by Jeffrey Fortgang, Ph.D.
When I joined the clinical staff of Lawyers Concerned for Lawyers over 20 years ago, I expected that the focal problem among our clients would be alcoholism and other addictions. After all, the genesis of LCL, before any funding or staff, was a group of lawyers in recovery who sought to help save the careers and lives of their alcoholic peers. And, make no mistake, problems with alcohol (and to a lesser extent, drugs) continue to abound.But the number one presenting complaint at LCL for years has been either anxiety, stress or depression, which often go together. Similar findings appeared in a large-scale survey of lawyers published in 2016, which also found that alcohol problems and depression often co-occur in the same lawyers. In this article I seek to provide an overview of depression as it appears in lawyers, some of the obstacles that can stand in the way of their getting appropriate help, and how these obstacles can be surmounted – drawing upon my clinical experience and a recent survey that I conducted.
Nature of Depression
Depression is among the more treatable mental health conditions. It develops as the result of multiple converging factors, including biological (affected by neurochemical phenomena), hereditary (particularly for bipolar depression), individual psychology and resiliency (e.g., self-esteem, degree of characteristic optimism, experience of healthy loving and supportive relationships), and environmental (both past, such as upbringing and trauma, and present, such as home and work environment). A depressed person may find temporary relief in alcohol or addictive drugs, but over time heavy or frequent use of such substances actually tends to worsen the depression.
More lasting improvement in mood may be derived from psychotherapy/counseling, antidepressant medication, or a combination of the two. Antidepressant medication does not lend itself to abuse, since its action is cumulative rather than immediate, but some trial and error may be involved in finding the most beneficial medication for the individual. Novel treatments—like the use of ketamine and procedures like transcranial magnetic stimulation—have not yet been fully examined.
There are also a number of lifestyle factors that can ameliorate and prevent depressions. These include exercise, meditation and relaxation, a balance between work and personal life, connections with community, and more. Unfortunately, the benefits of these factors are more difficult for a person in the midst of a depressive episode to grasp or pursue.
Obstacles to Getting Help
The legal profession, unfortunately but understandably, is imbued with a culture that tends both to contribute to the development of depression (under the “environment” category mentioned above) and to stand in the way of recognizing the problem and getting help for it. Much of the work of lawyers is inherently adversarial; in lawsuits or criminal trials, for example, there will be winners and losers, in about equal proportions. (Prominent psychologist Martin Seligman has discussed this issue in detail.) What’s more, attorneys may view other professional peers more as competitors than as comrades.
A skilled attorney possesses the ability to scan a document, argument, etc., for any errors or weaknesses – but this work mode, when transferred to life in general, is almost a prescription for how to lower one’s mood. Those who maintain better moods may be more likely to “see the glass as half-full,” and yet also recognize and accept their vulnerabilities. They allow themselves to express feelings in an authentic way to trusted others, and to ask for and accept help when needed. Lawyers, however, are acculturated to a role of problem-solver, in control; too many of them lose the distinction between professional role and true self. Having developed a professionally useful veneer of toughness, they may ignore their actual feelings and needs, in a counterproductive reach for self-sufficiency. And by design or practice, those practicing law are often less able to pursue the positive lifestyle choices that could serve as protective factors, often sacrificing the time necessary to pursue self-care, healthy relationships, or work-life balance to meet intense timing and workload demands while needing to appear both calm and competent.
These are generalization, of course, that certainly don’t apply to all lawyers and law students, and I have been encouraged by seemingly greater openness to these topics in new lawyers. But all too frequently clinicians at LCL are accustomed to encountering lawyers whose problems have been building for years, and who never sought any kind of assistance until they reached a point of major crisis.
Perspectives Gleaned from Survey
My LCL colleague Shawn Healy and I wrote a book about depression in lawyers, and I also conducted an anonymous survey of over 250 lawyers who identified themselves as having experienced clinical depression. The response rate seemed indicative of a pent-up wish to communicate about a problem that is widely prevalent among lawyers (at a rate that appears to be at least 3 times that of the general population) yet not often acknowledged. The anonymous nature of the survey seemed to provide a welcome means of sharing the experience of vulnerability in a profession in which that kind of openness might often be considered a liability.
Although most survey responders were over the age of thirty, the greatest number reported onset of depression during their twenties, an age that typically coincides with law school and the start of their careers. Other authors, in fact, have noted a surge in both depression and problem drinking during law school as the student is immersed in a demanding academic system and inducted into “lawyer culture.”
Among the depressive symptoms that those surveyed had first noticed were intense emotion (e.g., crying, despair), diminished energy and motivation, and a downcast perspective ranging from pessimism to hopelessness. In many cases, a sense of self-doubt and paralysis characterized the experience of depression. While a common phenomenon, it can lead to devastating consequences when important deadlines and correspondence are ignored (such as leaving mail from the Board of Bar Overseers unopened).
The lawyers represented in my survey tended not to confide in colleagues. Many of them pointed to shame, stigma, image, and fear of being viewed as “weak” as barriers to reaching out. Imbued in lawyer culture, a number of responders expressed the sense that slogging through a stressful work life, keeping much of their authentic selves very private, and viewing peers more as competitors than as supports were inherent aspects of professional life.
Surmounting Obstacles to Getting Help
Not all those who took the survey reported they were able to access effective treatment or experience improvement. Of those who did, many first turned to family members before finding and receiving the greatest benefit from professional mental health providers. In describing what helped them get past obstacles to acknowledging their depression and getting help, many pointed to getting a push from professional peers who, in some cases, were willing to share their own similar struggles and how they had gotten back on track. But such attempts to help can admittedly be awkward and perhaps especially complicated among lawyers. One survey respondent wrote, “Our system is one of confrontation rather than truth finding, which tends to make weakness a tool for winning rather than a cause for alarm for the health of a colleague.” On the other hand, I’ve received numerous calls over the years from lawyers and judges who are sincerely concerned about other attorneys. When they can find a way to persuade a colleague to come in, talk with me or one of the other clinicians, and put together a constructive plan, the long-term impact of their action can be invaluable.
Once an attorney recognizes he or she may have a problem, it is still challenging to ask for help. Delay and avoidance are very understandable, but often allow problems to mushroom to crisis proportions. Finding a provider who accepts the right health insurance plan is another obstacle. Lawyers Concerned for Lawyers can be one very useful resource.
LCL, funded through a small portion of your annual professional license fee, offers a range of services too varied to catalog here (see our website, www.LCLMA.org), provided by both law practice advisers and clinical staff. Clinicians meet with lawyers (and their family members) upon request to assess problems, offer brief counseling when indicated, and make referrals to outside clinical professionals for longer-duration services as needed. Referrals are made mindful of both individual needs and health insurance plan acceptance. As with any licensed mental health practitioner, our relationship with clients is confidential, and LCL is exempt from any requirement to report lapses in professional conduct. LCL also coordinates discussion and support groups, either in person or online, for those dealing with particular stresses.
Whether through LCL or another avenue toward appropriate treatment of depression, as one of the responders to my survey wrote, “There is no down side to treating this illness; you will feel better and you will be a better family member, friend and lawyer.”
Dr. Fortgang, licensed in psychology and alcohol/drug counseling, has been on Lawyers Concerned for Lawyers staff for 20 years and in private practice (Newton, Boston).