It puts me back in contact with nature, with the fresh air that blows and the ground where life is murmuring and waiting to come forth.  Novelist Margaret Atwood writes, “In Spring, at the end of the day, you should smell like dirt.”   I don’t know about you, but that’s my plan for the day.

Yes, Spring is a time of change; a transition from the hibernation of winter.  It’s a good time to go back to the drawing boards of our lives and look at what is and isn’t working for us; what is and is not contributing to our depression.  If something works, keep it; if not, chuck it. 

Springtime is a great time not only to clean out garages, but also our minds that get gooey with too much depressive thinking.  Too often, depressives are immobilized by . . . well, depression.  Because they think that they can’t get anything done, they . . . get nothing done.  That sort of thinking needs to be tossed to the curb along with the rest of the trash.

Depression seems to add 50 pounds of psychic weight to our bodies.  We drag ourselves around the block like a broken wagon, never feeling that we have enough energy to do anything.  Yet, it is profoundly true, that energy begets energy in this corner of the Universe; hence, my assault on the garage.  

Depression is hard-headed and stupid. For some reason, this thought pops into my head as I watch my dog Sherman chewing on an old toy, slobber running down his brownish coat.  

Depression can make you feel like that best thing for you to do is sit on the couch and watch Brady Bunch reruns while sucking down a Coke.  But what’s really needed to make you feel better is movement.

That’s why I’ll be hanging out in my garage today.  It’s such a simple thing to do.  No game changer in the grand scheme of things.  Just an ordinary thing, in an ordinary life, that makes me feel great.

                                       

As my Mother Lay Dying

The best conversations with mothers always take place in silence when only the heart speaks  – Carrie Latet

My mother is dying of cancer in a nearby hospital.  She just turned 82 years old last month.  She’s been in decline for the past year.  Her five children thought the thrust of her diminution was early dementia.  Sadly, we were wrong.  Mom fell and broke her leg two days ago.  Upon further examination, doctors found cancer throughout her body including her brain. 

I went to visit her in the hospital last night.  The place was new, more like a subdued resort than a place where sick people go.  I stepped off the elevator and could sense the quietude, so at odds with the standard beeping machinations of modern medicine.

Only one hour remained in visiting hours.  There was no one around except for the nurses at their station, their mood so at odds with my lugubrious gait.

I walked in mom’s room where she lay sleeping.  She could have been a child but for the deep furrows that ran across her face like newly plowed fields in the spring. I felt a sense of displacement, a breaking off of a piece of my Self.

I sat down and studied her face.  How complicated our journey through this life with are parents is.  We can gather pieces of it in our hands from time to time.  We try to make sense of it, but most of its meaning is shrouded in mystery.  While we can’t explain it, we know it at another level.  It is at moments like this that we are provided an illumination, a momentary aperture, where light transcends much of what we thought we knew about this life and our mothers.

All that my mom is and ever was and everything that I am were alive in that room last night.  I began stroking her head, her thinning grey hair providing no resistance.  She awoke briefly to look into my eyes and we met in that moment. 

“You know I love you Mom”.

She gestured that she did and said, “I’m just so tired.” 

After she drifted back off, I told her that it was okay to leave, that she didn’t have to struggle anymore.

Goals, Depression & Work

I find the great thing in this world is not so much where we stand, as in what direction we are moving — Oliver Wendell Holmes.

There are different concerns at different stages of one’s depression journey.  Lawyers who are in the throes of it, perhaps for the first time, need education about what depression is, understanding, medication, support and psychotherapy.  After they’ve started to feel better, they’ll need to turn their focus to their livelihood and how they’ll work at it in a way, hopefully, which takes into account their mental health so as prevent and/or mitigate any future depression.  Richard O’Connor, Ph.D., author of the best-selling book, Undoing Depression, has this interesting insight about depressives in the workplace:

“Sometimes when I have spoken to business organizations, I have surprised them by advocating for hiring the depressed; but aside from taking more sick days than others, depressed people can be the best employees.  We’re [Dr. O’Connor has long struggled with depression] good at being responsible.  We are good soldiers, honest and industrious.  We have high standards and want to do any job well.  We have too much guilt to pad our hours or take home office supplies.  Treat us decently, and we’ll be grateful and loyal.  Unfortunately for the depressed individual, however, we discount these virtues and have a difficult time enjoying the world of work.”

