Undoing Perpetual Stress Archives - Lawyers With Depression

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

Judges Struggling With Depression: More Common Than You Think

I’ve written a lot on stress, anxiety and depression in the legal profession, but not about the judiciary. There has been much commentary, research and Law Journal articles about what ails law students and attorneys — but not about judges.

I guess that’s not surprising. In my work, I have spoken with scores of judges from all over the country. It’s a noble, important calling in life. But it’s also very stressful, demanding and . . . lonely.

Isolation, Loneliness & the Judiciary

In an article for Judicature magazine, psychiatrist Isaiah Zimmerman culled through twenty years of notes he accumulated from treating state and federal judges. Here are the voices of the judges in their own words:

“Before becoming a judge, I had no idea or warning, of how isolating it would be.”

“Except for those very close, old friends, you cannot relax socially.”

“Judging is the most isolating and lonely of callings.”

“The isolation is gradual. Most of your friends are lawyers, and you can’t carry on with them as before.”

“When you become a judge, you lose your first name!”

“It was the isolation that I was not prepared for.”

“After all these years on the bench, the isolation is my major disappointment.”

“The Chief Judge warned me: ‘You’re entering a monastery when you join this circuit.’”

“I live and work in a space capsule – alone with stacks of paper.”

“Your circle of friends certainly becomes smaller.”

“Once you get on the appellate bench, you become anonymous.”

These weren’t isolated comments or small pockets of pedestrian sadness. Dr. Zimmerman notes that about 70% of the judges he interviewed came up with these observations on their own.

There are several things that contribute to a sense of judicial loneliness. The Code of Judicial Conduct imposes restrictions on judicial behavior both in and out of the courtroom. Judges must avoid the appearance of impropriety and thus must be cautious and keep an appropriate distance and bearing at social and bar events. There are good reasons to have these restrictions, but if a judge isn’t careful to live a balanced life, they can help trigger a profound sense of lonesomeness.

Loneliness isn’t just emotionally painful; it’s also dangerous to your health on multiple levels. According to an article by psychologist, Hara Estroff Marano, writes:

“Evidence has been growing that when our need for social relationships are not met, we fall apart mentally and even physically. There are effects on the brain and on the body. Some effects work subtly, through the exposure of multiple body systems to excess amounts of stress hormones. Yet the effects are distinct enough to be measured over time, so that unmet social needs take a serious toll on health, eroding our arteries, creating high blood pressure, and even undermining learning and memory.”

Given the pressures and isolation of the job, judges need to recognize the dangers associated with loneliness: unhappiness, discontent, health problems and perhaps . . . depression.

Judges and Depression

Judges are supposed to be problem solvers in black robes; not human beings with psychological problems of their own.

Given the position that judges occupy in our society, the stigma around disclosure to others –and perhaps getting treatment for clinical depression — is much, much greater.

One psychiatrist I know who treats judges told me that judges request very early or very late weekday or weekend appointments. Moreover, they ask not to be scheduled before or after another lawyer or judge and pay in cash so as not to attract attention or leave a paper trail.

For the first ten years of my career, much of my practice was spent litigating cases in state and federal courts in New York City. One of my best friends from those days is now a judge. When I decided to go public with my depression eight years ago by writing an article for Trial magazine, my friend called me for dinner to catch up on things. He wanted to know how I was feeling and expressed concern about my plans to go public about my depression.

“Dan, why can’t you write the article anonymously,” my friend said. “But that’s the problem, isn’t it?” I replied. “Why should I have to write such an article anonymously? What do I have to be ashamed of? Depression is an illness no different than diabetes or heart disease. Would I write an article about those illnesses . . . anonymously?”

We kept in contact with dinners and phone calls over the next eight years, but over time our conversations centered less on my depression and well-being and more on his. You see, my friend the judge disclosed to me that he was suffering from depression and had tried to commit suicide some years before.

I think he felt he could trust me. Moreover, I think my disclosure gave him implicit permission to talk about his pain and struggles; a hurt only his therapist and wife knew of. He spoke of the loneliness of his job and how he missed the collegiality of his old large firm. But, he said that on the balance, he’d rather be a judge and didn’t regret his change in vocation; a move from the courtroom to the chamber. He liked his job, enjoyed the intellectual challenge and the chance to do justice.

The statistics on lawyer depression are deeply troubling. They suffer from depression at a rate twice that (20%) of the general population. As such, about 200,000 of this nation’s 1 million lawyers are struggling with depression right now. No studies have been done on judicial depression.

There are 1,774 federal level judges in the U.S. Were you to plug in the 20% depression rate we see with attorneys to the number of judges; approximately 350 judges across America are suffering from depression. Even though there haven’t been any studies of judicial depression, why would we expect the 20% rate to be any different than that found with attorneys?

I couldn’t find any statistics on how many state judges there are in the U.S. New York State has 1,250. Were you to plug in the 20% depression rate we see with attorneys to the number of these judges, approximately 250 of the Empire State’s judiciary are suffering from depression.

This isn’t sadness or burnout, but true clinical depression. Sometimes, we confuse being down in the dumps with depression. They’re really not the same thing – not even close. Here’s how psychologist Richard O’Connor, best-selling author of the book Undoing Depression, distinguishes it:

“Everyone knows what depression feels like. Everyone feels the blues at times. Sadness, disappointment, fatigue are normal parts of life. There is a connection between the blues and clinical depression, but the difference is like the difference between the sniffles and pneumonia.”

