Hope Counts: One Lawyer With Depression’s Testimony

I am a lawyer, as many of you.

I went to law school and passed the bar exam like you.

I also struggle with depression like too many of you,  as well.

A new study by the American Bar Association and the Hazelden Betty Ford Foundation found that twenty-eight percent of over 12,825 practicing lawyers polled reported a problem with depression.  This is over three times the rate found in the general population. When put in perspective, of the 1.2 million attorneys in this country, over 336,000 reported symptoms of clinical depression.

Levels of stress, anxiety, and problem drinking were also significant, with 23%, 19%, and 20.6% experiencing symptoms of stress, anxiety, and hazardous drinking, respectively.

“This is a mainstream problem in the legal profession,” said the study’s lead author, Patrick Krill, director of the Legal Professionals Program at the Hazelden Betty Ford Foundation, and a lawyer himself. “There needs to be

The Struggle: Law Students Suffer From High Rates of Depression and Binge Drinking

The Above the Law website reports: “Once law students graduate, these problems do not improve, but seem to only get worse. According to a study conducted by the American Bar Association and the Hazelden Betty Ford Clinic found, one in three lawyers say they have a drinking problem, and 28 percent of them suffer from depression. Among those who reported problem drinking, 27 percent say their problems started in law school. Read the News

Law Students, Depression & Suicide

In January 2014, CNN reported that lawyers are among the top five occupations associated with suicide. In the summer of 2014, just before the start of the law school academic year, a law professor from the University of Vermont died by suicide. Since then, in a period of eight months, the United States law school community has seen seven law student deaths from suicide. Approximately one suicide per month, and the actual number may be greater than what has been reported by the media and the law schools.

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In the painful days, weeks, and months after a suicide, family members and loved ones often are left with unanswered questions. Many times one of those questions or comments is some version of “I don’t understand why (s)/he did not just ask for help.”

A study published in the American Journal of Psychiatry, it was found that of people aged 35 and younger who died by suicide, only 15% had received mental health treatment within one month of their death by suicide and just 24% had received mental health treatment within one year of their suicide. The study also found that 23% of those who died by suicide who were under 35 visited a primary care doctor within one month of their death and 62% visited a primary care doctor within one year of their death.

While interpretation of statistics should be done with caution, the data suggests that young people at risk for suicide present more often to primary care physicians than mental health professionals. And while this perhaps speaks to the need to better train primary care physicians to recognize warning signs of suicide, it also begs the question just posed: why don’t people who are feeling suicidal reach out for help?

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Based on feedback from law students who attended one of the Dave Nee Foundation’s Uncommon Counsel programs at 35 different schools in the 2013-2014 academic year, 64% agree or strongly agree with the statement that law students do not seek help when needed for fear of the professional consequences. One of our 2L attendees suggested: “…lobby the ABA and character and fitness people to recognize treatment for depression is a good thing, and that legal professionals are people too.” Another 1L attendee noted, “I think it is worthwhile to discuss the stigma associated with seeking mental health services, i.e. perception that s/he ‘can’t hack it’ is weak, thin-skinned, that you’re ‘unstable’ or ‘crazy’. Professional consequences of people knowing this about you, etc.”

While it is easy to point to the ABA and to other systems that may contribute to stigma, it is harder to see systemic change. It is easier to begin with individual change.  Here are some things that you can do beginning right now to help reduce the stigma associated with mental health treatment.

Talk non-judgmentally with anyone you are concerned about:

  • It is OK to ask someone if they need help.
  • It is OK to ask someone if they are thinking about suicide, it will NOT give them the idea.
  • It is NOT OK to say “You are not thinking about suicide are you?” or “What do you have to be depressed about?”
  • It is OK to say, “I have noticed some changes in your behavior, is everything OK?”
  • It is OK to say “It sounds like you are experiencing depression, often times people with depression have suicidal thoughts, are you thinking about suicide?”

Be mindful of language:

  • The term “died by suicide” is preferable to “committed suicide” as the term “commit” has negative connotations.
  • Avoid talking about suicide attempts as “successful or unsuccessful”; there are more suicide attempts in a year than completed suicides.
  • When describing individuals with a mental health diagnosis, try not to define them by that diagnosis. Put the person first, “s/he is a person with bipolar disorder” not “s/he’s bipolar.”

Promote mental health care services:

  • We are encouraged regularly to get a physical exam annually; we are regularly tested for blood pressure, glucose, and BMI.  Why not promote a mental health check up?
  • Visit Screening for Mental Health to find out how to bring an online screening service to your place of employment.

For more tips on how to help someone or for ways you can be involved in reducing stigma please visit the Dave Nee Foundation’s website.