I think that’s a great insight because overcompensating, even if it makes us miserable, can make us great workers.  God knows lawyers have high standards.  In essence, many of these people don’t fundamentally value themselves. They may fervently chase other measures of success – money, power and status.  Yet, inside, they often feel broken, sad, stressed or depressed.  Here’s what Dr. O’Connor said in an interview I had with in New York City about a depressive’s need to value him/herself:

We tend to think of lawyers as colossal egos bent on being Masters of the Universe; and there probably a good chunk of those people out there — who I never could stand anyway.  But, in my experience, there are many accomplished lawyers who suffer from depression who are of different ilk; “good soldiers” who bust their asses and don’t give themselves much, if any, credit.

I was doing a walk-a-talk with a friend of mine [a real non-lawyer type] recently in Central Park in New York City.  I stopped to munch on some peanuts that were a real disappointment. He was baffled when I told him I didn’t feel that I’d accomplished much in my professional life.  “You were just named to that that publication, ‘The Best Lawyers in America’. For Christ’s sake, count your blessings!” 

It wasn’t that I didn’t want to take credit.  It was because I couldn’t — I just didn’t know how to.   And, as Dr. O’Connor said, not taking credit doesn’t often have much to do with our professional success, but it has a lot to do with our satisfaction with our jobs.

There are emotional bridges that connect us to various aspects of ourselves and our environment. For depressives, there often isn’t an east-bound bridge connecting their good work to their emotional selves. Others may slap them on the back and plaques may parade across their office wall.  No matter, there’s still a disconnection; a sense that their accomplishments were an accident or a recent run of Lady Luck.  They often have a sense that they’ll be found out; that all of their success is a put-on.  They think they’re imposters who truly don’t deserve such accolades – especially from any genuine place inside of them. No matter how distorted this vision is, they’ll insist that it’s true till the cows come home.  I know because I’ve banged these drums a few times over the years. 

Then there’s the other bridge pointing west-bound.  It connects their goof-ups, mistakes and bad decisions to themselves. You see, lawyers have an exaggerated sense of responsibility for bad things and an underdeveloped sense of ownership for the good stuff they do. This take on life isn’t about taking responsibility for our mistakes.  Rather, it’s the toxic self-impugning; the inner critic run amok spraying bullets from an AK-47 at our self-esteem.

I’ve come to learn that feeling a sense of satisfaction and pride in my work because of my efforts is a skill that I have to work at – and I’ve come a long way.  One of the ways I’ve chosen to do this is by setting goals. For many years, like all lawyers, I swam upstream into the time currents of my day.  I didn’t have to set goals about when to get things done because the Court, my firm and other various incendiary devices did that for me. Finishing a set of interrogatories or successfully arguing a Summary Judgment motion, wasn’t a goal that I set for myself – it was simply another deadline in a litany of other deadlines.

Setting goals for ourselves that we’ve personally reflected upon is important step for those who wish to recover from depression.  It counters the sense of hopelessness and the confusing lack of direction characteristic of a depressive’s attempts to navigate through life.  Goals give us a Garmin for our game.

Even though setting goals would be a healthy thing for someone with depression to work at, they often don’t.  Again, Dr. O’Connor:

“Depressed people, pessimistic [a hallmark of lawyers thinking style] and lacking confidence, tend to avoid setting goals as a way to protect themselves from disappointment.  They don’t realize that the absence of goals leads to a completely different and frequently worse set of problems.  Even if you miss your target, you grow and benefit from the practice of productive activity.  But depressed people, who don’t trust their ability to adapt to bad news and hence avoid setting conscious goals, find lives that lack direction.  Your goal becomes just getting through another day.  In the depths of depression, that may be all you can manage, but it doesn’t take you anywhere.” 

