Friday, December 11, 2009

Taking on Depression: The Bottom Line: No Laughing Matter

The need to make a change in order to overcome depression has been the theme of this series. The mind, heart/feelings, and body are the 3-in-1, highly reciprocal triumvirate of the human personality. Change the mind, and the emotions and body respond. Change the body, and the mind and emotions respond. Change the feelings, and the body and mind respond. Therefore, when it comes to depression, there may be a variety of access points to begin to leverage change.

If you are someone who struggles with mild to moderate depression, you may find the strategies described in this series very useful, enlightening, and effective. If you have a persistent moderate depression, and experience difficulty implementing and/or benefitting from these approaches, you should consider “hiring” a good therapist to help you support and focus your efforts to change. In some cases, the use of medication for a period of time can help you get some traction to the point that self-reinforcing behaviors begin to “take,” and for many the need for medication diminishes.

Depression is no laughing matter and should be addressed as early as possible, preventing a more severe decline in mood. A long-standing, severe and entrenched depression is often best addressed as a medical problem, and anti-depressant medication is often necessary, perhaps for an extended period. In such cases, symptom reduction via medication can make it possible to make better use of psychotherapy to address deeper needs, wounds, beliefs, and losses.

Fundamental to these deeper sources of depression are troublesome undercurrent human emotions such as fear and anger. When, despite the discomfort associated with them, fear and anger are consciously experienced and acknowledged, i.e., when you “own” them, as some say, they have less power over you, and offer useful information about your personal experience. You are then able to respond, rather than react, with constructive, responsible, decision-making concerning the situations/conditions that evoked them. In so doing, you are no longer victim; you reclaim and exercise your power.

One of the issues to be addressed in psychotherapy may be what I call an unconscious commitment to depression. Sufferers of long-term depression may be quite aware that they are depressed, may even be quite aware of many of the root causes, but they may be quite unaware that their depression has become a part of their identity, that they are unwittingly clinging to it, trapped by their grief, and by their vulnerabilities and fears of a fuller engagement in life with all its surprises, disappointments, and responsibilities. When this is the case, they may refer to their depression as “my depression,” see themselves as defined by their depression, and anticipate feeling quite lost without it. They may doubt their capacity to even imagine feeling truly good, truly alive. No wonder depression can be, for some, so insidious and tenacious!

Depression can have an insidious affect on loved ones as well, as the sufferer of long-term depression may also unwittingly hold and subtly communicate an expectation that others understand and be complicit with their limitations. However, for others to take responsibility for, or somehow participate in the depression, only serves to generate guilt and resentments that tend to feed and “spread” the depression. The challenge for family members and friends is to offer compassionate acceptance and support without infantilizing or buying into the loved one’s incapacitation, and to insist that the depressed person obtain treatment. To curtail their own enjoyment of life in any way, or succumb to guilt for being happy or having fun when their loved one may be miserable is a type of co-dependent behavior that serves no one, especially not the depressed person. It is therefore important that family and friends take care of themselves and allow themselves as full a ration of fun and enjoyment as possible.

There ought to be no shame in suffering from depression, and no stigma for seeking help. Depression is part of the human experience, and severe depression is now recognized as a treatable medical condition. Combination therapy that may include medication, psychotherapy, and use of techniques such as those offered in this series are generally quite successful and offer the participant valid hope for change and the prospect of becoming more happily and gratefully engaged again in life.

When you take on depression, you are taking on a challenge; the longer and deeper the depression, the greater the challenge. Whether you struggle with a low grade, a moderate, or a severe depression, you can overcome it with persistence, determination and patience. Strive for progress, slow steady progress, and take it one day at a time, employing at least one strategy every day, starting as early in the day as possible. Keeping it in the day, so to speak, can help free you from the failures or regrets of the past (and we all have them) and protects you from anxieties about the future.

For many, overcoming depression, whether accomplished through self-help strategies or with professional help, is a learning, letting go, and self-acceptance process: learning how to be happy, letting go of (or becoming reconciled with) those conditions or parts of yourself that have held you back, and embracing yourself with compassion and humor.

Thursday, November 19, 2009

Taking On Depression: Part 5: Body Language

Just as you can change the focus of your thoughts (the content of your mind) in order to change your mood, you can also elevate your mood by doing a variety of things with/for your body. The most immediate change you can make may simply be your posture. Most of us prepare ourselves for our reflection in a mirror by making little adjustments before we look. But I dare you to take a candid look at yourself in a full length mirror. What do you see? Do you need to tuck in your tush and your tummy, straighten your back, lift your chest and relax your shoulders, tuck in your chin? Having done so, do you feel even a bit more self-possessed? More dignified? If this is not your usual, commit yourself to making it so, and every time you become aware that you are slumping or slouching, tidy it up. You’ll look better and feel better.

How about your face? Many of us are surprised by what we see when we’re caught by surprise in a mirror. We may see a furrowed brow, grim mouth, tense jaw, protruding chin, or other signs of tension. Many of us do store tension in our faces, so while you’re correcting your posture, put on a happy face, or at least release the tightness around your eyes, your brow, your nose and cheeks, your jaw and mouth. If you’re not smiling at this moment, think a pleasant thought and smile. The way you now feel is your proof that even smiling to yourself can shift your mood. You can give yourself the further enjoyment of smiling at others, including strangers, and watching their mood shift along with yours.

Then there’s the matter of exercise. Everyone knows about endorphins, the body’s natural mood enhancers, which are produced by aerobic exercise. You may know from your own experience that regular exercise is energizing and boosts self-esteem right along with the immune system and general fitness. The endorphins help lift mood, and so does exercising the self-discipline to do something you know is good for you. If you exercise with gratitude for a body that is able to exercise, regardless of your level of fitness, and further, do so mindfully and respectful of your limitations, you ramp up the benefit even further.

So, even simple things that you can do with and for your body can improve your mood. Anthony Robbins, the hugely successful motivational speaker acquired his material from exhaustive research as well as from his own experience overcoming major depression. One self-observation he made is somewhat similar to the “fake-it-‘til-you-make-it” strategy, or acting “as if.” At a time when he saw himself as an utter failure, he realized he immediately felt better by simply carrying and presenting himself as he would if he felt great about himself, i.e., by carrying himself straight and tall, by looking others in the eye, smiling and showing some interest in them, all actions that typically elicited positively reinforcing responses. By taking a shower, donning clean and self-respecting attire, shaving and combing his hair, correcting his posture, and being willing to smile, he came to realize how much power he could exercise over his own life and sense of well-being.

For him, this was the beginning of his implementation of a daily routine of deciding and visualizing what he wanted for that day, including what he wanted to accomplish, how he wanted to interact with others, the attitude and mood he wanted to carry, and how he wanted to respond to annoyances and frustrations. This harkens back to the previous blog addressing what you want. It is obviously helpful, therefore, to engage the mind in a manner that supports what you are doing. So, if you find yourself thinking, “That may work for some people, but not for me,” then transform that thought to something like, “If it works for others, it will certainly work for me, too.”