Nobody’s Perfect

Perfectionism is also an indicator for depression. In his article Even Judges Get the Blues, Judge Robert L. Childers writes:

“Because of the weight of public expectation, judges generally feel that they should be perfect. Not only do they feel that they should be fair, impartial, and make the right decision 100 percent of the time, but the public expects this of judges as well, as do the lawyers who practice before them. This can create undo pressure for judges and, consciously or unconsciously, keep judges from admitting or recognizing the signs of debilitating disease.”

An article from the ABA Journal, Perfectionism, Psychic Battering’ Among Reasons for Lawyer Depression, states: “Lawyers [and judges] are taught to aim for perfection, to be aggressive and to be emotionally detached. They ‘intellectualize, rationalize and displace problems on others’ . . .. They don’t take direction particularly well. They tend to have to have fairly elaborate denial mechanisms. And they tend to challenge anything they’re told.” In another article from the ABA Journal, it notes that when combined with depression, perfectionism makes it harder for a person to seek help. And in the worst case scenario, leads to suicide.

Loneliness & Depression

Depression is a multifaceted illness that has several different causes – some genetic, some physical and some emotional. In the depths of my depression, I felt very alone – like I was trapped at the bottom of a dark well.

Many with depression isolate themselves because it’s painful to be around others. I would hang out at Starbucks and do my work. I didn’t want others I knew to engage me; I didn’t want others to see the pain I was desperately struggling with.

I’ve found that loneliness and depression often travel the same road. This creates a lot of problems because the two can feed off one another.

According to psychologist Dr. Reena Sommer:

“Depression is a problem that often accompanies loneliness. In many cases, depressive symptoms such as withdrawal, anxiety, lack of motivation and sadness mimic and mask the symptoms of loneliness. In these cases, people are often treated for depression without considering the possibility that loneliness may be a contributing and sustaining factor in their condition.”

Generally, the debilitating symptoms of depression can usually be managed with antidepressant medication. But when the underlying loneliness is ignored or overlooked, the depressive-like symptoms will probably continue. Unless the reasons for loneliness and depression are separated out, it can easily turn into a ‘chicken and egg’ situation where depression leads to loneliness, and loneliness leads to depression.”

Turning It Around

While depression might not be our fault, it is our responsibility to get better. We need to start behaving and thinking in constructive ways. Here’s some food for thought for those on the bench:

Get help. You can’t handle this by yourself. It is a problem bigger than any individual person. The ABA’s Commision on Lawyer Assistance Programs created a Judicial Assistance Initiative. Reach out to them and they can get you pointed in the right direction.
You may have to take antidepressant medication to help you. That’s okay. You may have a chemical imbalance that you need to address. For many, psychotherapy alone won’t help until they quieted down their somatic complaints — e.g. fatigue from sleep problems – so that they can have the energy and insight to work on their problems.
Whether you need medication or not, you will need to confront your negative thinking with a therapist. A lot of research suggests that cognitive behavioral therapy is a particularly effective form of treatment for depression. Interview a couple therapists before you settle on one.
Exercise. The value of exercise is widely known: It’s simply good for everybody. For a person with depression, it becomes not just about a healthy habit, but a critical behavior and habit – they absolutely need to work out. In his book Spark: The Revolutionary New Science of Exercise and the Brain, Harvard psychiatrist John Ratey devotes a chapter to the importance of exercise in alleviating depression. Please check this book out.
If you have a spiritual practice, do it. If you don’t, think about starting one. This could be anything from a formal meditation practice, going to Mass, or walking the woods. A lot of research suggests that people who have a spiritual practice do better with depression recovery. If you believe in God or a higher power (I am Catholic), you can avail yourself of help and support from Someone who is bigger than your depression. If you do not believe in God, maybe you believe in some other form of spirituality you can tap into. Spiritual growth and development, in my opinion, are very important pillars of recovery. Two books from my tradition include Seeing beyond Depression by Father Jean Vanier and Surviving Depression: A Catholic Approach by Sister Kathryn James Hermes.
Get educated. Read some good books on the topic. As part of your education, learn about the powerful connection between stress, anxiety and depression. On this subject, I recommend Dr. Richard O’Connor’s Undoing Perpetual Stress: The Missing Connection between Depression, Anxiety and 21st Century Illness. Dr. O’Connor suggests that depression is really about stress that has gone on too long. The constant hammering away of stress hormones on the brain changes its neurochemistry. This can and often does result in anxiety disorders and/or depression.
Build pleasure into your schedule. Judges, like all those in the legal profession, are busy and have the “I will get to it later” mentally – especially when it comes to things that are healthy pleasures. We have to jettison this approach to how we live our days. We must begin to take time – now – to enjoy pleasurable things and people. A hallmark of depression is the inability to feel happiness or joy. We need to create the space where we can experience and savor good experiences and feelings.
Practice mindfulness. In mindfulness meditation, we sit quietly, pay attention to our breath, and watch our thoughts float by in a stream of consciousness. Normally, we immediately react to our thoughts (e.g. “I am losing my mind with all of these deadlines”). With mindfulness practice, we can begin – slowly – to let the thoughts and feelings float by without reacting to them. If such an approach to depression seems far-fetched, read the best-selling book The Mindful Way through Depression: Freeing Yourself from Chronic Unhappiness, for an excellent primer on how you can incorporate mindfulness into your day.
Remember to be kind to yourself. It sounds so simple. I tell this to depressed lawyers and judges all the time and they usually look puzzled. They often admit that they have rarely, if ever, thought about it and don’t know how to be kind to themselves. I believe that it first begins with a conscious intention – “I am not going to treat myself poorly anymore.” Such a simple refrain can help us. Depression is often built on poor mental, emotional and physical habits. We must learn to acknowledge that we are worthy of love from others and ourselves and that part of such love involves taking better care of ourselves.
Spend time outside and in nature. We humans forget that we are part of nature and the animal kingdom. We need fresh air and sunshine. Even more so when the darkness of winter strikes. If you live in a part of the country with long winters, load up on vitamin D and consider using a light box to help you.