Or, as the great Indian Chief Seneca once wrote: “Our plans miscarry because they have no aim.  When a man does not know what harbor he is making for, no wind is the right wind.”

Setting simple, realistic and concrete goals improve both our performance of the activity and our actual experience of it.  My Catholic take on it from Mother Teresa helps me put this in the context of my part-time faith:  “We can’t do great things; only small things with great love.” 

Work isn’t just about what is thrown at us by our jobs.  It’s also about the passion we bring to it. In this vein, it’s not just the immediate task before us that hooks us, but how we’ve set it up in our own minds.  Again, Dr. O’Connor:

“Making a commitment [to a goal] focuses our attention on where we want to go and helps us focus our thinking on getting there.  People feel happier as they progress toward their goals; they have a sense of involvement, they feel productive and useful, and they give themselves ego strokes for being good and industrious.  Because we’re so adaptable, however, those good feelings don’t necessarily last once we’ve got to where we are going.  We have to make a deliberate effort to savor and appreciate our achievements.”

The key words are deliberate effort.  The word “deliberate” comes from the Latin word “deliberates” which means to weigh carefully.  It requires us to reflect on our course of action and think about what actually works and what doesn’t for us on the job.

In my experience, depressives are often lacking the goal-setting skills they need to be happy and content in their work lives.  What’s the consequence of not setting goals is a sense of meaninglessness; ennui that won’t go away.  Depressed lawyers have an inner dialogue that goes something like this: “I have all this paperwork to get to today, but I have to be in court all morning.  And . . . oh shit!!  I forgot to call the judge back on that motion.” And so it goes as these worrisome thoughts pour out of our noggins.  We’re just jumping around putting out fires and surviving our days.  Is it really any wonder that we draw little or no satisfaction from our work with this approach? 

When I talk to depressed lawyers about this and suggest that they think about their goals and what they really want to achieve, you would have thought that I asked them to jump off the Brooklyn Bridge: “Are you kidding?  You want me to spend time thinking about my goals?  When the hell do I have time to do that?  I have no time during work and then when I get home I either want to (a) forget about my day and enjoy my family, (b) pass out on the couch and forget about everything in front of the T.V. or (c) do anything that doesn’t involve thinking about my job.

There’s no problem in using these ways to decompress after a day’s warfare at the office.  But if these activities, albeit pleasurable, avoid the important questions raised by work, and our connection to it, we may to rebalance the tires.

In my next blog, I will address some practical ways lawyers can set goals and draw pleasure from accomplishing them in their everyday work lives.

Mindful On The Job

 

Work is about a search for daily 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 through Friday sort of dying – Studs Turkel, author

Sunday night rolls around all too quickly.  The weekend, if we actually give ourselves a break from our jobs, can’t often prepare us for the frenzy of the week’s activity at the office that awaits us.  If we like our jobs as lawyers – and granted there are alot of us who do – we still may feel it’s half-baked- “it still could be better” we think to ourselves.

Michael Carroll, author of the book, Awake at Work, was employed at such places as Shearson Lehman, American Express and The Walt Disney Company.  More recently, he has been a consultant and coach to such companies as Starbucks and Proctor and Gamble.  His comments, into what workers really want out of their jobs, is insightful to the lives of lawyers on the job:

“In my role as a business consultant, I regularly ask my clients to complete the following sentence with the first word that comes to mind:

At work, I want to be. . .

While my survey is not scientifically reliable, I can report there are some patterns to the responses.  Here are the four most frequent answers:

  • Successful
  • Happy
  • Rewarded
  • Stress-free

Such responses come as no surprise.  Given the demands, risks and relentless pace of our modern-day workplace, it is little wonder that most of us would like a little stress-free happiness on occasion.  Rewards and success-isn’t that what we are all looking for at work?”

Who can’t relate to that take on the legal profession?  Whether we are happy in our jobs or not, we all think about how we can embrace more of these intangibles while at the office.

