Treating Lawyers with Depression: One Psychologist’s Top 10 Tips

 

Here is an interview I did with Dr. Tyger Latham, a clinical psychologist and psychoanalyst in Washington, D.C. and the Commonwealth of Virginia. He received his Ph.D. George Washington University.

What is depression?

Depression is a mental health disorder that affects roughly 10 to 15 percent of the general population. According to the DSM, the manual used by psychiatrists and psychologists to diagnose depression, a person is diagnosed with depression if she/he experiences depressed mood, along with several other related symptoms, for a minimum of 2 weeks. Some of these other symptoms include: disrupted sleep; diminished energy; changes in appetite or weight; difficulties with concentration; restlessness or lethargy; feelings of guilt, worthless, and helplessness; and, in extreme cases, thoughts of death or suicide. This is the medical definition of depression. However, this definition fails to capture the experience of what it’s like to be depressed. I think Paul Simon has described depression best when he wrote: “Hiding in my room, safe within my womb, I touch no one and no one touches me. I am a rock, I am an island. And a rock feels no pain; and an island never cries.”

Have you treated many law students, lawyers and judges for it?

At any one time, I would say about a third of my practice is comprised of lawyers or law students, of which a large majority suffer from depression or some related mood disorder such as persistent depressive disorder or bipolar disorder.

Can you tell us what kind of issues concerning depression lawyers come to you for? (E.g. problems on job, marital)

As with all of my clients, I find that lawyers come to therapy for a myriad of reasons, including depression. In the case of lawyers, however, the practice of law often serves as a backdrop for their presenting concerns. I have yet to work with an attorney whose work was not adversely affected by their depression. In fact, many lawyers who are diagnosed with depression only become aware of it after it begins to affect their productivity. These lawyers might complain of being unable to concentrate; feeling indifferent or apathetic about their work; withdrawing from colleagues; or, in some cases, they talk with me about feeling burned-out or they might share fantasies of leaving the practice of law altogether. All of these symptoms can be associated with depression and when taken together they build a strong case for clinical depression.

Attorneys will often employ a number of coping strategies – some adaptive, others not-so-adaptive – to deal with their depression. Most attorneys are accustom to working long hours, so I often see many attorneys with depression pour themselves into their work as a way to escape. I’ve also worked with a number of attorneys who have resorted to alcohol and drugs as a way of managing their symptoms. While I wouldn’t say all attorneys who are depressed abuse alcohol and drugs, the majority of attorneys who abuse alcohol and drugs almost always suffer from some form of a mood disorder like depression, bipolar, or anxiety.

Procrastination, Depression and the Myth of Multitasking

Most people who are depressed have a hard time being productive. Work—and here I mean everything from paid employment to child-rearing and housekeeping to the kinds of “work” we assign ourselves, like reading a good book or planting a garden—is a chore to the depressed. It drains us, leaves us feeling as bad as before, physically worn out and emotionally depleted, instead of proud of ourselves and invigorated. Other people with depression seem to work very hard all the time, but there is little payoff for their efforts.  As with so much of depression, there is a real chicken-or-egg question—is work so difficult because we’re depressed, or are we depressed in part because we can’t accomplish anything? And as with so many chicken-or-egg situations, we face a false dichotomy: the truth is, poor work habits and depression reinforce each other.

Depressed people tend to be great procrastinators. Procrastination means putting off for a later time what “should” be done now. The “should” may come from without, as with the teenager who dawdles over homework, or from within, as with me planting my garden. When it comes from without, it’s easy to see the rebelliousness that procrastination expresses. When it comes from within, it’s hard to see immediately what purpose procrastination serves—but it may serve many.

False Assumptions

Procrastinators have some big false assumptions about how work works. They assume that really productive people are always in a positive, energetic frame of mind that lets them jump right into piles of paper and quickly do what needs to be done, only emerging when the task is accomplished. On the contrary, motivation follows action instead of the other way around. When we make ourselves face the task ahead of us, it usually isn’t as bad as we think, and we begin to feel good about the progress we start making. Work comes first, and then comes the positive frame of mind.

Closely allied to this misunderstanding about motivation is the idea that things should be easy. Depressed people assume that people who are good at work skills always feel confident and easily attain their goals; because they themselves don’t feel this way, they assume that they will never be successful. But again, most people who are really successful assume that there are going to be hard times, frustrations, and setbacks along the way. Knowing this in advance, they don’t get thrown for a loop and descend into self-blame whenever there’s a problem.  If we wait until we feel completely prepared and feeling really motivated, we’ll spend a lot of our lives waiting.  See my page on developing greater willpower.

