Casting the First Stone

A news article in a local Massachusetts newspaper reported the recent arrest of a lawyer late one night for drunk driving, endangerment of two young children in the back seat, and other charges. I glanced at the comments posted by readers in response to this article, and was dismayed by how contemptuous and cruel they were. While this woman’s reckless, dangerous, and irresponsible drinking and driving behavior that put her, her children, and others at great risk understandably evokes anger and outrage, it may be helpful for us all to remember the wisdom and truth contained in the Biblical comment, “Let him/her who is without sin cast the first stone.” Other wisdom sources have their equivalents. Which of us who has lived long enough has not done something to be ashamed of? Which of us can stand up to full public exposure of everything we’ve ever done? Or of even just the one worst thing we’ve ever done? Although I don’t know her, I would like to at least consider the possibility that this woman, free of the impairing effects of alcohol, likely strives to be a good mother, good lawyer, good citizen. If she can accept this experience as a wake-up call and seek the help she needs for what may be a previously unrecognized problem, she may, like may others in recovery from alcoholism (or some other addictive behavior) end up saving more lives than she ever endangered. Heaping blame and shame on her will not support that process. Nor will punitive action on the part of her employer. This is a trouble woman who needs to find her way into recovery, a challenging and humbling but ultimately highly rewarding process that culminates in offering assistance and service to others similarly afflicted. Ideally, each of the individuals involved with this woman’s case, or life, will contribute in some way, however large or small, to a life transformed, enabling her to move beyond this moment of painful humiliation.

Fred's Story

[Fred's story was recently published in LCL's newsletter, briefings, and we reprint it here.]


My Name is Fred. . . and I am an alcoholic. My sobriety date is April 1, 2007. I volunteered to share my story here in the hopes that others of our honored profession who are similarly afflicted may catch a glimpse of the wonders of LCL and be encouraged to utilize this incredible resource. Of course, after I said I’d share my story, my alcoholic fear set in and I questioned what part of my story might best express my respect for the great people who are the heart and soul of
this organization. Then, without hesitation, I eagerly called a good friend from LCL and asked for
help.

The response I received to my call was, “Freddy, every time I hear you speak, your serenity is evident, so why don’t you talk about how you have achieved that?” Willingness to seek help is the most important part of my recovery, closely followed by the discovery of humility and the willingness to listen and follow suggestions offered by those who care. Thankfully, I now enjoy a feeling of serenity that only God could have given me. I now know that it derives from the gift of truly believing that everything is going to be OK, which was only achievable through the AA fellowship; recovery is unquestionably a “we” endeavor.

That call epitomizes what LCL has done for me. It has become an integral part of what another of my LCL friends calls my “Boston AA family.” My Boston AA family gives me the luxury of no longer having to rely upon my own alcoholic mind to manage my life; I can rely upon their experience to guide me. As a supplement to the daily support, direction, and genuine, unselfish care of my outstanding sponsor, the people of LCL have become friends, and along with the love of my daughters and my sister’s family in Maine, form a support system only God could have created.

The key, then, for me has been to completely surrender my will, and to trust and believe that if I stay here in Boston, listen to my sponsor and LCL friends, go to meetings, and make a real effort to work the program (including praying and helping others), what God wants for me will happen when he is ready for it to happen. This surrender and a genuine desire to grow spiritually (which for me includes living by the Buddhist view learned from another LCL friend that “Desire Brings Pain,”) allows me to live sober day by day. So equipped, I am thus able to happily endure almost any hardship in pursuit of my newly realigned goals of continued sobriety, love and respect of family, happiness, and, lastly, professional and financial success. They are helping me at long last to grow up!

This drastic movement away from fear-based selfcenteredness, arrogance, and selfishness and toward humility I credit mostly to my sponsor and LCL. My first attempt at recovery was very different. During that eightyear period, I attended meetings but did virtually nothing else – no sponsor, no reading the materials or working with other alcoholics. As a result, I became a miserable, dry drunk workaholic who not even my own children or wife cared to be around. I was emotionally empty and alone. My whole identity and self-worth were merely as a lawyer, so despite considerable professional success, I was destined for failure. I simply could not sit with myself, and when my world finally became so small and meaningless, I succumbed to the allure of “neon and nylons.” I now know this was largely a consequence of trying to recover on my own, which left me defenseless and without someone to call when I needed help. I had failed to find the happiness “from within” that the 12 Steps of AA and the fellowship can bring.

Over the next six years, I managed to lose my wife and children, my legal practice, my home, and any stability or morality. Ultimately, I ended up here in Boston, and the elevator continued to plummet to depths beyond anything I could have imagined, including a six-month incarceration in South Bay for alcohol-related misdemeanors, an indefinite suspension of my Ohio law license, homelessness, and, worst of all, the inability to see my children for two years due to probation restrictions against leaving the Commonwealth.

It was in that condition that I was first introduced to LCL. I will never forget that day! There I was, homeless, disgraced, professionally dead, and a shadow of my former self walking into a small room full of some of the most successful and distinguished sober lawyers of this major East Coast city. The reception I received was truly a gift from God! These individuals, as well everyone else associated with LCL, welcomed me with open arms and immediately took a genuine interest in me. They candidly discussed what was occurring in both their personal and professional lives along what they were doing to remain sober. There was no ridicule or judgment, just understanding and support. I immediately identified completely and soon knew I was no longer alone professionally as I was given phone numbers, encouraged to use them, and, most mportantly, invited to come back to the bi-weekly meetings whenever I could. I walked away from that experience with hope and the belief that if I kept showing up and listening they would help me learn to live my life as a sober father, fellow AA-er, and, eventually, I hope, as a Massachusetts attorney.

It has been over three years since that introduction to LCL, and with their help I have been reinstated as an Ohio attorney and sponsored for admission to the Mass Bar. I am active in, and hold myself accountable to, LCL, and I hope to be granted the honor of joining my friends in the practice of law here in Boston, God willing. I remain in Massachusetts, presently living at the generosity of one of my sponsees and his very kind and wonderful family. In recognition of the importance of my Boston AA program to my continued sobriety, I have opted against returning to my former practice in Ohio in favor of continuing – for now – my humble outdoor job in the tourism industry for nominal wages. A testament to the program, the needs of my daughters are more important to me now than my personal comforts, and the bulk of my earnings are happily and freely given for their support. Meanwhile, I patiently continue to pursue my dream of living and practicing here where I know I belong. To some who knew me before my recovery, my decision to stay in Massachusetts is hard to believe, but it is a decision my AA family helped me easily reach long ago.