Carroll, in addition to being in the business world for the past forty-four years, is a long-time meditator and proponent of mindfulness meditation.  Here’s a great introduction to what Mindfulness is about:

You don’t have to be a Buddha sitting in a lotus garden to appreciate this fundamental and simple way of approaching your day.  It’s not so much a different way of doing and accomplishing stuff; lawyers are great at that.  Rather, it’s a different way of seeing at work.  Moreover, seeing via a discipline of mindfulness meditation, seeks to plant our feet directly on the carpet. It’s not so much about being alert and wired to the swirling stimuli peppering us from every angle.  It’s taking a time-out and leaning against the wall; it’s about letting the other half of our brain complement our eagerness to get things done.

Coming back to Michael Carroll’s survey about what people want out of their work, he opines that it’s not really success, happiness, being reward and a stress-free work-life: 

“My survey indicates that most of us think we want to happy, successful, and to be stress-free at work, but we also know that such aspirations are wishful thinking.  We all know work offers both success and failure; happiness and angst.  We know that work, indeed all of life, unavoidably presents both rewards and penalties; joys and disappoints. So, while most of us wish to be happy and successful at work, what we really want, from my vantage point, is to be confident: confident that no matter what work offers up, we remain self-assured and at our ease.”

In my experience, truer words were never spoken. As lawyers, there is a wonderful sense we get about our craft when we achieve a certain level of competence and feel that we can handle whatever down the pike.  We can acheive this sense of competence not just through the nuts and bolts of accomplishments in the courtroom, but through practice as sense of presence in our daily lives.

Explore how mindfulness meditation can help you at the office.  Also, for those so inclined, check out the wonderful book, which I’ve previously raved about, The Mindfulway Through Depression.  It’s not only for those with depression, but suitable for anyone who struggles with a sense of dissatisfaction and/or unhappiness at work.

Newsweek Gets It Wrong: The Debate About Antidepressants

I yearned to get better; I told myself I was getting better.  In fact, the depression was still there, like a powerful undertow.  Sometimes it grabbed me, yanked me under; other times, I swam free. – Author, Tracy Thompson.

One study estimates that 19% – – or about 200,000 of this country’s 1 million lawyers – – suffer from depression.  This isn’t just some statistic; this is about people – folks who happen to be lawyers for one reason or another.

Just what are these people supposed to do about their depression?  Many if not most law students, lawyers and judges that I know have taken or are currently taking antidepressant medications. And they seem to be in the majority of people in this country who do so.

The ranks of the medicated are swelling.  The number of Americans taking antidepressants doubled in a decade, from 13.3 million in 1996 to 27 million in 2005. One in ten Americans are prescribed these drugs making them the most prescribed medications in the country.  By comparison, 18 million people take Lipitor for high cholesterol. 

The biggest reason lawyers take these drugs?  Like everyone else, they’re hoping want to feel better, but equally if not more importantly, attorneys want to return to their pre-depression levels of productivity at work.  A profession that doesn’t suffer fools well and demands a lot out of mere mortals.

But is medication effective in treating depression and achieving this objective?

Late last week, I was walking down an icy sidewalk minding my own business.  I could see the usual cast of characters in my peripheral field of vision; clusters of lawyers yucking it up on their way back from lunch, a judge lost in his own thoughts and a corporate lawyer I know (not particularly well) who once told me privately that he takes antidepressants, his lawyer wife  did as well and  five other lawyers in his firm did.  I guess he felt comfortable telling me this because of my public disclosure about my own struggles.  I often feel like a priest in a confessional; I hear about lawyers most private of struggles.  Then, like such disclosures never happened, the curtain is opened and we each walk our own ways.

Walking by a newsstand late last week, I noticed the current cover story of Newsweek Magazine which read, “Antidepressants Don’t Work:  The Debate Over the Nation’s Most Popular Pills”.  The large print seemed to stick a proverbial finger in modern psychiatry’s eyeball and toss the question –along with people who suffer with depression- up in the air. 

The article focused on a recent study which concluded antidepressants essentially worked no better than placebos (sugar pills).  Oh, just great, I thought. What am I, who have taken medication for the past eight years, supposed to do now?  Start popping M & M’s instead of Cymbalta?

The writer of the Newsweek piece concluded

“If placebos can make people feel better, then depression can be treated without drugs that come with serious side effects, not to mentions costs.”

