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The devastation of depression:
Lawyers are at greater risk--It's an impairment to take seriously
By Michael J. Sweeney

In 1995, a Portland lawyer wrote a suicide note to his family and then drove to his favorite fishing spot in central Oregon. While sitting in his vehicle, he shot himself. A year later, another lawyer practicing in the Willamette Valley of Oregon left a suicide note to the members of his law firm, and then walked to a park near his office and shot himself. Both lawyers were experiencing depression. With it came the distorted thinking that a permanent solution to a temporary problem was the answer.
I am shocked and saddened to lose a fellow lawyer due to suicide caused by depression. Lawyers suffer a high rate of depression. That is why it is important for lawyers and other bar leaders to understand the scope, nature and extent of this disorder. How extensive is the problem?
In 1991, Johns Hopkins University in Baltimore interviewed 12,000 workers about depression. Lawyers ranked No. 1 on the list of occupations that were most depressed.
While 3 percent to 9 percent of the population at any given time may experience depression, a quality-of-life survey conducted by the North Carolina Bar Association in 1991 reported that almost 26 percent of the bar's members exhibited symptoms of clinical depression. Almost 12 percent of them said they contemplated suicide at least once each month.
It is difficult to measure the economic and social consequences of lawyer depression (such as malpractice or neglect of cases), but it is estimated that depression in the United States population totals about $44 billion in both direct cost (i.e., patient care and medication) and indirect cost (e.g., absenteeism and lost productivity), according to the National Institute on Mental Health.
Symptoms of depression
If a lawyer has a "blue" mood that lasts for more than two weeks and experiences any of the following symptoms, it is likely that person is having an episode of depression. The symptoms include:

A change in appetite (eating too much or too little).
Problems with sleep (either insomnia or sleeping longer than usual).
A loss of interest or pleasures. (It may take a form of withdrawing from family or neglecting formerly enjoyed hobbies.)
The inability to sit still, pacing or hand-wringing ("agitation"). Or slowed speech, increased pauses before answering a question, monotonous speech, slow body movements or an overall decrease in energy level ("retardation").
A sense of worthlessness or feelings of inadequacy, and other forms of negative thinking, including inappropriate guilt.
Recurring thoughts of death and/or suicide.
Difficulty concentrating, slow thinking, indecisiveness (the smallest task may seem difficult or impossible to accomplish).
Memory difficulty and easy distraction.
Fatigue.
Episodes of clinical depression may last from six months to two years if left untreated. Most health care professionals believe that stress and genetics play an important role in the onset of depression even though they have been unable to pinpoint the cause of it.
Professional influences
Let's look at the law-related stressors. A few years ago, Standish McCleary, a lawyer-turned psychologist (with a Ph.D.), and I presented a program on stress management and burnout, and identified some of the reasons why lawyers are above the norm for depression. The stressors identified are:

