Shedding the Stigma of Mental illness
Vol. 43 No. 8
By Sherry Karabin
SHERRY KARABIN is a freelance reporter and writer in New York City.
Two years ago, Whittier Law School student Rick Ma began experiencing severe episodes of anxiety and depression. At the time, he was in his second semester in law school and serving as the American Bar Association’s acting Ninth Circuit governor for the Law Student Division.
“The biggest problem I was having was that when I went to law school I was surrounded by people who I thought were just as smart, if not smarter than me,” Ma said. “In college, I felt like I was the big fish in a little pond, but in law school, I had become the little fish in a big ocean.”
“MY MIND JUST SNAPPED”
Ma recalled feeling overwhelmed all the time: “I was mad at myself that I would not be the very best that I could be.”
It all came to a head in the middle of an ABA conference in 2013.
“My mind kind of just snapped,” Ma said. “It was a very dark period but thankfully I realized I had a lot of people around me who could help me.”
He enlisted the help of ABA student groups, spoke to Nancy Stek, associate director of the New Jersey Lawyers Assistance Program, and had a heart-to-heart talk with his parents for the first time in his life.
“My father went to law school and he told me that what I was going through was normal,” Ma said.
Now a 3L, Ma is back on track and armed with coping mechanisms to handle the tough moments that inevitably arise. “It feels easier, but when it is too much I remind myself that the work will always be here tomorrow but my health might not,” he said. “Sometimes I take a day or two off to do what I want to do instead of what I have to do.”
He also accepted an offer to become the ABA Law Student Division Mental Health Initiative project director. The initiative helps raise awareness about mental health and substance abuse issues among students and provides resources to help students take control of their well-being. The Law Student Division designated March 27 as the official National Mental Health Day at law schools across the country.
“Mental health issues are very common and we want to let students know that they are not alone and there are resources out there,” Ma said.
Indeed the statistics paint a very dark picture. According to the nonprofit Dave Nee Foundation, while students have a psychological profile similar to the general population prior to law school, there is a lot of dysfunction after the fact.
Statistics compiled by the foundation, which works to eliminate the stigma attached to depression and suicide, show depression rates at 8–9 percent prior to starting school, 27 percent after the first semester, 34 percent after two semesters, and 40 percent after three years (http://www.daveneefoundation.org/scholarship/lawyers-and-depression/).
According to the organization, stress among law students is 96 percent compared to 70 percent for those in medical school. In addition, the organization notes lawyers rank fifth in incidence of suicide by occupation.
A study by University of Washington Affiliate Professor of Law G. Andrew H. Benjamin reports similar findings, with law student depression rates about the same as the general public’s prior to matriculation and about 40 percent by the third year. Benjamin said alcohol and drug abuse rates also go up and these problems often endure long past graduation. In fact, one third of actively practicing lawyers suffer from depression, alcoholism, or both, he added.
A 1990 study by Johns Hopkins University found that among more than 100 occupations, lawyers had the highest incidence of depression.
No one has to tell former North Carolina attorney Brian Clarke about the dangers of depression and suicide. Now an assistant professor of law at Charlotte School of Law in North Carolina, Clarke was diagnosed with severe clinical depression in late 2005.
“The first time I ever sought professional help was during my second semester in law school, but in reality I think my first depressive episode happened in college,” Clarke said. “In law school, I was suffering from constant anxiety and stress. I started seeing a psychologist who told me my feelings were fairly normal given all that was on my plate.”
When he first started practicing, he said things were going smoothly despite the long hours as a litigator. But after the birth of his first child he began having work-life balance issues, he said, adding that pressures got much worse after child number two arrived in 2004.
“I wanted to be the perfect lawyer, husband, and father,” Clarke said. “No matter what I did, I felt overwhelmed and guilty. If I spent time with my family, I felt badly about not being in the office and vice versa.”
