Mental Health for Lawyers: The Paradigm Must Shift

Attorneys report high rates of depression and suicidal ideology. How high? Take this quiz:

1. True or false: The legal profession has the highest incidence of depression.
   
   True. According to studies, at least 20 percent of legal professionals experience depression. A new study published by Yale Law School shows lower rates, but the study requires further evaluation as it seems to have some potential flaws and is an outlier among many studies that show otherwise.
2. Which profession has the highest rate of suicide: legal, dentistry, or medicine?
   
   Legal. Suicide is the third-leading cause of death for lawyers after cancer and heart disease.
3. What percent of all U.S. lawyers suffer from alcoholism or substance abuse according to the ABA: 5–10 percent, 15–20 percent, or 25–50 percent?
   
   15–20 percent. Some studies show the numbers to be even higher. The younger the lawyer, the greater the risk of problem drinking. Thus, the joke: Once you pass the bar, you never have to pass another.
4. True or false: Lawyers are about three times more likely to suffer from depression than the average U.S. adult.
   
   True. Rates are generally reported to be at least 28 percent. According to a 1990 study at John Hopkins University, attorneys suffer high rates throughout their careers, although the rate does drop for lawyers over 60.
5. True or false: Lawyers worry about a stigma in seeking mental health treatment.
   
   True. The stigma is personal to individual lawyers and systemic to law firms and other legal institutions. It even pervades law schools.

The State of Mental Health in the Law

The study and practice of law engender stress, anxiety, and depression, which all too often result in suicide or suicidal thoughts. According to a 2006 study by the Canadian Bar Association, suicide represents the third-leading cause of death among lawyers. These statistics hold true in the United States, Canada, Australia, and the United Kingdom. A study released in 2021 by the International Bar Association (IBA) showed a similar situation worldwide. The problem does not link to any regional circumstances but seems endemic to the profession of law and perhaps the profile of those drawn to the profession.

Studies of law students reflect an 8–9 percent rate of depression prior to entering law school, 27 percent after one semester, 34 percent after two semesters, and a whopping 40 percent after three years. As a profession, medicine also offers stress. Some 70 percent of medical students and 43 percent of graduate students report feeling stress. The numbers jump to 96 percent for law students. Interestingly, for older, more experienced attorneys ages 35 to 39, the well-being score rises from 50 percent to 64 percent for ages 60 and above.

Law students have their own distinct problems. The stress of the workload, the competition, and the uncertainty of future success engender mental health issues. A study on the well-being of law students published in 2016 found that 25 percent of law students were at risk for alcoholism, 17 percent suffered from depression, 37 percent reported mild to severe anxiety, and 6 percent reported suicidal thoughts during the previous year. Differences in study protocols result in different numbers, but the severity of the problem persists.

Law school does not adequately prepare students to manage all the demands of practicing law. Nor does it equip students with skills of self-care and resilience to enable them to deal with the emotional stress and trauma that often accompany working with clients. A law professor I spoke to (who wishes to remain anonymous) said, “We eat our young.”

The Vulnerability of Lawyers

The fact that manifestations of depression occur consistently worldwide raises the possibility that the type of person drawn to the law comes with a high level of vulnerability to depression, anxiety, and stress.

The stereotype (not universally true, but not too far off in many cases) of lawyers as arrogant, combative, greedy, intimidating, devious, dishonest, manipulative, aggressive, and combative contributes to the stress of practicing law. Lawyers tend to have certain personality traits such as self-reliance, ambition, perfectionism, and competitiveness. These traits do not necessarily coexist well with the healthy coping skills and emotional elasticity normally necessary to withstand the pressures of a law career. They can exacerbate problems and create a climate for depression. They can also interfere with acknowledging the possibility of an issue. According to research, lawyers generally have low interest in emotional concerns and interpersonal matters and tend to prefer to “think” rather than to “feel.” The training lawyers receive endorses and encourages this by over-valuing rationality and objectivity. A highly skilled attorney, used to being in control, may feel that admitting depression or addiction will jeopardize his or her reputation. As a result, the attorney may ignore the symptoms and deny the problem. Problems often do not get recognized until the attorney faces disciplinary action. Many ethics violations result from depression as lawyers must provide competent representation, which includes not only legal knowledge, skill, and thoroughness but also action with reasonable diligence and promptness. Because depression overwhelms a person’s functionality, the depressed attorney may not comply with these requirements. Depression can also result in absenteeism, decreased productivity, lack of cooperation with colleagues, disruptive behavior, and substance abuse.