This conclusion is the latest in a long line of recent books leading the charge against the use of medication to treat depression. Charles Barber, in his book Comfortably Numb: How Psychiatry is Medicating a Nation, argues that antidepressants are doled out like Halloween candy in this society.  The motive: the big money made by the pharmaceutical industry.  This is an appealing take because Big Pharma is commonly portrayed as the villains in the popular press; guys in black hats and white lab coats stuffing greenbacks into their pockets.

In an article written for Salon, Barber wrote:

“One has to wonder:  Are we really that miserable?  Manipulated might be a better word for the miserable.  If we were to pick one factor that explains the dramatically increased number of antidepressants that now runs through our collective bloodstreams, it would be direct-to-consumer advertising, otherwise known as television commercials for drugs.” This point is well taken, but not surprising.  Pharmaceutical companies are in the business of making money.  Does such a motive make Lipitor any less effective?  Should commercials about it deter us from taking this drug?  I don’t so.

In fairness to Newsweek, they ran an accompanying piece which tried to give the other side of the coin.  It was penned by psychiatrist, Robert Klitzman who framed the question about the study’s conclusions in this way:

“What should we make of the [study]?  First, some facts: antidepressants have been shown to work for serious major depression.  Most evidence shows they are effective for dysthymia: milder but chronic depression that continues for two years or longer.  The question is whether they work for milder depression that may be shorter or less intense.  That’s important, since major depression affects almost one out of five people [in this country] at some point in their lives.  And most people with depression do not have severe forms of it.”

The response to Newsweek’s take on the study was sharp and quick.  In an Op-Ed in the New York Times, Judith Warner wrote this biting retort:

“Happy pills don’t work, the story quickly became, even though, boiled down to that headline, it was neither startling nor particularly true. Yet in all the excitement about ‘startling’ news and ‘sugar pills,’ a more nuanced and truer story about mental health care in America was all but lost.  The story begins to take shape when you consider what the new study actually said:  Antidepressants do work for very severely depressed people, as well as for those whose mild depression is chronic (dsythymia). However, the researchers found, the pills don’t work for people who aren’t really depressed – people with short-term, minor depression whose problems tend to get better on their own.  For many of them, it’s often been observed, merely participating in a drug trial (with its accompanying conversation, education, and emphasis on self-care) can be anti-depressant enough.”

As the article also points out, most people receiving antidepressants aren’t getting them from well-trained psychiatrists, but family doctors who don’t screen well for depression. One wonders how much training they get on  how to probably diagnose depression and whether they can keep up on all the research on the topic.  The result: we are, in some sense, an overmedicated nation; a country too quick to give sad or unhappy people pills that they shouldn’t be taking and don’t need. 

That conclusion, however, does not mean that these medications don’t work for many (though not all) people suffering from true clinical depression.  My take is that a family doctor who treats urinary tract infections and constipation shouldn’t be doling out Lexapro to a patient that he has spent 5 minutes with. Perhaps the problem isn’t just pharmaceutical companys bent on making a quick buck, but family doctors under managed care who don’t have any time to spend with patients and don’t know much about depression and the various medications used to treat it.

People feel ashamed and stigmatized by going to psychiatrists, but it could be a game-changer for many:  either you don’t have depression and shouldn’t be on medication or you do and you could finally get relief from some of depression’s more devastating symptoms.

There is no doubt that exercise, psychotherapy and some form of community and support will help people whether they are suffering from some transitory upset/sadness in their life (by the way, this helps people with depression too). However, for many people afflicted with clinical depression, it’s unlikely that they will have a real shot at containing or overcoming their depression without short-term or long-term use of medication. They won’t be able to muster the energy, commitment and motivation to engage in the other healthy stuff; to go for a walk, to work out their distorted and negative self-beliefs about themselves with a good therapist or join a support group.

Depression has a terrible undertow; its riptides are often unforgiving.  We need as many weapons in our arsenal to deal with it. People with transitory sadness or disappointments don’t need to become patients; they need to connect with other people or change their lives – maybe both.  Therapy or just working it out by themselves with supportive friends and family may be all they need.

