It’s not a choice to suffer from depression, but there is a choice in how you react. Read the blog.
From psychologist blogger Deb Serani, Ph.D., a great review of 3 blogs that make your laugh and boost your mental health. Read the Blog
From The New York Times, best-selling author and psychiatrist, Kay Redfield Jamison writes, “Certainly, stress is important and often interacts dangerously with depression. But the most important risk factor for suicide is mental illness, especially depression or bipolar disorder.” Read the News
The unmistakable rise in depression across the globe is unsettling. What explains the it? Read the Blog
If you haven’t experienced depression yourself, there’s a chance you believe some pretty ridiculous things about it. Read the Blog
Most people think of depression as a mental disorder, that is, a biological illness of the brain. Here I argue that the concept of depression as a mental disorder has been unhelpfully overextended to include all manner of human suffering, and, more controversially, that ‘depression’ can even be good for us—an idea that I first visited in my book The Meaning of Madness.
Let us begin by thinking very broadly about the concept of depression. There are important geographical variations in the prevalence of depression, and these can in large part be accounted for by socio-cultural rather than biological factors. In traditional societies human distress is more likely to be seen as an indicator of the need to address important life problems rather than as a mental disorder requiring professional treatment, and for this reason the diagnosis of depression is correspondingly less common. Some linguistic communities do not have a word or even a concept to talk or think about ‘depression’, and many people from traditional societies with what may be construed as depression present instead with physical complaints such as fatigue, headache, or chest pain. Punjabi women who have recently immigrated to the UK and given birth find it baffling that a health visitor should pop round to ask them if they are depressed. Not only had they never considered the possibility that giving birth could be anything other than a joyous event, but they do not even have a word with which to translate the concept of ‘depression’ into Punjabi.
In modern societies such as the UK and the USA, people talk about depression more readily and more easily. As a result, they are more likely to interpret their distress in terms of depression, and also more likely to seek out a diagnosis of the illness. At the same time, groups with vested interests such as pharmaceutical companies and mental health experts promote the notion of saccharine happiness as a natural, default state, and of human distress as a mental disorder. The concept of depression as a mental disorder may be useful for the more severe and intractable cases treated by hospital psychiatrists, but probably not for the majority of cases, which, for the most part, are mild and short-lived and easily interpreted in terms of life circumstances, human nature, or the human condition.
Another (non-mutually exclusive) explanation for the important geographical variations in the prevalence of depression may lie in the nature of modern societies, which have become increasingly individualistic and divorced from traditional values. For many people living in our society, life can seem both suffocating and far removed, lonely even and especially among the multitudes, and not only meaningless but absurd. By encoding their distress in terms of a mental disorder, our society may be subtly implying that the problem lies not with itself but with them, fragile and failing individuals that they are. Of course, many people prefer to buy into this reductive, physicalist explanation than, presumably, to confront their existential angst. But thinking of unhappiness in terms of an illness or chemical imbalance can be counterproductive, as it can prevent us from identifying and addressing the important psychological or life problems that are at the root of our distress.
All this is not to say that the concept of depression as a mental disorder is bogus, but only that the diagnosis of depression has been over-extended to include far more than just depression the mental disorder. If, like the majority of medical conditions, depression could be defined and diagnosed according to its aetiology or pathology—that is, according to its physical cause or effect—such a state of affairs could not have arisen. Unfortunately, depression cannot as yet be defined according to its aetiology or pathology, but only according to its clinical manifestations and symptoms. Given this, a physician cannot base a diagnosis of depression on any objective criterion such as a blood test or a brain scan, but only on his subjective interpretation of the nature and severity of the patient’s symptoms; if some of these symptoms appear to tally with the diagnostic criteria for depression, then, bingo, the physician is able to justify a diagnosis of depression.
One important problem here is that the definition of ‘depression’ is circular: the concept of depression is defined according to the symptoms of depression, which are in turn defined according to the concept of depression. For this reason, it is impossible to be certain that the concept of depression maps onto any distinct disease entity, particularly since a diagnosis of depression can apply to anything from mild depression to depressive psychosis and depressive stupor, and overlap with several other categories of mental disorder including dysthymia, adjustment disorders, and anxiety disorders. One of the consequences of our ‘menu of symptoms‘ approach to diagnosing depression is that two people with absolutely no symptoms in common (not even depressed mood) can both end up with the same unitary diagnosis of depression. For this reason especially, the concept of depression as a mental disorder has been charged with being little more than a socially constructed dustbin for all manner of human suffering.
