The Wall Street Journal Archives - Lawyers With Depression

Be Smart About How You Use Your Smartphone: Your Mental Health Is On The Line

Technology can be our best friend, and technology can also be the biggest party popper of our lives. It interrupts our story, interrupts our ability to have a thought or daydream, to imagine something wonderful, because we’re too busy bridging the walk from the cafeteria back to our office on the cellphone. – Steven Spielberg

My daughter in college, like most of her generation, seems addicted to her smartphone. She pulls it out of her back pocket like a gunslinger from the wild west.

Not necessarily talking on it, but texting. All the time. Every day. Like all her friends. When not pecking away, they’re on their laptops watching YouTube videos (no T.V., please!) or surfing the web on their mental boogie boards.

I like to think that I am not addicted to my phone. And I guess, by comparison, to my 19-year old daughter, I’m am not. I am on it about 2-hours per day. The average teenager spends about 9 hours a day consuming social media and music on their phones – often while doing other activities like studying for school. And anxiety and depression rates are skyrocketing since the introduction of smartphones.

Continue Reading Article

Too Much Stress Can Lead to Depression

I listened to a National Public Radio segment about the connection between playing NFL football and brain trauma.

One retired running back said that each time he was hit when carrying the ball it was “like being in a high-impact car accident”. What a tremendous cost to pay, I thought.

For many of us, daily life is so demanding and stressful that it’s like being in a series of high-impact “stress collisions”. The word “stress” doesn’t even seem to do justice the corrosive experience of so much stress. “Trauma” is more like it.

This trauma isn’t the type inflicted by bone-jarring hits during a football game — it’s psychological, though no less real.

Psychiatrist Mark Epstein, M.D., author of the book The Everyday Trauma of Life, writes in a recent New York Times article,

“Trauma is not just the result of major disasters. It does not happen to only some people.

Continue Reading Article

Is it Lawyer Depression or Burnout? Telling the Difference

Burnout is nature’s way of telling you, you’ve been going through the motions, your soul has departed; you’re a zombie, a member of the walking dead, a sleepwalker. False optimism is like administrating stimulants to an exhausted nervous system. – Sam Keen

Sitting across from Tom, a lawyer for the past 15 years, I was struck by his ashen face. Before he said a word, before I asked him how his practice had been going, his slumped shoulders spoke volumes about a good man weighed down. As we spoke over coffee, he asked if I thought he was suffering from the “Big D” – depression.

As we spoke, he asked if I thought he was suffering from the “Big D” – Depression.

“No, I don’t think so, Tom. You seem pretty burn-out, though,” I said.

According to an ABA Journal article, lawyers facing increasing pressure to “value engineer” their services have adopted a “better-cheaper-faster” approach to practicing law because that’s what their clients are demanding.

This is one of the conclusions contained in a recent report on the future of the legal profession prepared by The New York Bar Association.

“Consumers have become more suspicious of institutions,” the report says, and clients are less willing to take their lawyer’s advice at face value and more willing to sue when they are unhappy. Technology is also changing client demands.

“Electronic communication has fueled a culture in which clients want more legal information, answers on the spot, and lawyers who can interpret, rather than simply provide, information,” the report says.The result is more specialization and an emphasis on ability to deliver higher quality services at a lower cost and in less time.”

This was certainly true in Tom’s case. There were no limits to the demands put on him – by both others and himself – to be better, cheaper, and run faster. As if he were a machine. He hunkered down into a survival mode, had little positive energy to invest in himself or his family and ultimately burned out like a meteorite entering the earth’s atmosphere.

Just Perfect

Burnout isn’t just a consequence of trying to keep up with an insane schedule. It’s also fueled by a common personality trait found in many lawyers: perfectionism.

Author of the book Stress Management for Lawyers: How to Increase Personal & Professional Satisfaction in the Law, Amiram Elwork, Ph.D. writes:

“Because law requires objective logical analysis and close attention to details, the legal profession attracts perfectionists. These are people who live by the rule: ‘If I don’t do a perfect job in every detail, I will fail.’ Perfectionists tend to be workaholics who are often viewed as inflexible, uncomfortable with change, and obsessed with control but unconvinced that they have it. Since perfection can’t be achieved, striving for it can cause constant dissatisfaction.”

“My clients are perfectionists,” says Alden Cass, a therapist to both corporate attorneys and men on Wall Street. “They have very rigid ideals in terms of win-lose,” he continues. “Their expectations of success are through the roof, and when their reality doesn’t match up with their expectations, it leads to burnout—they leave no room for error or failure at all in their formula.”