Protecting Self-Esteem With Procrastination

Procrastination can also help protect the depressed person’s precarious self-esteem. We can always tell ourselves we would have done it better if. . .. The paradigm is the college term paper rushed together in a furious all-nighter. The student protects himself from the risk of exposing his best work by never having the time to do it right. This allows him to protect his fantasied sense of himself as special and uniquely gifted.  Procrastination is also a result of the depressed person’s tendency toward perfectionism, a crippling problem.  Research has shown that the more perfectionistic a depressed person is, the worse his chances of recovery.  Trying so hard to make every single little piece of a project perfect, we doom ourselves to disappointment and frustration.

Chaining

There is a simple, useful process psychologists call chaining or making one event depend on another event’s being accomplished first. You can make chains that help you get a lot of work done. I want to go play Tomb Raider on my computer, but I’m going to let that be my reward for first going through the outdated magazines. As I go through the pile, I find there’s one I really must renew my subscription to. Now I have to do that as well before I play Tomb Raider. Renewing that subscription reminds me that I have a stack of unpaid bills nagging at me. Maybe I can’t get the bills all paid, but I can take twenty minutes to get them organized and make a commitment to myself to pay them tomorrow. Now I can go play my computer game feeling a little less overwhelmed by events and a little more deserving of some time to goof off.  As you get used to this practice, your chains can get longer and longer without getting burdensome.

Finally, there’s also the Irish way of overcoming procrastination.  Confronted with a wall too high to climb, the Irishman throws his hat over it.  Now he must find a way over the wall.  If I have to paint a room, I’ll likely get the paint and start the first coat as soon as I can, disrupting the whole household in the process.  That way I’m fully committed and have to finish quickly.

Gluing Yourself to Your Seat

Controlling procrastination is more like controlling eating or exercise than smoking or drinking; it’s impossible to never procrastinate.  For one thing, often it’s not clear which of two is the most important activity.  Study for the exam right now, or eat dinner and then study?  Or eat dinner, take out the garbage, walk the dog, call a friend, check Facebook, and then study?  But procrastination is a habit that can gradually be replaced by the habit of not putting things off.

Rita Emmett, in The Procrastinator’s Handbook, gives us Emmett’s Law:  “The dread of doing a task uses up more time and energy than doing the task itself.”  Here’s O’Connor’s corollary:  “It’s amazing what you can accomplish when you finally get down to work.”  So my first advice for overcoming procrastination is to glue your seat to the chair, ignore distractions, and work for five minutes.  Then you can take a short break if you feel it’s necessary, but put in another five minutes after your break.  The procrastinating impulse in your mindless self won’t respond to logical argument, but it may respond to a narrowing of focus.  You’ll get in a groove, start feeling productive, and the impulse to procrastinate further will dwindle.  If it doesn’t work today, try again tomorrow.

One Task At a Time

A second piece of advice:  while you’re sitting glued to your chair, you’re not allowed to do anything other than the task you’re there for, no matter what attractive distraction might come to mind.  You don’t have to work on your primary task, but you can’t do anything else.  This can be torture, but it’s great mental discipline.  You’ll quickly see how easily distracted you are, but you’re forced to develop the willpower to withstand temptation.  Eventually, you’ll get something constructive done.

Hold yourself to pre-commitments.  No television (Internet, email) until I’ve worked for a half hour.  If I get X done, I’ll reward myself with pizza tonight; otherwise, it’s peanut butter.  Be sure to keep these commitments reasonable and don’t set yourself up to fail.  If you practice and get consistent at this, you can start to up the ante.

Reward Yourself

Procrastinators don’t reward themselves for finishing.  A drink with friends, a special dessert—things that normal people might do to celebrate an accomplishment—these things don’t occur to procrastinators (partly because they’re never satisfied with their results).  But it’s important to practice these rituals because, in our minds, the pleasure that comes with the reward comes to be associated with doing a job well.  In this way, work itself becomes more satisfying.

The Stress of a Mess

Clutter is highly associated with procrastination.  Each of those extraneous items on your desk, workspace, or computer desktop is a distraction, a reminder of something else to do.  Mental clutter works the same way; if you have a set of nagging chores, just making a list will help you focus on the present.  The list will contain the nagging.  Every time we are distracted, we lose efficiency.  You can reduce your procrastination greatly by eliminating distracting cues.