Memories_Dave

June of 2015 will be the 10th anniversary of Dave Nee’s suicide. Dave was a beloved and brilliant brother, friend, son, and student. The suicide of Dave Nee prompted his loved ones, friends, and family to honor Dave’s life and prevent deaths like his from happening again by establishing the Dave Nee Foundation. Ten years later, there is much that the Foundation has done to promote wellness, raises awareness about depression & anxiety, and to prevent suicide in the legal field via law school and state bar association presentations. We know that 97% of our Uncommon Counsel attendees agree or strongly agree that the information learned will help them to recognize the symptoms of depression. We know that 95% of our Uncommon Counsel attendees agree or strongly agree that as a result of the presentation they can identify three warning signs of suicide. Perhaps most importantly, we know that 97% of Uncommon Counsel attendees agree or strongly agree that they know what steps to take if they felt a law student was at risk for suicide. (All data based on 2013-2014 Uncommon Counsel program feedback.)

As much progress and impact we hope we have had, until there are NO news stories of lawyer and law student suicides, we will not be satisfied. We hope that our passion and commitment might inspire other stakeholders, perhaps more powerful ones, like the ABA, the NCBE, law school administrators, and Big Law firms, to take steps towards creating cultural change and help us to destigmatize getting help and treatment for mental health concerns in the legal profession.

By Katherine Bender

Upon graduating from Georgetown University as an English and Theology major, Katherine Bender began teaching at an independent Catholic secondary school for girls in Philadelphia. During this time, she became increasingly interested in the social concerns of young women and decided to pursue a degree in community counseling with a focus on women’s issues at the University of Scranton. After completing an internship providing individual counseling to undergraduate students at a residential college, as part of her Master’s degree in counseling, she began working as a full time mental health counselor for college students in Daytona Beach, Florida.

Recognizing that advocating for students with mental health issues in higher education would likely require a Ph.D., Kate began her doctoral work at Old Dominion University in January of 2011, focused her dissertation on research regarding college student suicide prevention, and in the summer of 2013, successfully completed her doctoral program. She now has a PhD in Counseling, Counselor Education & Supervision.

She joined the team at the Dave Nee Foundation as Programming Consultant in September of 2012 and became Programming Director in September 2013. In this role, she leads the Uncommon Counsel program and LawLifeline. She sees her role with the Dave Nee Foundation as an excellent way to continue to provide outreach services and to raise awareness about depression, anxiety, and suicide prevention for higher education students.

You can reach Kate by email at Kbender@daveneefoundation.org

 

 

In the Beginning: Depression in Law Schools

Everything has a beginning:  the Cosmic Bang, the French Revolution and depression in the legal profession.

There is little doubt that for many, depression begins in law school. One study of law students found they suffered from depression at the same rate as the general population before entering law school. Just two months into the school year, however, their negative symptom levels had increased dramatically.  By the spring of their first year, 32% of the same law students were depressed. By the spring of their third year, the number had risen to 40%.  Two years after graduation, 17% of the students – about twice the rate of depression experienced by the general population – were still depressed.  Such elevated levels of depression have been corroborated by later studies.

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Plug in these stats and an estimated 30,000 to 60,000 of this country’s 150,000-law students struggle with depression at some point during their law school experience

Andy Benjamin, J.D., Ph.D., the lead researcher in the above study and others that have looked at law student and lawyer depression, wrote me recently:

Since the publication of our research about law student and lawyer depression, depression still runs rife for law students and practicing attorneys – nearly a third of all law students and lawyers suffer from depression.  The data to support this statement have been published since the early eighties when the studies were first conducted.  Several subsequent empirical studies have corroborated the grim findings up until 2010.  As the stress, competition, and adversarial nature of the profession have continued to take their toll, not surprisingly, the rates of depression have not changed.  Law students and lawyers remain at the greatest risk for succumbing to depression, more so for any other profession.  After nearly forty years of compelling evidence about the prevalence of the severity of depression for the legal profession of law, more meaningful systematic changes must be implemented throughout the professional acculturation process of law students and lawyers.

It’s difficult for the legal establishment to face all of this. William M. Treanor, immediate past dean of Fordham Law School, told The New York Law Journal “Depression is a very important issue that often gets swept to the side.  It’s a real concern and a problem in the legal profession. Studies indicate that it is common among law students and common among lawyers. Given that, it’s important to try to figure out ways to combat it and to let people know if they are suffering, they are not alone.”

As author Kathleen Norris wrote, “The religion of America is optimism and denial.”  We’re a nation of suck-it-uppers; a people who drive their inner pain deeper and deeper into themselves until they break. The denial of depression in the law is both institutional and individual.