If you or a judge you know might be suffering from loneliness and/or depression, please forward this article to them. Here’s a list of depression’s symptoms and a self-test from the Mayo Clinic.

Breaking Bad Habits: You Can Do It

From The Washington Post, a story about Richard O’Connor, Ph.D.’s latest book, Rewire: Change Your Brain to Break Bad Habits, Overcome Addictions, Conquer Self-Destructive Behavior. Read the News

Undoing Depression in Lawyers

There’s some interesting research to suggest that happy people view the world through certain comforting illusions, while depressed people see things more realistically. [i] For instance, the illusion of control. You can take a random sample of people and sit them in front of a video monitor with a joystick, and tell them their joystick is controlling the action of the game on the screen. (But the point of experiment is that it actually doesn’t). Depressed people will soon turn to the lab assistant and complain that their joystick isn’t hooked up correctly. Normal people, on the other hand, will go on happily playing the game for quite some time.

I think this explains a lot about why lawyers are so prone to depression. Because of their experience with the law, most attorneys have lost their rose-colored glasses some time ago. (Or else they never had them and chose the law as a career because it suited their personality). Attorneys know that life is hard, and doesn’t play fair. They’re trained to look for every conceivable thing that could go wrong in any scenario, and they rarely are able to leave that attitude at the office. They see the worst in people (sometimes they see the best, but that’s rare). They tend to be strivers and individualists, not wanting to rely on others for support. They have high expectations of success, but they often find that when they’ve attained success, they have no one to play with, and have forgotten how to enjoy themselves anyway.

All this makes it hard for attorneys to get help with their depression. They tend not to recognize it as such; they just think it’s stress, or burn out, or life. They don’t expect that anyone is going to be able to help. Most of my attorney-patients have contacted me because their relationships are falling apart, but they don’t see that it’s depression that makes them such a lousy partner – tense, irritable, critical, joyless, tired all of the time, relying on alcohol or other drugs. If they’d gotten help for the depression a couple of years previously, their spouse wouldn’t be moving out now. The truth about depression is that it not only makes you feel horrible, it wrecks your life. And that’s why I wrote the book, Undoing Depression, in the first place. I was running an outpatient clinic, and grew exasperated with seeing the people whose lives wouldn’t have been so ruined if they had got some help when they first needed it – before they alienated their children and spouse, got fired, went into debt, developed a substance abuse problem, etc. I thought there was a need for an intelligent self-help book, one that points out all the bad habits that depression engenders and which, in a vicious circle, keeps reinforcing the disease. But the truth is that self-help isn’t nearly enough for most depression sufferers. It’s as if you stepped over an invisible cliff, and you can’t find your way back doing what you normally do, because that’s what led you over the cliff in the first place. Depression is the original mind/body disease; your physical brain is damaged because of the stress in your mind, and you’re unlikely to undo that damage without help.

Depression is highly treatable, but if you want a lasting recovery you have to change your life. The ugly fact is that depression is very likely to reoccur. If you had one episode of major depression, chances are 50:50 that you’ll have another; if you have three episodes, it’s 10:1 you’ll have more. But you can improve those odds if you get good professional help, with medication and with talk therapy. We won’t put your rose-colored glasses back on, but we can help you see how negative thinking and the negative acting is contributing to your disease.

[i] See for example, Shelly Taylor: Positive Illusions; and Julie Noren: The Positive Power of Negative Thinking.

Richard O’Connor, Ph.D., is the author of two noteworthy books, Undoing Perpetual Stress: The Missing Connection Between Depression, Anxiety, and 21st Century Illness and Undoing Depression: What Therapy Doesn’t Teach You and Medication Can’t Give You. He is a practicing psychotherapist with offices in New York City and Canaan, Connecticut. He has suffered from clinical depression and is a member of a depression support group.

Dan’s Latest Top 10 Book Recommendations on Stress, Stress-Management and Anxiety

Over the years, I’ve read too many books to count about stress, anxiety, and depression. Like most people, I’m always looking for tips and clues about how to handle things better.

Some of these books have turned out to be real stinkers. Others, retreads of books and articles that have said the same things over and over again.

I have found some gems, though. Books that have something original to say, or are well-written.

