LPAC's Bibiography of Related Articles on:

Stress, anxiety, and depression

Amiram Elwork, Ph.D., with contributions by Mark R. Siwik, J.D., and Douglas B. Marlowe, Ph.D., J.D Stress Management for Lawyers: How to Increase Personal and Professional Satisfaction in the Law Third Edition. 305 pages, 6"x9", soft cover, 2007
Although there are many books about stress, this one is written specifically for lawyers. It outlines the reasons that law is one of the most stressful professions and presents self-help methods that are particularly appropriate for attorneys. Even the busiest of lawyers find it easy and useful to read. When you practice law, stress comes with the territory. Such stressors as time pressures, competition and conflict can rob you of a satisfying career and fulfilling personal life. However, you don't have to suffer in silence. You can take action and this book shows you how. This book is designed to help lawyers stay calm and confident during stressful times, reduce anxiety and anger, eliminate negative thinking habits, prevent depression and alcoholism, balance their professional and personal lives, and manage their time more effectively.

Anonymous, Making Docile Lawyers: An Essay on the Pacification of Law Students, 111 Harv. L. Review. 2027, 2027-44 (1998)
This short article is written by a Harvard law student, and hence is an excellent article for other law students as well as teachers. It poignantly describes the emotional distress and deflation experienced by HLS students. The descriptions mirror observations at many more typical law schools: students arrive with enthusiasm and the desire to make positive changes for clients or society, and quickly become “demoralized, dispirited, and profoundly disengaged”. As a result, they lose their self-confidence and values and begin to surrender idealism for the security of more lucrative practice settings. The author describes the progression of these experiences through each year of law schools, and points out the negative contributing factors within the school and the broader legal community.

George E. Bailly, Impairment, the Profession and Your Law Partner, 15 Me. B. J. 96, 96-106 (2000)
A combination of denial, enabling, and the “conspiracy of silence” is discussed in relationship to professional responsibility. This article focuses on the need for firms to establish policies, procedures, and partnership agreements that address potential impairment issues at the inception of a working relationship, rather than as the result of a need. It includes a discussion of the prevalence of substance abuse in the legal profession, the negative impact of a substance abusing lawyer on the firm’s ability to function, interrelationships between disciplinary procedures and substance abuse, “how to” tips on intervening on a substance abusing partner and the function of a lawyer assistance program.

Connie Beck, Bruce Sales and G. Andrew H. Benjamin, Lawyer Distress: Alcohol – related Problems and Other Psychological Concerns Among a Sample of Practicing Lawyers, 10 J.L. & Health 1, 1-60 (1996)
Depression is not the only awful affliction that impacts the legal profession. Alcohol and drug abuse also plays a prominent role, and endures past law school graduation. In fact, the findings of this cross-sectional study of lawyers across practice years suggest alcohol problems are progressive in nature and profoundly affect the profession. In this large, stratified random sample of lawyers that used well-validated, reliable measures, 70% of the lawyers in active practice had a lifetime prevalence of clinically significant negative consequences related to alcohol abuse. Another set of surprising findings showed that for female lawyers, positive relations within a primary relationship served as stress protector. But the percentage of divorced female lawyers proved to be twice that of physicians and three times that of teachers. Female lawyers are the least likely to remarry of these occupational groups. When compared with the findings of a normal population, female lawyers remain significantly more angry in their primary relationships while male lawyers remain significantly more stressed.

J.C. Barefoot, K.A. Dodge, B.L. Peterson, W.G. Dahlstrom and R.B. Williams, Jr., The Cook-Medley Hostility Scale: Item Content and the Ability to Predict Survival, 51 Psychosomatic Med. 46, 46-57 (1989)
This study followed law students into their practice years as lawyers. Initially 15.8% of the students scored one standard deviation above the mean score on a highly credible measure of hostility that is derived from Minnesota Multiphasic Personality Inventory (MMPI) items. A proportional hazards survival analysis was conducted. Thirty years later when compared to those who scored one standard deviation below the mean (for the sample the mean= 14.65, standard deviation= 7.06, standard error=.65), the 15.8% group was 4.19 times more likely to die prematurely due to cardiovascular disease. The study concluded that those who suffered from high levels of hostility and cynicism as students were at significantly greater risk of dying of cardiovascular disease.

