Here’s a brief discussion of how depression leads to hurting yourself, sometimes in ways you’re not even aware of.
Depression is best understood as a vicious circle, the result of current stress acting on a vulnerable individual to push him or her into this cycle that feeds itself: depressed moods lead to depressed thinking and behavior, which leads to a more depressed mood, and so on in a downward spiral. Depression is also accompanied by negative thinking (I can’t. . .The cards are stacked against me. . .There’s no use trying) and hopelessness. In addition, depression affects the brain directly: we stop producing dopamine (hence have less drive and energy) and the cells that are meant to receive endorphins, the happy hormones, shrivel away so that we can’t experience good feelings. The depressed person is usually slowed down, stuck in molasses, unable to think clearly or see a better future; his/her speech is often a slow monotone that sounds like an effort and conveys no feeling at all. What does it matter. . .why bother. . .it’s useless.
If you have a mood disorder, by definition you have trouble with self-destructive behavior. It’s usually a passive form of self-destruction—staying home isolated, giving up hope, expecting the worst—though there are angry depressed people who get into fights and emotionally abuse others. You may turn to alcohol or drugs to help comfort you. Depression is usually accompanied by suicidal thoughts and impulses, and suicide is often a real risk. Impulses like driving into a bridge abutment or stepping off a high place can come out of nowhere and convince you that you are going crazy, though they’re very common with depression.
Your assumptive world changes drastically with depression, and the depressed assumptions turn into self-fulfilling prophecies that just make you feel worse. Depressed people tend to take too much responsibility for the bad things that happen in life, but feel that the good things are just accidents that they had nothing to do with and are unlikely to happen again. If you’re depressed, you are probably quite pessimistic in your thinking, assuming that everything is getting worse all the time, and there’s nothing you can do about it. You feel that you have to be in control every moment, and if you relax, things will fall apart; at the same time you don’t really believe that your efforts to control will really do any good. The glass is always half empty, good things are temporary and unreliable, bad things are permanent and pervasive, other people are always better, more attractive, more successful than you. When you know what you ought to do to feel better, but are too depressed to do it, you blame yourself for lacking will power, as if it’s a character trait that you either have or don’t have, and that adds to your low self-esteem.
Here are some of the self-destructive behaviors most commonly associated with depression:
Overeating to comfort yourself, a consolation prize
Social isolation because you don’t feel worthy of attention
Procrastination—for all kinds of reasons
A cycle of overwork and collapse
Staying in destructive situations—letting your partner, boss, or coworkers take advantage of you
Neglecting your health because you don’t feel you’re worth the effort
Poor sleep—insomnia or waking at 4 AM and obsessively ruminating is a classic sign of depression
Not exercising—you don’t have the energy and you don’t think it’ll do any good
Won’t ask for help because you’re ashamed and guilty
Suffering in silence—not expressing your feelings is both a cause and symptom of depression
Depressed shopping, spending money you don’t have to buy things you hope will make you feel better
“Wearing the victim sign”—unconsciously communicating that you can be taken advantage of
And many more
All these things obviously interfere with recovery, but they also make your mood problems worse. Every time you try to get control over these patterns and fail, you have another experience that confirms your own shame about your illness. You blame yourself, and you become more hopeless.
If you ask depressed people to spend ten minutes thinking about their problems, they become more depressed (because of all their negative thinking patterns). If you give them another subject to spend ten minutes thinking about, they become less depressed. Pay attention to this, because it’s counterintuitive; it’s important to our worldview to believe that if we just apply mental power to our problems, we’ll find a way out. But that just backfires with depression, because the illness has so pervaded our minds that our beliefs and assumptions are twisted, and our ability to concentrate and make decisions is damaged. In fact, it’s rather obvious that if the ordinary powers of the conscious mind were able to counter depression, we wouldn’t be depressed to begin with. This is a very ironic form of self-destructive behavior, and why I refer to depression as the Catch-22 of mental illness; trying your best to figure out what’s wrong and what to do about it just makes you feel worse. But no one recognizes this without help.
That doesn’t mean there’s nothing you can do about it. I ask people to keep a log of their depressed mood shifts, what’s going on around them at the time, and what their thoughts and feelings were. They thus learn to identify their triggers, and develop some control because they can strategize how to avoid or respond differently to things that make them feel bad. At the same time, they develop some of that metacognitive awareness that accompanies mindfulness; the fact that there are explanations for their mood shifts means that they’re not crazy or out of control, and lends hope.
