True Stories: A Lawyer With Depression’s Journey from Pain to Mental Health Advocacy

 

“True Stories” is a series of guest blogs I am running. Below, Gavin Alexander bravely tells his story of a journey from Harvard and Biglaw to becoming a champion for mental health and well-being in the legal profession.  

I felt comfortable enough to come out as bisexual when I was 16.  I didn’t feel comfortable enough to come out as suffering from depression until I was 30.  As a result, while I was pretty darn sure from around age 12 that the symptoms I was experiencing were tied to mental illness, I did not seek or receive any kind of treatment or mental health support until I was 5 years into my practice as a lawyer.  I was petrified that leaving any sort of “paper trail” of having received mental health treatment would place a cap on my ambitions, limit my career prospects, or even cause me to lose the support of my family and friends.

During my time in law school, I thought about killing myself nearly every day of every exam and study period. I believed, based on messaging I received from law school career services offices, law professors, and the legal media, that anything short of massive success would result in abject poverty and an inability to repay my over $200,000 of student loans.  I wound up finishing my 1L year at Boston University School of Law with the number 1 GPA in my section of over 80 students, transferring to Harvard Law School, graduating from Harvard in the top 10% of my class with a GPA of 4.02, and securing a clerkship with former Chief Justice of the Massachusetts Supreme Judicial Court (the “SJC”) Ralph Gants.  I provide these details not to brag, but to illustrate that depression and suicidal ideation can affect even those who show all external indicia of success.

True Stories: A Lawyer Tells All About His Traumatic Childhood, Drinking, Depression, and Recovery

“True Stories” is a new series of guest blogs I am running. Too often, lawyers don’t know the burdens other lawyers carry both outside and inside the office. Here’s an unvarnished and anonymous account by one BigLaw lawyer who shares his powerful story. 

I am an attorney with major depression. Understanding this recovery story from mental disease requires a trip back to my childhood, where depression first took root.

When I was nine months old, my mother left me alone with my father, an unpredictable, violent alcoholic. She returned to find a pile of blankets on the living room floor. Underneath, she found me, covered with welts. My father told her that I wouldn’t stop crying, so he hit me until I stopped crying. The physical (and later verbal) abuse continued for several years, as did my ability to accept it without responsive emotion.

At the age of four, I began going to the next-door neighbor’s house for before and after school care. There, the neighbor’s oldest son repeatedly sexually abused me.  He warned me not to tell anyone, so I didn’t.

Growing up in constant fear, I learned to hide all feelings, both good and bad, and keep secrets.

Don’t Let Burnout Get the Best of You

Burnout often results from extended periods enduring the emotional stress precipitated by unaccomplished expectations or failure to fulfill unreasonable demands. The symptoms can include intensified emotional exhaustion, physical fatigue, lowered self-worth, changes in eating and exercising habits, social withdrawal, sleep disorders, anxiety, and depression.

There are specific and reproducible patterns of changing neural activity and brain connectivity associated with the stress buildup that leads to burnout. In the high-stress state subjects’ neuroimaging scans reveal less activity in the higher, reflective brain (Prefrontal cortex/PFC) and more activity in the lower, reactive brain that controls involuntary behaviors and emotional responses.

Prolonged stress correlates with structural increases in the density and speed of the neuron-to-neuron connections in the emotion-driven reactive networks of the lower brain and corresponding decreases connections in prefrontal cortex conscious and reflective control centers.

The explanation of these changes is attributed to the brain’s neuroplasticity defined by the phrase: “neurons that fire together, wire together.” The brain literally rewires to be more efficient in conducting information through the circuits that are most frequently activated.

When stress is frequent, the more frequent activation of the neural pathways to the lower, stress-reactive brain results in their strengthening from enhanced wiring (dendrites, synapses, myelinated axons). These pathways can become so strong that they become your brain’s fast route to its lower, reactive control centers. The stressful, burned out state when the lower, reactive brain is in charge overcomes the calm, reflective, and productive higher neural processing in the (PFC) – the preferred brain locale for control of behavior and emotional self-management.