Walking in Bigger Shoes

Lawyers are an earnest, disciplined bunch.  They love evidence – the “show me the money” approach to life.  They’re hard-bitten pessimist, yet love the latest self-improvement projects pitched to them by the legal establishment.  You know — graphs, charts and the Oprah-like cattle call to “Change Your Life in Five Easy Steps!”  The goal of all these books and slogans is Happiness, as if it were a commodity for sale.  There was a snappy piece yesterday in the New York Times Review of Books entitled, “The Rap on Happiness.”  It’s a great take on this country’s obsession with finding the veritable Oz of bliss.

“The real problem with happiness is neither its pursuers nor their books; its happiness itself.  Happiness is like beauty:  part of its glory lies in transience.  It is deep but often brief (as the poet Robert Frost would have it), and much great prose and poetry make note of this.  Frank Kermode wrote, ‘It seems there is sort of a calamity built into the texture of life.’  To hold happiness is to hold understanding that the world passes away from us, that the petals fall and the beloved dies.  No amount of mockery, no amount of fashionable scowling will keep any of us from knowing and savoring the pleasure of the sun on our faces or save us from the adult understanding that it cannot last forever.”

Lawyers walk in shoes that are too small for them, living lives that are too confining, unimaginative and which fail to challenge them to be their best.  They need to switch from pinching wing-tips to cushy loafers.  This switch gives a vital bounce to their steps rather than a lugubrious gait. The opposite of depression isn’t happiness; it’s vitality. It’s like a Swordfish bounding out of the ocean’s waves in defiance of gravity or B.B. King playing a blues riff on his guitar.  They have a vibrancy that can’t be contained; they express themselves in a space where great stuff happens.

Part of the equation involves not so much pills or therapy, as the lifting up of our individual imaginations.  Putting aside what’s possible in a concrete sense ( you know, the mortgage or student loans), have you ever looked out your office window and imagined the life you’d like to have?  This is not the same as rumination; a constant churning of negative thoughts in our cranium which a depressive is prone to.

Rather, it’s an exercise in lively engagement with our Self. To engage in this effort, we have to pop our life’s stick shift out of “Neutral”, the frozen state that depression and/or anxiety can keep us stuck again.  Locate the “Drive” on your shift and engage.

In this exercise, it might be helpful to think about the choices we make in a different way.  Not in a self-recriminating way, but in a fashion that moves us in a constructive direction. We need to separate the wheat from the chaff in our lives; to decide what reduces or enlarges our spirits.  Quality questions can help in regard.  Not the common lament of depressives, “What the hell is wrong with me?”  That’s a dreary question that goes nowhere because the answer we give ourselves is – – “Everything!”  James Hollis, Ph.D., in his wonderful book, “What Matters Most: Living a More Considered Life” offers us a keen approach ourselves to view ourselves:

“Ask yourself of every dilemma, every choice, every relationship, every commitment, or every failure to commit, ‘Does this choice diminish me, or enlarge me?’  Do not ask this question if you are afraid of the answer.  You might be afraid of what your soul will require of you, but at least you then know your marching orders.”

Incline your inner ear.  Listen to your response to this challenging question.  Enlargement of one’s self isn’t so much about happiness, as meaning. Deep down, we all want a life of purpose; where we feel our lives have a point, or many points of light for that matter.  You don’t have to look far.  It’s right beneath your bouncing feet.

Turning Your Life Around

 

Lawyers often sense that their lives have gone off track; they just don’t know how to fix them.  They’re hit by daily demands that make it difficult to find their true north.

There are the demands that hurtle at them from the lives they occupy – the boss that’s yammering for more billable hours, families that feel upset by all the hours they spend at work or you-name-it-crap from this frenzied world.

Then there are the demands that emanate from somewhere inside of them; the part of themselves – their true selves – that wants a life with less stress, more meaning and a sense of connectedness to other people.  While they pine for such a life while looking outside their law office windows, such reverie gives them a brief respite from the grind.  But after the moment has passed, there’s an abiding sorrow.  A sense that something has been lost that can’t be found.