Depression will push our backs up against the wall. It often seems bigger than us: a bully. If we let it, it will pound us down. So, we’ve got to push back.
If we don’t fight back, together with the help of others, depression can consume our lives leaving only our pulse and some air in our lungs, but precious little else. The vitality, the passion and full array of emotions that make life worth living may be sucked up out of us as if by an alien ship from above.
There are many tools to fight depression. They can certainly help us regain our footing and make our lives functional and productive again. But isn’t life more than just about a return to “normal”? We all have dreams and aspire to live them. Theres’s something wild about dreams. So often, they are outside our “normal”. And regaining them is a big part of recovery for it is these passions that bring us most fully alive in the cosmos. And we have to fight for our dreams.
Just like fighting a bully, pushing back against depression takes courage. We have to reach deep down inside ourselves to listen to that part of our life force in us all that gives us the grit to say to depression,“no more”. We must say to ourselves, “I’m sick and tired of being ‘sick and tired’”.
When we’re ready to make some changes, we push the bully back. A small push in the beginning will do. We gain some space and separation from this goblin. We stop defining ourselves as a “depressed person,” as if our identity were wholly made up of our affliction. We are not our depression. It is a part, albeit a very painful part, of our lives. But it need not be all of it.
To fight back against depression, we need to empower ourselves to level the playing field. One of the best ways is learn mindfulness. With it, we gain detachment from our negative thoughts and emotions. Mindfulness teaches us that pessimistic thoughts and disturbing emotions are clouds passing in the sky, not reality. Check out the excellent book, The Mindful Way Through Depression to learn more.
If we don’t buy into the depressed stories our minds spin out, we can begin to see them for what they are: puffs of cerebral and neurochemical smoke. We don’t have to buy into them. We don’t have to live by that script.
This takes a lot of practice and we have to start slowing. This is, by no means, a quick “fix”. But in detaching ourselves from our mental jumble and the over reactive emotions that accompany my anxiety and depression, we gain freedom. We again have choices in life. We need not walk in the deep ruts of depression anymore.
And this is empowering.
Poet, Mary Oliver in her poem, “The Journey,”beautifully captures the sense of determination we need to recover from depression:
One day you finally knew
what you had to do, and began,
though the voices around you
their bad advice–
though the whole house
began to tremble
and you felt the old tug
at your ankles.
“Mend my life!”
each voice cried.
But you didn’t stop.
You knew what you had to do,
though the wind pried
with its stiff fingers
at the very foundations,
though their melancholy
It was already late
enough, and a wild night,
and the road full of fallen
branches and stones.
But little by little,
as you left their voices behind,
the stars began to burn
through the sheets of clouds,
and there was a new voice
which you slowly
recognized as your own,
that kept you company
as you strode deeper and deeper
into the world,
determined to do
the only thing you could do–
determined to save
the only life you could save.
In a previous blog, I noted that rumination – repeated dwelling on feelings, problems, and difficulties – is an important process maintaining depression. I also discussed the finding that repetitive thinking about upsetting events and unresolved problems is a normal and natural response – and that sometimes it can be helpful. For example, focusing on our difficulties can help us to come to terms with them and to solve problems. These contrasting effects of repetitive thinking led to the key questions of what factors determine whether repetitive thinking is helpful or unhelpful, and how does such thinking go wrong in depression?
These questions have been the primary focus of my research over the last 15 years and we are beginning to get some preliminary answers. This research is summarized in a research paper I published in Psychological Bulletin (2008).
First, it appears that the content and focus of the repetitive thinking is important. If you keep thinking about something positive, it is likely to make you feel better, whereas if you keep dwelling on something negative it will make you feel worse. In a nice meta-analysis of the field, Mor and Winquist (2002) found that attention to negative aspects of the self was strongly related to increased levels of negative mood, whereas attention to positive aspects of the self was related to lower levels of negative mood. The act of repetitively thinking about anything acts as a form of mental rehearsal for the content of inner speech, strengthening and elaborating the mental representations, making them easier to come to mind in future. It also tends to polarize and exaggerate thinking, making it more extreme. So, repetitive focus tends to exacerbate the current state and mood – if you are in a sad mood with negative thoughts, and you dwell on them, the mood will get worse, and the thinking will get more negative. Thus, repetitive thought acts as an amplifier of thoughts and feelings.
