Depression
What do Mike
Wallace, William Styron, James Taylor, Winston Churchill, Jim
Carey and Meriweather Lewis all have in common? They have each
suffered from an often debilitating depression. For these marvelously
accomplished people, this mood illness embraced them with devastating
effect. There has been a proliferation of books recounting the
descent into depression in the past few years, capped off by the
recent National Book Award winner, The Noonday Demon by
Andrew Solomon.
The beauty of such
efforts resides in the lengths to which each has gone to de-stigmatize
depression. Such an accomplishment is particularly salient in
the legal community. For those of us who exist — and thrive
— in an environment of competition and accomplishment, depression
has long been viewed as a failure of will. Thus, attorneys
are far more prone to view with judgment and some embarrassment
a condition that arises from a black inner corner and seems to
have no reasonable precipitating cause.
I have frequently
alluded to attorneys’ self identity being grounded in high
functionality and self reliance. As with many of life’s "gifts"
this comes as both a blessing and a curse. The blessing is self-evident.
We accomplish a tremendous amount. We are able to handle the world,
rather than be handled by life’s circumstances. Success in
law is frequently accompanied by a certain power within one’s
own community and the comfort of financial success. However, there
is a flip-side that we often eschew. It is a tendency to deny
any personal flaw that can’t be resolved through reason ,
intelligence and will. The affliction of depression is untouched
by these virtues — our unique gifts are useless before this
mood disorder.
We attorney’s
are far from immune to the exhausting assault of depression. In
1990, a study published in the Journal of Occupational Medicine,
conducted by Eaton and associates observed that lawyers were the
second most likely profession to suffer from depression. [1]
In a more recent study co-authored by U.W.’s Andy Benjamin
23.4% of Washington’s second-year lawyers were experiencing
depression.[2]
What
is depression?
Andrew Solomon,
in his artfully simple manner says, "If you feel bad without
reason most of the time, you’re depressed." Most functional
sufferers of depression experience an enveloping "dysthymia"
which according to the DSM-IV is typified by a combination of
any two or more of the following: poor appetite or overeating;
insomnia or hypersomnia; low energy or fatigue; low self-esteem;
poor concentration or difficulty making decisions or feelings
of hopelessness.
I think a less
clinical, and quite accurate, description of dysthymia is a general
sense of joylessness and a flatness in one’s reactions to
life. Depressed people will filter out their emotional responses
to life’s stimuli, leaving the lightness aside, but not the
sense of weight or irritability. Life is stripped of it’s
colors. Its ability to delight has bled away.
Certainly those
who are spared the attack of major depression, which leaves one
supine and utterly defenseless, may still feel as if they are
carrying around a 50 lb. weight strapped to their back. Without
question adherence to a routine, healthy diet and exercise and
the presence of a reliable support system will staunch the draining
off of our life’s energy - but we must be sensitive to our
experience. Every day lost to the flattening of depressed mood
is a day lost to us forever and it is the accumulation of these
days that may stifle our greatest chances for creativity, connection
to those we love and life’s joys.
As Andrew Solomon notes,
depression is often not a dramatic condition. As he eloquently
states, "Mild depression is a gradual and sometimes permanent
thing that undermines people the way rust weakens iron."
Untreated depression
is a major cause of marital rupture, as well as interpersonal
difficulties within one’s professional community - and the
central guiding theme of this column is that such losses are experienced
by men and women who are at the same time excellent and very
successful practitioners.
Depression as mistaken
thinking
Dr. Aaron Beck
has been a pioneer in the understanding and treatment of depression
for more than 20 years. Perhaps noone else has written with such
clarity and persuasiveness about the thinking of depression.
Beck was the major force in development of the therapeutic approach
to depression which is widely considered to be the most effective.
Cognitive therapy is described in many resources - two of the
best are the works of Dr. David Burns (Feeling Good) and
Dr. Martin Seligman (Learned Optimism). Seligman’s
fascinating study describes the cognitive tendencies of the depressed
to, for example, attribute good fortune to impersonal luck but
hardship to very personal shortcomings. Those of
us who are "stuck" in a depressive episode, truly and
honestly view all negative interpretations of events as "true"
and any positive gloss as mistaken. In depressed thinking, we
can engage in quite intense and, to us, rational debate over the
reality of a flat or hopeless or joyless interpretation of objective
life events.
Well if you were
diabetic......
In my therapy training,
I engaged in hours of group supervision, in which we would bring
our challenges and questions to our mentor. Virtually every one
of us had wrestled with how to talk about anti-depressant medication
to a recalcitrant, depressed ("I don’t want to take
pills") client. Again, the more self-sufficient in life,
the more resistant a person will be to using, in their words,
"a crutch." But what a freeing subject this is: The
neurochemistry of depression.
Setting aside,
for now, the debate about whether Prozac is promiscuously prescribed,
there really cannot be any serious dispute that the evolution
of anti-depressant medication, from the tricyclics like Norpromin
and Elavil to the SSRI’s (Selective Seritonin Reuptake Inhibitors)
like Prozac, Paxil and Selexa establish a biochemical basis
for much depression. The beauty of this approach is that we need
not feel guilty or even ashamed if we are not up to the struggle
with a mood disorder. Again, as elegantly put by Solomon:
"Chemistry is
often called on to heal the rift between body and soul. The relief
people express when a doctor says their depression is "chemical"
is predicated on a belief that there is an integral self that
exists across time, and on a fictional divide between the fully
occasioned sorrow and the utterly random one...There is a pleasant
freedom from guilt that has been attached to chemical.
If your brain is predisposed to depression, you need not blame
yourself for it. Well, blame yourself or evolution, but remember
that blame itself can be understood as a chemical process, and
that happiness, too, is chemical. Chemistry and biology are not
matters that impinge on the "real" self; depression
cannot be separated from the person it affects. Treatment does
not alleviate a disruption of identity, bringing you back to some
kind of normality; it readjusts a mulitfarious identity, changing
in some small degree who you are.
Still and all,
there is something both comforting and very true in the statement,
"Well, if you were diabetic, would you refuse to correct
your body chemistry with insulin?"
Helping ourselves
Our senses are
assaulted by a vast array of stimuli, some external but many from
within. Those of us who have ever attempted to meditate - to quiet
the mind to a single point of concentration - know the feeling
of "monkey mind." Thoughts fire off inside us in dizzying
succession and with remarkable randomness. It is natural for each
of us to erect a filter in order to make sense of our world. Some
of us, however, utilize a psychic filter which enervates, isolates
and flattens us. To compound the difficulty, this very filter
excels in self-justification, so if nothing else, we experience
our world-view as normal and "real." Such is the isolating
damage occasioned by depressed thinking.
If we listen to
those around us - if we embrace expressions of concern or simple
feedback without feeling blamed or belittled we may have taken
the first step toward addressing, and alleviating, the common,
painful and treatable distress occasioned by depression.
[1]
Elementary school teachers were the most likely. See, 32
J. Occup. Med. 1079.
[2] 10 J. Law & Health 1 (1995)