“I was always anxious and terrified of making a mistake or letting someone down. I didn’t know how to deal with this, so I tried to ignore it. Eventually, I started doing things that were out of character like not returning phone calls or emails,” he said. “One day I told my wife I was not sure I could do this anymore. She asked what I meant, and I told her ‘life.’ I was very close to taking my own life at that point.”
After therapy and medication, Clarke changed firms and, eventually, discovered his true calling, teaching.
“The legal profession can be very unforgiving,” he said. “The adversarial nature of the work together with the need to keep so many balls in the air and the inability to unplug can take a toll on a person.”
Today Clarke shares his experiences with his law students to decrease the stigma associated with depression and anxiety, encouraging potential sufferers to get help.
“I tell my first-year students in my civil procedure class about what happened to me and I try to offer them tips to avoid the same path,” Clarke said. “I tell them to make intentional choices based on the type of life they want to live, weighing the benefits of a small firm or a government job versus the high-pressure brass ring of partnership in a big firm.”
There are a host of organizations that offer assistance to those in the legal profession who struggle with mental health and/or substance abuse issues.
“Often, the first line of resources is at the law school level,” said Denise Golonka, a member of the ABA Commission on Lawyer Assistance Programs Law School Outreach Committee and clinical manager at the New Jersey Lawyers Assistance Program. “The dean of students is one of the best initial resources. The deans can help in very practical ways by guiding students to the best resources on campus and handling issues related to the classes themselves.”
In many cases, students will be referred to lawyer assistance programs (LAPs). Run by local bar associations, these programs provide confidential counseling and referral services to students, attorneys, judges, and their families with emotional or behavioral issues, substance abuse, addictions, or other personal concerns.
Eileen Travis, director of the New York City Bar Lawyer Assistance Program, said stress is one of the major reasons she receives calls.
“Some students feel overwhelmed by the many responsibilities required in law school,” Travis said. “Some self-medicate with alcohol and drugs, some use drugs like Adderall to enhance their ability to study.”
In addition to supportive counseling and referrals, she said LAP offers a monitoring program “for law students with a history of alcohol, drug, mental health, and legal problems that they will be asked to disclose on their applications for admission to the bar. Monitoring assists them in establishing a plan of action to remedy these problems.”
Travis said many lawyer assistance programs send lawyer volunteers to the law schools and schools also have student LAP representatives and mentoring groups known as Students Helping Students.
The Kentucky Lawyer Assistance Program (KYLAP) sends representatives to the three law schools in the state to make presentations to all of the classes, informing students of its services and encouraging them to reach out for help.
“There is a lot of pressure on law students to do well,” said Yvette Hourigan, director of KYLAP. “Many of these students are type A perfectionists and they get into law school and find 149 other perfectionists sitting next to them. It can be a very lonely time and a different dynamic than what they are used to.”
A recovering alcoholic and lawyer, Hourigan makes it a point to share her story with students. “I went through a big depression in law school, only I did not know that was what was happening,” she said. “It is very important that we lift this taboo, especially here in the South where these kind of issues may be more likely to be seen as moral failures.”
Hourigan said she often works closely with the Dave Nee Foundation. The foundation was created in 2006 in the wake of the suicide of Dave Nee, a graduate of Fordham University School of Law who was studying for his bar exams.
“There is a negative perception that people who seek help can’t hack it on their own,” said Katherine Bender, PhD, a national certified counselor and programming director for the Dave Nee Foundation. “Contributing to the problem is the fact that to be admitted to the bar, some states require students to answer questions about whether they have ever sought mental treatments. The fear of not being admitted to the bar after shelling out so much money for law school definitely keeps people from getting help.”
Bender runs the Uncommon Counsel program, which puts on events at law schools across the country.
“We are trying to encourage a more collaborative environment at law schools and remind students that their worth is not only based on a grade,” she said.
LAW SCHOOLS TAKE ACTION
Touro College Jacob D. Fuchsberg Law Center in Long Island, New York, was among the first schools to comprehensively address student mental health and substance abuse issues. In the fall of 2010, the institution began its Students Helping Students program, with upper- level students lending an ear and their time to those with concerns.