Interestingly, the rationale for this decision was best summarized by my daughters, with whom I now enjoy a fabulous relationship. After seeing my progress, meeting my sponsor, and hearing about all my friends, my youngest said, “Dad, whatever those people in Boston are doing to you, let them keep doing it; stay there! We love you and will join you there very soon.”

Restoration of that relationship has been my greatest reward. For that and so much else, I’m certain I will never be able to completely express my gratitude for my AA family in Boston. I only hope that in some small way I can “pass it on” and help others become so fortunate. However, the same gentleman who introduced me to Buddhism, and who also painstakingly helped me stay connected to LCL during my reinstatement sojourn in Ohio, may have summed up my emotions best on one cold winter night years ago while we were walking along Hanover Street on the way back from a meeting. After observing me enviously gazing from the “outside in” at the happy faces of restaurant patrons, he prophetically said, “Putting down alcohol may be the end of your little world, but Boston AA will help you discover a big, beautiful new one – if you let it.”

Today, my incredible new world includes enjoying friendships I never could have envisioned and trying to extend a helping hand to others as it was so unselfishly done for me. My time is filled with meetings, including the LCL meetings, sponsorship, attending a weekly commitment with my home group at a local hospital’s rehabilitation program, and I have even had the privilege of serving Thanksgiving dinner with my sponsor to other disadvantaged folks. Who would have known my life could be so full three years ago?!

God bless!

BU's Dean Marx Calls Attention to Addictive Problems in Law Students

Always a friend to LCL (and currently VP of our Board), Christine Marx, Associate Dean for Student Affairs at BU Law, is currently using her office’s blog to call attention to the fact that law students are far from immune to responding to pressures by “turn[ing] to alcohol or other substances in unhealthy, and potentially destructive, ways.” In her position, Dean Marx has seen the potential for students’ lives to “go off the rails” as an undesired byproduct of drinking or drugging. She elaborates on the story of “Jane,” a 2nd year law student who is now ready to share with others the story of her drinking and recovery. To read Dean Marx's blog, click here.

LCL has always highly valued its close relationship with area law schools. Multiple studies have established the lawyers have an especially high rate of both addictive behaviors and depression, and it appears that these begin to emerge during law school. Students who, like Jane, are able to recognize and address these challenges even before they begin their professional lives can avoid the kinds of pain and disruption that might otherwise disrupt their careers later on.

No Lawyer is an Island

Most lawyers are acculturated to present an image of themselves as knowing, capable, even invulnerable or self-sufficient. Yet lawyers are human beings, and thus subject to vulnerabilities and setbacks. It is on that basis that, when speaking to groups of attorneys I advocate for contacting LCL and other sources of assistance sooner rather than later, ideally before one’s practice is in danger of being compromised.

But my specific intent in this post is to remind you of how helpful and important it can be to have “practice buddies” – colleagues with whom you have regular, mutually supportive interactions. These may be more readily available if you work at a law firm, and less so if you practice alone, and yet more crucial. For years, I ran a Solo Practitioners group here at LCL (soon to re-emerge as a joint LCL-LOMAP enterprise), and learned how isolated and unsupported the solo practice life can be.

Beyond the problems of professional solitude in regular practice situations, what happens when you are out of commission for a while, whether because of physical illness, family crisis, depression, need for alcohol/drug treatment, etc.? There is no organized system, no committee or agency set up to take over for you in circumstances when you are ill, impaired, or worse. (This is unfortunate, since under the auspices of such an organization the lawyers providing coverage would be immune from liability.) You cannot ethically leave your clients unattended, but arranging for their coverage is entirely up to you. Imagine how much easier things are, then, if you have regular contact with one or more of your peers (e.g., who meet as a group once a month to discuss tough cases or developments in the law, or with whom you have lunch individually on a regular basis), with the understanding that each of you is ready to step in for the other(s) as needed. And when the time comes that you are summoned to Highest Court, there is no mystery as to what happens to your open cases.

As you might imagine, at LCL we repeatedly see lawyers who really are in no shape to practice for the time being, but who keep attempting to do so because they have no back-up – for their computers, maybe, but not for themselves. So, much as I myself resist articles providing unsolicited advice, may I suggest that you take a few minutes right now to think about who your professional buddies might be – and maybe make a lunch date.

[Two afterthoughts: (1) If you are interested our planned time-limited group for solo practitioners, email me at DrJeff@LCLMA.org – we hope to get it started in a couple of months; (2) My perspectives are psychological – to get more lawyerly advice on topics such as covering for an impaired colleague or taking over the practice of a deceased professional peer, review the illuminating articles by bar counsel on the BBO web site (http://www.mass.gov/obcbbo/articles.htm) ].

A Word to the (Recovering) Wise

As the days grow shorter, colder and darker, people find themselves inclined to “batten down the hatches” and stay indoors. This time of the year is known in recovery circles as the “trifecta” (Thanksgiving, Christmas, and New Years). This trifecta creates a very seductive season, with all the commercials, parties, office treats and overabundance of all things sweet, so folks in recovery need to make a very conscious decision to re-commit to sobriety.

If the holidays are for you a joyous time filled with fun and family, relaxation and enjoyment, then hats off to you! If, on the other hand, work is scarce, money is tight, and you are not optimistic about what comes next, or if spending time with family feels like a root canal without Novocain, or simply more of an endurance test than a Norman Rockwell moment, the holidays may require all the determination you can muster to keep yourself sane and content.

Determination to stay sane and content starts with taking stock of what you have and reflecting on ways you can change to meet conditions as they are, recalling you have no control over people, places and things. Regardless of how you feel about the holidays, it is always a good time to think about what you are grateful for, and despite the current difficulties, how it is better than your pre-recovery days of confusion and turmoil.

Remember also that the holiday season, whether good or not so good, will pass – so don’t make decisions about the worth of your life when things are tough…it gets better…nothing stays the same.

The trifecta gives up the opportunity to go to a lot of meetings, reach out to others, and try to find the goodness in as many places as we can!