I’ve found that the most useful ones make me want to read them further after the first 25-pages, or so. Good rule of thumb.

I hope you find help, hope, and insight between their pages.

Manage Your Time to Reduce Your Stress: A Handbook for the Overworked, Overscheduled, and Overwhelmed — Rita Emmett

The title of this book grabbed my attention because it seemed to capture so much more than just stress management. Stress management is truly about managing being overworked, overscheduled, and overwhelmed.

According to the author, the key is not time management but “stuff management — taking control of all those tasks to do, people to see, commitments and obligations to fulfill. Mismanagement of all that “to-do” stuff is what leads to stress. Emmett combines quick, easy-to-digest tips and infectious good humor to give readers positive ways to handle stress and their overly busy lives.

You can also check out her website for other helpful tips and ideas.

Monkey Mind: A Memoir on Anxiety — Daniel Smith

I first read about Smith’s book in a New York Times article called “Panic Buttons“. This memoir on stress and anxiety is not only informative and insightful, it’s well-written and funny.

The long list of things that, over the years, have made Daniel Smith nervous includes sex, death, work, water, food, air travel, disease, amateur theater, people he’s related to and people he’s not related to, so the prospect of a book review probably wouldn’t seem like a very big deal to him. Or would it?

This fleet, exhausting memoir, is an attempt to grapple with a lifetime of anxiety: to locate its causes, describe its effects and possibly identify a cure. Or, if not a cure, at least a temporary cessation of the worry that’s been plaguing him since his youth.

Check out his website, The Monkey Mind Chronicles, for more interesting stuff.

Hardwiring Happiness: The New Brain Science of Contentment, Calm, and Confidence — Rick Hanson

Rick Hanson, Ph.D. is a neuropsychologist and best-selling New York Times author.

Hardwiring Happiness lays out a simple method that uses the hidden power of everyday experiences to build new neural structures full of happiness, love, confidence, and peace.

In an interview discussing the book, he states:

“So, how do you get good things—such as resilience, self-worth, or love—into your brain? These inner strengths are grown mainly from positive experiences. Unfortunately, to help our ancestors survive, the brain evolved a negativity bias that makes it less adept at learning from positive experiences but efficient at learning from negative ones. In effect, it’s like Velcro for the bad but Teflon for the good.

This built-in negativity bias makes us extra stressed, worried, irritated, and blue. Plus it creates a kind of bottleneck in the brain that makes it hard to gain any lasting value from our experiences, which is disheartening and the central weakness in personal development, mindfulness training, and psychotherapy”.

Check out his website for more information about the book and his suggestions.

Why Zebras Don’t Get Ulcers: An Updated Guide to Stress, Stress-Related Diseases and Coping – Robert Sapolsky, Ph.D.

Why don’t zebras get ulcers–or heart disease, clinical anxiety, diabetes and other chronic diseases–when people do?

In a fascinating that looks at the science of stress, Stanford biologist Robert Sapolsky presents an intriguing case, that people develop such diseases partly because our bodies aren’t designed for the constant stresses of a modern-day life – – like sitting in daily traffic jams or racing through e-mails, texting and running to pick up our kids after a tough day at work. Rather, humans seem more built for the kind of short-term stress faced by a zebra–like outrunning a lion.

This book is a primer about stress, stress-related disease, and the mechanisms of coping with stress. How is it that our bodies can adapt to some stressful emergencies, while other ones make us sick? Why are some of us especially vulnerable to stress-related diseases and what does that have to do with our personalities?”

Sapolsky, a neuroscientist, concludes with a hopeful chapter, titled “Managing Stress.” Although he doesn’t subscribe to the school of thought that hope cures all disease, Sapolsky highlights the studies that suggest we do have some control over stress-related ailments, based on how we perceive the stress and the kinds of social support we have.

Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness – John Kabat-Zinn, M.D.

As a busy lawyer, I was immediately attracted to the title Full Catastrophe Living. It literally leapt of the bookshelf and cracked me on the head. Who doesn’t live a life so jammed with stuff to do that it feels like a catastrophe?

The author takes the phrase “full catastrophe living” from book and movie “Zorba the Greek”. If you’ve never seen it, an Englishman Basil – – who is half-Greek – – inherits a run down mine in a small Greek town. To help him restore it, he hires a local character named Zorba to be the foreman of the local laborers. Zorba, full of the zest of a life truly lived, is asked by Basil, “Do you have a family?” Zorba responds “Wife, children, house – – the full catastrophe!!!”

Undoing Perpetual Stress: The Missing Connection Between Depression, Anxiety and 21st Century Illness – Richard O’Connor, Ph.D.

Author of my favorite book on depression, “Undoing Depression”, Richard O’Connor, Ph.D., has written another simply brilliant book on the consequences of “perpetual” stress in our lives – the alarming and escalating rates of clinical anxiety and depression. This was the first book I read that made clear to me the connection between stress, anxiety, and depression. It formed the basis for my blog on the topic How Stress and Anxiety Become Depression. The human nervous system was never meant to handle this many stressors. It’s as if the circuit breakers in our brains are blown by too much stress running through our brain’s circuitry. This book is a perfect fit if you want to learn a lot about the brain and physiology of stress – I found it fascinating. If you’re looking for a quick read and pick-me-up, this isn’t it. Check out his website.

