The Dark Side of Success: A Psychiatrist’s Exploration of Depression in the Legal Profession

By Joann Mundin, M.D.

There are significant effects of depression in the legal profession that are pervasive. Lawyer depression can have terrible personal and professional ripple effects for attorneys but also impacts clients, business partners, employees, and staff.

The general population is significantly affected by depression, with 17.3 million persons, or 7.1% of all adults in the US, reporting having experienced a major depressive episode in 2017. But, the proportion of depression among attorneys is considerably higher: according to ALM’s Mental Health and Substance Abuse Survey from 2020, 31.2% of the more than 3,800 respondents report having a depressive disorder. This indicates that compared to the ordinary US adult, lawyers have an approximately three-fold higher risk of developing depression.

Nevertheless, the stigma associated with mental illness keeps lawyers from getting help immediately. This can cause excessive and prolonged distress, making the problem worse over time.

True Stories: Depression Sucks & It’s Lonely, Too

“True Stories” is a series of guest blogs I am running. Below, Michael Herman, a lawyer and partner at the Toronto offices of the global law firm of Gowling WLG, shares his experiences with the loneliness that comes with his depression.

“There’s a reason we feel lonely even though we’re not alone. It’s because loneliness is not about how many friends we have or how many people there are in the room with us … it’s a disconnection from other human beings.” – Ranata Suzucki

It’s about 9:30 at night, and I am sitting in the living room watching TV and trying to unwind from a long and stressful day at work, filled with meetings, responding to emails, and dealing with various problems. Just another day at the office. Out of nowhere, I start to feel it – an overwhelming sense of loneliness, as if there is no one in my life to whom I can turn for sustenance.

It’s a Saturday night, and I’m at a party surrounded by friends and family. People gather in small groups, talking, laughing, and enjoying each other’s company. I scan the room and think that I don’t belong. The only thing I want to do is leave and escape from the pain of the loneliness I’m experiencing in the midst of this group of happy people.

I am very familiar with these feelings; they’ve been my companions on and off since I was a young child. It’s as if no one can see me or hear me, as if I don’t really exist and, worse, have no reason to exist.

Too Much Depression, Too Little Sleep: 3 Things You Can Do to Get a Better Night’s Slumber

The worst thing in the world is to try to sleep and not to. – F. Scott Fitzgerald

When first diagnosed with depression, my sleep became fragmented in a way I had never experienced before.

Before this time, I, like most frenzied lawyers, had periods of restless sleep tinged by stress and anxiety. But my sleep would return to normal after a lengthy trial or round of contentious depositions.

But this was different.

Lots of Depression, Little Sleep

I was always tired, but couldn’t sleep through the night. I went to bed early, exhausted from trying to make it through another day with depression. Trouble sleeping is a symptom of major depression.  Kay Redfield Jamison, M.D., a psychiatrist, writes:

The body is bone-weary; there is no will; nothing is that is not an effort, and nothing at all seems worth it. Sleep is fragmented, elusive, or all-consuming. Like an unstable, gas, an irritable exhaustion seeps into every crevice of thought and action.”

The Suicide of a Law Student Hits Home

When people are suicidal, their thinking is paralyzed, their options appear spare or nonexistent, their mood is despairing, and hopelessness permeates their entire mental domain. The future cannot be separated from the present, and the present is painful beyond solace. ‘This is my last experiment,’ wrote a young chemist in his suicide note. ‘If there is any eternal torment worse than mine I’ll have to be shown.’ – Kay Redfield Jamison, M.D., “Night Falls Fast: Understanding Suicide”

A second-year law student at the University at Buffalo School of Law, Matthew Benedict, died by suicide earlier this week by leaping from the Liberty Building he had been clerking at according to the Buffalo News. Another account of Matt’s life and suicide was reported in The New York Law Journal.

Matt’s funeral is tomorrow. By all account’s he was a tremendous, loving, talented, bright young man.Matt was kind-hearted, passionate and driven.