Any discussion of caring for your body is incomplete without talking about “fuel.” It is common knowledge that a balanced diet low in sugar and fat is good for the brain and body and that both diet and exercise are critical to health maintenance and longevity. We all know the difference between good nutrition and junk food; we’ve been hearing the data and the warnings for years, decades really. You need not be a purist. I, for one, am a believer in the benefit of my daily dose of chocolate (rarely just one square). And I consider a slight excess of carbs to be one source of soul food. But without good nutrition, the amazingly adaptable and most forgiving body will begin to cause you problems and expense far greater than that of providing yourself good nutrition. Yes, it does take effort to budget the necessary time and money, but doing so is, again, self-empowering and helps lift and maintain a good mood.

Well, you may say, I can manage all these things quite comfortably when I’m not depressed. When I’m depressed, it’s more of a struggle to motivate myself and may even feel impossible. It is true that it may feel impossible, but it is not true that it is impossible. It may help to remember that you don’t have to do everything all at once. You can start by just doing one thing, even one very small thing, until it becomes routine, and then add another action. Do not permit yourself to be seduced by the feeling, but stay focused on what you want and what you are going to do, and then put yourself in motion. And don’t indulge in discouragement if results are not stellar at first. Persist and you will get your results.

Think about this: what impression would you like to create in the mind of someone meeting you for the 1st time, or even for the 1st time today? What do you want the “take away” to be from your encounter with another person today? Do you want it to be productive, useful, pleasant, fun? Do you want to relax and enjoy it and for both of you to walk away from it feeling at least generally positive? Imagine yourself engaged in such an encounter and then play it out in your interactions. If you can imagine it, you can do it, however much practice it may take. If you fear that making changes such as those suggested here will be too “out of character,” too noticeable to others, or evoke comments or compliments, don’t be deterred. In response, you can just smile mysteriously and say that you’re conducting a scientific study.

For some who are battling depression, the thought of having to make such an effort indefinitely may be overwhelming. Do it just for today. “Yesterday’s gone, tomorrow’s but a dream.” Commit to doing something just for today. Changing your behavior, i.e., your posture, your face, your care of your body, your energy, in some small way may produce an initially imperceptible difference, but the momentum builds. The long term results of persistent small changes can be huge.

Monday, November 9, 2009

Taking On Depression: Part 4: What Do You Want?

Overcoming depression is about change. Last time I talked about changing your thinking by focusing on thoughts of gratitude in order to generate the energy to act, to make further changes, to get where you want to be. For many with depression, especially long term depression, thoughts about what you want may have become habitually secondary to what you think others want from you. Early childhood experiences that honed your vigilant attentiveness to others’ needs may have represented an instinctive and necessary, i.e., adaptive survival strategy. While sensitivity and responsiveness to others’ needs can be rewarding, maybe even lead to a career path as a lawyer that employs your valuable people skills, it can also become an impediment to your discovery of what you really want and need, to what will enable you to experience “authentic happiness,” not just win others’ admiration and approval, and perhaps a spurious sense of security.

A common manifestation of this impediment is what is increasingly referred to as “codependency,” a relationship of mutual dependency based on an implicit bargain in which “I take care of you and you take care of me,” in which both parties avoid having to take full responsibility for themselves. While self-sacrifice is a part of all healthy committed relationships (spouses and parents do it all the time), sacrificing oneself in order to avoid something difficult, or to leverage payback from the other is a form of avoidance or manipulation. Whether it occurs in a personal relationship or a professional one, it is somewhat dishonest, self-defeating and disempowering and inevitably creates resentments, disappointments, feelings of victimization, and possibly depression.

Some have never learned to give themselves permission to want and to dream, to know their own feelings and wishes, or have done so in a very limited way. Some may be very clear about what they want in one sphere of their lives, say the professional sphere, and much less so in their personal life, e.g., the successful lawyer who lacks close satisfying personal relationships. So, how do you begin to identify what you want? One place to start is to simply think about what makes you feel good, enhances your self-esteem, that employs your unique talents, that piques your interest or gives you enjoyment, that inspires, energizes, and excites you, that makes you want to get up in the morning.

If you haven’t felt any of these things recently, or experienced them in only one sphere of your life, think as far back as necessary to when you did. Pursuing the things that make you feel good is not frivolous self-indulgence; it is a participation in life, in the creative process. True creativity is implicitly positive, additive, contributing to the larger community and greater good in some way, however small. Do you like to cook and make pleasing meals for your family? That is creative. Do you like to read and share your thoughts with a book club? That is creative. Do you grow vegetables or flowers in a garden? Exercise to maintain your health and energy? Keep a home that is welcoming to others? Work collaboratively with others at home, in the workplace, in the community? Share your energy, time, or money with someone in need of it? Do you smile at strangers? Write programs, plays, books, pamphlets, songs, poetry, menus? Do you pray, meditate, praise, appreciate? It’s all creative.

What do you want? If you don’t know, then you must figure it out, discover it, keep asking yourself the question until you do. Be sure to ask yourself the right question(s). Do not ask yourself questions such as, “Why can’t I do this?” or, “Why can’t I be happy?” or “Why haven’t I accomplished more?” Such questions invest a subtle belief in an undesirable condition. The questions are pointless and will yield invalid, useless answers. Ask instead, “How can I do this?” “What makes me happy?” “What can I do to make myself feel good right now?” The amended questions create a receptivity to discover new possibilities, ones you may not have previously considered.

If you want to feel good, you must discover, decide, and begin to move toward what you want. It involves training yourself to think in ways that open possibilities, create new opportunities. Give yourself permission to explore what you want. Dream, visualize, fantasize, and then take a step. In so doing, you are beginning to change yourself, consciously and intentionally, from inside out and outside in. Your best and healthiest self is happy, alive, involved, and active. If you realize you have an interest in something, stay with it and nurture it with some action, however small, that moves you in that direction. You can change course at any point as you gain clarity about exactly what you want. If you don’t know what to do, seek the assistance of someone who can help you discover what you want and overcome inertia.

A helpful and inspiring read is Martin Seligman’s book, Authentic Happiness. He correctly notes that happiness is not something that one can pursue directly; rather, that happiness is a condition that ensues from the creative utilization of our given talents in a manner that participates in and contributes to the greater community – be it your family, your workplace, your neighborhood, or the world. Everyone, even you at your most depressed, has something to offer. I’ll go so far as to invoke Chaos Theory; the truth is you may never know how even an unreturned smile to a stranger will reverberate and magnify to your own or another's ultimate benefit, or how your holding the door for someone may improve the course of that person's whole day. Small consistent efforts at change can produce enormous results over time. The important thing is to act, to put yourself in motion and enjoy the results.

Friday, October 30, 2009

Taking on Depression: Part 3: Gratitude

The “practice” of gratitude is one of the most powerful things you can do to overcome depression. Genuine gratitude includes both a thought and its emotional correlate. Thoughts usually carry an emotional valence: it’s a nice day, you feel glad; the partner likes your work, you feel competent; your child earned good grades, you feel proud; you’re going skiing, you feel excited; a snowstorm is coming, you feel annoyed. Because gratitude is a positive thought, it always carries a positive emotional valence.

Your thoughts and their emotional correlates do not occur in a vacuum. They occur in your body and influence biochemical processes. The mind-body connection is a well established fact. The most obvious examples are the connection between a happy, purposeful, socially connected life - and health and longevity; the connection between stress - and heart disease; the connection between the practice of meditation – and improved mood, concentration, and general health; the connection between the belief that you can’t do something - and attempts to do it that somehow fail.