G.Andrew H. Benjamin, Alfred Kazniak, Bruce Sales and Stephen Shanfield, The Role of Legal Education in Producing Psychological Distress Among Law Students and Lawyers, 1986 Am. B. Found. Res. J. 225, 225- 252 (1986)
Using highly valid and reliable psychological measures, this study repeatedly tested law students before, during and two years after law school. The symptom of greatest concern, depression, was shown to exist for only four percent of students before law school, a figure expected from any normal population. During the first year of law school, however, about 20% of law students developed depression. By the third year of law school, 40% of the law students had developed statistically significant levels of depressive symptoms. Law students suffered in significantly greater numbers than a comparison group of medical students. The level of depression did not significantly decrease after law school. A host of factors such as gender, GPA, and marital status did not predict who developed the elevated symptom levels. The authors speculated that the elevated symptom levels were due to legal education’s focus on analytical skill development at the expense of developing interpersonal skills.

G. Andrew H. Benjamin, Elaine Darling, and Bruce Sales, The Prevalence of Depression, Alcohol Abuse, and Cocaine Abuse Among United States Lawyers, 13 Int’l J.L. & Psychiatry 233, 233-246 (1990)
This first large, stratified random sample of lawyers that used valid and reliable measures to determine the prevalence rates of emotional, alcohol and drug abuse symptoms that afflict practicing lawyers in two different states. A measure of dissimulation showed that the sample honestly responded to the psychological measures. The study uncovered that one third of the sample suffered from scientifically significant levels of either depression or alcohol problems or both. Other symptoms were identified and reported.

G. Andrew H. Benjamin, Bruce Sales & Elaine Darling, Comprehensive Lawyer Assistance Programs: Justification and Model, 16 L. & Psychology Review, 113-136 (1992)
This review article specifies the components that must exist in Lawyer Assistance Programs to attract lawyers with early stage psychological and alcohol problems. If such components do not exist, lawyers will not seek help voluntarily from a bar association program. The necessity for including the various components became evident after a review of the empirical data that emerged from this research group’s earlier studies. These and other empirical data about lawyers are reviewed in this article to justify the model.

M. Dammeyer and N. Nunez, Anxiety and Depression Among Law Students: Current Knowledge and Future Directions, 23 Law & Hum. Behav. 55, 55-73 (1999)
This is a technical review of past research on anxiety and depression in law students. It concludes that law student populations appear to have highly elevated levels of both symptoms, generally exceeding that of medical school students, and in some cases approaching psychiatric populations. The authors observe that the research done on date on law student distress substantially lags the research done to date in other areas of law and psychology. The article identifies those studies which are methodically sound, points out the methodological problems with most previous research, and recommends further discriminative and hypothesis-driven studies.

W. Eaton, J. Anthony, W. Mandel & R. Garrison, Occupations and the Prevalence of Major Depressive Disorder, 32J. Occupational Med. 1079, 1079-87 (1990)
One of the most methodologically sound empirical studies that included lawyers, the research produced shocking results. The authors sampled 104 occupational groups and found that lawyers are 3.6 times more likely than any of the other occupational groups to suffer from major depressive disorder.

B.A. Glessner, Fear and Loathing in Law School, 23 Conn. L. Review. 627-68 (1991)
The author provides an in-depth analysis of law school stress and its undermining effects on learning, morale, and the legal profession itself, and offers suggestions for manageable change. This is not a new article, but the information remains accurate and useful. Of particular note, the author argues for a professional and moral responsibility of faculty members to respond to law school stress – a message of continuing importance given the persistence of this problem.