The successful attorney often finds the very traits that contribute to success in law prove counterproductive in personal relationships. Lawyers want to be right and win. That is, after all, their job. Terrence Real, a noted couple’s counselor and author, ranks the need to be right as number one of the five “losing strategies” in an intimate relationship. Lawyers have also reported feeling inadequate and inferior in personal relationships as well as experiencing anxiety and social alienation more than the general public.

The Stress of Practicing Law

The daily reality of the business of being a lawyer includes keeping up with tasks and deadlines in multiple cases, finding clients, tracking and billing time, collecting money, and paying staff and office expenses. Collectively, these tasks can overwhelm or frighten the perfectionist who has no preparation to deal with such matters. Law school trains lawyers but does not teach them about the business of law or how to successfully manage a business.

In the IBA study noted above, respondents reported they experienced the following regularly or most of the time: 70 percent, competing demands; 63 percent, long hours; 61 percent, unrealistic time pressures; 60 percent, inability to take breaks; 56 percent, target pressure; 55 percent, task neglect; 50 percent, workload control; 45 percent, lack of feedback; 35 percent, lack of support; 34 percent, lack of objective clarity; 26 percent, unclear expectations; 11 percent, harassment and/or bullying. In a survey in North Carolina, more than 25 percent of lawyers reported experiencing physical symptoms of extreme anxiety at least three times per month, and 37 percent suffered from depression.

Losing a case presents a veritable minefield of dangers. Attorneys must contend with the emotions and responses of clients, risk getting emotionally involved in outcomes, and feel that they have let the client down. Afterward, many attorneys relive the case, second-guessing their decisions at the time, which raises the stress of future cases. Fear of failure or of making mistakes results in increased stress hormones that can alter brain chemistry and lead to depression.

The stakes for lawyers to be successful are high—for both the attorney and the client. The lawyer works under constant scrutiny amid the critical eye of the courts, opposing counsel, and clients in an inherently adversarial, combative, and conflict-driven environment.

The IBA study reports that one in ten lawyers under the age of 30 experiences suicidal thoughts as a result of work. Young lawyers in big firms often work 60 or more hours per week in a very competitive atmosphere, which can result in tremendous stress and anxiety. The IBA study cited stress and pressure as having the most negative impact on lawyers, followed by workload, work culture and environment, and, particularly for young lawyers, work-life balance.

Although law firms are themselves businesses, sometimes very big businesses, the attorneys who run law firms (large or small) often lack extensive business experience or training. Firms generally equate success with income and quantify and measure productivity and a person’s worth to the company by numbers: number of clients, number of billed hours, number of hours worked, etc. Numbers are unforgiving and apt to create stress.

Many have suggested that the increased number of lawyers has led to more competition and diminished collegiality and positive personal relationships with other lawyers. Technology, which contributes to ease of work in some areas, increases the time pressure of many tasks. The proliferation of new laws has made the law increasingly complex. It can be difficult to understand what a law actually means and how to advise clients.

Depression, Anxiety, and Suicidality

Men, particularly younger men, report higher depression levels than women. Women, however, report more anxiety and stress. The ABA reported that the pandemic increased anxiety and stress dramatically among women lawyers and lawyers of color. Women who live with dependent children had to assume additional childcare responsibilities. Lawyers of color reported that they found it more difficult to keep home and work separate.

“Depression” in the context of mental health considerations does not mean occasionally “feeling down.” While sadness and grief over loss can lead to depression, they do not, in themselves, constitute depression. Depression in this context means chronic and persistent sadness and anxiety. Depressed people often feel hopeless and pessimistic. They also often feel guilt, worthlessness, and helplessness, with a loss of interest and pleasure in ordinary activities. Depression often results in withdrawal from family and friends. It can present as sleeping and eating disturbances accompanied by decreased energy and feelings of restlessness or irritability. It can include increased alcohol consumption or substance abuse. After one episode of depression, 50 percent of people are more likely to experience a second bout. An 80 percent chance of recurrence and chronic depression follows the second episode.

