Depression: Can We Finally Talk?
By Jenesta Sturrup, LMSW/ACP, MSRN
Talking about depression is one of those things -- like talking about sex -- that was considered taboo until the fifties. Fortunately, the public today is becoming more aware of and more willing to talk about depressive illness. Attorneys are not exempt from this malady. Many, however, do not realize that they are suffering from it. But when applying the criteria for depression to many of the problems suffered by attorneys, one can see that this profession actually has a higher-than-average number of depressed individuals.
The American Psychiatric Association Diagnostic Statistical Manual IV says that if you meet at least five of the following criteria, then you may suffer from some form of depression:
1. Depressed mood (feelings of being sad or empty);
2. Loss of interest in things you once enjoyed;
3. A change in eating habits, either eating more or eating less, and the corresponding weight gain or loss;
4. A change in sleeping patterns, either sleeping more or sleeping less;
5. Fatigue or loss of energy;
6. Diminished ability to think or concentrate;
7. Feelings of worthlessness, or excessive or inappropriate guilt; and/or
8. Recurrent thoughts of death or suicide.
The first symptom that many depressed people manifest is a loss of interest in physical appearance and physical surroundings. Usually, tidy people will become disorganized at work and at home. Their office becomes a disaster area and their home looks like a minefield.
In some people, anger and frustration erupt. Friends and family members notice and begin to discuss the person's moodiness. Losing things, blaming others, then getting upset becomes a real problem. "I did not put those socks in the refrigerator!" may sound like a joke, but underneath is a great deal of frustration and concern. Messages thought to be sent are not; tasks thought to be complete have actually gone undone; checks get written to pay the bills, but the envelopes never make it from the desk to the post office. And for many depressed people, everyone else is to blame.
Sleeping habits change. The depressed person's body develops an internal alarm clock, waking him up every couple of hours. The person will "work in his sleep," obsessing over personal problems when he actually is asleep, thus never getting quite enough real rest.
The depressed person seems to be ambivalent about everything. "I don't know" or "I don't care" are his or her most common answers to questions. This drives everyone else up the wall, provoking arguments and causing hurt feelings because the depressed person doesn't seem to care anymore. Frequent absences from work and a pattern of vague, persistent physical problems without discernable cause are another hallmark of depression.
Depression, like other diseases, comes in many forms. There is long-standing chronic depression (dysthymia), and the sudden, more acute disorder (major depression) which seems to arise from an identifiable event such as a birth, death, divorce, or loss of job. The aftermath of a traumatic event or news of a serious physical illness such as cancer can also lead to depression.
Perhaps the most destructive of all forms of depression is bipolar disorder, formerly referred to as ‘manic-depression.' Bipolar disorder takes the individual and those around him on a roller coaster ride of such highs and lows that everyone begins to wonder, "Who is this person?" People around the bi-polar sufferer may begin to question their own sanity. A man recently diagnosed with this illness once said, "The way I try to explain the disease to my family is ‘I travel the North Pole and the South Pole, and everyone else lives on the equator.'" This ‘traveling' can occur within minutes, days, weeks, or even years, depending upon the individual's cycle. Until the mid-seventies, a diagnosis of bipolar disorder was cause for institutionalization.
In the workplace, the signs of depression are often viewed by co-workers as evidence of a "bad attitude" or burnout. People think that the depressed individual has lost his zest, lost his drive, or has simply become lazy. A brilliant engineer once told me that when he was in the worst of his depression, he would hide in his office and stare for hours at his computer, praying for the day to end so that he could go home and drink himself into a state of unconsciousness. On the days when both depression and hang-over laid him low, he simply called in sick.
A very successful lawyer who'd practiced for years reported that he began to ask his assistants to read his briefs and do his depositions because he could not concentrate or focus. He would forget what he was saying in the middle of a sentence, completely lose track of his thoughts, and require others to fill in the blanks and cover for him. He lost interest in his wife and family, sex became a non-event, and he stopped attending family functions.
These people are not weak or lazy. They suffer from a medical condition called depression. People suffering from depression can no more "snap out of it" than can a person suffering from Parkinson's disease. Depression is a malfunctioning of the brain chemistry which manifests itself in the form of distorted or chaotic thinking and behavior. Because our society still stigmatizes mental illness, a depressed person may not seek treatment because of the shame or embarrassment of admitting that there's something wrong with his mind.
With gout, arthritis or the common cold, there are visible signs of illness; sufferers have permission to seek medical treatment. Such is not the always case with depression; its symptoms are visible, but only if one knows what to look for. The deterioration of a formerly-functional individual is only the first stage of depression. Many depressed people become destructive to themselves and others. They often become drug/alcohol abusers. They can land in jail or wind up homeless. The last stage of depression is often suicide. Many brilliant minds, lawyers among them, have been lost to depressive illness.