You are energized or enervated by your thoughts. Prove it to yourself. Think back to a time when you felt really grateful for something. How is that thought affecting you physically right now? Do you feel a relief of tension? Increased energy? Greater lightheartedness? How about emotionally and mentally? Are you, even briefly, less anxious or worried? More hopeful? Happy? Joyful? More emotionally available? Prove it further: tell yourself right now, “I am grateful that I am loveable and competent.” Repeat it several times, letting the meaning sink in. How are your mood and your body responding?

Gratitude is as automatic for some as negative, depressed thinking may be for others. The automatically grateful perhaps have had life experiences that gave them sufficient reason to believe that they were good and deserving and that life would unfold favorably enough if they just did their part. Lucky them. For others, life experience may have tipped the balance toward less optimistic beliefs and expectations, against the odds of which they seem to continually struggle in order to achieve at least partial success and happiness. We are all somewhere on that continuum, and those for whom gratitude is not automatic may have to work harder, with real commitment and determined practice.

If you are not among the group of “automatically grateful,” how do you become more grateful?

· Commit yourself to practicing gratitude. (If you pray, pray for the gift of gratitude.) Making the commitment alone begins to change your energy and your ability to follow through. There are an infinite number of things, past, present and future, for which you can be grateful.

· Short-stop negative thoughts with statements of gratitude, ideally, a statement that reformulates the negative thought into a positive thought. Example: “I wish I didn’t have to get where I have to go by walking in the rain.” Re-formulation: “Thank you that I have two legs and the ability walk. Thank you that I can see where I going. Thank you that I have an umbrella and a hand to hold it. Thank you for water. Thank you for the way rain enriches the colors of nature. Thank you for the sun and its eventual return. Thank you for the opportunity to practice gratitude.” Another example: “At this rate, I’ll be broke before I find a job.” Re-formulation: “Thank you for the job I last held, and for all the jobs I’ve held previously. Thank you for all the knowledge and experience, friends or mentors I acquired through them. Thank you for all my opportunities for education and training, and for my many abilities. Thank you for the people who come into my life who contribute to my search. Thank you for the creative ability to make the most of what I have now. Thank you for ‘the sun in the morning and the moon at night.’”

· Reinforce gratitude by keeping a gratitude journal. Write down the things for which you are grateful (and notice what happens to your mood and body in the process).

· Make a mental list as you go to sleep of the things for which you are grateful that day (and notice how quickly you fall asleep). Do the same when you awake, before getting up. If you awake at night and have trouble returning to sleep, resume thoughts of gratitude, perhaps beginning with having a safe, warm place to sleep and the ability to relax into it and enjoy it whether or not you’re sleeping, for the ability to breathe unassisted, for a comfortable pillow, etc. etc., etc.

· Remind yourself to be grateful. One person (referenced in the very helpful book, The Mindful Way through Depression) did this by carrying a small smooth stone in his pocket to remind him throughout his day to think grateful thoughts, setting it next to his bed at night, ending his day and beginning his next day with grateful thoughts.

· Practice. It does take practice to develop any new habit, including a mental habit. Making a habit of gratitude is a great on-going, practically failsafe defense against depression; the two cannot co-exist for long. This “attitude of gratitude” is a key element practiced by 12-step program members who over time find themselves surprisingly and wonderfully transformed. You will, too.

The practice of gratitude is a deliberate mental practice that carries a positive emotional valence which helps correct negative thinking, relieves potentially damaging stress to the body and generates increasing levels of energy, enabling you to see and respond to new previously unnoticed possibilities. As it builds, with your continued practice, you will find yourself regaining and consolidating your power, and depression losing its grip.

Friday, October 16, 2009

Taking On Depression: Part 2: Change Your Thinking

As I’ve stated before, in order to overcome depression something has to change. More accurately, you have to change something, because what you have been doing is clearly not working for you if you are depressed. One of the most important, effective, and perhaps most challenging changes you can make is in your thinking. What does your thinking have to do with how you’re feeling? Everything! While many believe that pleasant thoughts flow when you’re feeling good, the reverse is also the case: positive thoughts generate positive feelings. When immersed and perhaps feeling trapped in depression’s hallmark feelings of helplessness, hopelessness and worthlessness, you have first succumbed to thoughts that create a sense of helplessness, hopelessness and/or worthlessness.

I say ‘succumbed’ because you are unconsciously complicit with, or acquiescing to, negative thoughts, something easily done because they are often automatic, non-stop, and not usually subjected to our scrutiny. If we did examine them, we would find that they are also frequently unencumbered by reality and capital ‘T’ Truth. Our wakeful but unobserved thinking can carry a lot of mood deflating content consisting of fact-less opinions, invalid assumptions, skewed perceptions, misinterpretations, suppositions, pessimistic expectations, etc., aptly referred to by 12-step programs as “stinkin’ thinkin.” It is a disempowering, disabling cascade of subliminal thoughts that may begin with such phrases as, You never… I can’t…, I’m not…, I don’t…, If only…, which foreclose on all the possibilities lying just beyond worst case scenarios and a constricted imagination. Such thinking not only generates depression but shows up sooner or later in minor or major depleting, self-defeating, irrational, offensive or anti-social behaviors, and sometimes in quite significant emotional pain, as well. It can muck up our plans, screw up our relationships, interfere with our performance, and sink our mood.

But, just as 12-step participants learn to change their thinking in order to free themselves from their addictive behaviors, those with depression can do the same. You can exercise your option to become more aware of your thoughts, evaluate their truth and validity, and reject the distorted thinking that lurks behind and gives rise to every depression. And then you can substitute more accurate and positive thoughts that reflect reality, generate new energy, and inspire action.

Observing and changing what you think appears so simple and elemental a strategy that it may seem to trivialize the painful and debilitating experience of depression. However, simple does not mean easy. Anyone who makes the effort to change his/her thinking is quickly disabused of the belief that it is easy. It is a skill that is learned over time with practice, supported and reinforced by commitment and perseverance, and ideally, professional help.

Why is it so difficult? In order to begin to observe your thinking, you must slow down, quiet the noise and distraction, and listen to yourself. Part of the difficulty, therefore, lies in shifting one’s focus inward, and being willing to go against the grain of the dominant culture that values speed, productivity, constant stimulation, acquisitiveness, and conformity. Lawyer culture, in particular, emphasizes devoting precious hours to tangible productivity.

The other part of the difficulty lies in the nature of our thoughts and thinking. When not fully engaged in concentrated mental activity, or in a meditation practice, our minds usually roll along in subliminal, rapidly shifting, fragmented and unformulated thoughts, assumptions, opinions, wishes, memories, plans, often with attached feelings, much of which we are quite unaware of within nano-seconds of their occurrence, if at all. They are reactive to all forms of stimulation, may be habitual, and may represent components of defenses against unresolved painful emotional experiences. In addition, thoughts that seem particularly resistant to our efforts to change may be rooted in deep-seated false beliefs that were formed early, perhaps even at a pre-verbal stage of development.

In addition, becoming an observer of your thoughts eventually leads to also observing your behavior, augmenting the process of self-discovery that inevitably contains the good, the bad and the ugly, and sooner or later, a closer encounter with your own vulnerability. So, besides moving away from cultural norms, you risk seeing yourself through a wider angle lens. But the ensuing awareness and acceptance of your thoughts, feelings and beliefs form the springboard for volitional change, and the opportunity to lose the depression and feel more alive.