Making the Most of the Holidays

The holiday season is once again upon us. Do you welcome it? Dread it? Get depressed by it? Is your sobriety challenged during this season? Most of us have some understandably jaded feelings about the holidays, the annoyingly early and unrelenting commercialism, the non-stop media portrayals of idealized family gatherings, the presumption of abundance, and the pressure to spend beyond our means. In addition, memories, losses, unfulfilled hopes and dreams, and now economic reversals and uncertainties can take the luster off of a season that once held expectations of excitement and delight. The following tips may be helpful in not becoming a victim of the season:

Manage your mind: Depression thrives in that petri dish of negative thought about oneself, others, or life in general. A powerful causal relationship exists between what we think and believe, and what we feel emotionally. Negative thoughts beget negative feelings, which beget negative expectations, which beget negative behaviors, which create a cycle of negativity. An effective way to fend off depression involves being willing to become aware of when your thinking is veering into negative territory, and then consciously and deliberately taking it back into happier territory. Managing your mind takes determination, patience, persistence, and practice. And as with any exercise, you gradually build muscle – mental muscle! And you will gradually feel better and better, both emotionally and physically, the mind-body connection now being a well-established medical fact. A good starting point might be to remind yourself of all you have to be grateful for. Gratitude and depression cannot co-exist for long. An “attitude of gratitude” will change your life.

Participate and give: If you are one of the lucky ones whose life has been transformed by working the steps of AA or another 12-Step program, you are likely to have practiced, in one way or another, all of what is written here, and have learned repeatedly the joy of giving service, lending a hand, 12th-stepping. But you, too, may need the extra support and inspiration of the Program, its members, and its wisdom at this time of year. The opportunities for growth keep presenting themselves, and the Program never fails to offer perspective and hope. Keep going back.

Define your goals: Take charge and ask yourself, “What can I do to make this (or something else) better?” In other words, don’t be a sad victim. Do you want more control over your calendar orpractice management? Call LOMAP. Do you want more energy? Join a gym. Do you want a better relationship with your spouse? Talk (and listen) with him/her about it. Do you want to learn to deal with stress? Call LCL. These self-empowering steps help defeat depression. And when it comes to the holidays, ask yourself what you can do to make it a little happier for yourself and others. And, then, act.

Yes, act! A symptom of depression is helplessness. But helplessness is an illusion, often quite a persuasive or seductive one, but still an illusion. The truth is, if we’re willing, we can all dodge
that sense of defeat by exerting some control over our own lives. (Trying to change someone else is a futile substitute, guaranteed to fail and increase misery.) Acting in our own behalf often involves maintaining a determined attitude, and may require the use of various sources of support such as family, friends, your spiritual community, or LCL.

Take care of yourself, personally and professionally: Respect yourself by taking care of yourself, and you will enjoy better mental and physical health. When you treat yourself with respect, others are likely to do the same. We all know what good self-care means: eat nutritious food and avoid the more available junk food – but enjoy the holiday treats within reason. Sleep – at least 7 hours a day, more if necessary or possible, and take a mid-afternoon nap. Read a good book, take a walk in the woods, have breakfast with friends, go for a run, drop a bad client, or take your spouse to the movies.

Laugh: Especially at yourself. Resist taking things too seriously. Humor doesn’t mean you don’t take your work seriously; it just acknowledges a wider perspective. Keep the funny bone in gear so the kid inside can come out to play when the time right, be goofy even, have some belly laughs; it refreshes both the brain and the spirit and wards off depression. The people you make laugh will always be happy to see you coming.

Plan a vacation: It does not have to be the extravagant trip of a lifetime, although it can be, but plan your vacation time. (If you lack a travel companion, join a tour, or a club; then you’ll have many.) And don’t underestimate the value of one-minute vacations: close your eyes, relax your body, and envision yourself doing what you love. As with laughter, envisioning doing something, or being somewhere you adore refreshes mind and body and can lead to action that turns it into reality. If you can allow yourself to take a vacation.

Adjust your expectations: As a group, lawyers tend to enjoy challenges and set high expectations for themselves, especially at work. For some, seductive financial rewards for unreasonable productivity demands serve to reinforce a potentially destructive imbalance. This is a good time of year to re-evaluate priorities in favor of that which enhances year-’round peace and harmony in both spheres of life – professional and personal, work and love. (Of course, such re-balancing acts can represent a major change and must be carefully thought out, and discussed and planned in conjunction with others who would be affected, maybe even feel threatened, by them.) Balance helps create the conditions for health and happiness.

Change one thing: As creatures of habit and routine, we all know how tough change can be. It’s best to start slow and let the momentum build. Choose just one thing that you can realistically do differently. Consider what will have to shift (Fewer clients? Less TV? Making your own lunch to pay for housecleaning, a babysitter, gym membership? Less complaining?), and evaluate your willingness to make them. Journal your efforts, slips and progress. Keep visual reminders everywhere (write on your bathroom mirror, car windshield, or refrigerator). Enlist the support of a friend, consultant, or counselor to hold you accountable to your intention. Incremental changes are more likely to become habitual. Taking charge of one’s own life is empowering and confidence building and counteracts depression.

Finally, compassionate and good-humored self-acceptance greatly enhances our capacity for genuine enjoyment of ourselves and of others. A healthy, reality-based love of self, warts and all, generates and attracts more love. And love always partners with happiness.

Firm Future Conference Returns for 2011; Free Registration for LCL Blog Readers

The Firm Future Conference, taking place December 1, is put on by the Warren Group and co-sponsored by Lawyers Concerned for Lawyers, the Law Office Management Assistance Program, the Massachusetts Bar Association, and other Massachusetts legal stakeholders. The conference will feature programs on social media marketing, business development (including law practice start-up), mobile practice, alternative billing, work-life balance and more. Rodney Dowell, executive director of LCL; Barbara Bowe, clinician at LCL; and, Jared Correia, law practice advisor at LOMAP, will combine to appear on several conference panels. Nationally prominent experts presenting at the conference include: Larry Bodine (http://www.larrybodine.com/), of Lawyers.com (http://www.lawyers.com/); Reid Trautz (http://reidtrautz.typepad.com/), of the American Immigration Lawyers Association (http://www.aila.org/); Susan Cartier Liebel (http://solopracticeuniversity.com/about/about-history/_, of Solo Practice University (http://solopracticeuniversity.com/); Jay Shepherd (http://prefixllc.com/jay-shepherd/), of Prefix, LLC (http://prefixllc.com/); and, Alan Klevan (http://www.lawpracticestrategies.com/?page_id=2), of Klevan & Klevan, LLP (http://klevan.hytech.org/).

Visit the Firm Future Conference website (http://www.firmfutureconference.com/), for the complete agenda (http://www.firmfutureconference.com/agenda/index.html), including a full roster of speakers.