William E. Livingston, De-Stressing the Profession, 81 Mich. B. J. 24, 24-7 (2002)
This recent article reviews key studies of job dissatisfaction among lawyers over the past 20 years. These studies support that a diminished quality of life exists as evidenced by stressors inherent in the practice of law. The author describes recent stress-inducing changes in the practice of law as challenges to the profession, including a more reactive work environment, competitiveness in relationship to profit, and “psychic battering” that occurs from continually inducing conflict. Practitioners are encouraged to incorporate the good they find within the culture of law with the intellectual and emotional aspects of their selves to maintain a true quality of life.

C.A. Roach, A River Runs Through It: Tapping into the Information Stream to Move Students from Isolation to Autonomy, 36 Ariz. L. Rev. 667, 667-99 (1994)
The author describes the causes of isolation in law schools. She argues that isolation is a primary cause, rather than a result, of psychological distress, and that it further has negative institutional and academic impact which is disproportionately experienced by minority and nontraditional students. She surveys learning, theory, methods/testing research, and the emerging ability of Academic Support Programs to integrate such theory and methods to move students out of isolation towards success.

Benjamin Sells, The Soul of the Law: Understanding Lawyers and the Law (1994)
The author, a Chicago lawyer-turned-psychotherapist now specializing in treating lawyers, brings a treatment perspective to this widely-distributed book. Dr. Sells notes that many “lawyers in today’s world are…painfully lonely”, that there is often a “feeling of emptiness” in spite of material success, and that the incidence of depression and alcohol and drug abuse by practicing lawyers has increased significantly in recent decades. The author counsels lawyers to attend to their emotional health, that is, transition to acknowledging that the behaviour of each individual lawyer has ramifications for the legal profession and accepting alcoholism and drug abuse as a disease process that is often punctuated with relapse. Particularly interesting is the discussion of alcoholism as a mitigating factor in discipline sanctions.

Survey: Lawyers Want Less Stress, Boston Business Journal, Tuesday, October 7, 2008
For lawyers, time and less stress are worth more than money, according to a new report.

Thirty-one percent of attorneys said that they would reduce stress levels at their jobs if they could change one thing about their jobs, according to a new survey from Robert Half Legal, a division of Robert Half International in Menlo Park, Calif. About 90 of the 300 lawyers surveyed said that they would reduce work hours, while higher salaries ranked last on the list with only 2 percent of the lawyers saying they would change that aspect of their job.

In the survey, lawyers were asked: “If you could change one aspect of your job as a lawyer, which one of the following would it be? Decreased job stress, less work hours and career growth topped the list. Higher salaries and increased on-the-job training were last on the list.

R. Kellner, R.Wiggins, D. Pathak, Distress in Medical and Law Students, 27 Comprehensive Psychiatry 220, 220-3 (1986)This a solid study of varied distress levels among medical students and law students. The aim was to evaluate the severity of distress among tow matched samples (n=60) of medical students and law students at the same point sin their educational training, years one and three. Two established and valid self-rating scales were used: the Hopkins Symptom Checklist and the Symptom Questionnaire. While the study was conducted at a single university, and is now dated, the findings demonstrate (a) law students to be significantly more distressed than medical students, (b) gender differences, and (c) additional challenges among third year students.

CMHA & Wyeth Pharmaceuticals, A Report on Mental Illness in Canada, (2002)According to this study, two-thirds of Canadians are touched by anxiety and depression, or have a relationship with someone who has, and one in three believe people would think less of them if it were known they suffered from these conditions. The results of this survey confirm the need for continued education about depression and anxiety. The sense of shame, discrimination and social isolation presents a barrier to people seeking the help they need. Depression and anxiety are real, common and treatable medical illnesses that currently affect almost 3.4 million Canadians from all walks of life, yet more than two-thirds of people do not seek appropriate treatment for these conditions. 