“In the fall semester, we have a one-hour workshop that is mandatory for all first-year students,” said Marie Fuzia, director of student services and scholarship aid. “During the workshop a LAP representative from the New York City Bar Association comes in to discuss stress management.”
There is a trained student LAP representative on campus to help. In addition, there is an on-campus counselor in residence available to meet with students free of charge, even at locations outside the school.
Yoga and meditation classes are offered throughout the year. Additionally, at press time, the Student Bar Association was preparing to host a week of events to address mental health issues on campus in March, including a program titled “A Conversation About Health and Wellness in the Legal Profession.”
Fuzia said the school has set up several web pages to give students and faculty information about mental health and substance abuse issues. “Students Helping Students has two pages, one for the program and one that can viewed by anyone on campus,” she said.
Touro Law Professor Marjorie Silver also set up a dedicated page for faculty and administrators to share resources related to wellness.
“I have a history of major episodic clinical depression,” Silver said. “I have done a lot of outreach to help reduce the stigma and shame surrounding mental illness. I have been working to make Touro an institution that minimizes the anxiety and depression that students experience.”
She said she starts each class with two minutes of “mindfulness meditation,” where she invites students to focus on their breathing.
Tal Stanecky became a student LAP representative at Touro in September 2014.
“I got my undergraduate degree in psychology and was working at a private mental health institution in Maryland before law school, so when the opportunity to volunteer came about I wanted to do so,” said Stanecky, who is an evening student.“I, myself, barely got through the first year in law school because of stress and burn-out issues,” he said. “I had family and friends to turn to though. What I learned is that it’s important to take time off. If someone asks you to go out for a drink, you should go.”
As a student LAP representative, he works to maintain the anonymity of those who contact him, while giving them coping tools and resources where they can go for help. “Law students are better thinkers than feelers,” he said. “I try to give them an introspective view on themselves.”
In 2014, University of Washington School of Law rolled out a peer counseling program implemented by G. Andrew H. Benjamin, affiliate professor of law.
“Many law schools have been slow to adopt peer counseling,” said Benjamin, who also serves as clinical professor of psychology at the Seattle-based University of Washington.
“The program is a way to encourage more students to get help,” said Benjamin. “Law students tend to isolate when they have problems, which exacerbates their psychological condition. Many might not be comfortable speaking with a school official but might seek help from a peer.”
“Much of what we do is about listening,” said James Feldman, peer counselor and 2L at the University of Washington School of Law. “I try to help students identify choices based on their own values as opposed to telling them what to do.”
Feldman said some of the more common reasons students have enlisted his help are stress and anxiety related to exams, employment concerns, personal issues, and substance abuse.
“I think having a sounding board can be very therapeutic. If a situation arises that is more serious, I refer them to a licensed psychologist, he added.
“Being a counselor helps me keep things in perspective.”
David Jaffe, associate dean of student affairs at American University Washington College of Law, said tackling mental health and substance abuse problems begins on day one at the school’s orientation.
“I try to impart the excitement about starting law school, while making students aware of some of the potential negatives,” said Jaffe. “We have lawyer assistance programs, which exist throughout the country and are free and confidential for law students. Representatives visit our ethics classes each spring semester and meet with students to talk about the signs and services available for depression and substance abuse.”
Throughout the year, students are invited to participate in regular yoga and meditation classes on campus. In addition, there is an annual “puppies in the lobby day,” whereby the local shelter brings over the dogs so the students can spend time with them as one way of de-stressing prior to final exams.
“Schools can be doing more to monitor attendance practices,” said Jaffe, cochair of the ABA Commission on Lawyer Assistance Programs Law School Assistance Committee. “If a student is sequentially or periodically absent, it should be brought to the attention of an administrator, who can follow up in confidence to see if there is an underlying issue.”
“We are asking our faculty to let the dean’s office know if a student is missing,” he added.