LCL Blog (http://lclma.blogspot.com/) readers can register for the program for FREE through November 17.

Click here (http://www.firmfutureconference.com/forms/attendeereg?company=Lawyers%2BConcerned%2BFor%2BLawyers) to register for the conference for free, compliments of LCL.

When You Feel Trapped in Your Work

Even at a time like this, when most employed people (lawyers and others) are happy to have a job, we recurrently meet lawyers who feel suffocated and stuck in work settings that we have come to refer to as “toxic.” It is crucial, in such circumstances, to work toward a plan of escape, whether that is ultimately by way of leaving the job, effecting changes on the job, or finding better ways to cope, internally, with the situation.

Sometimes, as Sartre asserted in No Exit, “Hell is other people.” While the most obvious hellish person at work may be the boss (such as a law firm partner who applies great pressure but offers no support, or an experienced but burnt out attorney who offloads all difficult cases to his/her underling), coworkers, support staff, and draining clients can also exert a poisonous effect.

Sometimes the accumulating impact of spending months or years in such circumstances results in observable symptoms of stress, anxiety, or depression, manifested for example by sleeplessness, poor concentration, feeling paralyzed in thinking, or even getting panic attacks. (The self-tests at LCLMA.org can be one way to evaluate these syndromes.) Less overt are effects such as increased physical illness, deteriorated relationships, and declining self-esteem or regard for the profession.

One of the most useful psychological tools ever to come down the pike is the Serenity Prayer, well known to anyone familiar with 12-step meetings, and originally composed (with slightly different wording but making the same points) by theologian Reinhold Niebuhr. It distinguishes between things that are outside an individual’s realm of influence, which must be accepted (e.g., the culture of this law firm is unlikely to change) , and those areas in which a person does have potential impact, if one summons the “courage” (e.g., self-assertion with key figures who may have the capacity to listen, acquiring new skills, getting outside help, or changing one’s own ways of perceiving and defining negative situations). Both approaches require developing a level of awareness/ability to self-observe, and a degree of cognitive flexibility.

A major advantage to gaining this kind of perspective is that it can decrease the sense of entrapment and passivity, which in turn is likely to improve one’s mood, outlook, and readiness to grasp opportunities for positive change when they present themselves. It is also important to realize that we are each responsible to prioritize our own wellbeing (including health, some kind of balanced life, some gratification in each day) – external people or environments may severely challenge our personal needs, but they do not hold all the cards.

Many lawyers seem to forget that they need not be completely alone in facing such stresses. Although no one, including LCL, can swoop in and come to the rescue, there is value in having sources of information, new perspectives and tools, emotional support, etc. There is no reason to go it alone.

Our Heroes

Observed annually each September, “Recovery Month” sponsored by the US Department of Health & Human Services, promotes the societal benefits of treatment for substance use and mental disorders, celebrates people in recovery, lauds the contributions of treatment providers, and promotes the message that recovery in all its forms is possible.

What better time to recognize the success of LCL’s founding members whose commitment to sobriety, perseverance in recovery, generous sharing with their peers of experience, strength & hope, time energy & resources proved time and again that new life awaited the recovering alcoholic. As lives were healed, families salvaged, careers restored, and self-respect regained, our early recovering members, like those entering recovery today, became a source of inspiration and hope to others.

The challenges of recovery faced by our senior membership, however, were somewhat different from those of today. Extensive research conducted over the last 30 years has dispelled much of the ignorance about addiction and alcoholism that gave rise to social stigma and moral judgments. But in those days, discussions of the topic and the afflicted were conducted in hushed tones, or with angry indignation and condemnation. The alcoholic, already disempowered by his disease, was further disabled by disgrace and shame and by consequent deepening isolation. In view of the attitudes of the day, their recovery is all the more courageous and heroic.

Thankfully, things have changed. In the last few days the headlines proclaim that addiction, far from representing the moral issue of yesterday, is a “chronic brain disorder,” with observable and measureable physiological and neurochemical mechanisms that differ from those not afflicted. While this might make the disease a target for high-stakes pharmaceutical interventions, and perhaps a re-categorization by insurance companies, it also, we hope, supports the growing body of evidence that the alcoholic is not to be judged and condemned but medically treated and supported with compassion. Ideally, this information will enable physicians, who are often not comfortable raising the subject of alcohol and illicit drug use with their patients, to now more comfortably make such screening a routine part of their physical exams. And we can hope that its treatment, including relapse prevention, will be viewed like other chronic conditions, such as heart disease, as a long-term endeavor.

‘”The behavioral problem [associated with addiction] is a result of brain dysfunction,” agrees Dr. Nora Volkow, director of the National Institute on Drug Abuse, which estimates that 23 million Americans need treatment for substance abuse but only about 2 million get that help. She adds that doctors and families alike need to know that the frustration of relapse is common for a chronic disease. This expanded understanding of addictive behavior, including alcoholism, does not alter the diagnostic criteria. Symptoms remain the same, and typically boil down to behaviors that are repeated despite the harmful consequences to health, occupation, family, finances, social connections, or legal status. And the affected individuals still have to do the challenging work of recovery, i.e., change their behavior, an effort best made using appropriate treatment resources and recovery supports.

Many recovering alcoholics will hasten to say that alcoholism defined as a “chronic brain disorder” is not new information to them. They learned about their disease and what they had to do to manage it from the Big Book, from meetings and their peers in AA, from the self-discovery made possible by their work with their sponsors and therapists and 12 Steps, and from the perspective afforded by their own lives transformed from bondage to freedom. How could anyone have anything but deep respect for those who have confronted their disease, met the difficult challenge of behavioral change, addressed old wounds to self and others, and who keep moving forward, one day at a time - ever mindful of where they have been, of those who have helped them on their journey and those now in need of their support. Is a more complete life possible? LCL is proud of its members, and still considers it a privilege and priority to support and serve those in recovery, and those seeking recovery.

Another Look at Lawyer Suicide

Over a year ago, my first LCL blog of any substance dealt with the issue of lawyer suicide, at a time when 3 prominent lawyers had recently ended their lives, leaving many others not only saddened but also perplexed in a “Richard Cory” way. (For anyone unfamiliar with this reference, click here and also click here.)

Today, in the usually futile effort to reduce the pile on my desk, I came across Richard Schmitt’s article, “A Death in the Office” in the November 2009 issue of the ABA Journal that comes to the LCL office. Schmitt details the abruptly self-terminated life of Mark Levy, an ultra-capable, widely admired attorney with a seemingly perfect academic and professional background specializing in appellate practice.