Depression
By Mary Greiner

Everyone has moments when they feel low or blue. What is the difference between one of those moments and the kind of depression that requires professional intervention? Since as many as one in five people will suffer depression during their lifetime, you may want to learn more about what depression is and how to treat it.

Imagine your emotional state as a kind of seesaw. When you are on top, you feel great, the view is fantastic, and even if it's scary, you know you have a grip on things. When you drop down, the view is dramatically different, but you know that through your own efforts you can get back on top. Without a partner, however, you can push yourself up only so far. If the seesaw represents your mood shifts, your brain chemicals are your partner. When your brain chemicals are functioning properly, you feel fine or better. When certain chemicals drop in production (sometimes with no known cause, and other times the result of a painful event, such as a significant loss), the mood seesaw takes you down. You can still push yourself, but it takes more work. If the brain chemistry is altered significantly enough, however, then you feel abandoned on the mood seesaw, without a partner to help you reach an emotional high.

As our mood darkens, our behavior changes. We struggle to meet our professional and personal obligations, and let more and more go undone. We procrastinate, get irritable, can't concentrate, and may feel fatigued all day, no matter how much sleep we are getting. Nothing is fun anymore. We may feel worthless and guilty. We may feel nothing but a sort of numbness. We may sit and stare at the documents in front of us without really comprehending what they mean, or play computer games instead of working. We may use mood altering substances (such as alcohol, sleeping aids, or chocolate) or engage in mood altering behaviors (such as looking at pornography, shopping, or gambling).

As your depression deepens, you may experience changes in your appetite (not hungry or always hungry) and your sleep patterns (can't fall asleep or wake up in the middle of the night and can't go back to sleep). You may think that life is meaningless, and that "they" would be better off without you. You may decide that death is the only way out, and fantasize about some sort of accident that takes you out of your misery. Or, you may begin to actively plan your death.

Therapy and Antidepressants

The more of these symptoms you exhibit, the more likely it is that your depression requires professional intervention. Even though depression makes any new task seem impossible, it is vital that you reach out for help as soon as possible. Studies indicate that the longer the depression lasts, and the deeper the depressive mood may be, the more likely it is that future episodes of depression will happen. Research has shown that therapy or a combination of medication and therapy works best to lift depression.

There are many options when it comes to choosing a therapist. Whereas all lawyers follow the same educational path and are licensed by the same authority in their state, therapists can choose many educational options and can be licensed by different agencies. Psychiatrists, psychologists, and social workers are the most common types of therapists. You will probably want to get a referral from your doctor, a family member, colleague, or friend. However you go about choosing your mental health professional, the most important variable is whether you feel comfortable with that person and believe you can trust that person. Based on many studies, the therapeutic relationship has been found to be the key to healing, and therapy may be all you need to get better.

If therapy alone is not enough to resolve your depression, and you and your therapist agree that you are a candidate for antidepressants, you may need to see another doctor for the prescription unless your therapist is licensed to prescribe medication. When it comes to choosing the right doctor to prescribe antidepressants, many people go first to their internist, family doctor, or OB/GYN. Some of these specialists have read the literature and know how to treat depression. Others have not and may know as much about your depression as the legal software salesperson knows about trying your lawsuit. Your therapist or internist may also refer you to a psychiatrist-a specialist in brain chemistry-who will know the most about treatment and what you can expect as your depression responds to the medication.

There are many antidepressants to choose from. You may be one of the lucky ones who is able to regain emotional balance with the first drug you try. Others must try several different drugs in order to find one that works or that has the fewest side effects. Some people with milder forms of depression respond well to the herb St. John's Wort. Because the manufacture of this herb is currently unregulated, you should seek the advice of a doctor, pharmacist, or herbalist for the best brand and correct dosage for you

Antidepressants usually must build up in one's system to have a noticeable effect. Some people must take the drug for two, three, or even four weeks before noticing any real change. The people around you may, in fact, notice the change first. Taking your medication with consistency is vital. Stopping the medication just because you are feeling better can cause a rebound into deeper and longer depressions. It is crucial that you continue the medication until you and your doctor agree your episode of depression is past.

