You Don’t Have to Go It Alone: Finding Support When You’re Depressed

 

Strong, supportive relationships are one of the best safeguards against depression. In fact, studies have found that good social support helps to protect both our psychological and physical health.  Sharing our lives with others is pleasurable and helps us feel better at times when we feel down. The process of talking about our problems and being listened to by someone who cares can be healing by itself.

Friends provide us with many important things such as emotional support, practical assistance and information, a different perspective on our problems, a sense of personal worth and belonging, and ideas for solving problems.

How Exercise Might Help Keep Depression at Bay

The New York Times reports that a review of by scientists of studies about exercise and depression showed that exercise, especially if it is moderately strenuous, such as brisk walking or jogging, and supervised, so that people complete the entire program, has a “large and significant effect” against depression, the authors wrote. People’s mental health tended to demonstrably improve if they were physically active. Read the rest of this article.

If You Have Depression, You Likely Aren’t Getting the Treatment You Need

The Business Insider reports that there are plenty of people out there with chronic pain and low energy and who walk around feeling terrible all the time. But it never occurs to them that they might be depressed. And our healthcare system doesn’t do a good job of connecting them with the screening or treatment that could help them feel better. Read the complete article.

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 21st 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.

Lawyer Depression is Contagious

Catch a depressed mood the way you catch a cold? Not exactly . . . but similar. Can other people really be a source of the rising rate of depression in the United States? The scientific evidence suggests the answer is yes. Our social lives play a huge role in how we think and feel. After all, none of us are immune to the influence of others, for better or worse. How we react to others, and vice-versa, even has a measurable biological impact on our brain chemistry, as our newest brain research shows us. The evidence is rapidly mounting that depression is about much more than just an individual’s “bad chemistry.” Thinking of depression as a brain disease is proving to be too one-dimensional a perspective.

For attorneys, appreciating the social connection to depression is vital if the person is to be viewed – – and responded to – – realistically. Why are attorneys depressed? Go beyond biology as the cause and consider that law is a profession that:
• Often requires engaging in stressful, conflictual relationships.
• Often pressured by important and inflexible deadlines.
• Often is devalued by the general public and even may be misunderstood by friends and family.
• Often brings you into contact with some of the worst aspects of human nature.
• Encourages hazardous self-sacrifice for “the cause.”
• Encourages deceiving others as well as one’s self, a moral compass, in the push for maximizing   billable hours.
• Demands full commitment to making efforts to achieve things one has no control over.
• Encourages rumination, a poor coping mechanism.
• Can sometimes be almost as costly in winning as in losing, increasing uncertainty about what’s best.
• Can be as emotionally high and low as professional sports (“the thrill of victory . . . the agony of defeat.”)

The social aspects of depression have been too long ignored in favor of biological explanations. It would be more helpful to come to terms with the reality that no amount of medication will make potentially depressing situations, like the stressful aspect of practicing law, go away.
The rising rate of depression is not unique to either Americans or lawyers, lending further support to the growing recognition of depression being spread across boarders through social means. Through the studies of cultures, families, and the social lives of depressed people, we have learned a great deal about the social transmission of depression. Negative people can bring us down and good relationships involving an enduring commitment can bring us up. We have also learned how children model their parents in unexpected ways that increase their vulnerability to depression. Thus, in a purely social sense, depression is contagious.

The World Health Organization (WHO) is the international watchdog of health issues around the world. Recently, WHO declared depression the fourth greatest cause of human suffering and disability in the world (behind heart disease, cancer and traffic accidents). The WHO statement tells us how prevalent and how serious depression is right now. Even more troubling, though, is the WHO prediction that by the year 2020 depression will have risen to become the second greatest cause of human disability and suffering. It is a safe prediction for WHO to make, for we already have a half-century worth of data showing that depression has steadily been on the rise for decades.

By focusing on biology alone, as we have done when we talk about chemical imbalances in the brain or calling depression a “disease,” the social dimension has been all but ignored. This allows the social conditions that cause and exacerbate depression in many people’s lives to go unaddressed. Drugs alone cannot address the social factors that underlie depression, a likely reason that drug treatment alone (without additional skill-building) has the highest rate of relapse of any form of intervention. Just as there will never be a pill that can cure our other social issues such as poverty or racisim, there will never be a pill that will cure the depression that is associated with challenging life conditions. This is not to say biology doesn’t matter. It clearly does. But to focus on biology to the exclusion of life’s circumstances, especially the social ones, that lead people in general, and attorneys in particular into depression, is missing a vital target of intervention. Too often, well-intentioned doctors write a prescription for an anti-depressant medication but go no further into treatment. The evidence is growing that this practice is, to put it mildly, less than ideal.

The new understandings about the prominence of social forces in depression require we as mental health professionals to change some of what we do as we try to educate people about depression. The familiar phrasing that suggests “depression is a serious medical illness requiring medication” is an educational approach it that clearly doesn’t work very well. Most of the attorneys who are depressed don’t seek help. For some, it’s because of the stigma of seeking help for an emotional disorder, but for others it’s because they simply don’t think of themselves as “diseased.” They may feel stressed, unhappy, overwhelmed, trapped, or hopeless but they don’t consider themselves “depressed.” In fact, most of the attorneys who suffer depression, still manage to function despite their condition. They show up for work, they give their clients reasonably good legal advice, they get their briefs filed on time, and they participate in family events. But, they are struggling to get through each day. They are what many clinicians refer to as the “walking wounded.”

We can do better than suggest to people they’re diseased and need drug care. Who can do more than continue to push the one-dimensional biological explanation at people for their depression? We can help them understand that depression is caused by many contributing factors of which some are indeed biological, while others are rooted in individual psychology (such as your temperament and style of coping with stress) and social psychology (such as the quality of your relationships and your culturally acquired views). Striving to convince people they’re diseased doesn’t empower them to actively change their lives in meaningful ways. We can teach better relationship skills, better problem-solving skills, better decision-making skills, and better ways to cope with an increasingly complex world. We can teach attorneys-to-be while still in law school how to develop realistic perceptions of life as a lawyer so they won’t get so disillusioned they flee the practice of law so soon after graduating. These are just some of the skills that have not only been shown to reduce depression, but even to prevent it.

Editor’s Note: Michael D. Yapko, Ph.D., is a clinical psychologist and depression expert from Fallbrook, California. He is the author of Depression is Contagious: How the Most Common Mood Disorder is Spreading Around the World and How to Stop It. For more information visit his website at www.yapko.com.

 

 

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