This is a case that feels closer to me because, though I never knew him, I discovered that Mr. Levy was my classmate at Yale College (where, while I got by and spent most of my time on a cappella singing groups, he graduated summa cum laude). He went on to excel at Yale Law, then to clerk for the judge involved in both Watergate and the Pentagon Papers, and subsequently worked for a series of prestigious law firms as well as spending some years at the Justice Department.

Despite all of his accomplishments and a record of both successful cases and professional generosity, he was not adept at marketing or drumming up business. Like so many others in my generation, his values and grooming were oriented toward being a professional, valued for intellectual achievement and service to his society, not so much a businessman, valued for talent at making money or enhancing corporate growth. My own health-related field, too, has become a big business, with mega-hospital conglomerates competing for a piece of the insurance pie even as insurance companies vie to maximize shareholder profit -- and business sense tends to trump clinical savvy for those who flourish nowadays. This shift has come over our society as a whole, and there seems to be no way to turn it around (any more than to decide that the world was better off without Twitter and Blackberries), but it’s a shame.

One of my first clients at LCL, back around 1998, was a 50-ish man who had graduated Harvard Law. When he graduated, in the mid 1970’s, just doing a good job led to word-of-mouth referrals, and he made a fine living in a suburban solo practice. By the time he saw me, never having fancied himself a self-promoter and responding too late to the new realities, he was unable to keep up with the monthly obligations of supporting his family. And this was long before the economic meltdown.

At a much more elevated level, Mark Levy found that, distinguished career or not, he had become a commodity of decreasing value, having moved from one law firm to another in recent years. Taking his life in the very office from which he was being evicted (not even permitted, given his firm’s mentality, to remain there unpaid for a transitional period ) may have served partly to make a statement about today’s professionals –- disposable.

On an individual level, however, one wishes that no one would absorb that notion. So many lawyers have come into my office in a state of disappointment with their careers, alienated from their profession, unable to make enough of a living, etc., understandably exhibiting a depressed mood and perspective. Embedded in their reactions, to some extent, is an acceptance of the prevailing notion that financial success is the measure of personal and professional success. They are naturally hoping that someone will offer a straightforward solution, a way to switch career tracks and be redirected toward success (money, position). The reality for many of them is that they will need to cut back on lifestyle, make adjustments in their practices, maybe sell the house before it is foreclosed upon, and walk through a kind of grief process, mourning their former expectations, before turning the page to what can be a satisfying new chapter.

To psychologically survive such changes, it is important not to equate the vicissitudes of the professional market with any valid measure of one’s own worth. Rather, lawyers who face unanticipated setbacks must connect with the values and missions that originally inspired them to enter the profession, and continue to respect their own qualities and talents, even as they remain active in taking practical steps to readjust and reconfigure so as to make a living. Though there may be a reflexive or shame-based impulse to pull away from friends, family, and colleagues, these are the times when it matters most to connect with others, engage in new learning, find new ways to make an impact (even through endeavors that may produce no financial reward), and maintain hope for ultimately finding a new path that may even be more gratifying than what came before. In order to be at least partially immunized from the ever-changing environment, it helps if a healthy portion of the reward for one’s work comes from within.

When we, at LCL, seek to connect disheartened lawyers with therapists (especially those lawyers who are loathe to burden friends with the wounds to their self-esteem) or with career coaches or our comrades at the Law Office Management Assistance Program, or to our own recurrent Layoff Group series, it is because we see the potential for finding such a new path. Equally important is the recognition that to focus one’s sense of identity and value too much on career status (and too little on family, community, the arts, nature, reflection, charity, fun, etc.) is to accept the faulty notion that personal worth is a function of supply and demand.

Counterpoint to Myself (re plight of new lawyers)

Inasmuch as my previous post (“Is the Legal Profession Neglecting its Young?”) could be considered a bit inflammatory (though it is meant solely to support the needs of the profession’s newcomers), allow me to convey some additional information provided to me by lawyers within the walls of our suite.

With regard to the sorely missing training element of apprenticeship:

• Some states do offer some kind of apprenticeship. Delaware and Vermont require at least a few months (Delaware, 5; Vermont, 3) of full-time clerkship in a licensed lawyer’s office in order to be eligible for admission to the bar.
• Some other states, including New York, permit law students to behave as lawyers in certain settings, offering but not requiring the opportunity for this kind of real-life experience prior to independent practice. Here in Massachusetts, Northeastern University School of Law’s co-op program provides each student with four distinct 11-week work experiences in real-life settings as a standard feature of legal training. Some other law schools provide a “clinical” component that also offers some exposure to real legal work under the supervision of a licensed attorney with a Supreme Judicial Court Rule 3:03 certification. (This is more analogous to the practicum components of other kinds of graduate schools than to the post-graduation internship and supervised work experience.)
• A limited number of students each year who attend University of New Hampshire School of Law are permitted to bypass the bar exam by participating in a program of supervised practice.
• In Vermont, Virginia, California, and Washington, one may actually be admitted to the bar without having attended law school, but having instead spent an extended apprenticeship under the aegis of a judge or licensed lawyer.
• Many countries do require (and thus offer) an apprenticeship after achieving a law degree. These include: China, Israel, Japan, Belgium, Denmark, Finland, Germany, Ireland, Italy, Netherlands, Sweden, Switzerland, United Kingdom, and Canada. [This list of countries comes from Wikipedia, so we cannot fully attest to its accuracy. Other information provided above was confirmed via review of official state or university web sites.]

With regard to deficiencies in availability of post-law school education and guidance:

• For help with practice management (as opposed to the how-to of handling cases), Massachusetts attorneys are fortunate to be able to get guidance from the LOMAP program, in areas including marketing, technology, proper handling of client funds accounts, etc. Also useful in this regard is are the articles posted on the Board of Bar Overseers/Office of Bar Counsel web site, covering a wide array of topics.
• Although Massachusetts does not require continuing education, according to the ABA (http://www.abanet.org/cle/mcleview.html), all but 6 states do.
• While available mentoring programs are limited in their scope and intensity, they are available in one form or another through various bar associations. Our widely knowledgeable colleagues at the LOMAP program have offered two very useful blog posts on locating mentors, which you may access by clicking these links: http://masslomap.blogspot.com/2009/02/finding-mentor-tool-for-success.html, http://masslomap.blogspot.com/2010/05/mentor-de-perseverance-mountain-legs.html .
• Despite the paucity of guidance offered in any routine fashion to new lawyers, a lawyer who puts enough energy into the legwork can, I am told, develop his or her own cluster of mentors by continuing to approach candidates and not being deterred by those who decline.
• More so than in the clinical professions, sufficient reading/research (accompanied these days by all kinds of listserv options), can elicit much of the guidance a lawyer needs to address novel challenges. Resources include West Law’s Mass Practice, LexisNexis, Social Law Library, ABA’s SoloSez listserv, and more.