Slogging Through the Swamp of Lawyer Depression With Dr. James Hollis

Here is my fascinating interview with Dr. James Hollis, psychoanalyst and author of several best-selling books including “Swampland of the Soul” and “What Matters Most: Living a More Considered Life.”

Dan:  What is depression?

Jim:   I think first of all we have to differentiate between depressions because it‘s a blanket term which is used to describe many different experiences, different contexts and different internalized experiences of people.  First of all, there is the kind of depression that is driven by biological sources and it is still a mystery as to how that works.  We know it affects a certain number of people in profound ways.   Second, there is reactive depression which is the experience of a person who has suffered loss and as we invest energy in a relationship or a situation and for whatever reason, that other is taken away from us, that energy that was attached to him will invert as depression.  Reactive depression is actually normal.

“Aren’t Your Meds Working?”

A friend I hadn’t seen in months bumped into me at Starbucks.

I’d been standing in line waiting for coffee.  There was a tap-tap on my shoulder. Turning around, I saw my friend, Brian, who, like me, had been a lawyer for over twenty-five years. 

Accomplished and well-connected, Brian had a quiet composure that appeared to follow him wherever he went. I liked him. You could look into his eyes.  And he would look attentively back.  He knew I had struggled with depression.

“How are you?” he said.

“Not so great,” I slumped.

Can Creativity Cure Depression? An Interview With Dr. Carrie Barron

creativity cure book

Dr. Carrie Barron, a board-certified psychiatrist/psychoanalyst on the clinical faculty of the Columbia College of Physicians and Surgeons who also has a private practice in New York City.  She has published in peer-reviewed journals, won several academic awards, and presented original works related to creativity and self-expression at national meetings of the American Psychoanalytic Association. Along with her husband, Alton Barron, M.D., a hand and shoulder surgeon, she co-authored the book, The Creativity Cure: How to Build Happiness with Your Own Two Hands.

Dan:

Why is depression such a problem in our culture?

Carrie:

I think the level of stress has gone up enormously because we have so much to do and we’re on twenty-four hours a day. So I think because of technology, which offers us so many great things, but gives us much to do. I think that’s part of it. I also think, especially for children, we’re in a striving, ambitious, be productive all the time mentality – for children and adults. We need to play, we need to hangout, we need to have spontaneous time. I think spontaneous thought does a lot for alleviating depression and anxiety.

Your Brain on Depression: A Fascinating Interview with Neuroscientist, Dr. Alex Korb

Podcast: Play in new window | Download

 

The following is an edited transcript of the podcast recorded interview with Dr. Alex Korb.  

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 Frisbee 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 anxietymindfulness, physical fitness, and even standup comedy. Welcome to the show.

Do You Need To Take Medication For Your Depression?

Today’s guest post is by Dr. Eve Wood, a psychiatrist who treats patients struggling with depression, anxiety, burnout or extreme stress.

Do you find yourself wondering if you need to be on medications for depression, or hoping you can stop them? If so, you are not alone!

In 1980, Americans filled 30 million prescriptions for antidepressants, and in 2010, 30 years later, the number of prescriptions for antidepressants filled had risen to 264 million in a year!

What are we to make of this? Twenty eight percent of attorneys nationwide are struggling with depression! Why? And, what is to be done about it? In this short blog, I intend to highlight the relationship between stress, burnout, and “depression”, and the role of diagnosis, medical treatments, and other strategies. I encourage you to think broadly about what you can do to make your life better.

What is Depression?               

To be totally clear: We do not really know what depression is! We have a lot of theories, and can identify biological correlates, with some depressive symptoms. And, we do know that a small percentage of people suffer with an incapacitating illness that won’t quit. However, much of what is being called Depression today, is probably Burnout, or a normal response to abnormal stress!

While I am simplifying the diagnostic process a bit, I think you will appreciate the point. We diagnose Depression by establishing that you have a requisite number and type of symptoms, to meet the diagnostic criteria, as laid out in the DSM (Diagnostic and Statistical Manual). Over the course of the last 35 years, there have been 6 iterations of the DSM. As the book has gotten longer, and the number of diagnoses has progressively increased, the “illness” criteria has gotten too loose to be useful.