Let us grant, as the orthodoxy has it, that every person inherits a certain complement of genes that make him more or less vulnerable to entering a state that could be diagnosed as depression (and let us also refer to this state as ‘the depressive position’ to include the entire continuum of clinical depression and other states of depressed mood). A person enters the depressive position if the amount of stress that he or she comes under is greater than the amount of stress that he or she can tolerate, given the complement of genes that he or she has inherited. Genes for potentially debilitating disorders gradually pass out of a population over time because affected people have, on average, fewer children or fewer healthy children than non-affected people. The fact that this has not happened for clinical depression suggests that the genes responsible are being maintained despite their potentially debilitating effects on a significant proportion of the population, and thus that they are conferring an important adaptive advantage.
There are other instances of genes that both predispose to an illness and confer an important adaptive advantage. In sickle cell disease, for example, red blood cells assume a rigid sickle shape that restricts their passage through tiny blood vessels. This leads to a number of serious physical complications and, in traditional or historical societies, to a radically shortened life expectancy. At the same time, carrying just one allele of the sickle cell gene (‘sickle cell trait’) makes it impossible for malarial parasites to reproduce in red blood cells, and thereby confers immunity to malaria. The fact that the gene for sickle cell disease is particularly common in populations from malarial regions suggests that, at least in evolutionary terms, a debilitating illness in the few can be a price worth paying for an important adaptive advantage in the many.
What important adaptive advantage could the depressive position be conferring? Just as physical pain has evolved to signal injury and to prevent further injury, so the depressive position may have evolved to remove us from distressing, damaging, or futile situations. The time and space and solitude that the adoption of the depressive position affords prevents us from making rash decisions, enables us to see the bigger picture, and – in the context of being a social animal – to reassess our social relationships, think about those who are significant to us, and relate to them more meaningfully and with greater compassion. In other words, the depressive position may have evolved as a signal that something is seriously wrong and needs working through and changing or, at least, processing and understanding. Sometimes we can become so immersed in the humdrum of our everyday lives that we no longer have time to think and feel about ourselves, and so lose sight of our bigger picture. The adoption of the depressive position can force us to cast off the Polyannish optimism and rose-tinted spectacles that shield us from reality, stand back at a distance, re-evaluate and prioritise our needs, and formulate a modest but realistic plan for fulfilling them.
Although the adoption of the depressive position can serve such a mundane purpose, it can also enable us to develop a more refined perspective and deeper understanding of ourselves, of our lives, and of life in general. From an existential standpoint, the adoption of the depressive position obliges us to become aware of our mortality and freedom, and challenges us to exercise the latter within the framework of the former. By meeting this difficult challenge, we are able to break out of the mould that has been imposed upon us, discover who we truly are, and, in so doing, begin to give deep meaning to our lives. Many of the most creative and insightful people in society suffer or suffered from depression or a state that may have been diagnosed as depression. They include the politicians Winston Churchill and Abraham Lincoln; the poets Charles Baudelaire, Elizabeth Bishop, Hart Crane, Emily Dickinson, Sylvia Plath, and Rainer Maria Rilke; the thinkers Michel Foucault, William James, John Stuart Mill, Isaac Newton, Friedrich Nietzsche, and Arthur Schopenhauer; and the writers Charles Dickens, William Faulkner, Graham Greene, Leo Tolstoy, Evelyn Waugh, and Tennessee Williams, and many, many others. To quote Marcel Proust, who himself suffered from depression, ‘Happiness is good for the body, but it is grief which develops the strengths of the mind.’
You see, people in the depressive position are often stigmatised as ‘failures’ or ‘losers’. Of course, nothing could be further from the truth. If these people are in the depressive position, it is most probably because they have tried too hard or taken on too much, so hard and so much that they have made themselves ‘ill with depression’. In other words, if these people are in the depressive position, it is because their world was simply not good enough for them. They wanted more, they wanted better, and they wanted different, not just for themselves, but for all those around them. So if they are failures or losers, this is only because they set the bar far too high. They could have swept everything under the carpet and pretended, as many people do, that all is for the best in the best of possible worlds. But unlike many people, they had the honesty and the strength to admit that something was amiss, that something was not quite right. So rather than being failures or losers, they are just the opposite: they are ambitious, they are truthful, and they are courageous. And that is precisely why they got ‘ill’.
To make them believe that they are suffering from some chemical imbalance in the brain and that their recovery depends solely or even mostly on popping pills is to do them a great disfavour: it is to deny them the precious opportunity not only to identify and address important life problems, but also to develop a deeper and more refined appreciation of themselves and of the world around them—and therefore to deny them the opportunity to fulfil their highest potential as human beings.