As your efforts to achieve unreasonable goals are thwarted or increasing demands recur, and the lower brain dominates more frequently, you lose touch with your reflective brain. With less management coming from your reflective PFC, it becomes harder and harder to logically see these challenges in realistic perspective or to solve problems creatively.

Disappointments take on more emotional power and without your higher brain’s perspective, they are interpreted as personal failures. Your self-doubt and stress further activate and strengthen your brain’s involuntary, reactive neural networks. The spiral down to burnout accelerates as these circuits become the automatic go-to networks. Your brain achieves less success in problem-solving and emotional control and ultimately reacts by withholding efforts to escape the burnout state.

Reset Your Brain’s Default Neural Network from Retreat to IGNITE!

The good news is you can apply what we’ve learned from neuroscience about your brain’s survival mode to take actions to retrieve voluntary control of your choices and emotional wellbeing.

You can activate the same neuroplasticity, that gave dominance to the lower brain networks in the burnout state, to construct a new, stronger positive default response. With increasing successful experiences in achieving goals, you can reset the circuits to redirect your brain to access its highest cognitive resources. You can build up newly improved circuitry switching your responses from retreat to IGNITE for mindful awareness and creative problem-solving!

Since an effort-failure pattern sets up the brain’s survival response to withhold effort, you’ll need to strengthen your brain’s recognition that effort toward your goals can result in success. Your weapon of mass reconstruction can come from your brain’s very powerful drive for its own intrinsic neurochemical reward— dopamine and the deeply satisfying and motivating pleasure it brings. When the brain releases dopamine in rewarding bursts, you experience a deep intrinsic satisfaction along with increased motivation, curiosity, perseverance, and memory. Dopamine is particularly released when your brain recognizes that you’ve achieved a challenge (from the “I get it” of figuring out a joke to the satisfaction of completing a marathon).

To get the dopamine-pleasure response from challenges achieved, you’ll need to plan for your brain to experience frequent recognition (feedback awareness) of incremental progress. The choices of what you set as a goal should be guided by their desirability and the goal’s suitability to be broken down into clear segments. You want to set goals, the progress of which, you can chart or easily recognize with each stepwise challenge and success. The pleasure burst of dopamine’s intrinsic motivation accompanying your brain’s recognition of each progressive increment achieved in the goal pathway will keep you motivated to persevere.

Goal Buy-In for Your Brain’s Neural REWIRING

Buy-in and relevance are important in choosing your rewiring goal. Since your goal is to rewire your brain’s expectations that your goal efforts do yield progress, despite increasing challenge, you need to really want the goal. This is not the time to challenge yourself with something you feel you should do, but won’t really look forward to, such as dieting, climbing stadium stairs, or flossing after every meal.

The idea of planning and achieving goals as a burnout intervention is probably not new to you. These are likely to be activities you’ve considered but didn’t do for the obvious reason. They take time. when it comes to adding another activity to your schedule, past experiences have left you with the expectation that there is not enough time.

These first goals that can provide ongoing awareness of your progress are often tangible (visible, such as planting a garden or making pottery on a wheel, or auditory such as playing an instrument, or physical such as learning tai chi), but your goal can also be spending more time on something you already do, but want to do more frequently or successfully, such as journaling, practicing yoga, or sketching.

You’ll Find Your Own Goal for Buy-In, but Here are Some Examples of Planning 

Physical goals: Notice I didn’t say exercise. That’s not as motivating as “training” for a physical goal you want to achieve, even though they often overlap. If you want to run a 10K, and you enjoy running, the goal for an achievable challenge could first be building up to the distance starting with your baseline distance you comfortably run now. Then, plot out the increments that you’ll consider progressive successes, such as adding 100M each day or a week (with increments based on what you consider both challenging and achievable). Once you reach 10K goal, speed can become the next goal again plotted out in segments of incremental progress before you start.

Hobbies: From woodworking to shooting wooden arrows, hobbies really are opportunities for brain rewiring. Again, plan your stepwise achievable challenge increments. If you select darts, start with a home dartboard—low initial investment and throw from a close, but challenging distance at first. As you get better in accuracy move back further. Record your results with the notations of the distance of each improvement you set as an achievable challenge. If you get so good that you are no longer challenged by the dartboard, try that archery!