Perpetual stress can keep lawyers from ever dealing – in a constructive and persistent way – with what they really want in life. They check their Blackberry’s more than check in with themselves. They don’t really know what they want most of the time; they just know that it’s not this.  Emotional pain may be leaking out of them; for some lawyers, this has been going on for years.  The pain might be mitigated in healthy (e.g. exercise) or unhealthy (e.g. drinking, drugs) ways.  But, it will not go away – until they turn around and face themselves.

Lawyers need to become conscious of the choices they’re making during their waking hours.  Of course, there’re exceptions, but the majority of lawyers have choices.  They aren’t victims that are being forced to stay at their jobs.  They’re choosing to stay at their jobs and do the work they’re paid to do. 

Most lawyers, however, just don’t see it this way.  They feel stuck in their jobs and lives with few viable alternatives.  As odd as it may sound, they feel like victims.  Friends of mine who aren’t lawyers scoff at my observation:  “Lawyers victims?  Give me a break.”  Nonetheless, it’s true on an emotional level for many lawyers.

Lawyers can feel this way because (a) the “golden handcuffs” in which they’re just making too much money to quit; (b) they’re in too much debt; (c) they’d rather complain than face the abject fear that comes with making tough changes; or (d) they’re simply paralyzed by stress, anxiety or depression.

However, by turning from a stuck-victim status to a choice-maker posture they can begin to awaken to their true potential. They might have to make small changes in their lives or maybe a closet full of whoppers.  Perhaps they’ll have to go back to the drawing board of their lives and sift through and separate what’s really important versus what’s trivial. This will take time; let nobody fool you on this one.  People in our country are basically impatient; we want relief from our distress NOW.  But, meaningful and realistic changes never seem to unfold this way. That’s just the facts-o-life. 

Turning your life around may come down to this:  What are you willing to do to change your life?  Lots of people — not just lawyers — know that their lives aren’t working.  The same group approaches their lives with all the right intentions of changing it for better.  Most, however, will not change despite the chorus of voices from within telling them to do so.

I had a friend who would call me once a month and lament how unhappy he was.  I’d listen for thirty minutes and then he, having discharged his discomfort, would say goodbye only to repeat this weather pattern about thirty days later.

Finally, six month in this telephonic waltz, I said “Tom, what are you willing to do to change your about life?”  The question must have stunned him like a taser because there was silence —  a dead silence — on the other end of the line.  He evaded the question, said we would have to get together soon for lunch and hung up.  Tom never called again.

Tom didn’t really want to change – – he wanted to bitch, a common past-time for many lawyers.  He wanted my sympathetic ear to appreciate just how much he’d been screwed over by opposing counsel, an irate judge or his cranky wife.  I had sympathy for Tom, but also a good deal of frustration because I realized that I wasn’t really helping him.

I would ask you the reader:  “What are you willing to do to change your life” Are you willing to the feel the free floating anxiety that’s inevitable if you are to start changing your life?  The longer the discontent goes on, the bigger the changes will have to be.  The longer we delay, the bigger the kick in the pants from Life to wake us up.

Yes, work is only a part of life and many lawyers no doubt find outlets of meaning and joy along other avenues.  However, as Gregg Levoy, author of Callings:  Finding and Following an Authentic Life, such sizing up of our days miscalculates the energy and time we must invest in our daily jobs:

“Work is merely one of the arenas in which you play the game – the one the Gods are watching from the press-box atop Mount Olympus while sipping mint juleps.  It is only one of the arenas in which you express your humanity, search for meaning, play out your destiny and dreams, contribute your energies and gifts to the world and spend your precious nick of time.  It is also an arena in which you spend two-thirds of your waking lifetime and it is legitimate to love your work!  Life is a thousand times too short to bore yourself.  If someday your life does flash in front of your eyes, the very least you want it to do is hold your interest.”