Unplugging

Of course, personal computers and wireless communication have created many more temptations to procrastinate—games, Facebook updates, checking on the news.   Tweets, cell phone calls, and instant messages constantly break our concentration.  If we really want to focus on something, we have to remove temptation and prevent interruptions.  If you work on your computer, turn off your Internet browser and make it difficult to get back on.  Put the phone on silent.  Multitasking is a myth.

By Richard O’Connor, Ph.D.  Dr. O’Connor is the author of Undoing Depression, Undoing Perpetual Stress, and Happy at Last. For fourteen years he was executive director of the Northwest Center for Family Service and Mental Health, a nonprofit mental health clinic, where he oversaw the work of twenty mental health professionals in treating almost a thousand patients per year. He is a practicing psychotherapist with offices in Connecticut and New York and lives in Lakeville, Connecticut.

Further Reading:

Get It Done When You’re Depressed – great book!

“Three Strategies For Getting Things Done When Depressed”Psycentral website

“Ten Ways To Get Things Done Despite Depression” – Everyday Health website

Lawyers, Don’t Let Perfectionism Ruin Your Health

Duke University Law grad, Jennifer Alvey explores why lawyers have such poor mental and physical health: “Part of the answer lies in lawyers’ predisposition toward perfectionism. I often encounter lawyers who can only envision doing something if they can be all in. Doing something less-than-perfectly is seen as failure. When it comes to exercise and diet, this kind of thinking can set anyone up for failure because they will try to make big, grand changes at once, be unable to sustain them, and quickly quit in disgust.”  Read the rest of her Blog

Perfectionism and Depression: Nobody’s Perfect

We often mix-up a drive to excel and perfectionism; they’re not the same thing. A drive to be your very best can leads to a sense of self-satisfaction and self-esteem. It feels good to give it all we got. Perfectionism? It’s a horse of a different color. People who feel driven in this direction tend to be more motivated by external forces – such as the desire to please others rather than themselves. Common and recurring thoughts of perfectionists include:

  • Anything short of excellent is terrible
  • I should be able to do/solve this quickly/easily
  • I am best handling this myself
  • I must find the one right answer
  • Errors, failure, and mistakes are unacceptable
  • I have to do it all at once

One depression/perfectionist suffer writes:

My name’s Paul and I am a recovering perfectionist.

I am also recovering from depression. The two are connected.

I’d been trying to do too much, too well, trying to please too many people, expecting too much of myself for too long, putting too much pressure on myself, creating too much stress. That’s a lot of ‘too muches’ for one person. My self-esteem took a battering, I stopped looking forward to anything and I felt like I was useless and hopeless.”

Psychologist Dr. Gordon Flett has studied perfectionists and found that they set excessively high personal standards for themselves and others then harshly evaluate their performance on these benchmarks. Often, perfectionists believe it’s their parents, bosses, or spouses who expect them to be perfect. They believe that such people will value them only if they’re perfect. The constant demand to appear as if they have it all tougher is draining.

web-perfectionism

Others tend to see them as harsh and unforgiving – rigid and unkind – though the truth on the inside is they are vulnerable people who lack resilience. Flett fund that physicians, lawyers, and architects, whose occupations demand precision, are at higher risk for perfectionism, depression and suicide.

Causes of perfectionism run from parenting to a genetic link, but whatever it’s origins, try these fixes:

Separate self-worth from the requirement to do things perfectly.

Dr. Nicholas Jenner writes: Perfectionism is addressable by using and applying cognitive tools. Positive change can be had when thinking is changed and self worth is separated from the requirement to do things perfectly. If you constantly hear your inner critic berating you for not getting or doing that extra 20%, you have noticed your perfectionist beliefs. Discrediting and disputing these values and finding realistic evidence to prove them wrong is a key part of recovery. As humans, we are inherently imperfect. We have the ability to fail without ever being a failure. We sometimes just need to think it and believe it.

Put people first.

Before tasks and “stuff,” put your heart into connecting with the people you love.

Come out as a human being.

Authenticity, although messy, is required for the pleasure of love, joy, fun and overall happiness.

Pay attention to your own signs of trouble.

Perfectionists get more anxious and rigid when they are hungry, angry, lonely or tired. Use prevention strategies to manage this tendency.

Let go of high expectations. Try to accept people as they are. We are all unique and flawed as human beings.

The great songwriter and poet Leonard Cohen once wrote and sang, “Ring the bells that still can ring. Forget your perfect offering. There is a crack, a crack in everything. That’s how the light get’s in.”

We’re cracked open when stress, anxiety and depression become just too painful and perhaps begin to see this eternal truth about others and ourselves:

Nobody is perfect.

 

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