A Mindfulness-Based Stress Reduction Workbook — Bob Stahl

The author writes that the key to maintaining balance is responding to stress not with frustration and self-criticism, but with mindful, nonjudgemental awareness of our bodies and minds.

This book employs some of the same mindfulness strategies discussed in Full Catastrophe Living but does it in the format of a workbook. I find this format very helpful because it’s practical and gives me exercises to do to put into practice mindfulness to reduce my daily stress load.

The 10 Best-Ever Anxiety Management Techniques – Margaret Wehrenberg, Ph.D.

Medication, once considered the treatment of choice, is losing favor as more and more sufferers complain of unpleasant side effects and its temporary, quick-fix nature. Now, thanks to a flood of fresh neurobiology research and insights into the anatomy of the anxious brain, effective, practical strategies have emerged allowing us to manage day-to-day anxiety on our own without medication. Addressing physical, emotional, and behavioral symptoms, Margaret Wehrenberg, Ph.D., a leading mental health clinician, draws on basic brain science to highlight the top ten anxiety-defeating tips. Everything from breathing techniques to cognitive control and self-talk are included. I really like that the 10 chapters are highly readable and short. Dr. Wehrenberg is also a frequent blogger at the Psychology Today website. Here’s one of her blogs, The One-Two Punch of Negativity and Fear.

Things Might Go Terribly, Horribly Wrong: A Guide to Life Liberated from Anxiety – Troy DuFrene

This book approaches the problem of anxiety a little differently than most. Instead of trying to help you overcome or reduce feelings of anxiety, it will help you climb inside these feelings, sit in that place, and see what it would be like to have anxiety and still make room in your life to breathe and rest and live, really and truly live, in a way that matters to you. This approach is based upon a research-supported form of psychotherapy called Acceptance and Commitment Therapy, also known as ACT which starts with the assumption that the normal condition of human existence is suffering and struggle, ACT works by first encouraging individuals to accept their lives as they are in the here and now. This acceptance is an antidote to the problem of avoidance, which ACT views as among the greatest risk factors for unnecessary suffering and poor mental health

The Worry Cure – Robert L. Leahy

For “highly worried people,” or those who suffer from the “what-if disease,” this book presents a systematic, accessible self-help guide to gaining control over debilitating anxiety. Leahy is an expert in changing thought processes, and he walks worriers step-by-step through problems in the way they think, with pointers on how to change these biases. The author then outlines a seven-step worry-reduction plan (remember, I love plans!) beginning with identifying productive and unproductive worry, progressing to improving skills for accepting reality, challenging worried thinking and learning to harness unpleasant emotions such as fear or anger.

Self-Coaching: The Powerful Guide to Beat Anxiety – Joseph J. Luciani, Ph.D.

This is a good book for those who don’t want to see a therapist or, if they do, need extra doses of encouragement and practice to overcome their stress and anxiety. The author advises readers to identify themselves as specific personality types (e.g., “Worrywarts,” “Hedgehogs,” “Perfectionists”) and then gives specific instructions on how to change the particular thought patterns associated with this type of personality. So many people who struggle with anxiety never got what they needed while growing up – – enough love, encouragement, and affirmation. Lacking these core experiences, we develop can develop particular maladaptive strategies to cope with people and situations that push our buttons. This is the only book that I’ve read that pairs specific coping recommendations with particular personality types.

What books would you recommend? Hit the comment button and submit your favorites.

Next Steps:

If you are interested in talking to Dan about CLE eligible trainings he offers law firms, call him at (716) 913-6309 or via our contact form. One-on-one coaching is also available for lawyers who need individualized attention. Go to Dan’s website Yourdepressioncoach.com to download his free book and schedule a consultation.

Lawyer Fight-Or-Flight And Its Connection To Depression

Lawyers are control freaks. Okay, maybe they have to be. There’s is so much going on that they actually do have to control things to be good at their jobs. But it creates a grind of perpetual stress; every day, all-out stress seizures to control of events and people that are all too often uncontrollable leaving them depleted by the constant firing of their bodies’ fight-or-flight reaction.

We all learned in high school biology about the fight-or-flight response; a binary system of survival that kept our hairy, grunting ancestors alive in prehistoric times when meandering about the Sarengeti plains. This lighting quick response evolved to make us scamper from threats we could outrun and brawl with ones we couldn’t.

Today’s’ lawyers are embedded with the same nervous system their Neanderthal ancestors had 30,000 years ago. When they’re threatened on the job, their heart rate fires, breathing becomes shallower to divert oxygen to muscles and stress chemicals are dumped into their bodies. This all happens automatically, before they’ve even had a chance to think about it. And it happens even when they’re not being chased by a ravenous cougar or fighting a loin clothed adversary.

When our body’s stress response is triggered, it does not know the difference between true physical threats to our physical survival and psychological threats to our sense of self. Think about how much our hearts pounds in a contentious deposition, for example. Our bodies, unable to actually physically run or fist fight in the office, surge with stress hormones as if we were in a bloody life-or-death battle for control of that deposition with a dastardly adversary.

For lawyers prone to anxiety and depression, the daily surges of the stress hormone cortisol are particularly troublesome because of its impact on the hippocampus and the amygdala in the brain.