Rear-ended by Depression

The abject pain of clinical depression is magnified expontentially when one considers that sufferers usually blame themselves for their plight. “What’s wrong with me?” is a common refrain.  Most people with depression feel “bad” to their core.  They can’t always articulate why this is so, but they know that they can’t shake their own self-condemnation.  There is no place to hide from it, no true rest for the weariness it brings.  We lay awake at night and hope that tomorrow it will be better.

I had a conversation last week with a mental health professional who asked me, “What in the world do lawyers have to be depressed about?  They’re rich and powerful.  Lawyers should stop complaining and realize how good they have it.”  Yet a lack of gratefulness has little to do with depression.  I used to recite a list of things I had to be grateful about – and there were many – but it all fell on depression’s deaf ears.

When others tell us to “snap out of it,” we may buy it hook, line and sinker and even believe that they know what they’re talking about.  Well-meaning friends may try to reign in our sorrow by suggesting that they can identify with our suffering.

In her book about her own depression, An Unquiet Mind:  A Memoir of Mood and Madness, psychiatrist, Kay Redfield Jamison writes:

“Others imply that they know what is it is like to be depressed because they have gone through a divorce, lost a job, or broken up with someone.  But these experiences carry with them feelings. Depression, instead, is flat, hollow, and unendurable.”

Such attempts by others, even when well intentioned, always brought about a deep sense of loneliness in me.  I had, like most people, gone through my fair share of difficult experiences in life like losing a job.  But this experience – this blast furnace of melancholy – was not that.  We get over losses in our lives, we adapt.  We can’t just “get over” depression.

There is a sense that we have been rear-ended by depression; out of seemingly nowhere, our lives are crashed into and changed forever.  In a very real sense, we will never be the same.  Some will recover from their depression, many will not.  That’s not a very popular thing to say, but it’s been my experience from talking with hundreds of lawyers from around the country who I’ve been privileged to share with.  For many, recovery will be an on-again off-again sort of affair.  They will have to work hard to recover and make lots of effort to stay healthy.

Part of the reason why too many lawyers don’t get better is simple:  most don’t get any form of treatment for their depression.  A study by the National Institute of Mental Health revealed that as many as 80% of people in this country get no form of help whatsoever.  Looking out a window, I wonder how high the rate is for lawyers.  It’s most likely a mixed bag.  While it’s true that people from a higher socio-economic class tend to get treatment – mostly because of their access to good medical care – most attorneys still don’t because of the stigma associated with mental illness.

Such shame – dumped on people from others and the self-inflicted variety – is particularly deep for lawyers.  This is so because of the myths surrounding their internal world.  Lawyers feel like they’re supposed to be veritable Supermen able to bend steal and solve all manner of a clients’ problems without wrinkling their power blue suit. If they’re in pain, they’re told to “suck it up.”  We live in a nation of winners where, deep down, many feel like losers.

This sort of mentality, in part, explains the epidemic rates of depression in the law.  Studies have concluded that lawyers suffer from depression at a rate of twice the national average or about 20%.  This means that 200,000 out of the one million lawyers in this country suffer from depression.

What’s a depressed lawyer to do?  First, one must stop blaming oneself.  This is tough because most people with depression have been living with this cognitive distortion for a long time – maybe their whole lives – and this corrosive self-talk promotes the viscous cycle that is clinical depression.  If one can’t stop blaming oneself for having depression, it’s tough to get better.  Little by little, we need to learn to let that bullshit go and start walking a healthier path.

The poem, The Journey, by Mary Oliver, captures some sense of this path for me.  I hope it will for you.

One day you finally knew

what you had to do, and began,

though the voices around you

kept shouting

their bad advice – –

though the whole house

began to tremble

and you felt the old tug

at your ankles.

“Mend my life!”

each voice cried.

But you didn’t stop.

You knew what you had to do,

though the wind pried

with its stiff fingers

at the very foundations,

though their melancholy

was terrible.

It was already late

enough, and a wild night,

and the road full of fallen

branches and stones.

But little by little,

as you left their voices behind,

the stars began to burn

through the sheets of clouds,

and there was a new voice

which you slowly

recognized as your own,

that kept you company

as you strode deeper and deeper

into the world,

determined to do

the only thing you could do – –

determined to save

the only life you could save.

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