Mindfulness and meditation are certainly positive interventions for burnout and will be topics of a subsequent blog.

Your Rewired Brain’s Default Changes from Defeat to Ignite

With your understanding of what happened in your brain to create the hopeless frustration of burnout, you’ll hopefully have more positive expectations to help you put in the effort to try (or retry) suggested interventions. Your own natural dopamine-reward system will then be at work deconstructing the resistance network built by your burnout as you reset your circuits of motivation.

The repeated experiences of dopamine-reward you’ll experience as you monitor your goal progress will literally change your brain’s circuitry. Repeated effort-reward experiences promote the neuroplasticity creating neural networks that expect positive outcomes in your new default network. This is because your brain will build stronger connections into the memory pattern. The expectation in achieving this challenge will bring pleasure. As with other less used networks, the previous lower brain stress-activated go-to response network you developed in burn-out, that caused you to react negatively to stressors, will be pruned away from disuse.

You’ll be rewired with optimism and renew positive expectations about your self-efficacy. With your higher, reflective brain back in control, as you access your perseverance, innovation, and creative problem-solving when you need them.

Just be sure to take the time to break down big challenges into opportunities to recognize incremental progress as you achieve each small step en route to your goals. With that positive recharge, your well-deserved dopamine reward will sustain your brain’s motivated perseverance on to the next step of the path to your goals.

By Judy Willis, M.D., M.E

Dr. Willis is a board-certified neurologist and middle school teacher, specializing in brain research regarding learning and the brain. After graduating Phi Beta Kappa as the first woman graduate from Williams College, Willis attended UCLA School of Medicine where she was awarded her medical degree. She remained at UCLA and completed a medical residency and neurology residency, including chief residency. She practiced neurology for 15 years before returning to university to obtain her teaching credential and master’s of education from the University of California, Santa Barbara. She then taught in elementary and middle school for 10 years and currently is on the adjunct faculty of the Graduate School of Education, University of California, Santa Barbara.

This article first appeared in Psychology Today magazine

The Role of Anger in Depression

Sigmund Freud used to refer to depression as anger turned inward. While many people may regard this as an overly simplistic approach to the most common mental health disorder in the world, there is no doubt that anger plays a significant role in depression. As one study from 2016 found, when it comes to emotional disorders in general, the presence of anger has “negative consequences, including greater symptom severity and worse treatment response.” Researchers concluded that “based on this evidence, anger appears to be an important and understudied emotion in the development, maintenance, and treatment of emotional disorders.” When it comes specifically to depression, science seems to be further supporting Freud’s theory, showing more and more how anger contributes to symptoms. A UK study from 2013 suggested that going inward and turning our anger on ourselves contributes to the severity of depression.

Having worked with depressed clients for more than 30 years, these findings were not surprising to me. Many of the people I’ve worked with who struggle with depression also share the common struggle of turning their anger on themselves. As much as I try to help my clients express their anger rather than take it on and turn it inward, I witness first-hand how hard it often is for people to interrupt this process. It’s a challenge for them to recognize the nasty way they treat themselves; they are significantly more critical of themselves that they are of others.

People who suffer from depression often have intense “critical inner voices” that perpetuate feelings of unworthiness and shame. When they listen to this inner critic, they not only feel more depressed, but they also find it much more difficult to stand up to their depression. This includes acting against their critical inner voices, taking positive actions that could help them feel better about themselves (like engaging in activities they enjoy), and being more social.

Getting angry at these “voices” can be liberating, but that means getting in touch with our core feelings of anger rather than aiming it at ourselves. Dr. Les Greenberg, the founder of Emotionally Focused Therapy, describes an important difference between adaptive anger and nonadaptive anger. Anger is an adaptive response when it motivates you to assertive action to end a violation. For example, when we may feel angry at the cruel way we treat ourselves today, we’re in touch with our adaptive anger, and we feel like we’re on our own side. Letting ourselves feel and express adaptive anger can help us feel less burdened, freer, and more in touch with our real self.