The hippocampus is that part of the brain that remembers details and helps you put incoming information into context. It is without emotions, registering and storing details of events, functioning like a Joe Friday from Dragnet: “Just the facts, mam.”

The amygdala is the brain’s early warning system and is a major cause in genetically depressed moods and negative thinking. It acts as an importance meter, registering tone and intensity and tells your brain instantly if it should prepare for trouble. It scans the environment looking for danger.

Too much cortisol, over too long a period of a time, can cause depression and result in actual changes to the brain.

Physician John Ratey writes in his best-selling book Spark:

“Chronic depression causes structural changes to the brain. Research has showed that depressed patients had measurable changes in the amygdala and the hippocampus, crucial players in the stress response. We knew the amygdala was central to our emotional life, but they also found that the memory center was also involved in stress and depression. High levels of the stress hormone cortisol kill neurons in the hippocampus. If you put a neuron in a petri dish and flood it with cortisol, its vital connections to other cells retract. Fewer synapses develop and the dendrites wither. This causes a communication breakdown, which, in the hippocampus of a depressed brain, could partly explain why it gets locked into thinking negative thoughts – it’s recycling a negative memory, perhaps because it can’t branch out to form alternative connections. At the same time, MRI shows that new nerve cells are born every day in the hippocampus and possibly the prefrontal cortex – two areas shriveled in depression. Now we see depression as a physical alteration of the brain’s emotional circuitry.

Norepinephrine, dopamine, and serotonin are essential messengers that ferry information across the synapse, but without enough good connections in place, these neurotransmitters can only do so much. As far as the brain is concerned, its job is to transfer information and constantly rewire itself to help us adapt and survive. In depression, it seems that in certain areas, the brain’s ability to adapt grinds to a halt. The shutdown in depression is a shutdown of learning at the cellular level. Not only is the brain locked into a negative loop of self-hate, but it all loses the flexibility to work its way out of the hole.”

In the privacy of their offices or in anonymous phone calls, I’ve heard many lawyers with depression tell me they hate themselves. They hate themselves because they’re stuck in depression and spinning their wheels. Rather than see this predicament as something that can be explained as an illness going on in their brain, they mercilessly punish themselves and feel they’re weak and lazy.

In his book Undoing Perpetual Stress: The Missing Connection between Depression, Anxiety, and 21^st Century Illness, Dr Richard O’Connor writes:

“For an overwhelming number of people today, the result of the vicious circle of perpetual stress is a state of permanent malfunction: dissatisfied, irritable, overwhelmed and hopeless, out of control, frightened, physically run down and in pain. For want of a better term, this is what I call the “Perpetual Stress Response.” Overwhelmed by too many stress hormones in our system, our cells close down receptor sites to try to compensate; but that just makes the endocrine system pump out even more stress hormones. Continually bathed in neurotransmitters telling us there is constant danger. And our brains become rewired by stress, our neural circuitry restricted to firing along preconditioned pathways, so that we are literally unable to think of new solutions, unable to come up with creative responses.”

Anxiety and depression are terrible coping mechanisms. If so, why do lawyers in such large numbers suffer from these maladies? Because they don’t know what else to do and don’t realize the damage they’re doing to their bodies and minds by living with the fight-or-flight furnace turned on high all day long.

So what is a depressed lawyer to make of all of this? Like recovery from any illness, awareness goes along way. For many with depression, it will take a long time and periods of suffering, to see, to truly see, that anxiety and depression don’t work as coping mechanisms and that they have to learn better ways in which to run their lives to help their brains.

In my next blog, I’ll explore what we can do about this situation.

Dan’s Top 10 Stress and Anxiety Book Picks

There’s a wonderful piece in todays New York Times Magazine, The Manic in Me: If I Couldn’t Conquer my Anxiety, the Least I Could do was Understand It by Daniel Smith. He writes:

“There are two types of anxiety sufferers: stiflers and chaotics. Stiflers are those who work on the principle that if they hold as still, silent and clenched as possible, they will be able to cut the anxiety off from its energy sources, the way you cinch off the valve from a radiator. Chaotics, by contrast, work on no principle whatsoever. Although chaotics are sometimes stiflers when alone, when they are around other people, and especially intense interpersonal situations, they are brought into a state of such high psychological pressure that all the valves pipes open of their own accord, everything is released in a geyser of physicality and verbiage, and what you get is a kind of shimmery, barely stable equilibrium between internal and external states, like in those rudimentary cartoons where the outlines of the characters continuously squiggle and undulate”.

Smith captures some of the panicked nature of anxiety sufferers. But he’s not describing the anxiety that’s a normal part of life. Anxiety can even be useful when it alerts us to danger. But for some people, anxiety is a persistent problem that interferes with daily activities – – just as depression does – – such as work, school or sleep. This type of anxiety can disrupt relationships and enjoyment of life, and over time it can lead to serious health concerns and other problems.

Scientists know there is a high degree of comorbidity (i.e. the presence of a disease in addition to the primary disease) with anxiety and depression: up to 60% of patients whose primary diagnosis is anxiety also suffer from depression and vice versa. Check out my earlier blog, How Stress and Anxiety Become Depression.

All this being said, and without further adieu, here are my top 10 picks. Feel free to suggest your own.

