There are significant effects of depression in the legal profession that are pervasive. Lawyer depression can have terrible personal and professional ripple effects for attorneys but also impacts clients, business partners, employees, and staff.
The general population is significantly affected by depression, with 17.3 million persons, or 7.1% of all adults in the US, reporting having experienced a major depressive episode in 2017. But, the proportion of depression among attorneys is considerably higher: according to ALM’s Mental Health and Substance Abuse Survey from 2020, 31.2% of the more than 3,800 respondents report having a depressive disorder. This indicates that compared to the ordinary US adult, lawyers have an approximately three-fold higher risk of developing depression.
Nevertheless, the stigma associated with mental illness keeps lawyers from getting help immediately. This can cause excessive and prolonged distress, making the problem worse over time.
“If you look deeply into the palm of your hand, you will see your parents and all generations of your ancestors. All of them are alive in the moment. Each is present in your body. You are the continuation of each of these people” – Thich Nhat Hanh
Like all parents, my Mom and Dad were flawed people – as I am. Yet, they were something more than that.
I’ve struggled to understand them much of my adult life; maybe more so now that they’re both gone. Here’s a picture of them from 1946 cleaning up the reception hall after a two-day celebration.
Have you ever felt so stressed out and overwhelmed that you can’t think straight? We now know that prolonged stress or trauma is associated with decreased volume in areas of the human brain responsible for regulating thoughts and feelings, enhancing self-control, and creating new memories. A new research study, published in today’s issue of Nature Medicine, is a first step in uncovering the genetic mechanism underlying these brain changes.
Depressed People’s Brains are More FragmentedIn this study, conducted by Professor Richard Dumin and colleagues from Yale University, scientists compared the genetic makeup of donated brain tissue from deceased humans with and without major depression. Only the depressed patients’ brain tissues showed activation of a particular genetic transcription factor, or “switch.” While each human cell contains more than 20,000 genes, only a tiny fraction of them are expressed at a given time. Transcription factors, when activated, act like light switches, causing genes to be turned on or off. This transcription factor, known as GATA1, switches off the activity of five genes necessary for forming synaptic connections between brain neurons. Brain neurons or nerve cells contain branches or dendrites that send and receive signals from other cells, leading to interconnected networks of emotion and cognition. The scientists hypothesized that in the depressed patients’ brains, prolonged stress exposure led to a disruption of brain systems involved in thinking and feeling. Depressed brains appeared to have more limited and fragmented information processing abilities. This finding may explain the pattern of repetitive negative thinking that depressed people exhibit. It is as if their brains get stuck in a negative groove of self-criticism and pessimism. They are unable to envision more positive outcomes or more compassionate interpretations of their actions.
Glucocorticoids Damage Brain Neurons
The stress response involves activation of a brain region known as the amygdala, which sends a signal alerting the organism to the threat. This results in activation of the HPA (hypothalamic-pituitary-adrenal) axis and release of a cascade of hormones, including cortisol, widely regarded as the quintessential “stress hormone.” While short-term cortisol release prepares the organism to sustain “fight or flight” and fend off an attacker, long-term exposure appears to cause brain neurons to shrink and interferes with their ability to send and receive information via branches called dendrites. In animal studies, under chronically stressful conditions, glucocorticoids such as cortisol can remain elevated for long periods.
Traumatic Experiences Can Shrink the Hippocampus in Those Who Don’t Recover
This finding is another piece of the puzzle regarding how stress and prolonged distress may impair our ability to think in creative and flexible ways. Research in both mice and humans has demonstrated an association between stress exposure (foot shock in mice, life events in humans) and shrinking of the hippocampus – the brain center responsible for forming new, time-sequenced memories. Studies in women with PTSD resulting from childhood sexual abuse and Vietnam veterans with PTSD have shown 12-26 percent decreases in hippocampal volume, relative to those without PTSD. In another study, patients recovered from long-term major depression showed a 15 percent decrease in volume of the hippocampus, compared to non-depressed patients.
Major Life Stress Damages the Prefrontal Cortex
In addition to hippocampal shrinkage, major life stress may shrink brain neurons in the Prefrontal Cortex (PFC), the brain area responsible for problem-solving, adaptation to challenge, emotional processing and regulation, impulse control, and regulation of glucose and insulin metabolism. In a study of 100 healthy participants conducted by Dr. Rajita Sinha and colleagues at Yale University, and published in the journal Biological Psychiatry, those with more adverse life events had greater shrinkage of gray matter in the PFC, compared to their less-stressed peers. Recent major life events, such as a job loss, make people less emotionally aware while life traumas, such as sexual abuse, seem to go further, in damaging mood centers that regulate pleasure and reward, increasing vulnerability to addiction and decreasing the brain’s ability to bounce back.