Maladaptive anger, on the other hand, affects us negatively. For one thing, it can contribute to feeling victimized, sulky, or stuck in a feeling of being wronged. Examples of maladaptive anger turned inward can include feeling overly critical toward ourselves, hating ourselves, or seeing ourselves as powerless, pathetic, or helpless. The generally dysfunctional responses that result from maladaptive anger are based on emotional schema from traumatic experiences in our past. Often, our critical inner voice is at the root of maladaptive anger, driving us to remain in a state of frustration and suffering.

We can almost feel the difference between maladaptive anger dragging us down and deeper into a state of anxiety or depression and adaptive anger relieving us of a heavy burden, lightening us emotionally, and contributing to our taking constructive actions. While it can feel scary to face these deeper, core emotions, we must access adaptive emotions to transform our maladaptive emotions. This can be a vital process in helping us deal with depression.

One study by Dr. Greenberg showed that Emotionally Focused Therapy can transform maladaptive emotion through the process of expressing it and eliciting the response of an adaptive emotion, i.e. adaptive anger. This approach was especially effective in improving depressive symptoms, interpersonal distress, and self-esteem. As Dr. Greenberg described it, the process “aims within an affectively attuned empathic relationship to access and transform habitual maladaptive emotional schematic memories [articulated as critical inner voices] that are seen as the source of the depression.” Transforming these maladaptive emotions may, therefore, be one of the keys to fighting depression.

Our approach to transforming anger turned inward, which has some similarities to Greenberg’s approach, is to have the person verbalize their critical inner voices as though someone else was telling them these angry thoughts. We also encourage the person to express the feeling behind the thoughts. Often, when people do this, they express a lot of rage toward self. By saying the thoughts in the second person (as “you” statements), they begin to get some separation from their harsh, critical attitudes, and often have insights about where these thoughts come from. It sets the stage for them “answering back” to these attacks and taking their own side. The goal is also to help the person develop more self-compassion and a kinder, more realistic point of view toward themselves.

As we externalize our negative thoughts and the accompanying anger, we can better stand up to our inner critic and take a compassionate stance toward ourselves, treating ourselves as we would treat a friend. This doesn’t mean denying our struggles and setbacks, but it does mean embracing the practice of self-compassion. Self-compassion, as defined by researcher Kristin Neff, involves three key elements: self-kindness, mindfulness, and awareness of common humanity. Research has shown that the practice of self-compassion can significantly reduce a depressed mood. As one study pointed out, maladaptive or irrational beliefs underlie the development of depression, however, when high levels of self-compassion helped to counteract these negative thoughts, there was no longer a significant relationship between irrational beliefs and depression. This same study showed that it is “especially the self-kindness component of self-compassion that moderated the irrational belief-depression relationship.” Thus, the primary aim for someone struggling with resolving their emotions around depression is to treat themselves and regard their feelings the way they would a friend. It’s not about feeling sorry for ourselves, but about feeling strong and worthy and less afraid to make mistakes.

Ultimately, accepting that anger plays a role in our depression should be an empowering tool in our fight to feel better. When people express anger outwards in a healthy adaptive manner, they feel less depressed. Accessing and expressing this anger isn’t a matter of acting out, being explosive, or feeling bitter toward our surroundings. In fact, it means exactly the opposite. It’s an act of standing up for ourselves and accepting that we are not who our “voices” are telling us we are. It’s a process of facing up to the things that hurt us but also facing off against the inner enemy we all possess that drives us deeper into our suffering. The more we can take our own side and resist our tendency to turn our anger on ourselves, the more compassionate and alive we can feel in facing any challenge, including depression.

Lisa Firestone, Ph.D., is a clinical psychologist, author, and the Director of Research and Education for the Glendon Association. She studies suicide and violence as well as couples and family relations. Firestone is the co-author (with Robert Firestone and Joyce Catlett) of Conquer Your Critical Inner Voice, Creating a Life of Meaning and Compassion, and Sex and Love in Intimate Relationships. Firestone speaks frequently at conferences including the APA, the International Association of Forensic Psychology, International Association of Suicide Prevention, the Department of Defense and many others. She has also appeared in more than 300 radio, TV, and print interviews including the BBC, CBC, NPR, the Los Angeles Times, Psychology Today, Men’s Health and O Magazine.