Out of Sync With Core Values

Elwork opines that “another reason that some lawyers experience burnout is that their core values are not aligned with their own behaviors. Sometimes this problem reflects an internal psychological conflict, whereas at other times it is a conflict between the lawyer’s values and those of the organization at which he or she works.”

My friend Tom is in this boat. He works for an insurance defense firm. He’s a compassionate man who tries his best to be a good person. The culture of his firm, however, tells him to “hammer” personal injury victims at their depositions and trials. He hates to do this but doesn’t know what else to do. He has a family to support after all. He feels stuck at his job.

He suspects other lawyers at his firm are burned out, but doesn’t really know what a burned out lawyer looks like.

There are, however, telltale signs.

Burnout’s 10 Milestones

Over-commitment (always in motion)
Inadequate breaks and rest (continuous client involvement)
Idealistic standards
Constant low-grade stress (occasionally interrupted by crisis!)
Lack of help and assistance
Chronic fatigue from pushing oneself (“hitting the wall”)
Strong sense of responsibility, even when others “dropped the ball”
Guilty feelings about missing church events/activities
Heavy job and family responsibilities/expectations
Inability (or strong reluctance) to say no

Similarities Between Depression and Burnout

While they share some similarities, there are some important differences between the two conditions.

Both depressed and burnout sufferers show symptoms of withdrawal and fatigue.

Depressed individuals also show signs of hopelessness and disinterest. Severe depression can already alter the sleep-wake pattern of an individual thus triggering insomnia.
The most serious cases are those involving persons who possess some recurring thoughts about death. Those who experience a burnout are often accompanied by feelings of helplessness, self-doubt, and failure on top of the other feelings similarly experienced by depressed individuals.

Differences Between Depression and Burnout

Burnout is a state that is just induced by severe stress. Depression, on the other hand, is a clinical behavioral disorder affecting one’s mood. As such, it is, therefore, more appropriate to say that when you are having a burnout you are also at risk of experiencing or developing depression rather than the other way around.

Researchers have successfully found important physiological differences between people who suffer from burnout and those who suffer from depression: individuals suffering from burnout do not produce enough cortisol as if the body decided to go on strike. As a reversal, those who suffer from depression produce too much of it.
When one is suffering from depression, he or she is unable to attain or experience a state of pleasure. As a result, you often see depressed individuals shrouded in extreme sadness. Burnout sufferers look different because they feel overly exhausted to the point of doubting their own ability to carry out their regular activities of daily living. Severe burnouts may also lead one doubt his self-worth.
Depression is usually rooted upon a number of factors like when one is suffering from an incurable chronic disease or an extreme severance of relationship (death, breaking from a serious romantic relationship) with a very significant other. Depression has also been discovered to have some genetic predisposition and environmental roots. With regard to burnout, this condition is usually tied in with strains in work and high demand stresses of life in general.

A Strategy for Avoiding Burnout

It’s easier to avoid burnout in the first place than it is to overcome it. Here a handful of do-able strategies for escaping its clutches:

Rest, relax, recreate, renew. It’s the only avenue for sustaining us for the long haul.
Give something up before taking on a new commitment or responsibility. Don’t keep “adding floors” onto your already towering skyscraper of activities.
Learn to say no and to set up reasonable boundaries around your involvement. Specify the help you’ll need and the constraints on your time.
Set priorities and consult with your family. Service work occupies an essential role in our lives but must never take priority over family. Be willing to occasionally say no to low priority activities when they conflict with quality family time.
Get away from it all on a regular basis through hobbies, recreation, short “sabbaticals,” and sometimes just being a couch potato.
Listen to your body’s stress warning signals, such as headaches, backaches, dizziness, insomnia, and unexplainable fatigue.
Cut out the hurry and worry. Stress is the natural byproduct of trying to stuff 10 pounds of potatoes into a 5-pound bag. Do only what you reasonably can in the time available and with the resources available.
Consider changing jobs. Sometimes the only thing you can do is leave your job and seek employment at another firm.
Consider changing careers. Some lawyers tell me that they are “sick and tired of being sick and tired.” Being burned out has forced them to confront this decision. It can be done and there are many happy ex-lawyers out there.