If you believe you may have depression, please do seek help. Depression is not a weakness, nor must you recover from it alone. Your depression is not affecting only you, it affects everyone who depends on you-your family, friends, colleagues, and clients. Give yourself a break and get the treatment you deserve.

Mary L. Greiner, J.D., LMSW-ACP, practices psychotherapy and spiritually based divorce mediation at the Pastoral Counseling and Education Center in Dallas, Texas. She made a career transition after almost 20 years of law practice, primarily as in-house counsel to technology corporations. She can be reached via e-mail at mgreiner@flash.net.

This article originally appeared in the July/August edition of GP Solo Magazine. Reprinted by permission of the American Bar Association.

Overcoming Depression, by Daniel Lukasik, American Bar Association: GPSOLO “ Bumps in the Road IV” Vol. 26 Number 7, October/November 2009
Depression is not just a problem in the legal profession--it's a five-alarm fire. Recovery involves a mix of healthy strategies.

DEPRESSION, by Mary Greiner, American Bar Association: GPSOLO “ Bumps in the Road” Vol. 18 Number 5 July/August 2001
Everyone has moments when they feel low or blue. What is the difference between one of those moments and the kind of depression that requires professional intervention? Since as many as one in five people will suffer depression during their lifetime, you may want to learn more about what depression is and how to treat it.

Managing Stress for Lawyers, David C. Rainham, M.D., C.C.F.P.

Toolbox for a Health Practice. Toronto: Canadian Bar Association, Continuing Legal Education, 2000. (KF 3000 .A2 T66 2000 GLST)

The Lawyers Guide to Balancing Life and Work: Taking the Stress Out of Success Kaufman, George W.Chicago, Ill.: American Bar Association, Law Practice Management Section, 1999. (KF 300 .Z9 K38 1999 GLCI)

STRESS Management for Lawyers: How to Increase Personal & Profesasional Satisfaction in theLaw, Elwork, Amiram and Douglas B. Marlowe. Vorkell Group

Lawyers Guide to Coping with Stress, Gottleib, Gary Lloyd, Q.C,Garloy Press 1993

Managing Stress for Lawyers, Rainham, David, M.D., C.C.F.P
                         
Profit, Ron, Stressbusters, Sanity Savers and Practical Tips, Rainham, David, M.D., C.C.F.P

Stress Talk, Whole Person Press

Reducing Stress, Hindle, Tim, D.K.Publishing

The Hidden Sources of Law School Stress, Avoiding the Mistakes that Create Unhappy and  Unprofessional Lawyers, Krieger, Lawrence S.

 Personal & Professional Satisfaction in the Law. 2nd Ed., Gwynedd, Pa, The Vorkell, Group, 1997.

Living With the Law, Tamminem, Julie M., Chicago, Ill.: American Bar Association, Law Practice Management Section, 1996.

The Lawyer’s Guide to Balancing Life and Work: Taking the Stress out of Success, George W. Kaufman,Law Practice Management Section, American Bar Association, 1999.

Heather Fiske, Suicide, American Bar Association: GPSOLO “Bumps in the Road II” Vol. 21, Number 7, October / November 2004

Grief, by Judith F. Koeppl, American Bar Association: GPSOLO “Bumps in the Road II” Vol. 21, Number 7, October / November 2004
The practice of law offers no preparation for the deep and sometimes debilitating feelings of grief. The need to be strong, in complete control of your emotions, and “on top of your game” at all times interferes with the healthy resolution and integration of a significant loss. In a solo or small practice these issues are often compounded by the lack of support, time, and resources to deal with the grief while maintaining a practice. There is often no one to talk or turn to. The stress may be overwhelming and can negatively impact the quality of your work, life, and relationships.