Is it Lawyer Sadness or Lawyer Depression?

I can spot sadness on a lawyer’s face like a good poker player can read dog-eared cards in a smoky, backroom bar.  To others, his or her expression may seem like a seasoned lawyer’s humorless and steely resolve. But, I know better.  There is something tragic in his or her gaze, his or her face a subtler shade of grey.  The repartee, if any, is deeply cynical and sarcastic. It is a tough life for many in this boat, and many dream of a different life.  “Every man has his secret,” wrote Tennyson, “which the world knows not; and often times we call a man cold when he is only sad.”

sad woman

Such sadness, however, does not necessarily equate with clinical depression. Like all humans that walk this earth, sadness is woven into the life of every lawyer.  One of the tougher aspects of their lives is that their demanding careers often leave little time to be with and enjoy their families.  Because sadness is often about the loss of people we care about and/or the time we spend with them, this one seems to be particularly piercing for lawyers. Too much sadness is the price they pay for too much time at work.

For most of us, sadness seems to be short-lived before we bounce back up.  When sadness goes on for a day or two, we might say that we have “the blues.”

It’s normal to feel the blues; a bittersweet type of sadness that colors our lives from time to time. Blues music is very popular given the universal nature of this experience.

But while sadness and the blues are inevitable parts of life, clinical depression is not.  The most significant difference between sadness and the blues is that someone that’s sad goes about their daily business without much trouble.  But depression involves impairment in one’s ability to carry out daily task at work and home.

Dr.Richard  O’Connor, in his deeply insightful book Undoing Depression, captures some of the difference between the two:

“Everyone has had a taste of what depression feels like.  Everyone feels the blues at times.  Sadness, disappointment, fatigue are normal parts of life.  There is a connection between the blues and   depression, but the difference is like the difference between the sniffles and pneumonia.”

Other differences between the blues and depression include the length of time the sadness endures and whether or not there are other symptoms associated with depression which are tagging along with the perpetual sadness.

“I think the difference between just having the blues and depression lies in the symptoms,” writes Raymond Crowe, M.D., professor of psychiatry. “If the blues’ persist for more than a couple of weeks and are accompanied by trouble eating, difficulty sleeping, or suicidal thoughts, you should see a therapist or psychiatrist or your family doctor.”

depressed cave

Psychiatrist Peter Kramer, author of Against Depression, underscores the point that depression is a serious illness and not ordinary sadness:

For the psychiatrist, then, depression becomes an intimate.  It is poor company.  Depression destroys families. It ruins careers. It ages patients prematurely. It attacks their memories and their general health. For us – for me – the truth that depression is a disease is unqualified.  Depression is debilitating, progressive and relentless in its downhill course, as tough and worthy opponent as any doctor might choose to combat.”

It’s important to recognize the difference between lawyer sadness and depression because a suffering lawyer will not be able to resolve the depression by himself; talking it out with a group of workpals over some beers at lunch just won’t get to the heart of the problem.  This person will need a mental health professional to evaluate him or her and get him or her the serious help he or she needs.

Too frequently, the culture at large, and perhaps the legal profession in particular, mix up sadness, discontent, malaise, unhappiness and clinical depression.The titles of media and journal articles, while they may touch on depression, reflect this clumping together of unhappiness and depression.  I was interviewed for an article by The Wall Street Journal about depression in the legal profession.  While it was clear that the story was going to be about depression, the article’s title was Even Lawyers’ Get the Blues. A recent Law Journal article, which included a small section on depression, was titled How to Be a Happy, Healthy and Ethical Member of an Unhappy, Unhealthy and Unethical Profession.  Martin Seligman, the guru of the Positive Psychology movement, wrote a chapter in his book “Authentic Happiness” called, Why Are Lawyers So Unhappy? In the chapter, however, he wrote about both unhappiness and depression without attempting to differentiate the two.

This commingling of ordinary sadness, unhappiness and depression is confusing and misleading. And dangerous.  It is confusing because a sufferer and those around him may underestimate the gravity of the situation: “Bob is just sad, going through a tough patch at the law office.  He’ll get over it.”

But, Bob might not.  He may get worse.  The depression may deepen.  He may need medication that he’ll never get. He may need to talk to a therapist to address the distorted thinking that goes on during a depression. He may need medication to lift himself out of the darkness. Absent such help and hope, he may commit suicide.  As much as 80% of suicides are committed by those struggling with depression and lawyers have much higher suicide rates than the general population.

Others simply do not have a reference point for depression unless they have been through it before. Sadness? Yes. The deep psychic pain of depression? No. Misidentifying a person with depression as having the blues can have severe consequence because the more people do so in the life of the depressed person, the greater the isolation, the greater the pit of desolation the depressive falls into because no one understands. It causes them to queston themselves: “Why can’t I snap out of this?  What’s wrong with me?”