 

 

Rewire Your Burned-out Brain

Burnout often results from extended periods enduring the emotional stress precipitated by unaccomplished expectations or failure to fulfill unreasonable demands. The symptoms can include intensified emotional exhaustion, physical fatigue, lowered self-worth, changes in eating and exercising habits, social withdrawal, sleep disorders, anxiety, and depression.

If You’re Burned Out, Your Brain Has Rewired to Survival Mode

There are specific and reproducible patterns of changing neural activity and brain connectivity associated with the stress buildup that leads to burnout. In the high-stress state subjects’ neuroimaging scans reveal less activity in the higher, reflective brain (Prefrontal cortex/PFC) and more activity in the lower, reactive brain that controls involuntary behaviors and emotional responses. Prolonged stress correlates with structural increases in the density and speed of the neuron-to-neuron connections in the emotion-driven reactive networks of the lower brain and corresponding decreases connections in prefrontal cortex conscious and reflective control centers.

The explanation of these changes is attributed to the brain’s neuroplasticity defined by the phrase: “neurons that fire together, wire together.” The brain literally rewires to be more efficient in conducting information through the circuits that are most frequently activated.

When stress is frequent, the more frequent activation of the neural pathways to the lower, stress-reactive brain results in their strengthening from enhanced wiring (dendrites, synapses, myelinated axons). These pathways can become so strong that they become your brain’s fast route to its lower, reactive control centers. The stressful, burned out state when the lower, reactive brain is in charge overcomes the calm, reflective, and productive higher neural processing in the (PFC) – the preferred brain locale for control of behavior and emotional self-management.

As your efforts to achieve unreasonable goals are thwarted or increasing demands recur, and the lower brain dominates more frequently, you lose touch with your reflective brain. With less management coming from your reflective PFC, it becomes harder and harder to logically see these challenges in realistic perspective or to solve problems creatively.

Disappointments take on more emotional power and without your higher brain’s perspective, they are interpreted as personal failures. Your self-doubt and stress further activate and strengthen your brain’s involuntary, reactive neural networks. The spiral down to burnout accelerates as these circuits become the automatic go-to networks. Your brain achieves less success in problem-solving and emotional control and ultimately reacts by withholding efforts to escape the burnout state.

Reset Your Brain’s Default Neural Network from Retreat to IGNITE!

The good news is you can apply what we’ve learned from neuroscience about your brain’s survival mode to take actions to retrieve voluntary control of your choices and emotional wellbeing.

You can activate the same neuroplasticity, that gave dominance to the lower brain networks in the burnout state, to construct a new, stronger positive default response. With increasing successful experiences in achieving goals, you can reset the circuits to redirect your brain to access its highest cognitive resources. You can build up newly improved circuitry switching your responses from retreat to IGNITE for mindful awareness and creative problem-solving!

Since an effort-failure pattern sets up the brain’s survival response to withhold effort, you’ll need to strengthen your brain’s recognition that effort toward your goals can result in success. Your weapon of mass reconstruction can come from your brain’s very powerful drive for its own intrinsic neurochemical reward— dopamine and the deeply satisfying and motivating pleasure it brings. When the brain releases dopamine in rewarding bursts, you experience a deep intrinsic satisfaction along with increased motivation, curiosity, perseverance, and memory. Dopamine is particularly released when your brain recognizes that you’ve achieved a challenge (from the “I get it” of figuring out a joke to the satisfaction of completing a marathon).

To get the dopamine-pleasure response from challenges achieved, you’ll need to plan for your brain to experience frequent recognition (feedback awareness) of incremental progress. The choices of what you set as a goal should be guided by their desirability and the goal’s suitability to be broken down into clear segments. You want to set goals, the progress of which, you can chart or easily recognize with each stepwise challenge and success. The pleasure burst of dopamine’s intrinsic motivation accompanying your brain’s recognition of each progressive increment achieved in the goal pathway will keep you motivated to persevere.