Summary
While the evidence is not yet conclusive, these studies suggest that prolonged exposure to stress can shrink the brain, both via the damaging effects of cortisol on brain neurons and by disrupting expression of genes that facilitate neuronal connections. This raises the question of whether there is anything we can do to prevent such damage. Since we can’t always control how much we are exposed to financial, relationship, or illness stress, are there preventive activities we can do to maintain cognitive resilience so we can continue to deal effectively with the stressors? It is not known if we can reverse the damage by these methods, but we may lessen it and make our brains more resilient to stress.
Brain-Enhancing Activities to Combat Stress
While the below list is not exhaustive, the three activities below have enhanced brain functioning in controlled studies.
Take a Daily DHA Supplement– DHA or Docosahexaenoic acid is an Omega-3 fatty acid that is a central building block of brain tissue. DHA is thought to combat the inflammatory effects of cortisol and the plaque buildup associated with vulnerability to Alzheimer’s disease. According to Dr. Mehmet Oz, in one study, a dose of 600mg of DHA taken daily for 6 months led the brain to perform as if it were three years younger.
Exercise Most Days – In studies with mice exercise led to a more improved performance on cognitive tasks than exposure to enriched environments with lots of activities and stimulation. Exercise leads to increases in BDNF or brain-derived neurotropic factor, a substance that strengthens brain cells and neuronal connections. BDNF is also thought to promote neurogenesis or the creation of new brain cells from existing stem cells in the hippocampus. Although these effects can’t be studied in living human brains, researchers have found increases in BDNF in the bloodstream of humans following workouts.
Do Yoga, Meditate, or Pray – These activities can activate what scientist Herb Benson at Massachusetts General Hospital calls “the relaxation response,” which lowers blood pressure and heart rate and lowers subjective anxiety. Benson and scientists from a genetics institute showed, in a recent study, that inducing the relaxation response can beneficially alter the expression of genes involved in inflammation, programmed cell death and how the body handles free radicals. The effects shown were in the same genes implicated in PTSD and depression. According to Jeffery Dusek, Ph.D., co-lead author of the study, “Changes in the activation of these same genes have previously been seen in conditions such as post-traumatic stress disorder; but the relaxation-response-associated changes were the opposite of stress-associated changes and were much more pronounced in the long-term practitioners.”
Some interesting pilot studies in 2014 are providing hope for the future of depression. Curiously, these new possibilities all involve the mouth and nose. Breathing a certain way, speaking a certain way, and inhaling nitrous oxide all may have potential in reducing symptoms and breaking the cycle of depression. Read the News
New research suggest that night-owls may have trouble reducing negative thoughts, a trait that may lead to downstream mental health issues. Read the News
Frank walked into my office and said, “I was in therapy for 15 years, know my ‘issues’ inside and out, but I’m still taking an anti-depressant and an anti-anxiety med when I have to do any major presentation at the firm. It’s like my baseline is off. It’s great for being a lawyer. I’m always hyper-vigilant—looking out for the next danger, working very hard to stay on top of everything. But when I get into bed at night, my mind is racing and I feel this sinking feeling. Still, after all this therapy. What can you do for me?”
Frank doesn’t have a motivation problem, or a lack of insight problem. Frank has a brain problem.
Frank had come into my office after having done research into the benefits of neurofeedback for depression and anxiety. I see clients like Frank everyday and I call them my “Worrier Warriors”. Their nervous systems are in a state of ‘activation’ where the flight/fight/freeze brain is always in go-mode. And he’s right—it serves a law firm well. These brains are habitually trained to be on the watch for danger. Add a good analytic mind to that mix and you’ll have a highly successful lawyer who protects his or her clients well, but at a high cost of health and happiness.
We’ve come a long way in our understanding of the brain and brain functioning in producing the symptoms we call anxiety and depression. In the mental health field we used to think of them as ‘mind’ problems, but now we’ve come to understand that they are also brain problems.
We all know we are ‘creatures of habit’ but what that really means is that the brain is prone to habituated rather than fresh responses. The brain functions to be most efficient and effective in use of its energy to protect and maintain the body. The flaw in this system design is that the brain becomes efficient by using cues to approximate the present situation and then uses an old response pattern, which leads to misperceptions of the present moment and less than appropriate responses. We’ve all seen someone “lose it” and respond with an angry outburst when the situation warranted concern or a firm voice.