So, although the legal profession generally offers much less than other professions in structured, routine guidance and grooming, it’s out there for those who go after it. Those newly admitted to the bar must recognize that, even without formal requirements or supervised experience, their professional education is by no means finished upon obtaining the degree.

Is the Legal Profession Neglecting its Young?

Physicians follow their academic training with years in hospitals, through internship and residency, partly as cheap labor, but under the watchful/critical eye of more experienced physicians. Psychologists follow their years of classes with a year’s internship and two years’ supervised experience (generally in a clinic or hospital) before they can be licensed for independent practice. Social workers must also garner two years’ of closely supervised clinical experience before seeking independent licensure. Nurses, teachers, barbers, etc. all have mandated mechanisms for apprenticeship before allowing novices to go out and practice on their own.

Not so for most lawyers. After a mere three years in law school, and usually very little exposure to the real-life practice of law, new attorneys leave the nest on their own and, to mix metaphors, dive right into the deep end. Those who obtain employment in agencies or large firms at least have some kind of structure in place to undo their mistakes and provide some kind of quality control, though many find that they are highly stressed, given little guidance and many demands. But the many, many new lawyers who jump right into solo or small firm practice are often forced to learn on the job, making their inevitable mistakes at the expense of real clients. Those who care deeply about doing the best job often develop anxiety symptoms. Those who are less troubled by such worries may find themselves doing things that could come back to haunt them by way of undesired input from the Office of Bar Counsel.

Overwhelmed young lawyers may also find it harder to justify taking the time for continuing education courses – these, too, are mandated for health professionals, teachers, etc., but not for Massachusetts attorneys.

I am not pointing any fingers – this is the way the profession has evolved, and systems that are firmly in place are notoriously difficult to change, even if there were a consensus. Given this perilous state of affairs, it is impressive to recognize that, in the vast majority of cases, it seems that no great harm comes to clients or to lawyers’ careers (aside from stress-induced effects on health, family life, etc.). Is this because new lawyers get case-specific help from their more seasoned colleagues? Not so much.

Some bar associations have mentoring programs, generally offered in a group format, that provide a helpful kind of overarching support, but not specific advice on what to do at the moment when a lawyer, trying to appear knowledgeable, is suddenly confronted by an unforeseen development in the evolution of a case. When I was a new psychologist, as anxious as I felt when a patient seemed potentially suicidal or otherwise unsafe, it was immensely helpful to know that I could contact my clinical supervisor for guidance. In the analogous legal situation, some new attorneys are fortunate enough to have personal relationships with voices of experience, or are assertive enough to track down those they don’t know but who are often kind enough to offer their perspectives. (At least one other setting reportedly provides close supervision to newer attorneys: agencies that operate under the Committee for Public Counsel Services.)

When new and anxious practitioners come to LCL for consultation, we try to help them identify and pursue sources of helpful input. In some of our discussion groups, like the Solo Practitioners Forum, they get support. But let’s hope that, over time, the profession itself will find additional ways to guide its progeny into the jungle of real life practice.

[Coming very soon: Counterpoint to the above.]

BEHAVIORAL HEALTH COVERAGE -- COMING BACK TO THE PARITY

One of our main activities at LCL is referring lawyers, law students, etc to see behavioral health professionals. In my blog of August 2010, I briefly described the history of efforts to achieve insurance coverage for mental health and addictions treatment that was roughly equivalent to coverage for physical conditions. Laws with this purpose have been known as “mental health parity” laws. [None of this pertains to the more recent health care reform package.]

A major improvement of the Massachusetts parity law of 2000 came in 2009, when alcohol/drug abuse/dependence, as well as eating disorders, PTSD, and autism, were added to the list of diagnoses for which coverage was mandated. These illnesses, like those already included (e.g., major depression, bipolar disorder, schizophrenia, panic disorder), were no longer subject to arbitrary maximums of treatments, and even less severe conditions had to be covered up to 24 outpatient visits a year.

Then, the new federal parity law was to take effect in 2010, apparently bringing all psychiatric diagnoses under the parity umbrella, and applying even to most self-insured plans (which had been excluded from the state law, along with MassHealth and Medicare).

But things have become murkier with the advent of 2010. Some or all of the federal law seemed to be on hold and awaiting feedback until July. And I have not found any finalized word in my own Googling efforts. However, I notice that at least some Massachusetts insurers who post benefit information on line are no longer providing information about treatment maximums (which may suggest that the maximums no longer apply).

The upshot is that the chances that your behavioral health treatment will be covered are probably enhanced with the convergence of the federal and Massachusetts parity laws. But certainly you should be prepared for exceptions, which include plans through employers with 50 or fewer employees, and insurers may still find a way to exclude some conditions. And don’t forget that, if you have an HMO (and even the rare PPO, such as the Harvard Pilgrim plan now available through the state’s GIC program), no services will be covered without pre-authorization. Through the process of pre-authorization, the managed care company will determine how much treatment is “medically necessary.” Even without maximum numbers of visits, the mere fact that you and your treatment provider believe that therapy/counseling is indicated does not mean that the insurer will agree that they should be paying for it.

Although coverage remains as uncertain and ambiguous as ever, the overall trend is toward improvement. And though I wanted you to be an informed consumer, aware of the pitfalls, I certainly do not want you to use these complexities as an excuse to avoid getting the help you need.

Unsolicited Advice to Lawyers with Associates

Since I joined the LCL staff in 1998, I have personally seen 2 or 3 lawyers a year who come in distressed, and often depressed, with regard to their role as associate in a law firm. In some cases, they function as sole underling to a seasoned veteran who has taken them into an otherwise solo or small practice. In other cases, they are making a big income with a giant and prestigious firm. In either situation, the associates that I see (who are, of course, self-selecting to come to LCL) are struggling to keep their heads above water.