In “The Institutional Denial About the Dark Side of Law School,” Florida State University Law Professor Lawrence Krieger wrote:

There is a wealth of which should be alarming information about the collective distress and unhappiness of our [law] students and the lawyers they become.  We appear to be practicing a sort of organizational denial because, given this information, it is remarkable that we are not openly addressing these problems among ourselves at faculty meetings, and in committees and without students in the context of courses and extracurricular programs.  The negative phenomena we ignore are visible to most of us and are confirmed by essentially unrebutted empirical evidence.

Attorney Andrew Sparkler, a friend of then fellow Fordham law student David Nee who suffered from depression (unbeknownst to his friends) and committed suicide in his third year of law school, observed, “To admit that you are depressed [in law school], to yourself or to others . . .  , is a weakness and if you’re in a shark tank of hyper-aggressive folks around you, you’d be hesitant to expose it because why would you fess up to anyone that you have a problem?” Sparkler, his friends and the Nee family started the Dave Nee Foundation to address law student depression and suicide.

It doesn’t get much better when one graduates and enters the job market.  A John Hopkins study looked at 104 occupations to determine which ones had the highest incidence of depression.  Lawyers topped the list and were found to suffer from depression at a rate of 3.6 times that of other profession studies.  Other studies have found that about 20 percent of all lawyers struggle with depression.

Plug in these stats and an estimated 200,000 of this country’s 1 million lawyers are hurting.

Obviously, something is really rotten in Denmark.

There have been several theories bantered about as to why law students suffer from such high rates of depression: pessimistic thinking styles taught in law school (“learning to think like a lawyer”), personality types that go to law school, a breakdown in inner values and the current nasty economy and stress to find and maintain a good job.  The New York Times ran an article, No Longer Their Golden Ticket, – I was interviewed for this one – which spoke about the stress and uncertainty that law school students’ face:

“[The] days of [high pay and full employment] are over. As the profession lurches through the worst economic slump in decades, with jobs and bonuses cut and the internal pressures to perform rising, associates do not just feel as if they are diving into the deep end, but rather, drowning.”

However, there has been pushback against the theory that law school even causes much psychic damage.

In an article by University at Michigan Law Professor James White entitled Maiming the Cubs, he takes issue with Professor Krieger theory and argues that the law school experience does not “. . . cause permanent and irreversible change and that the ills of lawyers cannot be traced in any meaningful way to the stresses of the three years in law school.”  He concludes:

“I wonder, too, whether the anxiety and depression that we observe in some of our law students is the unavoidable consequence of the challenge of hard learning and of confronting the looming need to prepare to behave like a lawyer.  Soon after they come to law school, students must sense that however hard Contracts and Torts is, learning to be a successful practicing lawyer is harder, and that the road to success in the profession is even less clearly marked than the road to law school success.”

Sorry, I just don’t agree.

My take on law school depression

I think we must look at what makes people more vulnerable to depression before they enter law school – those 10% who already have depression or are at risk for developing it before they register for their first 1L class. For most, there is a genetic or family history of depression. Likewise, there is a history of family dysfunction: for example, alcoholism, physical and emotional abuse and/or neglect.   These folks bring those major risk factors into law school. It is my view that law school doesn’t cause depression; rather, it may be the straw that breaks the camel’s back for those who already have some risk for it. 

Pessimistic thinking and persistent stress , both powerful dynamics in law school, are known triggers for depression.  When these influences are mixed in with other pre-law school risk factors, law school creates a “perfect storm” for depression to happen.

We tend to mix up law student unhappiness and dissatisfaction with depression.

They’re not the same thing; not even close. Unhappiness and discontent are relatively transitory; other emotions aren’t pushed to the margins or extinguished. We are adaptable in response to our environment. We might feel stressed or exasperated by the law school grind, but everyone bumps up and down throughout their days.  We deal with our stress and balance ourselves out either with exercise, socializing or just by having stress resilient genes.  Not so with depression.  Richard O’Connor, Ph.D., in his best-selling book, Undoing Depression, writes:

“We confuse depression, sadness, and grief.  But the opposite of depression is not happiness, but vitality—the ability to experience a full range of emotion, including happiness, excitement, sadness, and grief.  Depression is not an emotion itself. It’s not sadness or grief, it’s an illness.  When we feel our worst, sad, self-absorbed, and helpless, we are experiencing what people with depression experience, but they don’t recover from those moods without help.”

There is also a biochemical poverty about depression; the scarcity of neurochemicals like serotonin and dopamine that wreck havoc in our brains and set the stage for depression.  As I wrote in Trial magazine about the connection between stress, anxiety and depression, the grind isn’t just about long hours in the office or law library cubicle, but the grinding up of our nervous systems.

We have a sense that such a lifestyle can be problematic to our happiness, but we’re willing to keep marching to that beat in the hope of later rewards (e.g. money, security, partnership). Yet, I can’t help but think that we’re dimly aware, if at all, of the risk we put ourselves in for major depression.