Neel Burton, M.D.
I was asked to write a guest blog for the PsyWeb website about what I think of others who struggle with depression. The best of my thoughts are summed up by one word: Hero. Read my Guest Blog
Psychiatrist, Neel Burton, argues here that the concept of depression as a mental disorder has been unhelpfully overextended to include all manner of human suffering. Read the Blog
“As to being happy, I fear that happiness isn’t in my line. Perhaps the happy days that Roosevelt promises will come to me along with others, but I fear that all trouble is in the disposition that was given to me at birth, and so far as I know, there is no necromancy in an act of Congress that can work a resolution there.” – Benjamin N. Cardozo, February 15, 1933
Law is a prestigious and remunerative profession, and law school classrooms are full of fresh candidates. In a recent poll, however, 52% of practicing lawyers describe themselves as dissatisfied. Certainly, the problem is not financial. As of 1999, associates at top firms could earn up to $200,000 per year just starting out, and lawyers long ago surpassed doctors as the highest-paid professionals. In addition to being disenchanted, lawyers are in remarkably poor mental health. They are at much greater risk than the general population for depression. Researchers at John Hopkins University found statistically significant elevations of major depressive disorder in only 3 of 104 occupations surveyed. When adjusted for sociodemographics, lawyers topped the list, suffering from depression at a rate of 3.6 times higher than employed persons generally. Lawyers also suffer from alcoholism and illegal drug use at rates far higher than nonlawyers. The divorce rate among lawyers, especially women, also appears to be higher than the divorce rate among other professionals. Thus, by any measure, lawyers embody the paradox of money losing its hold. They are the best-paid professionals, and yet they are disproportionately unhappy and unhealthy. And lawyers know it; many are retiring early or leaving the profession altogether.
Positive Psychology sees three principal causes of the demoralization among lawyers.
First is pessimism, defined not in the colloquial sense (seeing the glass as half empty) but rather as the pessimistic explanatory style. These pessimists tend to attribute the causes of negative events as stable and global factors (“It’s going to last forever, and it’s going to undermine everything.”). The pessimist views bad events as pervasive, permanent, and uncontrollable, while the optimist sees them as local, temporary and changeable. Pessimism is maladaptive in most endeavors: Pessimistic life insurance agents sell less and drop out sooner than optimistic agents. Pessimistic undergraduates get lower grades, relative to their SAT scores and past academic record, than optimistic students. Pessimistic swimmers have more substandard times and bounce back from poor efforts worse than do optimistic swimmers. Pessimistic pitchers and hitters do worse in close games than optimistic pitchers and hitters. Pessimistic NBA teams lose to the point spread more often than optimistic teams.
Thus, pessimists are losers on many fronts. But there is one glaring exception: Pessimists do better at law. We tested the entire entering class of the Virginia Law School in 1990 with a variant of the optimism-pessimism test. These students were then followed throughout the three years of law school. In sharp contrast with the results of prior studies in other realms of life, the pessimistic law students on average fared better than their optimistic peers. Specifically, the pessimist outperformed more optimistic students on the traditional measures of achievement, such as grade point averages and law journal success.
Pessimism is seen as a plus among lawyers because seeing troubles as pervasive and permanent is a component of what the law profession deems prudence. A prudent perspective enables a good lawyer to see every conceivable snare and catastrophe that might occur in any transaction. The ability to anticipate the whole range of problems and betrayals that non-lawyers are blind to is highly adaptive for the practicing lawyer who can, by so doing, help his clients defend against these far-fetched eventualities. If you don’t have this prudence to begin with, law school will seek to teach it to you. Unfortunately, though, a trait that makes you good at your profession does not always make you a happy human being.
Sandra is a well-known East Coast psychotherapist who is, I think, a white witch. She has one skill that I have never seen in any other diagnostician: She can predict schizophrenia in preschoolers. Schizophrenia is a disorder that does not become manifest until after puberty, but since it is partly genetic, families who have experienced schizophrenia are very concerned about which of their children will come down with it. It would be enormously useful to know which children are particularly vulnerable because all manner of protective, social and cognitive skills might be tried to immunize the vulnerable child. Families from all over the eastern United States send Sandra their 4-year-olds; she spends an hour with each of them and makes an assessment of the child’s future likelihood of schizophrenia, an assessment that is widely thought of as uncannily accurate.