A counselor is available three days a week at the law school. Several years ago, the school started a voluntary peer-to-peer program, where students who fought off their own problems work with others outside the purview of the school. “In this way, a student who is not ready to confide in a law school official still has a resource nearby,” he said.
Harvard Law School has several offerings in place to reduce stress and improve student health.
“At the beginning of the school year, we have a wellness fair where we invite educators from the university and the community to come in and provide resources to students,” said Lakshmi Clark, assistant director of student services at Harvard Law School.
Throughout the year, the school offers stress-break workshops and during final exams students can take advantage of free chair massages.
“The top reasons that students seek treatment are due to their feelings of anxiety, feeling depressed, or [being]worried about their relationship or marriage,” said Mary Henein, Psy D and post-doctoral fellow at Whittier College and Whittier Law School. “The law school students are also more likely to have substance abuse issues than the regular college population. The top concern they have is that everything about their treatment be kept confidential.”
Henein said she offers short-term therapy designed to relieve stress, decrease anxiety and depression, and allows students to gain clarity about their goals and relationships. Most often, the symptoms are alleviated in six to ten sessions. If concerns persist, she said she refers the student to off-campus, low-cost counseling or psychiatric services.
In the fall of 2014, Whittier Law School introduced “The Legal Mind” course, which is a requirement for all 1Ls. The course covers topics like critical thinking, logical reasoning, self-evaluation, mindfulness, and emotional intelligence, as well as having meditation exercises.
“We want to address the fact that law school is stressful and that as much as students need to memorize doctrine, they also need to learn and practice skills to help them manage stress,” said Martin Pritikin, law professor and associate dean of the law school, who teaches the course with three other professors.
During the course, students are introduced to the campus counselor who is available once a week.
“For many years, law schools did not address the stress component. We are looking to take a more holistic approach,” said Pritikin.
Katherine Bender, PhD, a national certified counselor and programming director for the Dave Nee Foundation, explained there are a number of warning signs that students may be experiencing depression or anxiety. These range from problems falling/staying asleep or sleeping all the time to eating too little or too much as well as feeling sad for no apparent reason or becoming euphoric for a few days and then becoming extremely sad.
“Generally, we want to be able to experience a range of emotions and not get stuck in any one emotion,” said Bender. “We want to be able to identify how we feel, express it, and let it go.”
She said the symptoms that may be associated with anxiety include frequent headaches, jaw clenching, rapid heartbeat, tightness in the chest, sweaty palms, and difficultly concentrating.
“What I try to emphasize with students is that if there is a noticeable change in their own or in a classmate’s behavior, then it is a sign to intervene,” Bender said. For example, if someone who is usually early for class and well-dressed begins to come in during the middle of class with poor hygiene or drops out of a study group and begins to isolate, these could be flags that something is wrong, she said.
Bender recommended students track the signs and symptoms in the same way that they would monitor a physical illness, paying attention to the frequency, intensity, and duration. LawLifeline (http://lawlifeline.org) lets students take an anonymous self-assessment of their conditions.
While students are not therapists, she said they are in a position to recognize when a classmate might need help. If a student has concerns about someone, there are several options available: Contact the dean of students or someone in the student affairs office of the law school, a peer mentor if the school has them, or a lawyer assistance program.
The student can also approach the person, focusing only on the behaviors that triggered the concern, she said. If the student has been repeatedly late to class, for instance, Bender suggested a statement like this one: “I noticed that in the last two weeks you have been late to class and you are usually the first one there. Are you ok?”
Although expressing concern is key, it’s important not to sound judgmental, she said. Students should consider a statement like “I am worried about these behaviors because they are so out of character, would you consider talking to someone?” as to opposed to “What’s wrong with you? You are acting weird,” she said.
“If we can keep in mind that it is about safety and wellness and not about punishment and judgment, I think the process for assisting our law students would be a smooth one,” Bender said.
Counseling services on campus (often free)
State lawyer assistance programs (also often free)
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