Supporting Loved Ones with Depression

Supporting Loved Ones with Depression

Canadian lawyers and articling students face significantly high rates of depression. According to the National Study on Psychological Health Determinants of Legal Professionals in Canada, while about 15% of Canadians are affected by major depressive disorder, the rate for Canadian lawyers is 28.6%. Even scarier, the rate for articling students is 43.6%, and 49.8% of Canadian articling students who participated in the National Study reported that they had been diagnosed with a mental health issue since commencing practice (page 178.)

Many depressed individuals try to hide their depression from people close to them or they downplay the extent of their despair. They do this for a myriad of reasons, but stigma is often at the heart—they fear being judged or viewed as “lesser than.” Stigma about mental health issues runs rampant in our profession.

It can be difficult for a depressed person to explain what they are feeling. If you break a bone or your appendix ruptures, everyone understands the biological issue (to a point) and a medical treatment like resetting a fracture or emergency surgery. Treatment and prognosis aren’t always as clear-cut with depression and other mental health conditions. There are treatment-resistant forms of depression, and often different modalities are deployed to treat depression: medication, cognitive behavioural therapy, and lifestyle changes, to name a few.

Given the prevalence of depression in our profession, I would like to talk about how we, as a profession, can inform ourselves both about depression and providing support to individuals experiencing depression.

We all learn in different ways. I first thought about this when my oldest child entered kindergarten. Among the many documents that parents were required to complete was a profile about our child, and one of the questions stumped me. It asked whether my child was a visual, auditory, or kinesthetic learner. I knew what those words each meant, but I didn’t understand the role that different learning styles could play or how I could possibly know.

I learned the hard way. As a visual learner, I thrived in elementary school and with the “whole language” model that has been the dominant reading model in our province for many years. My oldest child was very bright, but his reading was slow and laborious. To make a long story short, he was an auditory learner, and he had to sound out D-O-G on each page of a book to realize what sound it made. It didn’t help that my second child, twenty months younger, was a strong visual learner and could read and spell ahead of his brother. We discovered that he needed support for his auditory learning style and he caught on quickly, although things like punctuation and capital letters were meaningless to him for many years. One helpful teacher who noticed that his writing style was conversational and informal suggested that he listen to speeches by orators so he could internalize a more formal style of language—very helpful. So sidebar: do not despair if your child has a different learning style. My oldest child has three university degrees and is completing his medical residency next year.

And I had to adjust my mindset—we don’t all take in information on a written page the same way.

For all the auditory learners, check out the many podcasts about depression and related topics. I can’t comment on the quality of these podcasts because I need to take notes when taking in auditory information, but they can be great on a long car ride, something my auditory son and I do when travelling together.

I don’t know whether we have many kinesthetic learners in law unless they have learned adaptive strategies to take in information visually or auditorily. Kinesthetic learning involves physical interaction with learning materials: people who would take apart a clock and reassemble it to learn how it works, for example. If you are a lawyer or student whose learning style is kinesthetic, please let me know!

For visual learners and all learners who have adapted to reading as a source of information, may I recommend the following overviews?

• “What is depression and how is it treated?”
• Depression: An Information Guide

As lawyers, we are used to absorbing fact-based material like case reports. But sometimes, when we want to learn about something non-law related, we prefer material that we can engage with emotionally, regardless of our learning style. The most impactful article I have read about depression and trying to help someone with depression appeared in the New York Times last month, circulated by the Centre for Suicide Prevention (which has excellent resources and education campaign materials.)

This article, by David Brooks, provides insight both intellectually and emotionally about understanding a depressed person and how to, and how not to, provide support when a friend encounters treatment-resistant depression.
 
This is a story of friendship between two boys maturing into adults who are close friends. In spite of being successful by most of society’s benchmarks, the friend descends into a crushing depression. Please don’t read this article if this may trigger unpleasant thoughts or memories—or be ready to call Assists 24/ crisis line (1-877-498-6898 for support). But if you want to read some of the most poignant descriptions of what depression does to a person and strategies that may help you feel that you did everything you could to show your love and friendship, even when depression becomes terminal, this is one of the best articles I have encountered.

Peter was an ophthalmologist, married with two sons and many friends. He received all manner of clinical interventions, but he lost his battle with depression and ended his life. He was not able to “snap out of it” and he was not “weak” or to blame. We can all learn about how depression warps a person’s psyche, and we can share this story with our peers who suggest that people with depression are malingerers or not trying hard enough.

This is important for us as lawyers because not only do we have high rates of distress, but we also believe that others in our profession have negative perceptions about people with mental health issues. The National Study researchers asked study participants what they believe about four statements about mental health personally along with what they believe people in our profession think. I prepared the chart below as an illustration of perceived stigma—the gap between what we think and what we think our peers and colleagues think (any errors in this chart or the one above are mine and not the study authors):

 
If I can paraphrase these data, many of us have progressive views about mental illness, with only small percentages of survey participants expressing the belief that people with mental health issues could snap out of it if they wanted to and that mental health issues are a sign of weakness, for example. But we tend to believe that others in our milieu have much harsher views of how mental health issues work with close to half believing that their peers think people could just “snap out of” mental health issues and more than half believing that their peers believe mental health issues are a sign of weakness.

The gap between individual’s views of mental health challenges and their perceptions of how their colleagues view mental health challenges allows stigma to flourish.  And there is clearly work for us to do continue to educate our profession—including how we characterize individuals exhibiting sings of mental illness, both lawyers and others caught up in the justice system. Lawyers have our own stye of dark humour where we make light of things that are frightening, and mental illness certainly falls into this category. But when we make jokes about the suffering of others, we contribute to the myth that many lawyers associate blame and weakness with mental health challenges.

A shockingly high percentage of lawyers and articling students who participated in the National Study reported suicidal ideation since beginning their legal careers: at over 24% for lawyers and 19% of articling students who have only been our profession a short time, it is more than double the rate of suicidal ideation reported in the ground-breaking American Bar Association study (11.5%). Suicidal ideation can be passive (things would be better if I weren’t here) or active, and these studies do not differentiate on this basis, but the reported rate of suicidal ideation is a cry for help which we must also respond to.

And if you encounter someone sharing inaccurate myths about depression, please suggest that they read Mr. Brooks’ piece as well. Help us counter stigma in the legal profession by increasing our profession’s knowledge and sensitivity. And call Assist if you, or someone close to you, needs help.

If you are concerned about someone in your life who appears to be depressed and want to be able to provide support, you can meet with a professional counsellor through Assist’s program at 1-877-498-6898, with 24/7 crisis counselling where necessary. You can develop your skills at communicating with a depressed person and how to encourage them to reach out for help themselves. We provide Psychological First Aid training regularly, which is probably particularly helpful for auditory learners, and we have a small online course on our website called “How to Help Someone”. Our course presents information visually, but maybe we can turn it into a podcast to make it more accessible. Please let me know if you are interested in helping us with a little project.

There is no shame in being depressed or knowing someone who is depressed. Depression is a medical condition that can affect anyone, anywhere, anytime. Let’s commit to learning more about depression and providing support to those in our profession who encounter it.

Loraine