This skill of seeing the underside of innocent behavior is super for Sandra’s work, but not for the rest of her life. Going out to dinner with her is an ordeal. The only thing she can usually see is the underside of the meal – people chewing. Whatever witchy skill enables Sandra to see so acutely the underside of the innocent-looking behavior of a 4-year-old does not get turned off during dinner, and it prevents her from thoroughly enjoying normal adults in normal society. Lawyers, likewise, can not easily turn off their character trait of prudence (or pessimism) when they leave the office. Lawyers who can see clearly how badly things might turn out for their clients can also see clearly how badly things might turn out for themselves. Pessimistic lawyers are more likely to believe they will not make partner, that their profession is a racket, that their spouse is unfaithful, or that the economy is headed for disaster much more readily than will optimistic persons. In this manner, pessimism that is adaptive in the profession brings in its wake a very high risk of depression in personal life. The challenge, often unmet, is to remain prudent and yet contain this tendency outside the practice of law.
Low Decision Latitude
A second psychological factor that demoralizes lawyers, particularly junior ones, is low decision latitude in high-stress situations. Decision latitude refers to the number of choices one has – or, as it turns out, the choices one believes one has – on the job. An important study of the relationship of job conditions with depression and coronary disease measures both job demands and decision latitude. There is one combination particularly inimical to health and moral: high job demands coupled with low decision latitude. Individuals with these jobs have much more coronary disease and depression than individuals in other three quadrants.
Nurses and secretaries are the usual occupations consigned to that unhealthy category, but in recent years, junior associates in major firms can be added to the list. These young lawyers often fall into this cusp of high pressure accompanied by low choice. Along with the shared load of law practice (“this firm is founded on broken marriages”), associates often have little voice about their work, only limited contact with their superiors, and virtually no client contact. Instead, for at least their first few years of practice, many remain isolated in a library, researching and drafting memos on topics of the partners’ choosing.
A Win-loss Game
The deepest of all the psychological factors making lawyers unhappy is that American law is becoming increasingly a win-loss game. Barry Schwartz distinguishes practices that have their own internal “goods” as a goal from free-market enterprises focused on profits. Amateur athletics, for instance, is a practice that has virtuosity as its good. Teaching is a practice that has learning as its good. Medicine is a practice that has healing as its good. Friendship is a practice that has intimacy as its good. When these practices brush up against the free market, their internal goods become subordinated to the bottom line. Night baseball sells more tickets, even though you cannot really see the ball at night. Teaching gives way to the academic star system, medicine to managed care, and friendship to what-have-you-done-for-me-lately. American law has similarly migrated from being a practice in which good counsel about justice and fairness was the primary good to being a big business in which billable hours, take-no-prisoners victories, and the bottom line are now the principle ends.
Practices and their internal goods are almost always win-win-games: both teacher and student grow together, and successful healing benefits everyone. Bottom-line businesses are often, but not always, closer to win-loss games: managed care cuts mental health benefits to save dollars; star academics get giant raises from a fixed pool, keeping junior teachers at below-cost-of-living raises; and multi-billion dollar lawsuits for silicon implants put Dow-Corning out of business. There is an emotional cost to being part of a win-loss endeavor. In Chapter 3 of my book, I argue that positive emotions are the fuel of win-win (positive-sum) games, while negative emotions like anger, anxiety, and sadness have evolved to switch in during win-loss games. To the extent that the job of lawyering now consists of more win-loss games, there is more negative emotion in the daily life of lawyers.
Win-loss games cannot simply be wished away in the legal profession, however, for the sake of more pleasant emotional life among its practitioners. The adversarial process lies at the heart of the American system of law because it is thought to be the royal road to truth, but it does embody a classic win-loss game: one side’s win equals exactly the other side’s loss. Competition is at its zenith. Lawyers are trained to be aggressive, judgmental, intellectual, analytical and emotionally detached. This produces predictable emotional consequences for the legal practitioner: he or she will be depressed, anxious and angry a lot of the time.