Goal Buy-In for Your Brain’s Neural REWIRING

Buy-in and relevance are important in choosing your rewiring goal. Since your goal is to rewire your brain’s expectations that your goal efforts do yield progress, despite increasing challenge, you need to really want the goal. This is not the time to challenge yourself with something you feel you should do, but won’t really look forward to, such as dieting, climbing stadium stairs, or flossing after every meal.

The idea of planning and achieving goals as a burnout intervention is probably not new to you. These are likely to be activities you’ve considered but didn’t do for the obvious reason. They take time. when it comes to adding another activity to your schedule, past experiences have left you with the expectation that there is not enough time.

These first goals that can provide ongoing awareness of your progress are often tangible (visible, such as planting a garden or making pottery on a wheel, or auditory such as playing an instrument, or physical such as learning tai chi), but your goal can also be spending more time at something you already do, but want to do more frequently or successfully, such as journaling, practicing yoga, or sketching.

You’ll Find Your Own Goal for Buy-In, but Here are Some Examples of Planning 

Physical goals: Notice I didn’t say exercise. That’s not as motivating as “training” for a physical goal you want to achieve, even though they often overlap. If you want to run a 10K, and you enjoy running, the goal for an achievable challenge could first be building up to the distance starting with your baseline distance you comfortably run now. Then, plot out the increments that you’ll consider progressive successes, such as adding 100M each day or a week (with increments based on what you consider both challenging and achievable). Once you reach 10K goal, speed can become the next goal again plotted out in segments of incremental progress before you start.

Hobbies: From woodworking to shooting wooden arrows, hobbies really are opportunities for brain rewiring. Again, plan your stepwise achievable challenge increments. If you select darts, start with a home dartboard—low initial investment and throw from a close, but challenging distance at first. As you get better in accuracy move back further. Record your results with the notations of the distance of each improvement you set as an achievable challenge. If you get so good that you are no longer challenged by the dartboard, try that archery!

Mindfulness and meditation are certainly positive interventions for burnout and will be topics of a subsequent blog.

Your Rewired Brain’s Default Changes from Defeat to Ignite

With your understanding of what happened in your brain to create the hopeless frustration of burnout, you’ll hopefully have more positive expectations to help you put in the effort to try (or retry) suggested interventions. Your own natural dopamine-reward system will then be at work deconstructing the resistance network built by your burnout as you reset your circuits of motivation.

The repeated experiences of dopamine-reward you’ll experience as you monitor your goal progress will literally change your brain’s circuitry. Repeated effort-reward experiences promote the neuroplasticity creating neural networks that expect positive outcomes in your new default network. This is because your brain will build stronger connections into the memory pattern. The expectation in achieving this challenge will bring pleasure. As with other less used networks, the previous lower brain stress-activated go-to response network you developed in burn-out, that caused you to react negatively to stressors, will be pruned away from disuse.

You’ll be rewired with optimism and renew positive expectations about your self-efficacy. With your higher, reflective brain back in control, as you access your perseverance, innovation, and creative problem-solving when you need them.

Just be sure to take the time to break down big challenges into opportunities to recognize incremental progress as you achieve each small step en route to your goals. With that positive recharge, your well-deserved dopamine reward will sustain your brain’s motivated perseverance on to the next step of the path to your goals.

Dr. Judy Willis is a board-certified neurologist and middle school teacher, specializing in brain research regarding learning and the brain. With a unique background as both a neurologist and classroom teacher, she writes extensively for professional educational and parenting journals and has written six books about applying the mind, brain, and education research to classroom teaching and parenting strategies. The Association of Educational Publishers honored Dr. Willis as a finalist for the Distinguished Achievement Award for her educational writing. Check out her website.

 

 

‘Better Call Saul’ Highlights Stress and Mental Illness in the Legal Profession

The ABA Journal reports: “Chuck McGill’s suicide in Better Call Saul reflects what is happening within the legal profession throughout the United States. But anxiety and depression are not confined to practicing lawyers. A study of law school students at Yale University found that 70 percent admitted to suffering from some form of mental health issues. Eighty percent of those respondents considered help, but only half of them actually sought it out. Read the article.