A dramatic and sad illustration of this principle is the war vet who comes home with Post Traumatic Stress Disorder (PTSD) from his years of service. As a soldier he has been trained to respond to danger with ‘fight’ response. But now he is home from the war and is walking down his hometown street when a car backfires. The brain is habituated to “loud sound equals danger” and the vet’s brain goes into fight mode—yelling, pushes someone or becomes highly irritable and later starts a fight with a loved one.
An important piece of information to know about the part of the brain that operates the fight/flight response: it does not take orders from anyone. It is a part of the brain that needs to be able to respond in milliseconds, so it doesn’t take in information from other, more rational and analytic parts of the brain. As a result you could say to yourself, “I really shouldn’t get angry and fly off the handle.” But the part of the brain that decides that action, acts without input from our rational, willful self. It takes in sensory input and then makes a snap decision.
Why are lawyers so prone to anxiety, depression and anger outbursts? Their brains are habituated to the flight/flight/freeze response (anger/anxiety/depression) response. For whatever reason, and their could be many, they experienced a threat or threats at some point in their lives that were significant enough to habituate the brain to being in this activation mode. A quick way to find out if you are is to ask yourself this question, and answer quickly without thinking: Is the world a safe place? If the answer is ‘no’ then chances are your brain is habituated to thinking that you are in danger when you aren’t. It makes you a perfect candidate to become a lawyer where you always have to be thinking about what the risks are in any situation. Or to be an ENT or an emergency room doctor. Your brain is habituated to perceive risk.
Now what to do about this habituated brain? Here are some tips:
Breath. Seriously. The breath, slow and deep breathing are ways we can “tell” the brain that we are safe and it can go into a state of relaxation and regulation. Slow deep breathing for 5 minutes where you work your way up to counting to 5 on the inhalation and 5 on the exhalation will do wonders to communicate to the brain to come out of flight/flight and into calm awareness (the state of a regulated and balanced brain.)
Understand: Help yourself by having a good and clear conceptual understanding that your anxiety and depression and anger outbursts are a brain over-reacting, not an accurate assessment of the present moment’s situation. Your brain is reading a newspaper that’s 20 years old and acting as if it’s the here-and-now news.
Get exercise: I recently had a neurologist tell me that if the positive effects of exercise (increased heart rate 30 mins 5 times a week) were a drug, it would be considered a “miracle drug” and would generate billions of dollars a year in revenue.
Get enough sleep. Studies are now coming out showing the detrimental effects of chronic sleep deprivation—5 hours a night or less—on the development of chronic conditions.
Train the brain with neurofeedback. Neurofeedback trains the brain to optimize its functioning through allowing the brain to ‘see’ its unhelpful response patterns. And the brain learns to use the present moment to decide it’s next action rather than using those old habitual response patterns. As a result the trained brain sleeps better, is calmer, is better able to focus, and is more cheerful. And as one client said, “I have the same problems, they just don’t get to me anymore.”
Natalie Baker, MA LMHC, works as a psychotherapist and neurofeedback trainer in private practice in New York City. http://www.neurofeedbackny.com
If you look deeply into the palm of your hand, you will see your parents and all generations of your ancestors. All of them are alive in the moment. Each is present in your body. You are the continuation of each of these people – Thich Nhat Hanh, Buddhist monk
Like all parents, my mom and dad were flawed people – as I am. Yet, they were something more than that.
I’ve struggled to understand them much of my adult life; maybe more so now that they’re both gone. The nineteenth century German philosopher Arthur Schopenhauer once wrote: “The first forty years of life furnish the text, while the remaining thirty supply the commentary.” Maybe it isn’t till midlife that we really work hard to interpret the stories of our past. I believe there’s a strong urge in all of us to make a comprehensible story of one’s life at this juncture. And our parents are a large part of that tale.
The author of Slaughterhouse-Five, Kurt Vonnegut, a WWII veteran like my dad, wrote:
“The most important thing I learned was that when a person dies he only appears to die. He is still very much alive in the past, so it is very silly for people to cry at his funeral. All moments, past, present, and future, always have existed, always will exist. It’s just an illusion we have here on earth that one moment follows another one, like beads on a string, and that once a moment is gone it is gone forever.”
Now that I’m 50, I still wonder what role mom and dad played in my depression. Looking at the facts, I guess it’s all too obvious: drinking and mental health issues on both sides of the fence. In my most self-absorbed moments, I blame them and feel justified in doing so. In brighter moments of lucidity, I see that they, like me, were somebody’s children once. They didn’t start out in life the way they ended up – nobody does. They were, in a real sense, victims. This fact doesn’t excuse what happened; the real pain they inflicted on their children. But it does help me to understand their plights in life. And with that understanding comes some measure of peace, a peace of heart.
