just reread the article in The American Lawyer “‘Big Law Killed My Husband’: An Open Letter from Sidley Partner’s Widow ,” which details the progressive deterioration of Partner’s husband’s life, in the face of his work-place stress, to his ultimate suicide in the parking lot of his of his workplace. From the article:
Suicide has now become my new world and I am desperately searching for answers . . . Though it’s only the beginning stages of trying to figure out why this happened, I came across a concept, maladaptive perfectionism, that combines unrealistic standards of achievement with hypercriticism of failing to meet them. Gabe displayed most if not all of the characteristics. Simply put, he would rather die than live with the consequences of people thinking he was a failure.
Do you identify with Gabe? Do you struggle with self-doubt or work-life balance, or feel overwhelmed? Have you been told you ought to take medication for anxiety, sleep problems or depression? Do you wonder how to fix your life when work just isn’t working? If so, you are not alone.
Increasing numbers of attorneys are being diagnosed with and treated for depression, anxiety and stress-related illnesses. According to the 2017 report of the National Task Force on Lawyer Well-Being, of nearly 13,000 currently practicing lawyers … approximately 28 percent, 19 percent, and 23 percent are struggling with some level of depression, anxiety, and stress, respectively .
This article highlights the relationship between stress, burnout, depression and suicide, and considers the role of diagnosis, medical treatments and other strategies. When work-life balance is out of whack it can escalate to hopelessness, and in extreme cases, even suicide. People give up when they see no way forward or out. But whether help is needed for you, a loved one, or a colleague, it’s important to know that there are options to avoid suffering!
What is Depression?
To be totally clear: Depression is a complex concept and our understanding of it is limited. There are many theories for why it occurs. There are biological correlates with some depressive symptoms. And a small percentage of people suffer with illness that is incapacitating and just won’t quit. However, there is a good chance that much of what is labeled as depression today is probably simply burnout, or a normal response to abnormal stress.
To simplify, depression is diagnosed clinically and medically by establishing a requisite number and type of symptoms to meet the diagnostic criteria in the Diagnostic and Statistical Manual (DSM). Over the course of the last 35 years, there have been six iterations of the DSM. As the book has gotten longer, the number of diagnoses has progressively increased.
While many factors contribute to the increase in mental health disorder diagnoses, in my 35 years in medicine I have not seen the number of people with serious depression (true debilitating symptoms that no one could deny were life-threatening) change much. I have, however, seen a significant escalation in the number of people who are told they “have depression” and consequently get treated with medications but not with appropriate therapy or counseling assistance.
I have also seen an escalation in suicide rates. Over three people take their lives daily in Colorado, and the rate in the legal profession is higher. According to the latest data from the Centers for Disease Control’s office of vital statistics, suicide is rarely caused by any single factor, and over 50 percent of people who die by suicide do not have a diagnosed mental health condition at the time of death. People should be encouraged to engage in counseling and therapy for issues that cause them suffering, regardless of whether there is a mental health diagnosis. Getting help could be a lifesaving endeavor ; at a minimum, it benefits both our personal and professional lives.
What About Anxiety Disorders?
The story here is similar to that of depression. There are biological correlates for some anxiety disorder symptoms, and there has been an escalation in the rate of diagnosis alongside an increase in the number of anxiety disorders and the loosening of DSM criteria. More and more people simply dealing with the challenge of making life work are being given diagnoses and prescriptions.
Today, a person who might just be dealing with burnout, exhaustion, disillusionment or extreme worry may be given a clinical diagnosis or two and prescriptions. This strategy discourages people from looking at the precipitants to distress and proactively identifying solutions. It also exposes them to the side-effects and unnecessary risks associated with prescription drugs.
Do Antidepressants, Sleeping Pills and Antianxiety Medications Work?
Clinical trials of antidepressants show that only one-third of patients get better in eight weeks. The other two-thirds respond in part or not at all. And within three years, 75 percent of the responders have quit treatment, likely due to side effects, cost or diminishing efficacy 1. In many studies, drugs perform no better than placebos; several studies have found that the biggest predictor of response is the belief that medication will help .
Benzodiazepines, commonly prescribed for sleep issues and anxiety problems, tend to work well for a small number of people in the short run. But if used for more than a few weeks or on a regular basis, they can make the symptoms worse for some individuals.
So, are pills the answer? At times yes, and they even save lives. But they don’t consistently help most people. Other interventions might be just as good, or better tolerated. Interventions with clear anti-depressant and anti-anxiety efficacy include improved work-life balance, therapy or coaching, specific breathing practices, yoga, mindfulness, light exposure, meditation, nutritional interventions, cognitive restructuring techniques, spiritual practice, time in nature and exercise.
How Should You Manage Your Stress, Sleep and Mood?
The answer is unique to you. But here is what I have seen in 35 years working with attorneys. Many are experiencing normal responses to extreme stress. While you have tremendous power to self-heal, rebound, and thrive when episodically stressed, you become depleted and burned out when the pressures are continuous.
The symptoms of burnout, emotional exhaustion, interpersonal disengagement, and a low sense of meaningfulness and accomplishment are very similar to those of depression and anxiety disorders. And they impact sleep. Interventions for burnout often transform those symptoms. Most of my clients never start, or massively reduce their medication need, as they tackle burnout, build resilience, decrease stress and improve their lives.
In choosing your next steps, consider when you last felt well and your attendant life circumstances. What was working or gave you joy? Assess for burn-out. Are you taking pills because you can’t seem to make your life work? Do you need training on techniques and tools to promote well-being?
If your life is not as you wish, you can change it! You are a gifted, capable person, as evidenced by how far you have come. You can learn evidence-based solutions, to transform what doesn’t work. Give yourself that opportunity, and never give up! D
1 Gerbarg et al., Complementary and Integrative Treatments in Psychiatric Practice (Amer. Psychiatric Pub. 2017).
Sarah Myers, executive director of the Colorado Lawyer Assistance Program, is the coordinating editor of this series of Wellness articles. If readers have suggestions for topics of future Wellness articles in the Docket, or feedback to the articles, contact Myers at firstname.lastname@example.org.