 

SHUTDOWN: WHY PEOPLE WITH DEPRESSION FEEL SO NEGATIVE

Depression is a state of shutdown in which an individual’s psychological system shifts toward negative feeling states and diminishes the positive feeling states. The hallmark features of a depressive episode is a high negative mood state (characterized primarily in terms of depressed/demoralized/defeated/despairing feelings and secondarily in terms of anxiety, irritability/defensive hostility, and guilt/shame) and a diminished positive mood state (loss of interest, pleasure, energy, desire, and excitement).

Why do people get depressed? The primary reason people enter depressive shutdowns because they cannot obtain the necessary psychological nourishment needed to energize their behavioral investment system. Think of it as being akin to a state of starvation, only instead of physiological nutrition, the individual is lacking psychological nutrition. What is psychological nutrition? The fundamental principle that underlies psychological organization is that of behavioral investment. The psychological system is organized to direct mental energy and action toward investments that offer a return on those expenditures. When one is a getting a good return on one’s investments, then one feels fulfilled, energized and engaged. However, when one is not getting a good return, one begins to feel frustrated, anxious, irritable, or disappointed. If one cannot find an effective pathway for getting one’s needs met, one begins to enter into a state of psychological shutdown called depression.

So what are the core psychological needs that people have that need to be nourished? There are many different possible classification systems of needs (and motives and goals that people seek fulfillment around, see, e.g., here). I offer five categories here that overlap loosely with Maslow’s classic hierarchy of needs.

Safety and Security Needs. First and foremost, the psychological investment system is concerned with basic safety and survival. If one’s physical safety is chronically threatened, if one is in constant pain, if one is chronically hungry, and so forth, the attention of the system will largely be focused here.

The Base Pleasures. Good sex, tasty food, relaxing on a warm summer day on the beach after working hard. The “hedonic” pleasures serve as a fundamental reward and signal positive investments (at least in the short term). Good investment systems are generally characterized by meaningful effort and hard work toward a productive goal, followed by short periods of relaxing and enjoying the base pleasures.

Relational Needs. Our core psychosocial need is to be known and valued by important others. Most notably, this includes being known and valued by members of our family of origin, friends/peers, romantic partners, and community. Needs for relational value are reflective of one’s degree of social influence. And folks go about achieving social influence and relational value in different ways. For example, see here for power and achievement needs relative to belonging and intimacy needs.

Developmental Growth Needs. We can think about an individual’s psychological system as being akin to an investor’s portfolio. An investor has resources that have the potential for growth and loss. An investor with a diverse portfolio whose investments are growing in a way that is exceeding expectation is flourishing. The same is true for an individual. Each individual will have “personal projects” that are engagements they are involved in that afford opportunities for growth (hobbies, interests, creative and playful endeavors, meaningful work projects, etc.). If an individual is chronically stuck and not growing or is largely cutoff from their growth pathways, or is frequently failing to meet expectations, or is deeply investing in pathways based on extrinsic reasons that are not consistent with their underlying emotional/motivational needs (or intuitive sense of potential), then the investment system is vulnerable.

Existential/Transcendental/Virtuous Needs. Adult humans are meaning-making creatures that need to have a narrative for how their lives and personal projects make sense. As Victor Frankl notes in his timeless classic Man’s Search for Meaning, if they cannot place their suffering, personal projects, virtues and relationships in the context of a larger narrative that provides meaning, then they will be vulnerable to developing a nihilistic attitude, which is the belief that their lives or actions really don’t matter, because really nothing matters. A nihilistic narrative can undercut the emotional value that folks get from engaging in such projects, leading to existential crises or depressions.

Why do people have trouble getting their psychological needs met? Sometimes the answer is obvious. For example, consider the city of Aleppo in Syria. The people of that city have been completely brutalized and many folks there undoubtedly feel depressed. (As an interesting aside, it is worth noting that the field of psychiatry/clinical psychology is divided as to whether such individuals should be considered “clinically depressed”). In other obvious cases, folks get depressed because of chronic pain or illness, or death of a loved one or because they get addicted so substances that ruin their lives or because they are abused or isolated.