Here are steps you can take to become a better observer and manager of your thoughts:

  • Prime the pump by holding the intention to observe your thinking with objective interest and without judgment. This helps to summon, mobilize and focus new energies.
  • Journal. Frequently. The process of formulating unedited thoughts and feelings into more or less coherent words and sentences is clearly consciousness raising.
  • Tell it to someone. Speak your thoughts and feelings to a skilled and trusted therapist (or friend, or clergyperson) who functions as a sounding board, a source of feedback and perspective, an asker of questions you might not think to ask yourself. Scheduling regular appointments is one way to create a time and space for you.
  • Begin a daily spiritual practice, i.e., something that helps you slow down and listen to yourself. This may be a walk on the beach or stroll in the woods, attending church or temple or a good 12-step meeting, meditation (alone and/or in a group), listening closely to beautiful music or visiting an art museum, reading poetry or spiritually inspiring literature, journaling, drawing, or other solitary creative activity, etc.
  • Tag and correct negative thoughts. Substitute a corrected thought that specifies what you want. Reinforce the corrected thoughts with repetition, and don’t get discouraged when they recur; stay the course until they weaken and fade.
  • Identify and visualize what you want. Depression short-circuits thoughts about what you want and what you can do to achieve it. Begin to move toward “the unachievable” in little steps. Dreams can come true one little step at a time.
  • Cultivate self acceptance. “If your compassion does not include yourself, it is incomplete.” (Siddhartha Gautama) When you are feeling down on yourself, identify the reason/thought, e.g., for “I’m too depressed to get anything done,” use this “mantra” to re-focus yourself: “Even though I feel so depressed, I deeply and profoundly love and accept myself.” Say it repeatedly until you feel it. Modify it to suit other forms of perceived personal failings or troublesome feelings. (Notice that working this thought effectively demonstrates how positive thoughts generate positive feelings.)

Loving, compassionate self-acceptance is a condition for change and for beating depression.

Changing your patterns, especially well-established thought patterns, is challenging. Meeting that challenge means taking responsibility for your own well-being and is the antithesis of depression because it is proactive, empowering, and enlivening. Changing your thinking is a powerful strategy. Does depression ever gradually or spontaneously remit without your active participation? Yes. Agreeable external events may occur that restore confidence, a sense of personal worth, raise expectations, or inspire new positive thinking and behaviors. However, passive waiting for “things to get better” is much more likely to result in more of the same, i.e., continuing or worsening depression. When you take charge of your own journey and take charge of your thinking, expect to feel more alive. Depression and aliveness are mutually exclusive states.

Next time: What Do You Want?

Friday, October 9, 2009

Taking on Depression

What do you do when you feel utterly uninspired? When your usual sources of joy and pleasure cannot rouse you from an immobilizing, listless dullness? When you may not have anything to feel bad about, but also can’t find anything to feel good about? When you can’t depend on your usual ability to focus and concentrate? When you are easily annoyed and generally irritable, or when you find yourself in a sudden outburst of anger that is just not you? When you’re tired but can’t sleep, or you sleep too much. When you’ve lost your appetite, or eat too much. What’s going on?

Those of you who have been there would recognize this description of depression, and in the absence of a diagnosable physical cause, that is probably what you’re experiencing. Depression can seem to strike suddenly, or it can be a subtle and gradual process that we’re barely aware of, if at all, until its persisting effect on health, job, relationships and general functioning is no longer tolerable to us and/or others, and we are forced to address it as the problem it is.

Most of us have experienced at least mild depression. It can be regarded as part of the human condition, a fact of life. Some are more vulnerable, some less, for reasons that can be biochemical, circumstantial, genetically determined, even socio-cultural. The triggers setting off an episode of depression are many and sometimes easily identifiable, such as an external event: a blow to the ego (a perceived slight ignites an old vulnerability); a major loss (of a loved one, a job, income, home; even a personally treasured object, a dream, or a social role); a personal or professional failure (divorce, failing the bar exam, losing an important case).

Sometimes the source of depression is not immediately apparent. We may feel awful, begin to realize we have felt awful for too long, and have no clue as to where this encroaching lethargy came from, and only with some (perhaps professionally assisted) digging and soul searching begin to discover a myriad of intersecting events, conditions, memories, unresolved losses and more that affect us at a core level, leaving us with those three major emotional earmarks of depression: feeling helpless, hopeless, and worthless.

Much has been written about what some authors call the “epidemic” of depression in this country, even among children. If the incidence of depression is escalating, we can suspect that something may be going on in the culture, even in the collective psyche, as well as in or within our own personal lives. Times like these, of unpredictable economic, political and financial events, fractures and polarizations in the sense of national unity, etc., can contribute to depression by diminishing our sense of control over our lives, eroding self-confidence, overwhelming one’s usual coping strategies and bringing on fear and doubt. To recognize that a co-occurring wider phenomenon may be taking place may offer a useful context and perhaps perspective. However, personal responsibility for one’s own sense of well-being still obtains.

Lawyers are disproportionately over-represented among the depressed, due in part, as many have noted, to the adversarial nature of their work, the constant stress of managing details, deadlines, and demanding clients (or partners), the need to present themselves as always competent, in control, and able to deliver the answers and solve the problem. Add to that the tendency to over-prioritize the clients’ needs to the neglect of, or even disconnection from, their own needs, and the burden reaches critical mass.

Lawyers’ struggles to meet such demands of the job, without adequate self-care, may be inimical to the very things that really count, that make life worth living, that give pleasure, and that support physical, mental, and spiritual well-being and balance, i.e., that prevent depression. Depression is a sign that balance has been lost and some action is necessary to restore it. The good news is the right actions will restore balance and vitality. Because depression can be so disempowering, enervating and immobilizing, discovering the source(s) of depression and identifying and prioritizing appropriate actions may require, or is at least expedited by, professional assistance. No matter how smart and savvy you are, negotiating the slippery slope of your own mind can be tricky, can amount to missing the forest for the trees. What is most helpful is someone who can compassionately mirror back to you what you yourself can’t (yet) see, and who can help you figure out what you are willing to do, so that you can make the changes necessary to feel better.

Overcoming depression is all about getting your power back - power over your own life, your own self, your own mind and spirit. Overcoming depression is not about controlling or exercising power over other people, places or things. Overcoming depression is not achieved by changing anyone but yourself, anyone’s behavior but your own, anyone’s thinking but yours. You may notice, however, that self-empowering actions you take to combat your depression may evoke positive and self-reinforcing changes in others’ responses to you. Self-change is where your true power resides, and as you begin to exercise that power with increasing confidence and skill, you need never succumb to debilitating depression again. Depression may recur, but you will be able to successfully deal with it.

Yes, you have to change, change your thinking and change your behavior. And you are the only one who can do that. What’s good about that is you don’t have to wait for anyone else, or depend on anyone else in order to make changes that will help you begin to feel better. That’s the good news. There is no bad news, unless taking up the challenge in your own behalf is not what you had in mind. Realistic expectations of professional assistance and family or close friends may be an important part of the process of taking up the challenge; for some it makes all the difference. Depression will not be remedied by magical thinking, longing, or mere wishing that things were different. It may require determined, persistent work, and in the case of certain intractable depressions that don’t respond immediately to your best efforts, the use of medication for a period of time may be very beneficial. The important thing is to never accept defeat, and never accept victimhood.

In subsequent blogs, I will suggest specific actions you can begin to practice to loosen the grip of depression.