DSM

According to The Diagnostic Statistical Manual (DSM), the bible used by mental health workers, to be diagnosed with depression you need to have had a depressed mood or loss of interest or pleasure in daily activites for more than two weeks.  According to the National Institute of Mental Health, you also must have some, but not all, of the following symptoms:

  • Difficulty concentrating, remembering details, and making decisions
  • Fatigue and decreased energy
  • Feelings of guilt, worthlessness, and/or helplessness
  • Feelings of hopelessness and/or pessimism
  • Insomnia, early-morning wakefulness, or excessive sleeping
  • Irritability, restlessness
  • Loss of interest in activities or hobbies once pleasurable, including sex
  • Overeating or appetite loss
  • Persistent aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment
  • Persistent sad, anxious, or “empty” feelings
  • Thoughts of suicide, suicide attempts

Do you think either you or someone you care about is suffering from depression?

Take this depression test to see if you or someone you care about might be suffering from depression.  If so, get help now.

 

 

 

It’s Just Cancer – Get Over It.

 

bigstockphoto_Man_In_Depression_5432510 

 

 

 

 

 

I arrived in New York City’s JFK Airport yesterday.  My family and I are visiting friends over the weekend.  While walking through the terminal, I saw a large advertisement from the Depression Is Real Coaliation. If you haven’t heard of this organization, check out their website.  The ad read as follows:

YOU’D NEVER SAY, “IT’S JUST CANCER, GET OVER IT”.  So why do some say that about depression?

When I first developed depression over seven years ago, at least five people told me to “get over” or “snap out of” it.  Get over or snap out of “what” I often thought.  I searched my mind for some frame of reference.

When people are too preoccupied with themselves and their problems, we have all thought or told them to end their narcissistic nonsense.  “Life isn’t so bad.  So stop complaining,” is our common refrain.   We judge them to be selfish, inconsiderate or even burdensome. Yet, were such people suffering from a physical illness – say cancer, diabetes or heart disease – we would never imagine saying such a thing for fear of being thought cruel, rude or simply ignorant. 

Sadly, all too often, people treat people with depression as if they don’t have an illness, but a problem of self-absorbtion.   And for people who have experienced the Black Dog, they know exactly what I am talking about. Such comments make us doubt ourselves:  “maybe I am just a complainer,” or “I’m just selfish.”  But deep down, we may sense otherwise.  If we do, we know that something is seriously amiss.    

Critical comments from others made me feel like the accused.  I imagined what must have been going through their minds:  “You’re faking it.  Now let’s get back to the business of practicing law.” They just didn’t seem to believe me.  That didn’t believe that I had a chemical imbalance in my brain, that it wasn’t my fault and that this had made me sick – very sick.

In the beginning of my journey, I wanted everyone to understand me.  I wanted them to just say, “It is okay, Dan.  You have a medical illness and need treatment.”  Sometimes this happened and sometimes it didn’t.  When it didn’t, I felt hurt and even angry.  I thought, “Just step in my shoes for an hour and you’ll know that what I’m experiencing is true.”  We need to be careful who we choose to expect sympathy from.  Make no mistake about it, we need allies when we are in a depression.  Most often, it will come from other depressives who have “walked the walk,” people who have known and loved others with depression, or just big-hearted, everyday people.

In his book, Against Depression, psychiatrist, Peter Kramer, M.D., takes an unflinching account of the illness that is depression.  Check out his Blog.  Kramer cites a number of scientific studies linking depressive symptoms with abnormalities in the hippocampus and prefrontal cortex of the brain.  Kramer also emphasizes that depression is more than a brain disease.  “It is a neurologic, hematologic and cardiovascular disease.  Overactivation of stress pathways causes a liability to clots and [heart] arrhythmias – and along or together, they predispose to heart attacks, silent strokes, disturbed mood and sudden death”, he wrote.  Listen here to Dr. Kramer being interviewed by National Public Radio.

Richard O’Connor, Ph.D., author of the best-selling book, Undoing Depression: What Therapy Doesn’t Teach You and Medication Can’t Give You, makes clear why depression should be likened to other major medical illnesses:

“Heart disease is a good analogy to major depression.  Heart disease is “caused” by a complex of factors, including a genetic predisposition, emotional factors like how we handle stress, and habits like diet and exercise.  You don’t catch heart disease from an infection.  You develop it gradually, over time, as plaque builds up in your arteries.  Once you cross an invisible threshold marked by standards of blood pressure and cholesterol levels, you have heart disease . . . . Depression may be a similar threshold disease – genetic and biochemical factors may determine a different level of stress for each of us that, once reached, puts us over the edge into depression.”

It is critical to remember that depression isn’t your “fault.”  However, it’s equally important to remember that it’s your responsibility.  We must take responsibility to get better and stay that way.  Yes, the critical judgments of others hurt. That’s why it is imperative to not go through this alone.  Join a depression support group.  They have also dealt with the judgments of others.  There truly is strength in numbers.

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