Other times the issue is much more complicated. Consider that there are many people that live in nice houses and seem to be surrounded by caring people and are achieving in their lives, yet they also get depressed. Indeed, despite the fact that we have more and more technology and more and more resources and control over our environment, we seem to be struggling more than ever with feelings of depression and anxiety. What is going on in these cases?

The short answer is that I think the modern, fast-paced society is placing many new, unusual stressors on our emotional system. And I don’t think people have been well-educated about how to appropriately process negative feelings. People have been given much more freedom to acknowledge negative feelings than in past generations (read this story to see what I mean), but there has not been good education on how to learn and grow from such feelings (see here or here). What I see in my clinic is that individuals try to avoid negative feelings, and wish everything would just be fine. They often try to act publicly like everything is fine, but they have no idea how to maturely process and learn from their negative feelings. Instead, they enter into an intra-psychic battle with their negative feelings, often working to banish them, or criticize themselves out of their feelings or try to “stay positive”. This creates a powerful “split” in their psychological systems. Namely, their feeling system is sending one signal, their internal narrator is in conflict with that signal, and they are trying to publicly present a totally different image than their inner conflict. All of this sets the stage for a “neurotic breakdown”.

In addition, I see many parents who value their kids, but who do not know how to guide their children in processing negative feelings. Instead, too many have been caught up in “self-esteem nation” and act in an overprotective way, essentially communicating both that their kids are fragile and that others are responsible for keeping you happy. Another group teaches their kids to repress and minimize their feelings. I am not blaming parents here. The modern world is complicated and psychologists and psychiatrists have generally not done a great job being clear about the nature of emotions and relational needs.

At the societal level, we need to recognize both the dramatic changes the information technological revolution has brought to our world and how many of the institutions that provided guidance for the good life are breaking down. Religious systems have lost much of their authority. The political system has broken down into a polarized way. I think our educational system is broken in the way it assesses performance and fails to teach character values. Science often seems to characterize the world as an amoral, meaningless physical system. In other words, in terms of our existential/transcendental understanding, there seems little that supports the deep-seated need that many people have for true meaning making. So, we live in a fast-paced, high-stress world in which we are overloaded with choice, we regularly observe massive amounts of inequity in power and resources, we give lip service to negative feelings but often characterize them as disease states and provide very little real education about human emotions and needs, and institutions that provided deep meaning making systems have lost their authority.

The bottom line is that depression arises, in most cases, when people do not receive the necessary psychological nourishment from their investments. This arises because of brutal environments and injury from traumas, diminished capacities to meet growth expectations, intrapsychic and interpersonal conflict with important others. Unable to find a path forward folks shutdown and, unfortunately, getting depressed in modern society likely creates more problems than it solves. So folks get trapped in neurotic depressive cycles.

There is clearly no easy fix, as depression is a massive health problem. But I do believe there is much that can be done. We need (and can achieve) a much better shared understanding of human psychological needs and nourishment. We also need a clear recognition from institutions like the World Health Organization that depression emerges as a function of psychological malnourishment, rather than being brain disease stemming from neurological malfunctions.

My ultimate vision is for the development of a holistic meaning-making system that harmonizes the natural sciences, the social sciences, and the humanities in a way that affords an understanding of our human natures such that we can have a more effective guide toward fulfillment during these rapidly changing times.

Gregg Henriques, Ph.D., author of A New Unified Theory of Psychology, directs the Combined Clinical and School Psychology Doctoral Program at James Madison University. He is a licensed clinical psychologist with expertise in depressionsuicide, and the personality disorders. He has developed a new meta-theoretical system for psychology articulated in many professional journals and is now applying that system to researching well-being, personality, and social motivation, and he and his students are working on the development of a general system of psychotherapy. Henriques received his M.A. in Clinical/Community Psychology from UNC-Charlotte and his Ph.D. in clinical psychology from the University of Vermont. He also completed several years of post-doctoral training at the University of Pennsylvania under Aaron T. Beck exploring the effectiveness of various cognitive psychotherapy interventions for suicide and psychosis. Henriques teaches courses in personality theory, personality assessment, social psychology and integrative adult psychotherapy.

 

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