Article on Depression

I said on the community blog that I'd try to find an article on depression that I wrote for the WV Bar Journal around 2002. I found it lurking on the server, so here it is:

Dear Tom -

Tom, I know that this letter comes sort of out of the blue – we have known each other for more than 20 years, and I’m presuming on that long friendship quite a bit today.

I need your help. I want to say things, speak some words that I really believe some of our fellow lawyers need to hear. But, just putting them into a dry article without some personal communication seems cold or imperious or inappropriate or something like that – sorta like talking to an empty jury box. So, this is a letter to you. If this were a typical article, the title would be something like --

Depression and the Lawyer, or
Like Hell it Can’t Happen to me.
[The multiple title thing is straight out Rocky and Bullwinkle. I like Rocky and Bullwinkle. and if (former Bar President) Jim Stealey can wax eloquently about the Three Stooges in an article, I certainly can cite Rocky and Bullwinkle to you.]

Tom, I’ve been depressed for years. I’ve mentioned that in some private conversations and rarely in Court or to a client who I think needs screened for depression. It’s really painful to disclose this. It’s quite a bit more painful to live with it.

You know, depression has WAY too good a reputation-Churchill was depressed, and look at all he did; Lincoln was REAL depressed (which you can see as he sleeplessly “Walks at Midnight” on our Capitol lawn); LBJ was episodically depressed; Sylvia Plath was depressed to the point of suicide, and on and on. But somehow the literati describe their disorder as something which makes them more “tragic” figures and somehow “grander” or “nobler” because they have suffered so and have overcome such an obstacle to achieve greatness, blah, blah, blah. Great writers are depressed, or talk about depression:

We are the hollow men
We are the stuffed men
leaning together
Headpiece filled with straw. Alas!
Our dried voices, when
We whisper together
Are quiet and meaningless
As wind in dry grass
Or rats’ feet over broken glass
In our dry cellar
–from T. S. Eliot’s “The Hollow Man”


But the truth- the hard truth- is that depression is a truly horrible place to be, it alters your judgment, it haunts you, and experiencing it doesn’t have the least element of noble tragedy.

I have even worse news - One in 4 women, and one in 8 men, will experience at least one serious episode of depression in their lifetimes. Ane 17 million Americans, right now, today are experiencing severe depression.

WHAT DEPRESSION IS:

The DSM defines depression with neat “shopping lists” of symptoms, and those also can be found in many depression resources. These indicators include:

• A depressed mood (e.g., feeling sad or empty, crying, which may be the most personally uncomfortable problems of all)
• A diminished interest or pleasure in all, or almost all activities fun with the kids, outdoor activities, pleasurable reading, going to the movies, sex-YIKES
• Insomnia or hyper-insomnia (sleeping a lot), and other sleep problems
• Psychomotor agitation or reparation - Pacing, fidgeting, and so forth
• Fatigue or loss of energy
• Feeling of hopelessness - That one is SO bad for you
• Irritability - Ane that one is SO bad for the people around you
• Feelings of worthlessness or excessive or inappropriate guilt- Hoo, boy, that’s a biggie
• A diminished ability to think or concentrate, or indecisiveness
• Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or suicide attempt or a specific plan for committing suicide.

Depression can happen once (“single event”), now and then (“episodic”) or constantly (“bloody well terrifying.”) It can occur at any age, but the first episode usually is in the prime of our productive practice years, ages 25 to 44.

Now, all that being said, so far we’re not being much help to the individual, are we? How do you know whether you or your partners or people around you are depressed to some extent? It’s not my goal to have people “play doctor” with themselves here, but rather to help folks recognize when it may be time to have the doctor play doctor with them or with the people who matter to them.


YUP, IT’S REAL

First, let me talk about the “feel” of depression. Usually, depression doesn’t appear suddenly-it comes on “like a thief in the night.” We’ve been dipped in a John Wayne society which doesn’t recognize depression, or thinks it’s just a matter of a lack of self control, or even caused by fundamentally bad character. There now, everybody gets a little blue now and then. I’ve heard that one a lot. And it’s true. It’s also true that everybody has a little chest discomfort. When it’s severe chest pain, you ought to get your butt to the hospital. Oh, and there’s the “I just don’t know HOW someone could think like that,” usually in the context of talking about people “hurting themselves” or “doing something to themselves,” or some other cute little euphemism for suicide. How can someone in that dark place of depression explain it?

Listen, Tom - Everybody who has been seriously depressed has thought about suicide. Everybody. The worst of the place called depression is lonely and dark and pointless and futile and directionless and scary beyond words that can be printed on a page. Moreover, there is no perspective or logic or sense of self- To the person in the pit, he or she “knows” that everyone around them feels the same way, and so who are they to complain? In that pit, these feelings are the natural, crummy order of things. In telling you these things, my friend, I’m not “accurately” describing the worst of this place called Depression. All I can do is shine a little light behind it and cast two-dimensional shadows of the three dimensional technicolor nightmare.