Thursday, October 1, 2009

Coping Mechanisms for Managing or Relieving Stress in the Wake, or in Fear, of Job Loss (4-Part Series) -- Part IV: Accepting Help, Giving Help

Too often we turn away opportunities and offers of assistance when most needed because of some misguided, though completely understandable, sense of pride, shame, and/or embarrassment. If there is one positive thing that has come out of the nation’s economic crisis –if you can call any of this “positive” –it is the fact that because so many are experiencing layoffs at the same time, employers rarely dwell on the reasons for an applicant’s laid off status during the interview process.

Here are a few things to keep in mind, lest you turn away your next great opportunity:

· DON’T BLOCK THE BLESSING! Helen Keller once said, “When one door of happiness closes, another one opens; but often we look so long at the closed door that we do not see the one which has been opened for us. . . . " Too often we get so bogged down in our circumstances that we proceed through life with blinders on and miss potential opportunities that come across our path. Be conscious of when you feel yourself pulling in that direction and do an about-face. Don’t become so mired in the negative that you don’t hear when opportunity knocks. Maintain positive expectations and be open to possibilities.

· ACCEPT “THE GOOD” There is nothing to be embarrassed or ashamed about being laid off, especially in the current economic climate. Don’t let pride or shame lead you to turn away offers of assistance and opportunities. Identify and utilize all available resources to advance your goals. Similarly, now is not the time to decide to stop participating in your profession-related extracurricular activities, such as boards, task forces, committees, bar association groups and sections, etc. Now, more than ever, you want to cultivate and maintain those connections, which may prove useful in the end. This also ensures that you won’t give in to the urge to isolate yourself, or become disconnected from others. It can be quite beneficial to have fellow committee members see you “in action.” They would be able to comment on such things as your ability to lead, how well you work with others, whether you are a “team player,” your work ethic, and how well you get along with others. After all, you never know from where your next opportunity will come.

· SET UP YOUR OWN PERSONAL “DREAM TEAM” Your “dream team” is a person, or group of people, whom you trust to be there for you in a supportive role as you embark on this journey towards the next chapter in your work life. Some turn to people they’ve identified as mentors or role models, while others choose close, positive-thinking friends or confidants who they know will help to keep them moving forward. Ultimately, they should be people who know what your goals are and who are going to help you to achieve them by checking in with you on a regular basis to ensure that you are moving towards your goal and accomplishing tasks you identified for them during the prior call.

· PAY IT FORWARD. Helping others is not only good for the person you help, but also for your own soul. Remember also that good attracts good. Take the time to volunteer your services through pro bono work and public service. This has added benefits, including helping you to continue to practice and feel connected to the profession, advancing and honing your legal skills, networking and opening yourself up to other opportunities, as well as potentially exposing you to other practice areas. Additionally, if you were contemplating going into a particular practice area, but weren’t sure about whether you would like it, this is one way of making that determination prior to committing yourself via a long-term contractual arrangement. Contact your state and local bar associations, as well as your state’s legal aid office(s), to find out what pro bono and public service opportunities are out there. You can also simply pick up the phone and call solo, small, and/or mid-sized firms which specialize in the contemplated practice area and ask whether they could use some volunteer help in exchange for their willingness to allow you to be, in essence, an apprentice and shadow them. In today’s economy, with many firms being forced to significantly downsize in order to remain open, you are certain to find lawyers who will gladly take you up on that offer.

Even with these coping mechanisms, you may still need professional help with getting through your stressful situation, which may seem overwhelming and all encompassing. THERE IS NO SHAME IN GETTING OR SEEKING HELP, SO PLEASE DO SEEK PROFESSIONAL ASSISTANCE WHEN SUCH STRESS, OR ISSUES SUCH AS ANXIETY, DEPRESSION, SUBSTANCE ABUSE, OR OTHER TROUBLING BEHAVIORS PERSIST. For assistance, please contact us at Lawyers Concerned for Lawyers, Inc. (31 Milk Street, Suite 810, Boston, MA , (617) 482-9600, email@lclma.org, or visit our website at http://www.lclma.org/). Help can also be accessed through your: healthcare provider; local hospital; psychologist, psychiatrist, social worker, clinician or other mental health professional; or community healthcare center.See our web site Resource Page for a list of relevant stress resources.

Ms. Walcott presented this and other material in a program entitled, “Staying Positive in a Down Economy: Beyond The Group Hug” (June 30, 2009), which was part of the ABA’s Recession Recovery Teleconference Series. A download and course materials for this program are available online at http://www.abanet.org/cle/programs/nosearch/tspdmo.html.

Friday, September 25, 2009

Coping Mechanisms for Managing or Relieving Stress in the Wake, or in Fear, of Job Loss (4-Part Series) -- Part III: Using The Time to Your Advantage

While you certainly did not want, and probably did not expect, to be laid off or between jobs, there are certain things that you can and should do now that you have the time. Not only will doing these things help you to present for your next career opportunity at your best, but there is the added bonus of helping you to feel better about yourself, thereby decreasing your levels of stress. The following are some examples of actions that should be taken during this period:

· USE THE TIME WISELY. Think about all the people, places, and things you may have neglected or overlooked in recent years, and use this time to reconnect with people and to tackle some of those projects. You will feel better for having done so, will feel a sense of connectedness which is important at this time when many are tempted to isolate themselves. This will also give you a sense of accomplishment whenever you complete a task. As an added benefit, you never know from where your next opportunity will come. One of those people you reconnect with may prove useful in helping you to determine next steps, to come up with contacts that you may not have thought of, or may have some great ideas or avenues for you to pursue or incorporate in your job search. You never know.

· WORK TOWARDS A NEW AND IMPROVED (AND MORE MARKETABLE) YOU. Take courses, learn new skills, update and hone old skills, in an effort to reevaluate what it is you want to do next (i.e., do you want to continue what you’ve been doing, or have you been secretly yearning, but putting off, doing something else). In the same way that the ABA Recession Recovery Teleconference series is offered free of charge, there have been numerous other offerings in recent months advertising free online courses aimed at helping people to produce better resumes and cover letters, state and local bar association programs designed to assist in assessing one’s marketability and putting together a career development plan, committees dealing with transition issues for lawyers, etc. Check out the ABA website, but also the websites of your state and local bar associations, as well as running a web search for webinars, and other free teleconferences and podcasts.

· KEEP TO A ROUTINE. No matter what, get up and do something aimed at helping you in your job search every day. At the end of every day, make a list or schedule of things to accomplish the next day, and tell someone what it is you intend to do. Somehow saying it aloud helps to give you a sense of accountability. You want to keep up a routine so you don’t feel as if you are aimlessly wandering from day to day, but instead have purpose.

· COMMIT IT TO PAPER. Identify and write down the largest sources of your stress. For many, this is financial. If this is the case, as an initial step, review the spending habits of yourself and your family and think of ways in which you can begin to cut costs. Once written, investigate ways in which to alleviate some of the financial stress and begin to look into them (i.e., with respect to mortgage issues, there are a number of repayment and other programs now available to assist in this effort, and a host of nonprofit entities ready to talk to you about them. With respect to credit card payments, some companies will entertain lowering your interest rates, so it’s worth it to call and ask. There are also reputable credit counseling companies out there to assist you.)