Why Zebras Don’t Get Ulcers: An Updated Guide to Stress, Stress-Related Diseases and Coping – Robert Sapolsky, Ph.D.

Why don’t zebras get ulcers–or heart disease, clinical anxiety, diabetes and other chronic diseases–when people do? In a fascinating that looks at the science of stress, Stanford biologist Robert Sapolsky presents an intriguing case, that people develop such diseases partly because our bodies aren’t designed for the constant stresses of a modern-day life – – like sitting in daily traffic jams or racing through e-mails, texting and running to pick up our kids after a tough day at work. Rather, humans seem more built for the kind of short-term stress faced by a zebra–like outrunning a lion.

Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness – John Kabat-Zinn, M.D.

Chronic stress saps our energy, undermining our health, and making us more vulnerable to anxiety, depression, and disease. The heart of the book is based on Kabat-Zinn’s renowned mindfulness-based stress reduction program at the University at Massachusetts Medical Center. Check out this video clip of Dr. Kabat-Zinn. The author takes the phrase “full catastrophe living” from book and movie Zorba the Greek. If you’ve never seen it, an Englishman Basil – – who is half-Greek – – inherits a run down mine in a small Greek town. To help him restore it, he hires a local character named Zorba to be the foreman of the local laborers. Zorba, full of the zest of a life truly lived, is asked by Basil, “Do you have a family?” Zorba responds “Wife, children, house – – the full catastrophe!!!”

The Mindful Way through Anxiety: Break Free From Chronic Worry and Reclaim Your Life – Susan M. Orsillo, Ph.D.

Anxiety isn’t the same thing as stress. You can’t just “get over” anxiety. In fact, the very things most people do to try to feel better–avoiding feared situations, pushing worry out of mind–only make the problem worse. This book presents a powerful new alternative that can help you break free of anxiety by fundamentally changing how you relate to it. Mindfulness, a simple yet powerful way of paying attention to your most difficult emotions and life experiences, seems like it is everywhere these days and being offered as a solution to much of the mental distress that ails modern society. Yet, in my own limited experience, it is worthy of such attention because it works.

Undoing Perpetual Stress: The Missing Connection Between Depression, Anxiety and 21^st Century Illness – Richard O’Connor, Ph.D.

Author of my favorite book on depression, “Undoing Depression”, Richard O’Connor, Ph.D., has written another simply brilliant book on the consequences of “perpetual” stress in our lives – the alarming and escalating rates of clinical anxiety and depression. This was the first book I read that made clear to me the connection between stress, anxiety and depression. It formed the basis for my blog on the topic How Stress and Anxiety Become Depression. The human nervous system was never meant to handle this many stressors. It’s as if the circuit breakers in our brains are blown by too much stress running through our brain’s circuitry. This book is a perfect fit if you want to learn a lot about the brain and physiology of stress – I found it fascinating. If you’re looking for a quick read and pick-me-up, this isn’t it. Read the Book Review.

The 10 Best-Ever Anxiety Management Techniques – Margaret Wehrenberg, Ph.D.

Things Might Go Terribly, Horribly Wrong: A Guide to Life Liberated from Anxiety – Troy DuFrene

Get Out of Your Mind and Into Your Life – Steven C. Hayes

This is another book that uses the ACT approach. It’s different than the book above because it offers a five-step plan for coping with painful emotions such as anxiety and depression. How I love plans! I also liked the wisdom contained here: the recognition that painful feelings cannot be controlled will open you to the possibility of fully emotional living. When anxiety arises in our bodies and minds, we erroneously believe that we have the power to rein these in, stop them and thus effectively eliminate it. However, this approach only leads us further down into the well of panic. Anxiety is not the problem. It is our attempts to squash and control it that strengthen anxiety and prevent us from coping with it effectively. Learn what steps you can take to approach anxiety differently.

The Worry Cure – Robert L. Leahy

The Anxiety and Worry Workbook – David A. Clark, Ph.D.

Like many of the other books I’ve recommended, this one is also grounded in cognitive behavior therapy.

I like this book because included in it are carefully crafted worksheets, exercises, and examples that reflect the authors’ decades of experience helping people who really, really struggle with anxiety. Learn practical strategies for identifying your anxiety triggers, challenging the thoughts and beliefs that lead to distress, safely facing the situations you fear, and truly loosening anxiety’s grip–one manageable step at a time. Like depression, coping effectively with anxiety involves learning helpful new and constructive ways of thinking about the problems we all face. So often, it isn’t the reality of a situation that makes us anxious, but the stories we tell ourselves about the events that happen moment-to-moment.

Self-Coaching: The Powerful Guide to Beat Anxiety – Joseph J. Luciani, Ph.D.

This is a good book for those who don’t want to see a therapist or, if they do, need extra doses of encouragement and practice to overcome their anxiety. The author advises readers to identify themselves as specific personality types (e.g., “Worrywarts,” “Hedgehogs,” “Perfectionists”) and then gives specific instructions on how to change the particular thought patterns associated with this type of personality. So many people who struggle with anxiety never got what they needed while growing up – – enough love, encouragement and affirmation. Lacking these core experiences, we develop can develop particular maladaptive strategies to cope with people and situations that push our buttons. This is the only book that I’ve read that pairs specific coping recommendations with particular personality types.