But, as bad as this place is, for a REAL LONG TIME the people around you may not have a clue that you are depressed. It’s not their fault, either-part of the illness is creating “defenses” and masks to hide the pain and the shame. I will remember what was probably my very worst day-hours before my partner intervened in a big way - I was in the Courthouse and saw a Judge who I practiced before, walking along with a medical expert who was a wonderful and pleasant fellow I also saw frequently in hearings. I remember talking to them, joking with them, and from their perspective it was a “normal” or even “jovial” person with whom they were interacting. Inside, I was screaming turmoil, but neither of them could have had a clue.

There isn’t a single classic kind of depression, some “one-size-fits-all”diagnosis. It can include anxiety. It can include a post-trauma stress diagnosis. It can be mild; it can be bad. It can be purely biochemical; or mostly environmental. We know that there is a strong genetic component. But wherever it comes from, it’s real. But as deep as the pit is, there are ways out. And getting out and seeing the sunshine and people again is the greatest relief imaginable.


DO YOU RECOGNIZE YOURSELF IN THIS DISEASE

Ok - listen to me-are you listening? LISTEN TO ME - You cannot DEFINITIVELY diagnose depression in yourself. Depression alters perceptions of reality and clogs whatever mind mechanism we have which determines the true importance and prioritization of competing needs and issues. But you CAN see things wrong which are indicators of depression coming. If you do, remember that you are a LAWYER - you have an obligation to take care of the tools of your craft - in this case, your head. Fortunately, you have lots of contracts and resources so that you can talk to someone qualified who can ask the right questions.

First - LISTEN TO YOU.

How do you feel? Are you happy? Content? Is living just a chore? Do you wish it would all just go away? Or do you want to just get in bed and pull the covers up over you?

How active are you? Do you spend all your time on the couch? Or do you get your butt in gear and get out and be active?

Look at your ability to do things - Are you “blocking” on more cases than usual because you just can’t deal with them? Do you duck more phone calls? Do you make promises or predictions to clients that you really sort of know in your heart are unrealistic at the time you make them?

Look for unplanned significant weight change, either up or down. And emotional lability [that means "crying," for the uninitiated], that’s a BIG indicator. That seems inconsistent with another depression marker, irritability or anger but they can coexist quite nicely, thank you.

How about your work? Do you work in periods of slow motion punctuated by time of a frenetic pace? Sometimes, you may feel so bad while depressed, the idea of fanatical work is attractive - it focuses your mind, and gives you some markers of external value. Remember what Theodore Roosevelt said: Black care rarely sits behind the rider whose pace is fast enough. Of course, depressed people routinely ignore the self-value things anyway. In my own experience, focusing on work and a parent’s last illness kept things very nicely at bay for months and months. Then, those months came to an end. Dang.

Oh, another big indicator is boozing. People drink for all kinds of reasons, mostly stupid ones. One of these is to “self-medicate” for the depression or to dull the anxiety within the depressed person or brought on by interactions with others who just don’t have a clue. Changing your alcohol habits can be the beginning of bad news, in lots of ways. Oh, by the way, alcohol is a depressant, so any “positive” effects are pretty quickly canceled out by more weight on your mind.

Next, watch what’s going on around you and listen to what people are telling you. Depression comes on generally over long period of time, but it’s hard to maintain a complete pretense forever-and hopefully, sooner or later, the people who do care about you will talk to you. If your spouse or partner or friend raises the subject, ASK what they see. Remember your Robert Burns, Tom:

Oh, wad some Power the giftie gie us,
to see ourselves as other see us
It wad frae manie a blunder free us,.....

Interpersonal turmoil can hint at depression, particularly among those you’re close to. domestic turmoil is unfortunately so very common.

Sometimes, the depression becomes so bad that the sufferer cannot stand to get out of bed, brush their teeth, and walk out of the house. In a way, that can be a GOOD thing - it’s hard even for the densest of people around you to ignore that. Mostly, though, we see the “functionally depressed,” people who feel really lousy but who depend on habit and ability to continue functioning on some level. those are the hardest to spot and the ones most likely to have serious bar trouble.

You cannot diagnose yourself, but there are some very basic screening tools available. Psychologists use short written questionnaires (the “Beck Depression Inventory” comes to mind) to get a “quick and dirty” look at someone’s “morale” status. [Practice pointer: If you have a client who is too macho to ask if s/he is depressed, ask it as “How’s your morale?] ”The web is also full of resources- for years, I have used a Depression Inventory at Queendom.com, a site with a ton of fascinating personality and intelligence tests (as well as lots of other good stuff!). Their depression inventory consists of 85 questions covering the full range of symptoms, and takes about 10 or 15 minutes to do. It spits out a cautious opinion if the score is elevated, with is chock full of sound advice and good sense:

I would advise you to get help (preferably a psychiatrist). Depression is treatable and the success rate is very high. Please, see a doctor; you really do not need to suffer this way. Remember, depression is a medical problem and it is not “just in your head.” It is not something you did, you are not being punished, and it is not your fault. there is help, so please, go and get it.