· EAT HEALTHY, EXERCISE MORE, AND LAUGH MUCH! It sounds basic, but it’s important to remember to take care of yourself. You need all your synapses firing at full throttle, and they won’t be able to if you aren’t getting enough rest or exercise, and are eating junk. It is especially important to avoid turning to self-destructive attempts at relieving stress, such as: drinking, drugging, gambling, smoking, and emotional eating, to name a few. Also, it’s been said that the mere act of laughing in and of itself has stress relieving properties. So, read a funny book, go to the movies and opt for a comedy, hang out with your friends who are the most upbeat and funny (and thus, less likely to bring you down).

Even with these coping mechanisms, you may still need professional help with getting through your stressful situation, which may seem overwhelming and all encompassing. THERE IS NO SHAME IN GETTING OR SEEKING HELP, SO PLEASE DO SEEK PROFESSIONAL ASSISTANCE WHEN SUCH STRESS, OR ISSUES SUCH AS ANXIETY, DEPRESSION, SUBSTANCE ABUSE, OR OTHER TROUBLING BEHAVIORS PERSIST. For assistance, please contact us at Lawyers Concerned for Lawyers, Inc. (31 Milk Street, Suite 810, Boston, MA , (617) 482-9600, email@lclma.org, or visit our website at http://www.lclma.org/). Help can also be accessed through your: healthcare provider; local hospital; psychologist, psychiatrist, social worker, clinician or other mental health professional; or community healthcare center.See our web site Resource Page for a list of relevant stress resources.

Ms. Walcott presented this and other material in a program entitled, “Staying Positive in a Down Economy: Beyond The Group Hug” (June 30, 2009), which was part of the ABA’s Recession Recovery Teleconference Series. A download and course materials for this program are available online at http://www.abanet.org/cle/programs/nosearch/tspdmo.html.

Friday, September 18, 2009

Coping Mechanisms for Managing or Relieving Stress in the Wake, or in Fear, of Job Loss (4-Part Series) -- Part II: Shifting One's Perception

Losing a job, for whatever reason, is a life-altering event on many different levels –familial, professional, financial, behavioral, social (etc.) –and affects people in many different ways. For most, however, there are certain experiences that should be simply taken as givens:

1. There will be some degree of worry and/or stress.

2. There will be some level of interest in knowing who is (and is not) going through a similar experience.

3. There will be some people in your life who –for whatever reason –feel the need to constantly update you on how much worse things are than you thought. (I’ve lovingly dubbed these people naysayers, voices of doom, and town criers.)

4. There will be a point in time, however brief, when you experience self-doubt, lowered self-esteem and/or decreased self-confidence.

5. At some point, it will take more of an effort than usual to keep up the social and professional relationships you had when employed, and to continue in your professional extracurricular activities.

In moderation, all of these experiences are completely normal and to be expected given the circumstances (i.e., job loss). It is only when they get in the way of moving forward towards accomplishing your goals that it becomes a problem. The following are some examples of self-defeating actions which should be avoided at all costs:

· WORRYIN’ NEVER CHANGED ANYTHING, SO DON’T GET STUCK ON THE WORRY TRAIN. If you have a lot of free time with nothing to do, that also gives you a lot of time within which to stress or worry. Fretting, worrying, and being stressed or anxious are all normal. There’s nothing wrong with doing any of those things, for a time. Just don’t get stuck there – it’s self-defeating.

· STEER CLEAR OF NAYSAYERS, VOICES OF DOOM, & TOWN CRIERS. While there is certainly comfort in knowing that you are far from alone in this situation, be careful not to spend all of your time dwelling on the negative, as opposed to working towards a goal. Avoid those people who can’t seem to talk about anything other than the state of the economy, lawyer layoffs, unemployment, firm closings, decreases in available jobs, and the like. While I am in no way suggesting that you should avoid discussing what happened to you, I am cautioning against not being able to move beyond it. Also, there will always be those people who tell you all the reasons why you can’t do something, instead of supporting you in your efforts to make an attempt to accomplish your goal. Avoid such naysayers and surround yourself with supportive people.

· DON’T BECOME A SLAVE TO THE MEDIA. This serves no useful purpose other than to stress you out and keep you coming back for more. The media is more likely to give reports focused on the bleak, tragic, downtrodden, and hopeless (from its skewed perspective), than the positive, successful, hopeful, and victorious. That’s just the way it is. While you should absolutely keep abreast of what’s going on around you and what opportunities may lay out there for you, you can accomplish this by quickly skimming your media outlets for this information.

· ACCEPT THE SITUATION, BUT DON’T BE LABELED BY IT. It goes without saying that being unemployed is quite a humbling experience. Use it as a life lesson –absolutely –and if you come out wiser and stronger for it, then you have come out the victor. However, remember that being laid off doesn’t define who you are, or what you’re about. Indeed, it is no reflection whatsoever of your value. Nor is it an indictment of your worth. It’s merely a temporary place called unemployment, which you’ll soon depart.

· DON’T BE M.I.A. Very important: Make sure people know where you are and how to contact you! Often people give their work addresses to bar associations and others as their preferred contact method. After leaving a place of employment, however, they forget to update the bar associations with their new contact information, so they no longer receive notifications of any relevant and/or free course, program, and other bar association offerings. You don’t want to stop getting this information –stay connected. Be sure to also update your alumni offices (law school, college) of your whereabouts because some of them are offering programs as well.

Even with these coping mechanisms, you may still need professional help with getting through your stressful situation, which may seem overwhelming and all encompassing. THERE IS NO SHAME IN GETTING OR SEEKING HELP, SO PLEASE DO SEEK PROFESSIONAL ASSISTANCE WHEN SUCH STRESS, OR ISSUES SUCH AS ANXIETY, DEPRESSION, SUBSTANCE ABUSE, OR OTHER TROUBLING BEHAVIORS PERSIST. For assistance, please contact us at Lawyers Concerned for Lawyers, Inc. (31 Milk Street, Suite 810, Boston, MA , (617) 482-9600, email@lclma.org, or visit our website at http://www.lclma.org/). Help can also be accessed through your: healthcare provider; local hospital; psychologist, psychiatrist, social worker, clinician or other mental health professional; or community healthcare center.See our web site Resource Page for a list of relevant stress resources.

Ms. Walcott presented this and other material in a program entitled, “Staying Positive in a Down Economy: Beyond The Group Hug” (June 30, 2009), which was part of the ABA’s Recession Recovery Teleconference Series. A download and course materials for this program are available online at http://www.abanet.org/cle/programs/nosearch/tspdmo.html.

