Stress and Lawyers

The Journal of the Delaware State Bar Association recently published an article I wrote for them titled “Stress and Lawyers.”  It is longer than what I usually post here, and quite technical in its approach to stress and stress management.  But I thought it had some useful information so I am reposting it here.  The DSBA requires this language in any reprints of their articles:

This article originally appeared in the December 2017 issue of The Journal of the Delaware State Bar Association, a publication of the Delaware State Bar Association.  Copyright © Delaware State Bar Association 2017.  All rights reserved. Reprinted with permission.

In the twelve years that I have been teaching Mindfulness Based Stress Reduction I have only had three attorneys take the program.  This does not strike me as unusual given my experience working with attorneys as a Psycho Forensic Evaluator, mostly working on homicide cases.  The attorneys that I’ve met are driven to succeed, very goal directed, and proud of their capacity to take on more and more work without showing any signs of stress or strain.  But what is missed in the driven, high stress culture of the practice of law that I’ve observed is that, as famed Psychiatrist Bessel van der Kolk has noted in working with stressed out and traumatized people, the body keeps the score!

Let me explain what I mean by describing the activity of the autonomic nervous system.  In order to survive your body needs to maintain a steady balance between stimulation and relaxation.  When your body’s senses perceive any kind of stimulus the sympathetic nervous system (one branch of the autonomic nervous system) activates and increases your heart rate, blood pressure and respiration rate while suppressing the digestive and immune systems.  In this condition, the stress response, you feel awake and aroused.  Once the stimulus is removed from your perception your body activates the other branch of the autonomic nervous system, the parasympathetic nervous system, and the relaxation response begins.  Now your heart slows down, your blood pressure and respiration rate return to their baseline levels, your digestive and immune systems return to normal, and you begin to feel relaxed, and more likely to be able to fall asleep.  Both of these responses are sensitive to levels of stress hormones in your blood, particularly cortisol.  An increase in stress hormones activates the sympathetic nervous system, a decrease in stress hormones activates the parasympathetic nervous system.

Neither the stress nor the relaxation response is inherently more valuable than the other, but for a body to remain healthy there must be a balance between the two.  When the preponderance of activity is the stress response, serious medical and psychological consequences will ensue.  Medically, people living in chronic stress have much higher rates of heart disease (e.g. hypertension, heart attacks), illnesses of digestion (e.g. ulcers, Irritable Bowel Syndrome, Gastro-Esophageal Reflux Disease, Colitis), obesity (stress hormones increase fatty deposits, especially in the abdomen), insomnia, and headaches.  Psychologically, people living in chronic stress have higher rates of depression, anxiety, and addiction.  Since I am a mental health professional, I’ll focus on the psychological consequences of chronic stress as it affects attorneys.

A report in the Journal of Addictive Medicine published early in 2016 screened a sample of 12,825 licensed, employed attorneys and found that a tremendous level of distress and impairment is widespread.  On the mental health side of the issue of attorney stress, 61% of the sample reported diagnoses of anxiety disorders during their legal career.  Depression diagnoses were confirmed by 46%, and 11.5% reported suicidal thoughts experienced during their legal career, including high rates of self-injurious behaviors and prior suicide attempts.  On the addiction side of the issue, nearly 21% of the sample reported problematic drinking, with 36% reporting hazardous drinking styles (e.g. binge drinking).  About 75% of the sample reported using stimulant drugs, half acknowledged using sedatives, nearly one third reported marijuana use, and more than 20% reported using opioids.  About 25% of the sample reported patterns of use consistent with some level of drug misuse.

A 2017 report in the Journal of Health and Social Behavior surveyed 8,243 attorneys from Canada and the United States and found that rates of depression, anxiety, substance abuse, and overall poor medical health were far higher in attorneys than the general population, and much worse in the United States than Canada.  This study looked closely at measures of perceived status and found that attorneys working for high prestige law firms suffered disproportionately compared to peers in mid-level or small firms.  Rates of stress-related illnesses, both medical and psychological, were highly elevated in high status, young attorneys, with very low levels of overall life satisfaction.  The predictive factor?  Extraordinarily high levels of work hours and little time for personal activities.  In other words, these attorneys have no work/life balance, and are slowly killing themselves through carrying a tremendous stress load in their bodies.

I am happy to report that there are two antidotes to this problem: managing your body’s stress load through intentional activation of the relaxation response and/or cutting back on the amount of work you’re doing.  In this article I’m not going to try to fight the battle of work load, so instead I’ll focus on stress management skills.

Remember earlier in this article when I said that “the body keeps the score”?  The first principle I want to express is that stress is a biological phenomenon, not a failure of the mind or the will!  Too many people, including people in my field of mental health caregiving, act as if their body’s stress load is the result of being weak minded.  Nothing could be further from the truth!  The body reacts moment-to-moment as stressors appear.  You can’t stop that from happening, but you can recognize when it is happening and engage in practices that give your body a necessary break.

Which leads me to the second principle I want to express: there are simple things you can do to help your body to reduce its stress load.  Take a walk, meditate, do some yoga or exercise, watch a funny movie.  All of these activities lower stress hormone levels in the body.  What you will notice each of these activities has in common is that they all involve focusing the mind on fewer objects of attention, and allowing the mind to stop making decisions and judgments.  The body’s stress response is absolutely proportional to the number of mental objects it must keep in awareness (think “multi-tasking” here) and how demanding each mental object is to you.  A phrase you can use to describe the state of mind in which you keep your mind focused on a single object of attention in a non-judgmental way is “being mindful.”  Fifteen minutes of mindfulness practices will go a long way to bringing your body’s stress level back to a baseline level.  And, ironically, taking a break to become mindful and relaxed actually increases job productivity!  In other words, you’ll get more done in less time if you allow your body to stand down for fifteen minutes a few times a day, every day.

A third and final principle I want to express is that stress-related impairment in the work place is called burnout, and it is preventable.  More and more corporations are now incorporating stress management opportunities as part of their corporate culture, and not just in Silicon Valley.  Old line companies like Proctor & Gamble, Aetna, General Mills, and Deutsche Bank have meditation and yoga programs built into their corporate fiber.  In fact William George, the former CEO of Medtronic and current Harvard Business School Professor, has meditated since 1974 and now counts mindfulness as a key element to business leadership.  The emerging generation of lawyers expect that their employers will seek to help them maintain a work/life balance, and value the accommodations that can be made in the workplace to help manage stress load.

There is no honor in being stressed out.  There is only poor health and mental diminishment that can lead to broken relationships, broken careers, and broken lives.  Self-care is not a sign of weakness.  Stressed out people are simply less able to be fully available to the people they serve, and in any profession with fiduciary responsibilities, like the practice of the law, you can’t afford to allow a high stress load to impair your judgment.  Taking care of yourself is the same as taking care of your clients.  Self-care is a sign of commitment to the highest standards of ethical practice.

 

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