Turning the pages to our Past
Jonathan Frazen, author of the best-selling book Freedom about a family that struggles with depression, writes:
“Depression, when it’s clinical, is not a metaphor. It runs in families, and it’s known to respond to medication and to counseling. However truly you believe there’s a sickness to existence that can never be cured, if you’re depressed, you will sooner or later surrender and say: I just don’t want to feel bad anymore.”
Here’s Jonathan Frazen talking about his novel on PBS:
How much of our life is determined by our familial past? How much of it is spun by choices we make apart from that past? Apart from what happened to us at the hands of parents, can we really change? I believe that shifting through our past helps us to become “unstuck.” And after all, depression is about being stuck. We can’t go forward, if we can’t go backwards and to see the truth of about past.
There are some things we can change and some we can’t. We can’t change our genetics and scientists now know that the genes we inherit play a significant role in our vulnerability to depression. There is a gene that regulates how much of a chemical called serotonin is produced. Serotonin is a neurotransmitter. The amount of serotonin that flows to your brain influences your mood, and emotional state. Those whose serotonin transporters included a gene that was shorter than would be typically expected at a certain point had a harder time bouncing back after experiencing a stress event. Chronic stress and anxiety, as I’ve written about before, have a strong correlation to a vulnerability to clinical depression.
This bit of news makes me want to know my ancestors, these ghosts of my past. These folks and I have something in common: irksome chromosomes that could flip off the happy switch in our brains from time to time.
I heard on National Public Radio that there have been 60 generations that have lived and died since the time of Jesus. Since the extent of my knowledge about my family only goes back, at best, 100 years to the time of the birth of my grandparents, that leaves me about fifty-eight generations or 1900 years of emotional and genetic history unaccounted for. I wish there was some kind of recorded history of their lives because I am a continuation of them even as my daughter is of me.
Dad’s Story
Dad was born in Buffalo in 1926, the oldest of five born to immigrants from Poland. I never met my grandparents, but from family lore I’ve learned that they were tough people who lived even tougher lives: brute physical labor for their daily staple of meat and potatoes, playing pinochle while plumes of cigarette smoke wafted up to the ceiling and crates of cheap booze on the weekends. If you looked crossways at them, they’d likely belt you in the mouth.
Alcohol played a big role my family’s drama through the generations. Sometimes they drank at home, but more often in what my grandma called “Gin mills.” Men would cash their checks in these Polish joints, throw their money on long wooden bars sip draught beer as they talked about all the scraps they’d been in that week just trying to get along in life.
My dad grew up in this world. At 17, he went off to fight in the Pacific theater against the Japanese. War must have deeply affected him, as it does all young men. Robert E. Lee, writing of his experiences in the Civil War, wrote his wife in 1864:
“What a cruel thing is war; to separate and destroy families and friends, and mar the purest joys and happiness God has granted us in this world; to fill our hearts with hatred instead of love for our neighbors and to devastate the fair face of the earth.”
Last year, I read a New York Times review of a book out about J.D. Salinger, author of The Catcher in the Rye. The article notes that Salinger, who served in the infantry during WWII in Europe, witnessed a lot of death and mayhem and struggled with depression his whole life:
“Salinger’s experiences during WWII heightened his sense of alienation. The war left him with deep psychological scars, branding ‘every aspect’ of his personality and reverberating through his writings. Salinger had suffered from depression for years, perhaps throughout his entire life, and was at times afflicted by episodes so intense that he could not relate to others.”
Ultimately, he stopped publishing, moved into a cabin in rural Connecticut and practiced Yoga and Zen meditation.
Dad clearly suffered from undiagnosed depression and PTSD, something that would, like Salinger, haunt him for the rest of his life. But war can’t explain all misery, can’t explain the storms that would rage in his head. His younger brother Roman, also a war veteran, became an alcoholic. Dad’s younger sister suffered from depression and been treated for it with medication suggesting a possible genetic propensity in our family for the illness.
Mom’s Story
Mom, like dad, was also part of WWII generation. Her older brother Joe went off to war in the Pacific for three years. As fate would have it, he met my future Dad aboard a ship in the Philippines and said, “If we ever get the hell out of this shithole, I’ve got this cute, blonde sister back in Buffalo.” They survived, my parents met, fell in love and married.
Mom had an alcoholic father, also an immigrant from Poland. She recalled being asked by her mother to go find her dad on a regular basis when he didn’t return home after work. Often, during the harsh Buffalo winters, she would find him passed out in a snow bank. The only intimate moments she remembered sharing with him was when for her eighth birthday he took her to a Shirley Temple movie and bought her candy.