Countering Lawyer and Unhappiness
As Positive Psychology diagnoses the problem of demoralization among lawyers, three factors emerge.Pessimism, low decision latitude, and being part of a giant win-loss enterprise. The first two each have an antidote. I discussed part of the antidote for depression in Chapter 6, in my book
Pessimism, low decision latitude, and being part of a giant win-loss enterprise. The first two each have an antidote. Chapter 6 of my book details a program for lastingly and effectively countering catastrophic thoughts. More important for lawyers is the pervasive dimension-generalizing pessimism beyond the law – and there are exercises in Chapter 12 of my book, Learned Optimism that can help lawyers who see the worst in every setting to be more discriminating in the other corners of their lives. The key move is credible disputation: treating the catastrophic thoughts (“I’ll never make partner,” “My husband is probably unfaithful”) as if they were uttered by an external person whose mission is to make your life miserable, and then marshaling evidence against the thoughts. These techniques can teach lawyers to use optimism in their personal lives, yet maintain the adaptable pessimism in their professional lives. It is well documented that flexible optimism can be taught in a group setting, such as a law firm or class. If firms and schools are willing to experiment, I believe the positive effects on the performance and moral of the young lawyers will be significant.
As to the high pressure-low decision latitude problem, there is a remedy as well. I recognize that grueling pressure is an inescapable aspect of law practice. Working under expanded decision latitude, however, will make young lawyers both more satisfied and more productive. One way to do this is to tailor the lawyer’s day so there is considerably more personal control over work. Volvo solved a similar problem on the assembly lines in the 1960’s by giving its workers the choice of building a whole car in a group, rather than repeatedly building the same part. Similarly, a junior associate can be given a better sense of the whole picture, introduced to clients, mentored by partners, and involved in transactional discussions. Many law firms have begun this process as they confront the unprecedented resignations of young associates.
The zero-sum nature of law has no easy antidote. For better or for worse, the adversarial process, confrontation, maximizing billable hours, and the “ethic” of getting as much as you possibly can for your clients are much too deeply entrenched. More pro bono activity, more mediation, more out-of-court settlements, and “therapeutic jurisprudence” are all in the spirit of countering the zero-sum mentality, but I expect these recommendations are not cures, but Band-Aids. I believe the idea of signature strengths, however, may allow law to have its cake and eat it too – both to retain the virtues of the adversarial system and to create happier lawyers.
When a young lawyer enters a firm, he or she comes equipped not only with the trait of prudence in lawyerly talents like high verbal intelligence, but with an additional set of unused signature strengths (for example, leadership, originality, fairness, enthusiasm, perseverance, or social intelligence). As lawyers’ jobs are crafted now, these strengths do not get much play. Even when situations do call for them, since the strengths are unmeasured, handling these situations does not necessarily fall to those who have the applicable strengths.
Every law firm should discover what the particular signature strengths of their associates are. Exploiting these strengths will make the difference between a demoralized colleague and an energized, productive one. Reserve five hours of the work week for “signature strength time,” a non-routine assignment that uses individual strengths in the service of the firm’s goals.
There is nothing particular to the field of law in the re-crafting of jobs. Rather, there are two basic points to keep in mind as you think about these examples and try to apply them to your work setting. The first is that the exercise of signature strengths is almost always a win-win game. When Stacy gathers the complaints and feelings of her peers, they feel increased respect for her. When she presents them to the partners, even if they don’t act, the partners learn more about the morale of their employees – and of course, Stacy herself derives authentic positive emotion from the exercise of her strengths. This leads to the second basic point: There is a clear relation between positive emotion at work, high productivity, low turnover and high loyalty. The exercise of a strength releases positive emotion. Most importantly, Stacy and her colleagues will likely stay longer with the firm if their strengths are recognized and used. Even though they spend five hours each week on non-billable activity, they will, in the long run, generate more billable hours.
Law is intended as but one rich illustration of how an institution (such as a law firm) can encourage its employees to re-craft the work they do, and how individuals within any setting can reshape their jobs to make them more gratifying. To know that a job is a win-loss in its ultimate goal – the bottom line of a quarterly report, or a favorable jury verdict – does not mean the job cannot be win-win in its means to obtaining that goal. Competitive sports and war are both eminently win-loss games, but both sides have many win-win options. Business and athletic competitions, or even war itself, can be won by individual heroics or by team building. There are clear benefits of choosing the win-win option by using signature strengths to better advantage. This approach makes work more fun, transforms the job or the career into a calling, increases flow, builds loyalty, and it its decidedly more profitable. Moreover, by filling work with gratification, it is a long stride on the road to the good life.
Martin E. P. Seligman, Ph.D., is the Fox Leadership Professor of Psychology at the University of Pennsylvania, the Director of the Positive Psychology Network, and former President of the American Psychological Association. Among his 20 books are Learned Optimism and The Optimistic Child. Here, from his book Authentic Happiness: Using the New Positive Psychology to Realize Your Potential for Lasting Fulfillment, is his chapter entitled “Why Are Lawyers So Unhappy?”
© by Martin Seligman. Reprinted with permission from the author.