Charlotte School of Law professor Brian Clarke has written a series of articles that I hope all of my students and colleagues and blog mates will consider reading (here and here and here). Professor Clarke has written about his own struggle with depression and supplied statistics on the high number of students and lawyers who grapple with this illness. He is the latest in the line of attorneys to come out to discuss depression and has made a particularly insightful and personal case for those who are struggling with the condition. (I am emailing the links to Professor Clarke’s writings to all of my students this term)
Every year, I speak to first year students in my torts sections about depression to make them aware of the statistics and why it is no longer a barrier to success in the legal profession. Clarke does a wonderful job in presenting those statistics with a personal authenticity and realism that makes this series a must read.
He feelings before being diagnosed with depression in 2005 are likely all too familiar for many in this and other professions:
“While I do not remember all of the details of my descent into the hole, it was certainly rooted in trying to do it all—perfectly,” he writes. “After my second child was born, I was trying to be all things to all people at all times. Superstar lawyer. Superstar citizen. Superstar husband. Superstar father. Of course, this was impossible. The feeling that began to dominate my life was guilt. A constant, crushing guilt. Guilt that I was not in the office enough because I was spending too much time with my family. Guilt that I was letting my family down because I was spending too much time at work. Guilt that I was letting my bosses down because I was not being the perfect lawyer to which they had become accustomed. Guilt. Guilt. Guilt. The deeper I sunk into the hole, the more energy I put into maintaining my facade of super-ness and the less energy was left for either my family or my clients. And the guiltier I felt. It was a brutal downward spiral. Eventually, it took every ounce of energy I had to maintain the facade and go through the motions of the day. The facade was all there was. Suicide seemed rational.”
The statistics for law students have long been known within the academy. One of the most disturbing studies was done by Washington University Prof. Andy Benjamin (U. Wash.) that found that, by the spring of their 1L year, 32% of law students are clinically depressed. Yet, when those students entered, they had the same percentage as the population at large of roughly eight percent. That percentage rose to 40 percent by graduation but then dropped to to 17% two years after graduation. That is still higher than the national average. However, as we previously discussed, the estimate of the population at large continue to grow with the latest study suggesting that one out of ten Americans have depression.
Clarke cited Canadian figures showing how eleven percent of suicides are found to be lawyers and suicide remains the third leading cause of death for lawyers in the period studied from 1994 to 1996.
Clarke notes part of the problem can be traced to the type of work we do:
“Whatever the problem, the client is counting on the lawyer to fix it. Every lawyer I know takes that expectation and responsibility very seriously. As much as you try not to get emotionally invested in your client’s case or problem, you often do. When that happens, losing hurts. Letting your client down hurts. This pain leads to reliving the case and thinking about all of the things you could have done better. This then leads to increased vigilance in the next case. While this is not necessarily a bad thing, for some lawyers this leads to a constant fear of making mistakes, then a constant spike of stress hormones that, eventually, wear the lawyer down. The impact of this constant bombardment of stress hormones can be to trigger a change in brain chemistry that, over time, leads to major depression.”
He ends with message that I hope will be read by many:
“I write this because I know that when you are depressed you feel incredibly, profoundly alone. You feel that you are the only person on earth who has felt the way you do. You feel like no one out there in the world understands what you are dealing with. You feel like you will never feel ‘normal’ again.
But you are not alone.”
Source: ABA Journal
It’s often a spotlighted, consequential, judgemental, competitive, sink-or-swim, adversarial profession.
Well I think the terminology needs a total overhaul.
Jason, There is a big difference between situational depression and clinical depression. But, your point about northern latitudes contributing is indeed true. When I first heard about Seasonal Affective Disorder 20 or so years ago I scoffed @ it as one of those phony diagnosis like RSDS. I was wrong, it is a significant factor for some people. However, light therapy is probably the best remedy, no drugs, just light daily.
Sounds like some toker in Wisconsin. Too lazy for laundry, no good action for 400 miles, -20 degrees, everybody else is drunk, no money to move, and feels lucky he isn’t replaced at work by some felon for less money. Don’t have a clue how you guys diagnose depression without confusing it with……things generally suck and you’d be off-track feeling any other way. There are privacy, enrichment, food, climate, etc. etc. needs not being met that could adversely affect a dude. This is why pills–there are usually too many contributors causing the plight.
Until someone actually finds what mental illness actually is, in terms of human biology and not in terms of mere social constructions of imagined reality, mental illness may continue to be treated primarily by chemical straightjacketing of clinical signs which are present only in the minds of clinicians and may not exist at all in the neuroanatomy of an alleged (impatient?) patient?
Or not?
