Combatting Stress, Anxiety and Depression Among Students and New Professionals
Long before last week’s deaths by suicide of designer Kate Spade and chef/writer Anthony Bourdain, the legal profession had started to focus on stress within the legal profession. Science has long confirmed that stress is part of a continuum that can lead to anxiety and depression. A 2016 ABA/Hazelden Foundation survey of legal professionals found that nearly 50 percent of lawyers reported “concerns with depression.” And a 2016 survey of law student well-being noted that nearly one out of five participating students had been diagnosed with depression.
I’ve summarized below key facts everyone should know about how we can start to address stress, anxiety and depression within the legal profession.
What do we know about the prevalence of mental health issues within the legal profession?
Several recent surveys suggest that a variety of mental health issues are common within the legal industry. In 2016 the American Bar Association and Hazelden Foundation released the results of their joint survey which includes the following findings:
- Levels of depression, anxiety, and stress among attorneys are significant, with 28%, 19%, and 23% experiencing mild or higher levels of depression, anxiety, and stress, respectively.
- In terms of career prevalence, 61% reported concerns with anxiety at some point in their career and 46% reported concerns with depression.
- Significantly higher levels of depression, anxiety, and stress are found among those screening positive for problematic alcohol use.
According to the ABA/Hazelden survey, male lawyers report significantly higher levels of depression; women lawyers report higher levels of anxiety and stress. The survey further found that anxiety, depression, and stress scores decreased as participants’ age or years worked in the field increased.
With regards to law students, in August 2016, the Journal of Legal Education published “Suffering in Silence: The Survey of Law Student Well-Being and the Reluctance of Law Students to Seek Help for Substance Abuse and Mental Health Concerns.” Key findings include:
- [R]oughly one-quarter to one-third of respondents reported frequent binge drinking or misuse of drugs, and/or reported mental health challenges.
- 18% of participants had been diagnosed with depression.
- 23% screened positive for mild to moderate anxiety; 14% screened for severe anxiety.
- 21% report they had seriously thought about suicide in their lifetimes.
For additional data regarding stress, anxiety and depression among law students and within the legal profession, visit the DaveNee Foundation (www.daveneefoundation.org).
What do we know about causation?
Let’s not fool ourselves. Mental health issues can be hugely complex, with causative factors varying dramatically from person to person. However, wide agreement exists with two factors.
First, we know that some mental health issues have a genetic component. Science has yet to determine which genes or combination of genes are relevant. However, twin studies point to genetic makeup as a contributing factor. Second, we know that numerous environmental factors can contribute to mental health issues. Science confirms that children exposed to alcohol and/or other toxic substances during the course of the mother’s pregnancy can suffer irreversible brain damage. Additionally, a link has long been established between the consumption of lead and nervous system damage.
To the extent that we wish to help law students and new lawyers more effectively manage stress, it’s critical that we arm these professionals-to-be with a basic understanding of the biology, biochemistry, and neuroscience that underlie stress, anxiety, and depression. At a minimum, they should know the following:
Stress can be positive. It can push any professional into a “peak performance zone” and bring a sense of excitement to life.
Stress turns negative (and even dangerous) when it builds without relief. Chronic stress often results in feelings of fatigue and helplessness. It’s also tied to a variety of health issues, including high blood pressure, obesity, elevated cholesterol levels, abnormal glucose levels, etc.
Health professionals tell us that the critical event is the activation of the flight-or-flight response within the brain. Once triggered, the body responds by pumping more blood and releasing adrenaline and cortisol. It appears to be the ongoing activation of this response that increases the risk of developing many physical and mental health problems.
We must communicate the following very important, empowering message to students and new lawyers: You have elected to join a stressful profession, and you have the power to control how you will react and respond to day-to-day stresses.
What are the warning signs that someone has moved from being stressed to struggling with a potential mental health issue?
Everyone is familiar with the physical signs that suggest we may have activated our fight-or-flight response system: breathing patterns change, from calm and steady to rapid and short; heart rate increases; and muscles tense.
Signs that students and new lawyers may be moving into a state of chronic stress include:
- Experience difficulty concentrating, being creative or decisive;
- Withdraw from social interactions or, when interacting with others, anger quickly;
- Become nervous, panicky, impatient, or emotionally upset; and
- Develop headaches, muscle aches, changes in eating habits, or problems sleeping.
The most recent edition of the Diagnostic Statistical Manual (DSM-V) lists symptoms for “Major Depressive Disorder,” which include:
- Depressed mood or a loss of interest or pleasure in daily activities for more than two weeks.
- Mood represents a change from the person's baseline.
- Impaired function: social, occupational, educational.
- Specific symptoms, at least 5 of these 9, present nearly every day:
- Depressed mood or irritable most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful).
- Decreased interest or pleasure in most activities, most of each day
- Significant weight change (5%) or change in appetite
- Change in sleep: Insomnia or hypersomnia
- Change in activity: Psychomotor agitation or retardation
- Fatigue or loss of energy
- Guilt/worthlessness: Feelings of worthlessness or excessive or inappropriate guilt
- Concentration: diminished ability to think or concentrate, or more indecisiveness
- Suicidality: Thoughts of death or suicide, or has suicide plan
Please note the following: When any of the above symptoms emerge, we must encourage students and new professionals to connect immediately with their physician or their organization’s EAP.
What practical strategies seem to make a difference?
Since we know that feelings of stress start with the activation of the fight-or-flight response, it’s imperative that we provide students and new associates with a variety of strategies that they can implement on an ongoing basis. Some strategies that work include:
Make time for exercise. Physical movement can help relieve pent-up energy, anger and anxiety. It also releases endorphins, the body’s natural mood enhancer.
Undertake activities that stimulate the prefrontal cortex portion of the brain (where executive thinking, problem-solving and planning occur) and thereby prevent the limbic portion of the brain (from which the fight-or-flight response emanates) from ruminating about potential problems or threats. By consciously recognizing a specific emotion and deciding how to address it, new professionals can move from a “worry state” to an “action state.”
Avoid becoming a victim. New and established professionals report that the unending requests they receive from internal and external clients are the primary cause of their stress. As one partner recently told me, “I start every workday with a plan that will allow me to get home and see my kids. Then I receive a slew of new requests and find myself working late to meet the new commitments that I’ve made.” Take control of assignment due dates. Rather than assume an immediate turn-around is required, be prepared to ask, “If I get that response to you within XYZ hours, will that meet your needs?”
Practice mindfulness. I know that lots of you have sought to introduce mindfulness training to your law schools and law firms only to encounter some professionals who roll their eyes. Help your very logical lawyers understand that there is absolutely nothing magical about a particular sitting position or some words that they choose repeat (call it a mantra or a mental cue). Rather, mindfulness training should be undertaken as a challenging mental exercise that can help professionals bolster their prefrontal cortexes.
One last important thought. Increasingly law schools and legal employers tell me that many new professionals push to work from home. Junior lawyers maintain that they can easily access needed work materials via secure internet connections, and by eliminating commutes to/from the office, they stay billable to the max. Orientation programs should note that coming into the office may help new professionals establish and build the human relationships that are especially critical to addressing stress, anxiety and depression. Because connecting with others electronically does not produce the same biological and psychological benefits that accrue from face-to-face interactions, allowing new professionals to work from home 24/7 may contribute to the isolation that is often associated with several mental health issues.
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