Second, the style of the repetitive thinking is equally important. It is possible to focus on negative information in helpful or unhelpful ways.
Imagine that you are faced with an upsetting and saddening event such as the unwanted end of an intimate relationship. The break-down of a relationship will be experienced as negative by nearly everyone and will likely lead one to dwell on its demise. However, there are quite distinct ways of dwelling on it.
One understandable way to dwell on this split is to think about why it happened, what it means, what caused it, and its implications for the future. In this style of processing the break-up, you would be focused on the causes, meanings, and implications of what happened. This way of thinking tends to move away from the specific details and contexts of what happened and to more general abstractions, which capture the key gist of the event and what this event might share with past events and with other situations in the future. Hence, this style of thinking is called abstract processing. Typical questions might include “Why did this happen? What does it mean about me? What does it mean about the future?” An extensive social psychology literature indicates that such “why?” questions tend to make thinking more abstract and to distance individuals from the specifics of situations.
This abstract style of processing negative events is typical of depressive rumination and anxious worry. You can see how if you are feeling down and have low self-esteem, focusing on yourself and thinking about a break-up in this abstract way could be unhelpful, because asking these questions about causes, meanings, and implications is likely to lead to negative self-blaming conclusions, e.g., “It is my fault”. Moreover, because abstract processing tends to broaden out across situations, such thinking will pull in past memories of rejection and loss (e.g., “This keeps happening to me”), and may lead to general conclusions about the future, such as “I will never have a lasting relationship”, all of which worsen mood and exacerbate depression.
In contrast, you could repetitively reflect on the break-up by focusing on exactly how it happened, replaying in detail the events that led up to the split and the final few meetings and conversations with your ex, noting in detail what happened. In this style of processing the break-up, you would be focused on the specific details, the sequence and the circumstance of how the relationship came to an end. This way of thinking focuses on the context (when, where, how, what, who) of what happened and how it happened and stays close to your actual concrete experience of the end of the relationship, rather than thinking about its meaning. Hence, this style of thinking is called concrete processing. Typical questions might include “How did this happen? What did I do? What did my ex do? How did I feel? How did this unfold over time?”
A series of experiments in my lab, replicated in other labs, have found that, when faced with problems or upsetting events, adopting a concrete style of processing is more helpful than an abstract style of processing. For example, when asked to generate solutions to interpersonal difficulties such as an argument with a partner or a disagreement with your boss, we found that prompting currently depressed patients, formerly depressed patients and never depressed controls with either no questions, abstract “Why?” questions, or concrete “How?” questions, influenced the quality of solutions generated. Replicating other findings, patients with depression were worse at solving social problems than recovered depressed patients and non-depressed individuals when left to their own devices. However, when prompted to ask concrete questions, patients with depression were as good at solving problems as the other two groups, suggesting that these “How?” questions ameliorated this difficulty. Further, asking abstract “Why?” questions worsened problem-solving in people who were formerly depressed, suggesting that these questions activated their previous difficulties. We believe that concrete processing is more helpful for problem-solving because it makes an individual aware of the specific circumstances and behaviors that occurred in a situation, suggesting possible alternatives to resolve the situation.
In another study, we found that training students to think about the meanings and implications of emotional events for 30 minutes caused them to feel worse to a subsequent stressful anagram task than students who practiced thinking about the concrete details of emotional events. Thus, relative to concrete processing abstract processing increases the negative emotional response to difficulties. Similar effects have been found when studying how quickly people recover from previous upsetting events, with a concrete style of thinking about past sad or traumatic events proving to be more helpful.
Taken together, this research suggests that repetitive thinking about the self, negative feelings and problems in an abstract style will be particularly problematic, driving depression and anxiety. Further, it suggests that shifting to a more concrete way of thinking about difficulties could be helpful for people with depression. Building on this hypothesis, we have investigated whether training people with depression to become more concrete and specific can itself help to reduce depression. This will be the subject of another blog.
The term clinical depression finds its way into too many conversations these days. One has a sense that something catastropic has occurred in the psychic landscape – Leonard Cohen
Everything has its 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.
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 last summer:
“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 last year: “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.
“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 recently 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 Justesen White, 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.
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 the students need to hear it straight-up. 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 Associaiton. Here’s a trailer clip of this recently finished film:
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.
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).