Further reading —

The Happy Lawyer: Making a Good Life in the Law by Nancy Levit and Douglas Linder

The Reflective Counselor: Daily Meditations for Lawyers by F. Gregory Coffey and Maureen C. Kessler

Can’t Get No Satisfaction: Burnout – New York Magazine

Lawyer Burnout: Avoidable, Not Inevitable – ABA Journal

Knockout Burnout! – Attorney at Work

Stress Starts Up the Machinery of Major Depression

From The Wall Street Journal, new revelations about the nuts and bolts of major depression focuses on the role of stress. Read the News

The Depression Machine: Why Too Much Stress Cranks It Up

I listened to a NPR segment this week about the connection between playing football in the NFL and brain trauma.

One retired running back said that each collision he suffered during a game “was like being in a car accident.” What a tremendous cost to pay, I thought.

For many of us, daily life is so demanding and stressful, that, like a football player, it’s like being in a series of car accidents. The word “stress” doesn’t even seem to do justice the corrosive experience of so much stress– “trauma” is more like it.

The trauma isn’t the type inflicted by bone jarring hits during a football game — it’s psychological, though no less real.

In his book, The Everyday Trauma of Life, psychiatrist Mark Epstein writes in a recent New York Times article,

“Trauma is not just the result of major disasters. It does not happen to only some people. An undercurrent of trauma runs through ordinary life, shot through as it is with the poignancy of impermanence. I like to say that if we are not suffering from post-traumatic stress disorder, we are suffering from pre-traumatic stress disorder. There is no way to be alive without being conscious of the potential for disaster. One way or another, death (and its cousins: old age, illness, accidents, separation and loss) hangs over all of us. Nobody is immune. Our world is unstable and unpredictable, and operates, to a great degree and despite incredible scientific advancement, outside our ability to control it.”

Such trauma not only impacts our psychological/emotional and spiritual selves, but our physical brains.

In a brilliant article in The Wall Street Journal this week entitled, “Stress Starts Up The Machinery of Major Depression”, Robert Sapolsky, Ph.D., points out that there are many factors that increase our risk of major depression including genes, childhood trauma, and endocrine and immunological abnormalities.

But a frequent trigger is stress.

Sapolsky writes, “The stress angle concerns ‘adhedonia,’ psychiatric jargon for ‘the inability to feel pleasure.’ Adhedonia is at the core of the classic definition of major depression as ‘malignant sadness’”.

As a person who has a genetic history of depression in his family and childhood trauma, I was drawn into Sapolsky’s article. What was the connection between stress and the malignant sadness I’ve experienced off and on since being diagnosed with depression twelve years ago?

Who would have thought that rat brain research would help me understand the link?

Sapolsky gives us a little background about our brain structure by letting us know that our abilities to anticipate, pursue and feel pleasure revolve around a neurotransmitter called dopamine in a region of the brain called the nucleus accumbens. Then he turns to the rats for further illumination:

“Put a novel object – say, a ball – in a mouse’s cage. When the mouse encounters the ball and explores it, the arousing mystery, puzzle and challenge cause the release of a molecule in the nucleus accumbens called CRF, which boost dopamine release. If an unexpected novel object was a cat, that mouse’s brain would work vey differently. But getting the optimal amount of challenge, what we’d call ‘stimulation,’ feels good.”

We humans need just enough challenge and stress to make life interesting.

“CRF mediates this reaction: Block the molecule’s actions with a drug, and you eliminate the dopamine surge and the exploration,” writes Sapolsky. “But exposing a mouse to major, sustained stress for a few days changes everything. CRF no longer enhances dopamine release, and the mouse avoids the novel object. Moreover, the CRF is now aversive: Spritz it into the nucleus accumbens, and the mouse now avoids the place in the cage where that happened. The researchers showed that this is due to the effects of stress hormones called glucocorticoids. A switch has been flipped; stimuli that would normally evoke motivated exploration and a sense of reward now evoke the opposite. Strikingly, those few days of stress caused that anhedonic state to last in those mice for at least three months.”

Sapolsky concludes:

“But meanwhile, these findings have an important implication. Life throws lousy things at us; at times, we all get depressed, with a small letter “d.” And most people—as the clichés say—get back in the saddle; prove that when the going gets tough, the tough get going. What then to make of people who are incapacitated by major depression in the clinical sense? Unfortunately, for many, an easy explanation is that the illness is a problem of insufficient gumption: ‘Come on, pull yourself together.’ There is a vague moral taint.”

The trauma of everyday stress is an important player in major depression. When combined with genetic history and a difficult childhood, it can tip the applecart and result in what Andrew Solomon calls “The Noonday Demon”. The takeaway is that the better we get at managing the “trauma of everyday life”, the better chance we have at preventing depression.

My worry is that the society we’ve created and the hectic lives we lead make the management of stress very difficult, indeed.