They complain that they feel swamped with work demands, but ill-equipped to do a good job. The more senior attorneys to whom they answer are quick to point out the associates’ errors, but mostly unavailable to provide guidance. (In some cases, their “door is always open,” but on most given occasions they are too busy.) In a small practice, the associate is sometimes in the predicament of having to try to juggle many different kinds of cases at once, all of them with little previous experience, further reducing their chances of attaining mastery. They have little or no say about how they are to spend their time or how a case is to be addressed (i.e., the senior attorney expects that it will be handled just as s/he would have done). Many of these individuals were highly successful in law school and now feel much less competent, humbled if not humiliated.

Some of these associates blame the seemingly uncaring boss to whom they answer. Others blame themselves. Either way, as their mood declines, so does their productivity. They respond by working more hours. As their home lives or social lives deteriorate, their lives become less balanced and they are less able to function in a healthy way. Eventually, they either make it through this “rite of passage,” gradually master the needed skills, and re-achieve personal equilibrium, or they leave the firm. In some firms, large and small, the turnover rate is high.

From a psychologist’s point of view (and these thoughts are influenced by the writings of Dr. Martin Seligman, father of “positive psychology,” who has addressed himself to depression-promoting aspects of the lives of lawyers), if someone running a law firm wanted to keep the firm’s associate(s) happier and more productive, and to retain more of these newer lawyers for a longer period once they have learned the ropes, one might do some of the following:

• Provide actual mentoring, not just oversight. Take some time, even one uninterrupted hour a week, focused entirely on the associate’s questions, concerns, and ideas. The time you invest will likely pay for itself in the associate’s increased productivity, flowing not only from the concrete information and advice that you can provide, but also from his or her increased effort in response to sensing your support and interest.

• People are generally more productive (and happier) according to Seligman and others, not to mention common sense, when empowered to have a say in what they do (what he calls “decision latitude). That suggests that your associate will do better if there is some discussion about what s/he will do and how, and if the associate has a voice and choice in determining how their time will be spent. That is likely to include a chance to master certain kinds of tasks before plunging into others.

• Different associates are likely to have different strengths, based not only on past experience/learning but even more on personality and native talents. You can utilize a win-win strategy by noticing and capitalizing on their particular strengths, increasing their sense of efficacy and optimizing their contribution to the firm.

My sense is that such efforts will pay off in productivity, retention, interpersonal atmosphere, decreased conflict, etc. Meantime, LCL remains a consultative resource for those (at any level of the hierarchy) who find their work environments a source of stress and dysfunction.

Integrity Among Lawyers (and Others)

[The following thoughts arose out of discussions of some of the struggles endured by members of the LCL Solo Practitioners Forum that I facilitate.]

There is no greater delight than to be conscious of sincerity on self-examination. (Mencius)

• A legal task took less time than you expected. Although ample funds are sitting in the client funds account, you bill only for time actually spent.
• A practice that is profitable but ultimately irresponsible has gained momentum in the law firm that employs you. To the extent that it is improper, responsibility for it is spread across the whole firm, including those in positions of greater power than yours. Despite that, and the fact that raising the issue may have a negative impact on how the partners view you, you speak up.
• You find yourself burning the midnight oil, putting an inordinate amount of effort and diligence into a family law case on behalf of a client who you know will probably never pay you; but you do it anyhow, even though you wish you’d never met this client.
• You find that you can board a Green Line train to work from a rear door by merely waving any card, and you watch others do so and take their seats. You bother to walk to the front of the train and pay the $2, by which time no seats are left.
• A fellow lawyer, you observe clearly by her behavior in his office and in court, is in rough shape, not firing on all cylinders. Though you hate to intrude into someone else’s business, you can see that she is on a path toward harming clients and her own career. You express your concern and offer to go with her to LCL for a confidential assessment, knowing full well that the suggestion may well elicit an angry, defensive reactio
  

Nothing is at last sacred but the integrity of your own mind. (Ralph Waldo Emerson)

Issues of integrity arise (whether or not consciously acknowledged) in all our lives every day – perhaps even more so in the lives of lawyers, who on the one hand sometimes find themselves representing the interests of the dishonest and vile, and on the other hand operate within an intricate foundation of laws that would seem to require an honorable respect in order to remain standing.

Fear of discovery, punishment, humiliation, etc. is, of course, a major help in making responsible choices in the face of all the short-term rewards of cheating. That’s a major raison d’être for institutions such as the auditing wing of the IRS, or the Office of Bar Counsel. But it has not stopped the Bernie Madoffs or Bernie Keriks of the world (no offense to people named Bernie), or those who ignored construction standards in the Big Dig, or those scientists and pharmaceutical companies who publish only studies supporting their (profitable) propositions and ignore contradictory evidence, or … well, you know all of this. And the fact that so many people, so much of the time, ignore social values and go for quick profit (even your personal trainer who demands to be paid in cash) makes it all too easy to rationalize doing the same.

But there is an upside to behaving ethically, responsibly, and maintaining personal integrity. You go about your life without fear of being “caught.” You do not carry the burden of guilt, or go to great lengths to escape awareness of that guilt. To the extent that “what goes around comes around,” you are ready for what comes around. Your friends and associates come to trust you, and with reason. Your knees don’t shake if you get a letter from the BBO (at least not as much as some other lawyers’ knees). If you believe that the purpose of life is to amass the most money or fame in the shortest time, you may be disappointed. But, as they say, you can look at yourself in the mirror. Your clients, coworkers, bosses, and friends may never notice, may never thank you. But inside, where it counts, integrity must be its own reward.

This above all; to thine own self be true. (William Shakespeare)

The Many Demands of Solo Practice

The other day I was telling a colleague about the lives of the lawyers who attend our monthly Solo Practitioners Forum. In the process, he and I both realized that running a solo practice requires a surprisingly long list of skills. Some of them are:

· Legal/Intellectual – this goes without saying, and calls upon much of what you learned in law school and in subsequent reading and continuing education, but no one can know it all. A major problem arises when lawyers, not recognizing their limits, fail to ask for guidance from someone who knows more about a particular subject.

· Accounting – unless you have paid staff, you have to log your time spent, bill your clients, and keep track of where your accounts stand. I can’t tell you how many lawyers I have met who are months behind in billing. For some of them, it’s because they are uncomfortable asking for money, especially from clients they know are far from well off. (Naturally, this is easier when someone else asks on your behalf.) They may feel a degree of shame for billing for services that were, perhaps, not delivered in a timely fashion. Or they may just have a brain that is allergic to columns, rows, and figures.