Annie,
Medicare/Medicaid does not limit the number of visits, but they limit the hospital stay. Doctors are under tremendous pressure to get the patient out, often before they even have a good diagnosis, or see if the medication is working.
I saw the handwriting on the wall when I got a frantic call from the psychiatrist in charge of the Dual Diagnosis unit at a local psychiatric hospital where I was on the staff. Dual diagnosis means the patients on that unit have a substance abuse problem overlaid with some other psychiatric disorder.
He needed a new patient evaluated and a report back, STAT. As in two hours.
An unusual request, so he explained, “This patient was admitted last night at 7:00 with a suicidal depression and cocaine habit. His insurance company allowed him a 23 hour stay in the hospital. I have one day to cure a suicidal depression and coke habit.” He had to discharge the patient no later than 6:00 PM that day.
I found the guy to have one of the worst depressions I have seen, with prominent suicidal ideation. He was trying to self-medicate with cocaine. I never found out what happened to him. His managed care company refused to pay for any more treatment. I suspect he probably ended up committing suicide.
It was not long after that, I made the decision to leave Mississippi and move to the mountains. Mental health care in this area is not only no better, in some ways it is worse.
From the perspective of insurance companies, it is more cost effective if the patient is dead than alive.
Chuck, it’s great tha Medicare and Medicaid doesn’t limit number of visits. If we ever get single payer they can just build on Medicare. I recall tha some patients had to be discharged early because their insurance had a limited amount of time they were covered as an inpatient.
This current civilization is a depression machine in many ways.
It is after all of us it seems sometimes.
There is plenty of cure and healing available if we look for it and seek it our.
Cheer to all.
Depression is one of the most easily diagnosed and treated of all mental disorders. That’s the good news. The bad news is that the depressed person, and often friends and family, don’t recognize it for what it is. They see somebody who is simply cranky and may have trouble sleeping. Or lazy, because they don’t feel like working or socializing. Even washing dishes, doing laundry or schoolwork is a chore, so they let it go.
The other bad news is that the mental health system in this country is so badly broken it is almost irrelevant as a service. I tell people our local mental health center is a contradiction in terms. Getting in to see a psychiatrist is difficult, especially if you are poor. Many private practice psychiatrists no longer take insurance because the insurance industry has jerked mental health providers around for so long. Family physicians prescribe about 90% of all psychiatric medications these days, but most family doctors will tell you they are uncomfortable with this arrangement. In doing disability examinations, I find the doses given by PCPs are often well below the therapeutic threshold for being effective. That is simply because psychiatric medications are potent and some risk causing seizure disorders or other unwanted side effects; therefore, the PCP is overly cautious.
Even though depression is treatable, it is the one mental disorder most likely to end in suicide. The best and most effective treatment is a combination of medication and psychotherapy. The combination works better than either one in isolation. Unfortunately, all too many insurance plans and EAPs limit the number of visits to a mental health professional. Some plans have a provision limiting a patient to six (6) visits to a mental health professional.* Period. It is all about the money. I am not sure if the ACA has changed that, but plan to look into it in the near future.
Finally, having a depressed person in the family is almost like having an alcoholic in the family. It affects everyone.
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* Medicare/Medicaid does not limit the number of visits. Another argument in favor of a single payer system.
Depression and panic attacks has had an enormous effect on our daughter. What has been so inspiring is her refusing to let it define her. She is quite open about the battle w/ people, feeling the energy so many people use to keep it secret is wasted energy needed to battle the disease. It is heartbreaking as a father to see the valleys. But there are real good shrinks out there, you just have to weed out the many ham n’ eggers. Treatment has made big steps within the past few decades. The stigma, not so much. Part of my daughters courage in being upfront is her attempt to be part of removing the stigma. I remember the heartbreaking speech of Edmund Muskie speaking of his battles w/ depression and that ending his run for the presidency. That was almost years ago. Being treated for depression is still a deal breaker for many jobs in our culture. The treatment has come much further than the stigma. Kudos to this professor and Jonathan for fighting to end the stigma. Battling the disease is tough enough.
Kudos to Prof. Clarke on his battle with the disease and his wonderful insights that may help someone else.
I use science in my work (I’m a science-based advice columnist) and I wanted to recommend Dr. Jonathan Rottenberg’s “The Depths” to those suffering from or who would like to understand depression. It disputes practices that are not based in good science and offers new understanding of depression. Rottenberg himself has suffered a major depression. (I have read his book and had him on my weekly science-based radio show and found this to be a cut above much of the information and thinking that’s out there.)
As with counselors, clients too can spiral. Good article.
Professor Turley, Thank you for passing this along.
I hear and understand this topic very well….. Great job…