Time constraints and deadlines..
The high stakes involved, including a loss of property, freedom and even life.
The high expectations of expertise.
The constant scrutiny and critical judgment of our work from opposing counsel or the courts.
The legal process in general, which is inherently conflict-driven. An opposing counsel is always determined to prove us wrong.
The threat of malpractice, Murphy's Law, and CYB (cover your backside) from other lawyers and even our own clients.
A tendency to assume the clients' burdens.
The demise of professional cordiality and camaraderie.
The contrast between effective advocacy and personal relationships. While lawyers are trained to be aggressive, judgmental, intellectual, emotionally defended or withdrawn, and while that style may have practical value, it may not be popular outside the arena of the legal case.
The professional training that requires us to notice and anticipate the negative and the downside in all situations.
The group norms or culture in the law firm, which carries certain expectations, including high billable hours. On top of work obligations come CLE requirements, bar activities and community service work--all expected from the "good" lawyers.
The depletion of energy that comes from high demands, strong focus and the need to stay on task.
Frequent use of defense mechanisms--such as rigidity, compulsiveness, and perfectionism. (See "The depressing nature of the law: Is law hazardous to your health?", page 14.)
Burnout
Continued high levels of stress over a long period of time, without adequate coping strategies, can lead to burnout. Burnout is nothing more than a form of depression. It has been defined as a type of depression characterized by apathy, negative feelings about the job, declining productivity, increased illness, and difficulty in personal relationships. Sometimes it includes an increase in substance abuse.
Everyone occasionally feels frustrated, depressed and dissatisfied. But when someone experiences depression or burnout, these negative emotions become chronic and last for weeks or months. There is only so much psychological energy to get us through the day, and our work may completely deplete us of this energy. When this happens, our work performance is further reduced in terms of quality and quantity. The lack of emotional energy makes it harder to deal with our personal relationships and we may become frustrated and easily angered with family and friends. Lawyers experiencing burnout may find themselves wondering "why bother?" about work that previously invigorated them. Even the word, burnout, implies that at one time they were on fire, but the flame has now flickered.
Burnout has been called a "romantic disorder" because it is characteristic of a work ethic admired in our culture. Long hours and a selfless dedication to work--to the exclusion of self-care--can lead to burnout. In the North Carolina bar survey, it is noteworthy that 36 percent of lawyers surveyed in North Carolina had not taken even a one-week vacation in the year prior to the survey. Learning how to manage stress and take care of ourselves is critical to preventing burnout. This, in turn, can help minimize the effects of depression.
Alcohol abuse
There is a definite relationship between alcohol and depression. Alcohol is a drug that operates as a central nervous system depressant, and approximately 30 percent of all depression cases are alcohol induced. When the lawyer stops drinking and remains sober for an extended period, depression disappears. When depression is the presenting problem, it is important that a trained professional evaluate the lawyer for alcohol or chemical dependency.
Studies in both Washington and Arizona show that lawyers suffer from a higher rate of alcoholism than the general population. While approximately 10 percent of the population suffers from alcoholism, the number jumps to almost 20 percent in the legal profession, or one in five lawyers. This higher rate of alcoholism in lawyers also explains the higher rate of clinical depression.
What can bar leaders do?
While it may seem daunting and even depressing to hear the statistics regarding addictions and mental health illnesses in our profession, the problem does not go away by ignoring it. In the last decade many state and local bar associations have created Lawyer Assistance Programs (LAPs) to assist lawyers suffering from impairments. Most programs initially dealt with alcoholism and drug addiction, but as programs develop and budgets increase, some LAPs have expanded to address other impairments such as gambling, career issues and burnout, as well as depression. Budget and staffing limitations prevent other LAPs from doing the same. Having a director and/or a well-trained staff to make a correct assessment and referral to appropriate medical professionals is important.
LAPs market their services to lawyers and educate the legal community about addiction. Once a person knows enough about the disease or illness to recognize symptoms, the person can call the LAP for further assistance or information. LAPs exist because of support of bar leaders, Supreme Courts, and the general bar membership. This is a testimonial to LAPs and their effectiveness.
A few years ago I was contacted about a young lawyer who suffered from depression. I was able to match the lawyer with a peer volunteer who had spent years battling depression and had successfully overcome the illness. One day the depressed lawyer took an overdose of pills. Shortly after, he called the peer lawyer. The depressed lawyer was taken to the emergency room and his life was saved.
While the Oregon Attorney Assistance Program has helped thousands of lawyers through the years, I often think of this one lawyer because I believe he is alive today because bar leaders in Oregon had the foresight to create and support a LAP. The author is a program attorney with the Oregon Attorney Assistance Program in Portland. He provides confidential assistance to lawyers on problems including depression, relationships, stress, burnout and career issues. He developed a specific program tailored for solo and small-firm practitioners, which has more than 600 members and holds monthly meetings in six cities throughout Oregon.
Sweeney is a Certified Employee Assistance Professional, chair of the Governor's Council on Alcohol and Drug Programs and co-founder of the Oregon Partnership, a non-profit prevention, education and treatment referral service for alcoholism and drug abuse. He is also the past president of the Oregon Council on Alcoholism and Drug Addictions; past president of the Columbia River chapter of EAPA; and past member of the Oregon State Bar Committee on Combining Family and Career. He has written and lectured on impairment issues to national, state and local bar associations.