· Marketing – there may have been a time when just being a competent lawyer would eventually create enough word-of-mouth referrals, but that is no longer enough. Aside from CPCS as a ready source of (low-paying) referrals, the solo practitioner must figure out ways to get business. For most, it’s uncomfortable and oh-so-avoidable to contact people asking them to send business your way, or, for example, to do public speaking or spend a bunch of money on ads.

· Interpersonal – a slew of interpersonal skills are required to know how to deal with a variety of clients with different personalities, not to mention legal adversaries, judges, clerks, etc. – each of whom calls for a different approach. It helps to be able to read body language, discern unspoken agendas or expectations, etc., and to consciously manage your own reactions to individuals who “press your buttons.” Some practices call for evolved skills in negotiation or persuasion. And some clients behave in ways that require diplomacy in the form of clear limit-setting so as to avoid burning out or losing your temper.

· Organizational – in order to make a living, any lawyer has to be relatively efficient and productive. Most clients would not care to pay for your hours spent in reverie, even if you are finding parallels between their case and your readings of Proust, never mind Facebook. So you need to schedule yourself, keep yourself motivated, keep on top of deadlines, and prioritize tasks by importance, urgency, etc. Those who work at law firms have others around, and to whom they answer, to notice if their noses veer from the grindstone, or if they are putting undue work into matters that don’t demand it, or if they are taking too long to get back to clients, but those in solo practice must be their own overseers.

I’m sure that there is much more, but it becomes obvious how many skills and tasks must be juggled in order to carry on a solo practice. In order to thrive, and stay out of trouble, it is important to be aware of how you are doing on each dimension – few people could be adept at all of these functions. Identifying real deficits in any of these areas calls for action, such as delegating some tasks or getting further training or coaching for yourself. Those who attend our Solo Practitioners Forum use the opportunity to clarify, vent, brainstorm, and seek solutions. But that group is not always the right option for the lawyers who come to us for assessment; sometimes the thing that helps most is a referral to, for example, an organizational coach, mentor, or counselor. We also frequently refer to the Law Office Management Assistance Program (LOMAP), which is funded by LCL. It makes sense for practitioners to make use of such resources when you realize just how demanding and multifaceted a job they face.

Universal Coverage? Not Exactly

On occasion, the “universal” health coverage system initiated in Massachusetts during the Romney administration and sustained in the Patrick years has been pointed to as a model of what might be accomplished on a national scale. As the various kinds of “public options” seem to be fading away, it looks even more similar – adding a requirement for all citizens to arrange coverage, without any substantial renovation in the system (e.g., there is clearly no appetite for adopting the kinds of systems found in most other countries, even though many of them reportedly offer better care at much lower expense). It is quite understandable that the idea of losing our familiar forms of medical coverage triggers anxiety in most of us. The Massachusetts plan does have a kind of “public option,” but it has not made coverage truly universal. The problem, and I am not claiming to have the answer on its solution, is that many citizens, having no way to pay for the mandated coverage, continue to go without it. [Let me be clear that I am taking no political side here, since there are clearly drawbacks in any approach that has been proposed – my concern is strictly for those who need care that they cannot get.]

Personally, I was very pleased when the Massachusetts plan came along, because I had been able to present few treatment options to lawyers who came to LCL (or others who consulted with me elsewhere) in need of therapy or medication but with no means to pay for it. Publically subsidized clinics and mental health centers had long since become unable to offer truly low-cost services (probably since the end of the Dukakis administration), so the main option remaining was to refer people to community-oriented hospitals drawing upon a statewide “free care pool.”

Little did I suspect that I would be faced with a significantly larger number of uninsured lawyers after the advent of “universal” coverage here in the Bay State – and virtually nowhere to send them (since the free care pool subsequently diminished or disappeared).

I don’t think that the advent of expanded coverage itself could have caused an increase in numbers of uninsured middle class citizens – that must be a reflection of the economy – and I’m sure it has reduced the number of uninsured citizens in dire poverty. [I don’t have evidence that the trend toward more uninsured even extends beyond lawyers who come to LCL, but there was no mistaking it among those I saw there.] Aside from imposing state income tax penalties on those without coverage, the new Massachusetts plan brought about two main changes in coverage options: (1) private insurers began making some more affordable plans directly available to consumers and (2) the state began offering its Medicaid plan, MassHealth, to a significantly expanded group of residents, under the name of Commonwealth Care.

But consider the case of an LCL client (or other citizen) with a spouse, 2 kids, and a combined family income of $70,000. The private insurers have developed stripped down plans, with less extensive coverage resulting in lower premiums for young adults -but not much lower for those who have reached middle age. So, what about the public option, Commonwealth Care? In order to qualify for Commonwealth Care (the application is somewhat cumbersome and processing takes well over a month), your income must be less than 300% of Federal Poverty Guidelines. For our hypothetical lawyer/consumer with a household of 4, that means under $66,168 – and he will still have to pay about $1200 a year in premiums. In order to get the least comprehensive plan and not pay premiums, the annual family (of 4) income would have to be under $33,084. An individual (family of one) would have to make less than $16,260 to receive fully subsidized coverage. (That individual can get Commonwealth Care with an income of under $33,084, but would be paying premiums.) Of course, just like private insurance, the plan also requires co-pays for office visits and prescription drugs (with an annual cap on out-of-pocket expenses).

Thus, more than one lawyer seeing me at LCL has demonstrated that, since s/he makes too much money to qualify for Commonwealth Care, there is no way to afford health insurance without giving up, say, food, the house, or the car. They can better afford the tax penalty. Certainly, hospitals will not throw them out on the street if they require emergency care. But for less urgent services, and certainly for most LCL referrals, consumers are on their own – “free care” is apparently difficult or impossible to come by. As the state’s coffers empty, the capacity to subsidize coverage may further erode. At LCL, we do what we can to help, but too often it is simply not possible to arrange the kind of treatment to which we would refer any of our insured clients. This may be the best that can be realistically expected in this place and time, but it is not “universal” care.

If you live in Massachusetts and currently lack health insurance, here is how to find out what you’re eligible for: Get on the internet (at the library if you don’t have it at home), and go to www.mahealthconnector.org. Click “Individuals and Families” or “Young Adults,” whichever applies, fill in the requested information (e.g., family size, income), and you will be led to either the opportunity to apply for Commonwealth Care or to a selection of private health plans, with information on their costs and benefits. If you are still left in the cold…. Well, let’s see what happens on a nationwide level…….

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.

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.

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.