WHEN YOU SUSPECT YOU’RE DEPRESSED:

It’s a lot harder to recognize problems and get to this point than to move on from here - that’s the good news.

You need to take care of the problem and its cause; and its effects. You CANNOT take care of the problem ALONE - you have to bite the bullet and see a doctor. (The flip side is, your doctor can’t do much without YOU on board and actively participating.)

What will your doctor do? Beats me, it HAS to be individualized treatment - one size does not fit all. The doctor will consider treatment options, which include counseling (“cognitive therapy”) or medications or both.

Counseling/therapy really sucks for some people; it’s really enjoyable for others. I think for most folks, though, there are elements of both the good and the bad in it. Sharing things and finding things and going places you have been avoiding and don’t want to go, even though they’ve been eating you up from the inside out, can be an intensely painful experience. Or, it can be intensely relieving. I found it to be both, and I’m glad that I went there. Counselors are about the nicest, most competent and most caring people you’ll meet. [Even so, sometimes you just won’t be on the same page as a counselor/therapist. Then, it’s time to find another one.] Counselors generally don’t have the answers. You do. You just don’t know how to access them. They do-With question like “What would it feel like to...” or “Whose rule is that, yours, or [pick one]?” A competent (and loving) therapist has been a guide to me out of many dark places.

The medication thing is scary-but it shouldn’t be so much so. The meds do not “put thoughts into your head,” they use different ways to let YOUR thoughts start flowing normally again. One cause (or effect?) of depression is that the chemicals which feed emotions (the neurotransmitters”) are transferred around in the brain too quickly or too slowly, or something scientific like that. Most medications for depression alter those chemical transmissions to let YOU show through, and most of these medications have no or minimal side effects.

AVOIDING THE “PERSONAL AND CONFIDENTIAL” LETTER FROM THE OFFICE OF DISCIPLINARY COUNSEL

You CAN take care of most of the effects. First and foremost, TELL PEOPLE WHO NEED TO KNOW-your spouse; your partners; your judges. these are the people who will see the effects of depression first, and be most concerned. For me, there was a small wake up call from our circuit judge. Before I told him of my own difficulties, he came to me and my partner to ask “what’s going on?” That was an appropriate thing, and a supportive thing. It’s SO MUCH BETTER that the judges hear it from you, not on the street.

Also, at some point the Office of Disciplinary Counsel may need to be told. A bad alternative is that somebody else tells them. That’s not to say that ODC hearing about a lawyer being depressed is “bad.” Trust me, the people are ODC are good lawyers who care about the bar and its members. None of them has horns, red eyes, claws nor, from my rather limited study, Satanic tattoos or scales. Their first concern is to protect clients and the public, which means that they want to be part of the solution to encourage the impaired lawyer to get help.

The ODC is not limited to deciding to “hammer” someone or not- that isn’t their role. In some instances, they hear themselves of someone having problems and inquire-not formally, but to see IF there’s a problem. If the problem is being handled without danger to clients, ODC is a resource and a cheering section. If there are ethical dilemmas which arise they will help lawyers through them. If action is necessary, they will be just as cooperative as the affected lawyer. (The sowing what you reap thing) For instance, a quiet voluntary suspension/vacation is eminently “doable,” of course with the concurrence of the Court. The Office of Disciplinary Counsel and the Lawyer Disciplinary board want to be part of the solution- under former Chair David Romano of Clarksburg, the Board began taking an active role in ethics affairs in addition to its traditional reactive role, and current Chair Al Karlin of Morgantown has continued that philosophy.

CAST BREAD UPON THE WATERS

One last word-Lots of people are depressed, including those you meet in your practice. Our role is to help people, our profession is about helping people. Whether you recognize the possibility of someone being depressed because of your personal experiences or just from reading stuff like this, don’t simply ignore it. Some depressed people are living in a solitary hell-and are just waiting and hoping and praying for SOMEONE, for ANYONE to recognize that and take just a little initiative in directing the person to the help that she or he may know is needed. It tells them that they are not alone in the world. This is an opportunity to do a good thing that we cannot pass up.

We lawyers get a bit cocky, don’t we? This kind of thing should remind us that the blood which runs through us is the same as in any other human-and that, when it comes right down to it, we are all in this life together.

Ok, Tom-I’m done-Why have I written this? Maybe I’m just tired of feeling bad about feeling bad, and this is my goodbye to that. Bob, a wonderful therapist I know, always asks how you feel. And he requires that you first put your feeling into the “Six Words:” Happy, Sad, Mad, glad, Lonely, Scared. Well, I feel pretty glad to say this-and just a little bit scared. That will pass, though. This is just too important for us to ignore any longer.

Have a good day, Tom, and I’ll see you soon.

Your Friend,
Roger