Healing Anxiety and Depression — Daniel Amen, M.D.

Dr. Amen is a true pioneer in uncovering the connections between the brain and behavior. In this excellent book, he provides an overview of how the brain works and how medication, diet, supplements, exercise and social and therapeutic support can help anxiety. Check out this video clip of Dr. Amen talking about his comprehensive approach. As science’s understanding of how anxiety and depression work has grown, there is an emerging picture that both of these conditions are “whole body” problems that demand whole body solutions. Like depression, we can’t just take a pill. Rather, we need to look at every aspect of our lives so that we can address anxiety on multiple levels.

How Stress and Anxiety Become Depression

Lawyers suffer from depression at an alarming rate. I am one of them.

I have been a litigator for more than 22 years, and I didn’t suffer depression in the beginning of my career. But I did have trouble managing the stress of my practice.

Over time, this constant stress developed into anxiety. I started feeling like I couldn’t control everything. I would go to bed fearing the problems and disasters to confront me the next morning. After years of this, the pendulum swung from states of anxiety to states of depression. Why did this happen? It took me a long time to understand.

Recently, scientists have been focusing on the connection between stress and anxiety and the role they play in triggering and maintaining depression. This is something that should be of concern to all lawyers, who carry high stress loads in their law practices.

Too Much Stress Can Lead to Anxiety

“Stress” is anything in our environment that knocks our bodies out of their homeostatic balance. Stress responses are the physiological adaptations that ultimately reestablish balance. Most of the time, our bodies do adapt, and a state of balance is restored. However, “if stress is chronic, repeated challenges may demand repeated bursts of vigilance,” warns Dr. Robert Sapolsky, an expert on stress-related illnesses and author of the best-selling book, Why Zebras Don’t Get Ulcers: An Updated Guide to Stress, Stress Related Diseases and Coping. “At some point, vigilance becomes over-generalized, leading us to conclude that we must always be on guard – even in the absence of stress. And thus the realm of anxiety is entered,” writes Sapolsky.

About 20% of the population will experience some form of anxiety disorder at least once in their lifetime. Studies show that law students and lawyers struggle with anxiety at twice that rate.

Anxiety and Depression

Stress went on too long in my life as a litigator. I had, indeed, entered the realm of anxiety. I felt like I had a coffee pot brewing 24/7 in my stomach. I became hypervigilant; each file on my desk was like a ticking time bomb about to go off. At some point, the anxiety made me dysfunctional, and I was unable to do as much as I had before. I felt ashamed of this. I denied it to myself and hid it from others, but the litigation mountain became harder and harder to climb as the anxiety persisted over a period of years.

Sapolsky writes, “If the chronic stress is insurmountable, it gives rise to helplessness. This response, like anxiety, can become generalized: A person can feel . . . at a loss, even in circumstances that [he or] she can actually master.” Helplessness is one pillar of a depressive disorder that becomes a major issue for lawyers because we think of ourselves as invulnerable superheroes who are the helpers, not the ones in need of help. Lawyers often don’t get help for their depression and feel ashamed if they do.

Many lawyers do not appreciate the connection between their stress and anxiety and their risk for developing clinical depression. But the occurrence of anxiety disorder with major depression is frequent; in fact, 60 percent of people with depression are also suffering from an anxiety disorder.

Maybe this connection helps explain studies that find such high rates of both anxiety and depression in the legal profession.

Depression “is stress that has gone on too long,” according to Dr. Richard O’Connor author of the book Undoing Perpetual Stress: The Missing Connection between Depression, Anxiety, and 21st Century Illness. Many people with depression have problems dealing with stress because they aren’t “stress resilient,” writes O’Connor. It’s not some central character flaw or weakness, but a complex interplay bewteen genetics and one’s experiences over a lifetime.

How our bodies and brains deal with stress and anxiety hasn’t changed much in the last 10,000 years. This wonderful defense mechanism, which is wired into our nervous system, is called the fight-or-flight response. When confronted with a threat – – whether real or perceived – – this response kicks in and initiates a sequence of nerve cell firing and chemicals like adrenaline, noradrenaline and cortisol that flood into our bloodstream and propel us into action to meet a threat. This was an essential survival device for our ancestors who lived in the jungle and would have to flee beasts or fight foes trying to kill them.

Lawyers don’t fact these types of real life-or-death threats. But they perceive life-or-death threats in their battles with opposing counsel while sitting in a deposition or sparring in the courtroom. Our bodies respond as if we were being chased by a hungry lion. Accordingly, the stress response can be set in motion by mere anticipation, and when humans chronically believe that a homeostatic challenge is imminent, they develop anxiety.

Over time, this chronic anxiety causes the release of too much fight-or-flight hormones. Research has shown that prolonged release of too much cortisol damages areas of the brain that have been implicated in depression: the hippocampus (involved in learning and memory) and the amygdala (a fear processing hub deep in the brain). Another area of the brain, the cingulate (an emotion-dampening center located near the front of the brain), in tandem with the amygdala, helps set the stage for depression.

Lawyers need to learn better ways to deal with stress and anxiety to avoid the multiple triggers that can cause or exacerbate clinical depression. Turning and facing those things that make us stressed and anxious, and doing something about it, gives us the best protection against depression.