Friday, September 11, 2009

Coping Mechanisms for Managing or Relieving Stress in the Wake, or in Fear, of Job Loss (4-Part Series) -- Part I: Shifting One's Perception

Almost everyone has a friend or family member who is contending with a layoff, between jobs, or who fears the same may be in their future. There is cold comfort in knowing that one is in the good company of others who share a similar fate, not by virtue of personal or professional shortcomings, but by an economy that has failed them. Even so, such a life-altering event can affect all dimensions of one’s life: finances, for sure, but also family and social relationships, self-esteem and self-confidence, energy, thought processes, and daily routines formerly structured and organized by work schedules. Losing a job, or delayed success in finding a job, is no small thing.
While stress in moderate amounts, or when adequately managed, provides motivation and drive, that is not the case when the stress is in excess. Stress has been described in the simplest of terms as resulting from the way in which one interprets and reacts to events. Accordingly, a person who changes her perception of a situation in a positive direction should, in turn, experience a decrease in stress. The following are suggestions for assisting in this perception shift, and ultimately for managing and relieving stress:
· THIS TOO SHALL PASS. Chances are you’ve been through worse times, and survived darker periods in your life, so keep it all in perspective. Reflect on some of those periods when you thought you just couldn’t make it through, and recall that in spite of everything, you did. You’re a survivor! The ability to cope or deal with adversity is not new to you. You’ve coped and adapted before in a myriad of situations, whether involving yourself or others –including clients! What would you do and advise if a client came to you with this situation? What would you say? It’s important to remember that transitions in whatever form are a natural part of our lifecycle, requiring adaptability and often, the ability to reinvent oneself. Some examples of life events triggering some form of reinvention include: becoming a new parent, divorce, dealing with a major illness (yours or that of someone close to you), having your child go off to college for the first time (empty nest syndrome), relocating to a new country/state/city/town, etc. No matter your situation, remember that things could always be a lot worse.

· CELEBRATE YOU! Reflect on all of your past accomplishments and significant experiences and milestones. Make a list of the things of which you are most proud and grateful. (i.e., birth of a child, wedding day, trial victory, high praise or compliments from colleagues on your delivery of a masterful argument, 1st time finishing a 5K race, watching your child take his/her first steps, the first time you hear your child say “dada” or “mama,” finally reaching the mountain top during a long and arduous climb, losing that final 5 pounds, graduating from college and law school, passing the bar exam, etc.). This should help to put things in perspective and remind you of just how great you are and how much you’ve achieved. Also, it will help you to remember that in the large scheme of things, this is but a blip on the radar. Whenever you feel yourself heading back towards the worry train, remember this list.

· FLIP THE SCRIPT! Rather than think of this as the worst thing that could have ever happened to you, flip the script and look at it as an incredible opportunity. Use the time to reevaluate where you are, both professionally and personally. In terms of the professional, are you doing what it is you really want to do? Too often, we become complacent in our day-to-day lives and forget about some of our dreams and goals. This is a perfect opportunity for you to reexamine your priorities and to take stock of where you are, and where you‘d like to be.

· THINK BABY STEPS OR SMALL, ACHIEVABLE GOALS –NOT LEAPS AND BOUNDS. When trying to lose weight, it is usually ill-advised to think in terms of how much you wish to lose all at once (i.e., 100 pounds). Instead, if you break down how much you want to lose into smaller, incremental portions (i.e., 10- or 20-pound increments), and then tackle it piece by piece, it’s much less daunting. This also allows you to enjoy periods of achievement throughout and it prevents you from having to wait a long time to celebrate an accomplishment. The same should be true of finding your next employment opportunity. If you break it up into small achievable goals, then it allows you to maintain momentum.

· BEEN THERE, DONE THAT. Try to remember that we, as a profession and as a nation, have weathered storms just like this one in the past, and we always get through it, just like we will this time. Nothing lasts forever –not even the current state of affairs.

Even with these coping mechanisms, you may still need professional help with getting through your stressful situation, which may seem overwhelming and all encompassing. THERE IS NO SHAME IN GETTING OR SEEKING HELP, SO PLEASE DO SEEK PROFESSIONAL ASSISTANCE WHEN SUCH STRESS, OR ISSUES SUCH AS ANXIETY, DEPRESSION, SUBSTANCE ABUSE, OR OTHER TROUBLING BEHAVIORS PERSIST. For assistance, please contact us at Lawyers Concerned for Lawyers, Inc. (31 Milk Street, Suite 810, Boston, MA , (617) 482-9600, email@lclma.org, or visit our website at http://www.lclma.org/). Help can also be accessed through your: healthcare provider; local hospital; psychologist, psychiatrist, social worker, clinician or other mental health professional; or community healthcare center.

See our web site Resource Page for a list of relevant stress resources.

Ms. Walcott presented this and other material in a program entitled, “Staying Positive in a Down Economy: Beyond The Group Hug” (June 30, 2009), which was part of the ABA’s Recession Recovery Teleconference Series. A download and course materials for this program are available online at http://www.abanet.org/cle/programs/nosearch/tspdmo.html.

Friday, August 28, 2009

Parity Time

The world of health insurance and managed care is confusing, especially when it comes to mental or behavioral health coverage (interchangeable terms), even for the lawyers who compose our clientele at LCL. In fact, assistance in searching for adequate and covered treatment is one of the key reasons that lawyers come to LCL rather than seek help on their own. Right now, things are changing in mental health insurance coverage (largely for the better), though few consumers are up to date on these changes (which some insurers have not seemed eager to mention, e.g., in their on-line benefits information).

Mental health coverage has long been the “stepchild” of health insurance, partly because it is more difficult to evaluate or define these conditions with precision, or to determine a specific optimal treatment plan. That very vagueness has served as an excuse for inadequate coverage. When I was first licensed as a psychologist in 1981, before managed care, most people in Massachusetts had an old-fashioned Blue Cross Blue Shield policy. By law, those policies covered up to $500 a year in mental health coverage. Believe it or not (partly because, even then, the insurer gave itself a discount), that was enough for at least 10 sessions. Nowadays, coverage is generally defined by number of services (which helps accommodate inflation), and most people have HMOs, which require “pre-authorization” before subscribers can actually utilize these benefits.

In one form or another, insurers have set fairly arbitrary maximums in mental health coverage, even while there were no such maximums for coverage of most physical health conditions. Sick as you might be, even with severe mental illness, once you had used up your maximum for the year (or, occasionally, your lifetime), you were on your own. In 2000, more or less concurrently with a number of other states, Massachusetts passed its first Mental Health Parity law, which removed predetermined maximums from coverage for psychiatric conditions seen as largely biological in nature. These were:
♦ Schizophrenia
♦ Schizoaffective Disorder
♦ Major Depression
♦ Bipolar Disorder
♦ Psychotic Disorders
♦ Delirium and Dementia
♦ Obsessive-Compulsive Disorder
♦ Panic Disorder
♦ “Affective Disorders” (defined slightly differently by different insurers)

In addition, the 2000 law stipulated that, for most other conditions, the maximum number of outpatient visits per year could not be fewer than 24 for adults (thus every Massachusetts-based insurer began covering 24 visits), with no limits for children. Excluded from the law entirely were alcohol and drug dependence, which are often covered up to just 8 sessions per year. (I am not focusing, here, on the maximums for inpatient hospital stays, since those are virtually always kept extremely brief regardless of stated maximums.) It always seemed very curious to me that alcohol and substance dependence were handled this way, since the biological aspects of those behavioral disorders are so central.

What’s new is that, as of this past July 1, Mass. state law has added four more diagnoses (including chemical addictions) to the list of those covered without a hard-and-fast maximum:
♦ Alcohol/Drug Abuse and Dependence
♦ Eating Disorders
♦ Post-Traumatic Stress Disorder
♦ Autism.

This state law does not apply to (a) self-insured plans [where the money that pays the claims comes directly from the employer], (b) MassHealth, or (c) Medicare.

There is also a new federal parity law coming down the pike. It was actually bundled with the measure congress passed late in the Bush term to permit the massive bailout of financial institutions (in this case the “pork” going toward what I regard as a good cause). As of January 2010,

♦ No plan is required to offer mental health coverage, but if it does (which is mandatory in Massachusetts), the coverage for all legitimate mental health diagnoses must be equivalent to coverage for medical/surgical procedures.
♦ It applies even to self-insured plans, but excludes employers with no more than 50 employees.