Besides the psychological-physiological links to depression, we live in a culture that breeds melancholy.  How could this not eek its way into the law school experience?

Maybe it’s the moral and spiritual bankruptcy of our times; the torpor of the imagination which fails to inspire our young people, to live an engaged and spirited life in the law, or the cynicism to think that such a life is even possible that worries me. Or, by the time young people get to law school, they’re so jaded by our consumer driven culture they just want the diploma to start making the big bucks. All of this contributes to depression, to a lonely society that undermines what it means to live a decent, healthy and happy life.

In 2008 the American Bar Association launched a Mental Health Initiative to address mental health problems on law school campuses.  See the Mental Health Toolkit for Student Bar Organizations and Administrators distributed as part of this effort.  Such initiatives’ involve mental health days (e.g. check out Marquette Law School) where they had out a document from Professor Krieger called The Hidden Sources of Law School Stress, “wellness” web pages on law school websites (e.g. check out the one at Harvard Law School) and referrals to a school’s counseling center (e.g. check out Cornell Law School).

While laudable, they’re an arm’s length effort to confronting such a deeply personal and painful human experience.  Moreover, it seems like any presentation on the issue of depression in law schools is limited to first year orientation. What about the second and third year students? Studies conclude that depression rates continue to rise into the second and third year.  If that’s true, what is being done to help these students?  Another query: Just how many of the people who speak at these programs are law students or lawyers who actually had or are currently suffering from depression and disclose it?  My hunch is few, if any.

Why should that matter?  Because students need to hear it — they need to listen to someone in the trenches of a profession they’ll soon be entering.  Without such depression experiences, a speaker is like someone trying to enlighten someone about the dangers of smoking and cancer, but has never smoked. Wouldn’t it be a more powerful, credible and informative experience for students to listen to a law student and/or a practicing lawyer, who has depression and is willing to talk about it?

Instead, students are served up programs, usually offered up by well-meaning Dean or Vice-Deans of Student Affairs and therapists from a University’s Counseling Center. There’s a lump-it-all-together approach to it all.  I was asked a few years back, when I was just beginning my advocacy work, to give a brief, 15-minute talk on depression. The school trotted out a variety of people in fifteen minute increments to talk about stress, drinking, drugging and, eventually, depression. Speaking in that big first year classroom, I was reminded of the ancient Greek amphitheaters.  Many of the Greek dramas were tragedies.  And make no doubt about it, depression is a tragedy.

I was saddened by the whole charade, the paucity of imagination and effort that went into addressing such a critical problem; the let’s pool this list of mental ills together into a small program on “mental health.”  I sensed that the students failed to see how any of this was connected to them.  The sliver of time allocated to depression couldn’t help but leave the students with the impression that the school really didn’t take the problem that seriously.

Over 130 million people suffer from depression worldwide on a planet where it is the leading cause of disability. In our country, it’s also the leading cause of disability and some 20 million people are afflicted.  It’s been characterized as an “epidemic.”  If that’s true, what does that say about the higher rates of law student and lawyer depression?  Just what adjective could one use to describe the scope of the problem?

 Addressing Depression In Law School – Really

Here’s what can be done right now:

1. Law Schools – show the thirty minute documentary, “A Terrible Melancholy: Depression in the Legal Profession.”   Copies of the film on DVD are available form the Erie County Bar Association. A trailer of the film is on this website.

2. Have someone come in to speak to the students that are in the legal profession who has suffered from depression to reach these students.  Give it more than 15 minutes of your time and have programs for second and third year student on this critical topic.

3. Law Students – show up, watch the film and think long and hard about it.

Finally, I want to urge all of you reading this blog to write in and express your views about your law school experience, whether you’re in school now or it’s been thirty years.  There’s much to be gained by such sharing. Please write.

Further reading:

Todd David Peterson & Elizabeth Waters Peterson, Stemming the Tide of Law Student Depression: What Law Schools Need to Learn from the Science of Positive Psychology, 9 YALE JOURNAL OF HEALTH POLICY & ETHICS (Summer, 2009); Susan Daicoff, Lawyer Be Thyself: An Empirical Investigation of the Relationship Between the Ethic of Care, the Feeling Decision-making Preference, and Lawyer Well-being, 16 VIRGINIA JOURNAL OF SOCIAL POLICY & LAW (2008-2009); Patrick J. Schlitz, On Being a Happy, Healthy, and Ethical Member of an Unhappy, Unhealthy, and Unethical Profession, 52 VANDERBILT LAW REVIEW 871 (1999) and Depression and Anxiety in Law Students: Are We Part of the Problem and Can We Be Part of the Solution?, 8 JOURNAL OF LEGAL WRITING INSTITUTE 229 (2002).

 

 

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