Before the printing of DSM III, the incidence of depression was quite low, prevalence rate of 1.2% in 1996. After the DSM III was released in 1980, a NIMH study found the prevalence of Depression had risen to 5%. After DSM III-R the prevalence rate had risen to 10 % of the adult population in the United States. And, the rate continues to rise.

In my 35 years in medicine, I have not seen the numbers of people with serious depression, true debilitating symptoms that no one could deny were life-threatening, change much. I have, however, seen a significant escalation in the numbers of people told they “have depression” and consequently get treated with medications.

Today, when you might be dealing burnout, exhaustion, disillusionment, or extreme worry, you are given a clinical diagnosis or two, and prescriptions. This strategy stops you from looking at the precipitants to your distress, and proactively identifying solutions. It also exposes you to “side-effects” or unnecessary risks.

But, Isn’t my Depression due to a Chemical Imbalance in my Brain?

Chances are pretty good you’ve been told that your depression is due to a chemical imbalance in your brain, and medications correct that abnormality. The problem is, all attempts to prove that theory have totally failed.

The fallacy is reinforced by the names given to psychiatric medications. For instance, the term SSRI (selective serotonin reuptake inhibitor) was chosen to imply that the medication inhibits the uptake of a neurotransmitter and thus creates benefit. It originated when the pharmaceutical company SmithKline Beecham, was trying to distinguish its medication Paxil, from its competitor Prozac.

“SSRI” came out of their marketing department and was used to market a new “class” of drug, even though all antidepressants (new and old) have some impact on serotonin. And, we have no idea how significant that impact is! The term SSRI gives rise to cool pictures of neurons and chemicals which can be used to sell drugs.

Do Antidepressants Work?

Clinical trials of antidepressants show that only 1/3 of patients get better in 8 weeks. The other 2/3 respond in part or not at all! And, within 3 years, 75% of the responders have quit treatment, likely due to side effects, cost or diminishing efficacy.

In many studies of antidepressant effectiveness, drugs perform no better than placebo. And, several studies have found that the biggest predictor of response is you believe meds will help, and vice versa!

So, do pills work? At times, yes, and they even save lives. But, they don’t help most people consistently. And, other interventions might be just as good, or better tolerated. Examples with clear anti-depressant efficacy include improved work-life balance, therapy, specific breathing practices, yoga, mindfulness, light exposure, meditation, nutritional interventions, cognitive restructuring techniques, spiritual practice, time in nature and exercise.

What Should You About Medication?

You are probably wondering whether you should be on medicine. The answer is unique to you and your history. That said, here is what I have seen in 35 years of work with attorneys. Many of you are experiencing normal responses to extreme stress. While you have tremendous power to self-heal, rebound, and thrive when episodically stressed, you become depleted, and burned out when the pressures on you are continuous.

The symptoms of burnout; emotional exhaustion, interpersonal disengagement, and a low sense of meaningfulness and accomplishment are very similar to those of depression. And, interventions for burnout, often transform depression symptoms. Most of my clients stop, or massively reduce their medication need, as they tackle burnout, build resilience, decrease stress, and improve their lives.

In choosing your next steps, consider when you last felt well, and your attendant life circumstances. What was working, or gave you joy? Have medicines saved your life, or are you taking pills because you can’t seem to make your life work? Do you need training on techniques and tools to promote well-being, and minimize your need for medications?

If your life is not as you wish, you can change it! You are a gifted, capable person, as evidenced by how far you have come. You can learn evidence-based solutions, to transform what doesn’t work!

Dr. Eve A. Wood helps lawyers and judges dealing with depression, anxiety, burnout and extreme stress learn to transform their lives for well-being, joy and professional fulfillment. She offers practical, science-based programs and coaching that promote whole person healing, decrease stress and depletion, transform anxiety/depression and reduce reliance on medication.

 

 

 

 

 

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