When the state and federal laws are in conflict, the more consumer-friendly one generally applies.

Two caveats:
(1) Who can say how Health Care Reform (which I support in principle) may ultimately be worded, and whether, as some kind of trade-off, it will override these legislative measures. In any case, I assume it will not take effect before 2011.
(2) Despite the removal of automatic maximums, the insurers will continue to require pre-authorization—that is, HMOs will cover only those services that they have determined are “medically necessary” for an individual. That is a very slippery concept when it comes to mood and behavior problems. In truth, even with reform or with a “public option,” some kind of mechanism is needed to prevent wasteful spending on unnecessary health care. I do wish, however, that someone would come up with a better means of accomplishing that purpose than the cumbersome,(unpaid) time-consuming, and privacy-reducing forms that providers and their patients/clients often face.

In any case, if you are in need of assistance, now is a good time to look for the right therapist. LCL can help with that process if you are a Massachusetts lawyer, law student, or judge, or a family member of people in those categories. Understand that LCL itself does not use your health insurance – our primary service is to evaluate and refer (not to provide ongoing therapy), and is funded through lawyers’ annual licensing fees. We do, and must, take your health insurance into account in the process of our efforts to refer you for further services.

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Update Feb 2010: You may have noticed that we are not hearing anything about the federal parity law from our insurance providers. As a provider, I can tell you that when I look up new patients' eligibility on-line, there are still references to the 24-session/year maximum for diagnoses not on the Massachusetts list of parity diagnoses.

Based on some web searching, it seems that, although in one sense the federal parity law is already in effect, in another sense it is still in a non-final, feedback-gathering phase until July 1 -- so that may be the point at which it will really kick in.

In addition, while most interpreters of the law see it as applying to all mental health diagnoses (thus not just the ones that Massachusetts has deemed parity-worthy), some commentaries note that this only applies to coverage of conditions included in the plan. Although I have seen no evidence of this as yet, it seems possible that an insurance company could decide, for example, that they do not cover substance absue at all, or that they do not cover adjustment disorders at all. My impression is that they could get away with that gambit, because the law only states that whatever is covered must be covered equivalently to medical/surgical conditions, and that providing no coverage whatsoever, for a given condition, gets around that requirement. We'll see. In either case, we should be beyond the 24-session limit that is probably still being shown in your insurance provider's information packet. Caveat: I am a psychologist and not a lawyer or policy expert. My only expertise is that I've been dealing with health insurance claims, authorizations, and limitations (though a series of changes) since 1981 as a working clinician, and that I've taken the time to look up this information extensively on line.

Friday, July 10, 2009

ON LAWYER SUICIDES

The recurrent issue of lawyer suicide has come to the fore recently with reports that lawyers at three prominent firms have taken their lives since December. In subsequent months, there has been a flurry of correspondence as to what kinds of programs can be offered to target the problem. The prevalence of unhappy lawyers, and the very high incidence of depression in the profession are, of course, not new findings. Despite repeated calls for humanizing and balancing the lives of attorneys, there seems to have been no way to stem the tide of ever-increasing stress, the emphasis on billables and bottom lines for those who work in large firms and the difficulties making ends meet for many sole practitioners and small firms. I see so many lawyers who wish they could find another way to make a living but feel trapped; it is always a refreshing counterpoint to visit with some of my college buddies who went into the law and are enjoying themselves.

Feeling trapped, of course, can readily lead to both depressed mood and suicidal thinking (an exit), especially for people who are predisposed, either biologically or psychologically, to depression. The risk is heightened in the presence of a disinhibiting substance (most commonly alcohol) and/or access to a gun (particularly lethal in response to an impulse).

The programs being contemplated may be very helpful in addressing the needs of the grieving survivors – those of us who have lost a colleague, friend, family member, or client to suicide. The normal sense of grief is, in these cases, often compounded by such feelings as guilt (“What could I have done?”), anger (“How dare he choose to take himself away from his friends, family, etc?”), and even fear of contagion (“He seemed no different from me… Will this happen to me, too?”). In addition, when a loss seems to come from out of the blue, it is difficult not to become more vigilant, seeing the world as a place where dire events can strike us without warning. Fortunately, for most of us these emotions fade over time as we gain perspective and talk it over with others, but if not, it’s a good idea to talk it over with a therapist.

Brief prevention programs, on the other hand, seem not to be very effective in reducing rates of suicide – no more than those one-shot high school drug education assemblies made a long-term difference in who would eventually use or develop an addiction. What is likely to make more of a difference are long-term, ongoing factors. To what extent does an individual feel connected to, cared about, and accepted by a community – of friends, coworkers, fellow congregants, etc.? To what extent do lawyers allow themselves to become overwhelmed with burdens (cases, finances, home life, etc.) and tell no one, because of a perceived need to always appear in control? And although in many cases we see no advance warning of a suicide, do we make ourselves available to listen when something seems amiss with a colleague, or do we feel that acknowledging human frailty on the job would be a faux pas?

These kinds of factors probably make a great difference in the path toward (or away from) the sense of entrapment or despair. Listening is a powerful antidote to the sense of aloneness and isolation, but it’s hard to come by nowadays. Primary care physicians, back in the days when they were known as “general practitioners,” had time to listen. Managed care, combined with the cost of maintaining their desired lifestyle, has made it almost impossible for physicians to take time with patients, as you may have noticed last time you went to the doctor.

Fortunately, the vast majority of lawyers, even the many who may have fleeting thoughts of suicide, never reach the point of readiness to take their lives. But at the lawyer assistance program, we often wish that people had come to see us sooner – before the onset of severe symptoms or the license suspension or the daunting pile of unopened mail or the drunk-driving arrest. People tend to put off reaching out for help, a feature especially prominent in lawyers (and also doctors) – those who feel they should be the “knowers” and not the “needers.” [Lawyer assistance programs, however, are not emergency services; if the danger of harmful action is imminent, the appropriate resource is an emergency room, or if slightly less imminent, a suicide hotline – shown for each state at suicide hotlines.com.]

I feel particularly heartened when a lawyer comes to LCL accompanied by one or two friends/colleagues who have prevailed upon him or her to see me for assessment. There is no need for the concerned party to diagnose the problem – just to recognize that something is wrong and to not turn away. Sometimes, of course, the colleagues are partners in a firm seeking to avoid losing a valuable lawyer – and that’s certainly a good idea. But at other times the only motivation is friendship and human concern, motivation of a higher order. Although some individuals, whose covert agenda is to avoid change, find ways to give lip service and evade my further attention and recommendations, some actually grab the lifeline and embark on a path toward health.

Friday, May 15, 2009

Hello and Welcome.

We, the staff of Lawyers Concerned for Lawyers of Massachusetts, look forward to finding ways to increase our usefulness to the legal community through the medium of blogging.

At this location, you will begin to see a series of observational and informational postings about the human side of lawyering from the perspective of non-lawyers who have interviewed hundreds of lawyers over the years, usually for the purpose of assessing problems that are impeding their functioning (professionally or personally or both). We are excited about adding this means of communication to our existing toolbox, which includes, for example, the many articles and resources posted on our web site, our many types of presentations, our newsletter, and our Q&A column featured in Mass. Bar Association Lawyers Journal.