Alcohol or drug abuse is often linked with depressive illness and makes for a dangerous, sometimes deadly combination. The story of a lawyer named "Paul" is a classic example. After attending a prestigious military academy and rising through the ranks to achieve senior officer status, Paul served for twenty years in the U.S. Marine Corps. While in the Corps he followed all the rules and drank only within the parameters delineated by Marine regulations. After retiring from the Marines at age 38, Paul embarked on a new career -- a career which welcomed his hard-driving personality and allowed him drink a bit more. Paul went to law school. He made good grades but found himself binging on alcohol during every break in order to cope with the pressure, or, as he phrased it, to "stop the leaves from flying around in my head." Paul finished school and went to work, driving himself harder and harder, working impossible hours, until one day he was unable to get out of bed. He could no longer run fast enough to stay one step ahead of the depression which had been snapping at his heels for a long, long time. Paul's feelings of hopelessness, worthlessness, and helplessness began to mount. Alcohol no longer worked to quiet his mind. Suicide began to look like a viable option. Paul couldn't bear thinking of himself as a failure. Fortunately he called someone for help. He received treatment, stopped drinking, went on anti-depressant medication, and pulled his life back together.
Family history is a vital part of the chain of depression and addiction. In every case where depression exists outside a situational crisis or major trauma, the chances of a genetic link are considerable. Therapists who push for family information from clients often encounter great resistance. No one thinks of keeping it a secret that Aunt Jane developed diabetes as a young child, died at the age of 23, and was well loved in spite of her illness. Why, then, does the family not mention the fact that Aunt Jane was also an alcoholic by age 18, bed-ridden from depression at 20, and dead of a self-inflicted insulin overdose at 23? Both Aunt Jane's diabetes and her depression were physical illnesses; the diabetes was being treated properly and the depression was not. Why the mystery? The point is that the first story is socially acceptable, and behind the second story lurks the notion that Aunt Jane's depression was ‘all in her head.' That she could have ‘snapped out of it' if only she'd had more will-power.
A bright and talented lawyer named "Helen" was passed-over repeatedly for good jobs because she seemingly refused to apply herself. She knew that life seemed to be an awful struggle at times, but she found that she experienced moderate relief from her sadness by adhering to an extremely demanding daily exercise program. Helen's first marriage to a man who worked seven days a week and only slept for two or three hours a night ended in divorce. During Helen's second marriage, the depression she'd formerly held at bay through compulsive exercise began to affect her life, causing her to miss work. Helen began spending more and more time in bed. Her new husband decided that he was an artist and a writer, thus unable to work at a regular job which would stifle his creativity. Helen had reached the breaking point when she came for therapy. After several sessions of exhaustive history-taking which included asking her mother to talk about close relatives whom the family had never discussed, some critical information was uncovered. On Helen's father's side of the family there were four generations of brilliant people who'd displayed major symptoms of depression, bipolar disorder, and/or addiction. Helen's mother's family had a history of depression, bipolar disorder, and a myriad of physical disabilities. As Helen's treatment progressed through individual and group therapy, she read more and more about her illness and realized that she had duplicated family history in both her marriages. She began to feel better, missed work less often, was less angry, and felt more focused in her life. Her memory improved, her motivation increased, and she divorced her dead-beat husband. Helen broke her family's chain of depressive illness and dysfunctional personal relationships.
Some people currently believe that depression is a disease that arose only in the late 1980's and 90's, highlighted by the wonder drug Prozac and embraced by self-absorbed individuals looking for a ‘quick fix.' Nothing could be further from the truth. Depression and related depressive illnesses are biochemically based and have existed for millennia. Many brilliant, creative people have suffered from depressive illness - Ernest Hemingway, Vincent Van Gogh, William Styron, Virginia Wolfe, Cole Porter, Irving Berlin, Ezra Pound, and Eugene O'Neill -- to name but a few.
Over the course of the last twenty years, advances in the treatment of depression have brought the subject out into the open. In the last five years, the shame associated with being depressed has decreased in part because of the explosion in medical research and new medications to treat the illness. Prominent people like Mike Wallace and Cathy Cronkite have spoken freely about their struggles with depression and have encouraged others to seek help.
Data continues to accumulate which points to the biochemical genesis of depression, thus helping to ameliorate some of the stigma attached to this illness. Improved anti-depressant medications and new treatment modalities mean that depression no longer need lead to suicide, alcoholism, drug abuse, or a life of marginal functionality in which each day seems to be more of a struggle than the last. When the depression sufferer and those around him realizes that he has a medical problem -- not an ‘attitude problem'-- he will find that help is easily accessible for every person suffering from this debilitating, life-threatening disorder.
Reprinted from Texas Bar Journal, March 1998.