Mom and dad quickly had three kids. Things went well the first ten years of their marriage, but the wheels began to fall off from there on out: dad drank too much, became a gambler, womanized and had unpredictable outbursts of high octane rage. Mom collapsed back into herself and never really recovered. She began to eat a lot, added lots of pounds to her slender frame and watched T.V. all the time. Maybe the dopey sitcom narratives sliced through the quiet pain my mom carried – all the time – all of her life.
Dad died 32 years ago at the age of 56 (I was 19) from too much drinking and smoking. He died sort of unrepentant, never saying he was sorry for anything. But, in my own mind at least, I think he was sorry. I think he just couldn’t bring himself to say it because of the enormity of his sins. But I have learned to forgive him, this enemy of my childhood who I had wished as a boy that he would just die. The great poet Henry Wadsworth Longfellow once wrote:
“If we could read the secret history of our enemies we should find in each man’s life sorrow and suffering enough to disarm all hostility.”
As for my mom, well, she died almost two years ago at the age of 82 of brain cancer. I devoted a blog to her passing, but didn’t say just how difficult it was to really know mom. She was always somehow distant, like a star in the sky. She never had any friends, her family was her circle. She loved us, but often did not connect with her children; maybe because she had never been cherished as a child. She did, after all was said and done, the best she could and, in this sense, was so much easier to forgive and let go of than dad.
Walter – Second Edition
Walter, my oldest brother at age 59 and dad’s namesake, and I were walking back the other night to the parking lot after our hometown hockey team, the Buffalo Sabres, had taken a real shellacking. I asked him in the frosty, hidden darkness where men – – if they do at all – – share a sliver of their true inner lives: “Do you ever think of dad and what did he meant to you?” He replied, after a few huffing breaths: “Not really, just what a real asshole he was.”
My brother has never been in therapy, never taken antidepressants. But he had heroically forged ahead “carving out a living” as he was prone to say. Yet, I couldn’t help think about the profound effect dad’s abuse had had on him and my other three siblings. I wonder if he sometimes thinks about it at night while lying in bed with the windows cracked open on a hot summer’s night. Does he wonder why he can’t stop feeling bad about himself? Why he doesn’t feel more confidence? And the toughest part of it all, the thing that keeps me up at night when I think of my burly, big-hearted brother, is that he probably blames himself for all of these feekings as adult children of alcoholics are prone to do.
My Coming Around
As for me, a real veteran of therapy and antidepressant medications, I know all too well that my parents are still tangled up with me long after their deaths. My therapist once said that I had to work out the long buried grief of never having had the parents I needed. Over the years, I have done a lot of grieving for the childhood I didn’t have. Yet, as I was to learn, it wasn’t only my grief about my childhood troubles that I was to deal with, but for my parents as well. For the loss of their innocence, their difficult childhoods and all that they could have been.
Despite the pain in my family, there was love; fractured though it may have been. As he aged, I sensed that my dad knew that too much had gone wrong that he couldn’t fix. But in small gestures here and there, he showed affection and love. As my mom’s wake last May, I was privileged to give the eulogy. What I said was my mom’s defining quality wasn’t success, intelligence or gardening, but kindness – that this is where she planted her flowers that continue to grow in the hearts of her children and grandchildren. And what a gift that is. One that’s always in bloom.
My parents were both hopeless in their own ways. They were dealt a crummy hand in life. They were born with certain genes, into a family and time in history that they didn’t choose. The difference between them and me, the blessing that came out of my depression that didn’t for them, was that my pain forced me to finally confront my wounds and work hard to heal them – an ongoing project for us all. It forced me to examine the long unexamined within me. It gave me a choice: I could continue to live out my parents damaged views of life or embark on my own journey and discover what was real and true for me.
While it is true that none of us can avoid the pains and difficulties that come from living on this planet, what modulates the pain is love — pure and simple. Andrew Solomon, who has suffered from depression for much of his adult life, captured this in his book The Noonday Demon: An Atlas of Depression:
“Depression is a flaw in love. To be creatures who love, we must be creatures who can despair at what we lose, and depression is the mechanism of despair. When it comes, it degrades one’s self and ultimately eclipses the capacity to give or receive affection. It is the aloneness within us made manifest, and it destroys not only connection to others but also the ability to be peacefully alone with oneself. Love, though it is no prophylactic against depression, is what cushions the mind and protects it from itself.”
In the end, love really is the only thing that saves anybody.
Have you ever felt so stressed out and overwhelmed that you can’t think straight? We now know that prolonged 
