Volume 19, Number 1
January/February 2002

GPSolo proudly presents a standing column, "In the Solution," focusing upon lawyers’ experiences with substance abuse, mental health, stress, and quality of-life issues. For more information, please call the ABA Commission on Lawyer Assistance Programs at 312/988-5359.

In the Solution

Take Time to Care

By Charles L. Hinton III

The practice of law has always been stressful to lawyers and staff. It was suggested years ago that we did not invent stress but we improved upon it. Now, the events of September 11 have traumatized all of us. We have seen the airplanes fly into the World Trade Center towers over and over again on television. We have witnessed first- and second-hand the desperate occupants of the Trade Center towers leaping to their deaths. We have gasped in horror at the collapse of first one, then the other of the towers. The shock and horrors, the full depth of the tragedy, have rolled over us much like the cloud of dust and debris rolled down the streets of New York City. Stress, post-traumatic stress disorder, and depression cannot be far behind.

It is estimated that millions of Americans will need treatment for psychological wounds suffered on September 11. The Wall Street Journal on October 12 reported in its "Health Journal" column that pharmacies across America during the two weeks following the attacks filled nearly 1.9 million new prescriptions for antidepressants, including Zoloft, Paxil, Celexa, and Prozac—an increase of 16 percent over the same period last year. Anxiety medications and sleeping aids increased by more than 2 million new prescriptions, a 7 percent increase.

So what are all of us to do? First and foremost, we need to educate ourselves and others as to just what these illnesses—stress, post-traumatic stress disorder, and depression—really are.

Stress is a physical response to an undesirable situation(s). It can be caused by life events both big and small, such as annoyances, being stalled in traffic, family problems, and work responsibilities. Stress can be short term (acute) or long term (chronic). Reactions to immediate threats, real or perceived, lead to acute stress. Everyday life with pressures that feel unrelenting can cause chronic stress.

How we cope during a stressful event and the choices we make based on it can minimize or avoid stress and its effects. When our coping is ineffective, a physical stress response occurs within the body. Adrenaline is released. The heart beats faster, breath quickens, and blood pressure goes up. Blood sugar increases, and blood flow is increased in our large muscles and brain. We prepare for fight or flight.

When the threat passes, the body relaxes; heart rate and breathing slow, blood pressure and sugar levels drop. The body can handle occasional episodes like this, but repeated alerts lead to chronic stress and trouble. You have had too much stress when the following signs appear:

• Irritability.

• Sleep problems—sleeping all the time, insomnia, or repeated wakenings.

• Lack of joy.

• Changes in eating habits, either too much or too little.

• Strained relationships, no longer getting along with family or friends.

Too much stress can appear as illness and/or fatigue. It can damage your immune system and lead to cardiovascular disease, depression, and other illnesses.

Post-traumatic stress disorder (PTSD) starts with an acute stress reaction from living through or witnessing a life-threatening or emotionally devastating event. It is important to understand that PTSD is a real illness that can become chronic and life shattering. For most people, PTSD starts within three months of the terrible event, although others may show no effects until years later.

If you have PTSD, you may have frequent nightmares or recurring thoughts about the terrible experience or event, and you may try to stay removed from anything that reminds you of it. You may feel angry and unable to trust or care about others. You may become hypervigilant, constantly looking over your shoulder for danger. Sudden, unexpected events may anger or upset you disproportionately.

Depression, the "invisible disease," is a serious medical illness different from normal emotions such as sadness, loss, or "the blues" that often pass with time. Clinical (unipolar) depression is persistent, pervasive, and can interfere significantly with an individual’s ability to function in social, family, and work settings.

The American Psychiatric Association’s diagnostic criteria for clinical depression, listed in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., include the following:

• Depressed mood with overwhelming feelings of sadness and grief.

• Loss of interest and pleasure in activities formerly enjoyed.

• Insomnia, early-morning waking, or oversleeping nearly every day.

• Decreased energy; fatigue.

• Noticeable changes in appetite and weight (loss or gain).

• Inability to concentrate or think; indecisiveness.

• Physical symptoms of restlessness or being slowed down.

• Feelings of inappropriate guilt, worthlessness, and helplessness.

• Recurrent thoughts of death and suicide; suicide attempts.

These symptoms are pervasive and seem to be present "most of the day" or "nearly every day."

Episodes of major depression can be mild or severe. They often recur. Depression can devastate all areas of a person’s life, including family relationships, friendships, and work or school productivity. Unfortunately, many people still believe that symptoms of depression are not real, that they can be "shaken off" or willed away if only the person tries harder. People with depression may not recognize the symptoms of a treatable disorder or not seek treatment because of feelings of shame or stigma. Sadly, untreated or inadequately treated depression can lead to suicide or to a lifetime lived in despair.

The National Institute of Mental Health (NIMH) has published the following facts about depression:

• Depression affects nearly 10 percent of adult Americans ages 18 and older.

• Unipolar major depression is the leading cause of disability in the United States and worldwide.

• Nearly twice as many women (12 percent) as men (7 percent) are affected by depressive illnesses each year.

• Eighty-five percent of people with depressive illness significantly improve with treatment.

• Only one in three people with depressive illness seeks treatment.

These facts point out the tragedy of untreated unipolar, major depression. Effective treatments are available today for depressive illnesses, ranging from antidepressant medications and psychotherapy to electroconvulsive therapy. Most often, a combination of therapies is used.

What can you do if you recognize the symptoms in partners, associates, coworkers, or staff? Keep in mind that we are not called on to be therapists or doctors but simply to identify the symptoms. Often, people dealing with these illnesses no longer have the stamina or ability to recognize symptoms or locate treatment resources. They need help seeking help.

If a friend or coworker exhibits symptoms of stress, PTSD, or depression for a period of several weeks or more, take a proactive approach. Talk with the person and suggest he see a mental health professional. Do not accept the proverbial "I’m fine" response to your inquiry about how he is. Make time, take time to talk. Let him know you care. Be patient and persistent. Be informed. Help them get help.

Charles L. Hinton III is a sole practitioner in Raleigh, North Carolina. He is a member and past chair of the North Carolina Bar Association’s Lawyer Effectiveness & Quality of Life Committee and co-director of the North Carolina Depressive & Manic-Depressive Association.

The author of this article has granted permission for reproduction of the text of this article for classroom use in an institution of higher learning and for use by not-for-profit organizations, provided that such use is for informational, non-commercial purposes only and any reproduction of the article or portion thereof acknowledges original publication in this issue of GPSolo, citing volume, issue, and date, and includes the title of the article, the name of the author, and the legend "Reprinted by permission of the American Bar Association."

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