Attorneys report experiencing high levels of fatigue, disrupted sleep, anxiety, emotional upset, depressed thoughts, poor physical health, family and social issues, suicidal thoughts, and self-harm—all of which contribute to depression and can set the stage for suicidality.

In 2014, CNN aired a report called Why Are Lawyers Killing Themselves? In it, Yvette Hourigan of the Kentucky Lawyer Assistance Program said, “Being a physician has stress. However, when the surgeon goes into the surgical site to perform his surgery, they don’t send another physician in to try to kill the patient.” Being an attorney in many if not most cases requires the lawyer to take an adversarial position and hold it against those who try to overcome it for the benefit of their own clients.

As noted above, suicide represents the third-most common cause of death in attorneys, following cancer and heart disease. For every successful suicide, some 25 people try and fail. Often, attempts get treated as accidents and are not recognized as suicide attempts. This prevents interventions that could save a life. The common myth that people who talk about suicide don’t attempt it has proven categorically untrue. We should always take talk about self-harm seriously. The symptoms of suicidality look similar to the symptoms of depression with a few additions such as reckless or risky behavior, rage or uncontrolled anger, feeling trapped in hopelessness, and talk about having no reason for living.

A 2016 study of attorneys by the Hazelden Betty Ford Foundation and the American Bar Association found 11.5 percent of study participants reported suicidal thoughts, 2.9 percent reported self-injurious behavior, and 0.7 percent reported at least one suicide attempt. Another study by the National Institute of Mental Health in 2019 puts the suicide rate for lawyers at 66 suicides per 100,000 deaths. This means attorneys are five times more likely to die by suicide than the general population.

The fear of admitting that they need help starts early in the career of young lawyers. The application process to take the bar includes the character and fitness test that can, according to lawyer Brian Cuban on Clio’s Matters podcast, ask about substance abuse and mental illness. The applicant may see the message as “If I ever need or get treatment, I will have to disclose it, and it will ruin my career.” While generally untrue, the fear often persists. The culture of law firms and other legal institutions does little to dispel such fears.

The focus on the importance of numbers impacts the willingness of law firms to address depression because treatment can mean less time at work and loss of billable hours. Most law firms take a position of denial of mental health issues among their attorneys: Just quit drinking! Quit whining! Work harder! Attorneys buy into this and fear appearing to be weak, a failure, or even crazy, so they deny the problem and often don’t seek help until an outside force such as friends, family, or disciplinary action by the bar intervenes and/or compels that result.

Getting Help

Antidepressants usually serve as the first line of treatment for depression. They can help restore the chemical balance in the brain, although they may take some time to start working. Not all people and not all medications work the same way. Different drugs have varying levels of effectiveness with each individual. A primary care doctor can prescribe them, but professionals in mental health generally feel that a patient gets served best by having a psychiatrist address the issue of medications, as choosing and dosing the proper drugs can be complicated and nuanced.

Psychotherapy can prove extremely helpful in treating depression, particularly after antidepressants alleviate low moods and negative thinking. Only psychotherapy can address the underlying problems that trigger depression. It can also help the development of coping strategies that may increase individual resilience in a stressful profession. Therapy does not just address crises. It can also offer benefits in helping an individual, couple, or family deal with human experiences, interactions, and the wide range of human emotions.

Every state has some form of lawyer assistance program. Such offerings can provide access to resources and support. Bar associations have grown increasingly supportive of resources for members’ mental health. Some law schools have begun to address this issue, and colleges and universities now often provide mental health support and treatment for students and faculty, including their own staffing and referrals to outside providers. Peer-support groups such as the Lawyers Depression Project also offer support for legal professionals. Some firms have gone so far as to make an on-site psychologist available. Others have not gone that route. Joseph Andrew, global chairman of the Dentons law firm, said in an interview with Jeena Cho in a 2017 Above the Law article that he was hesitant to have an on-site psychologist out of a fear that “our competitors will say we have crazy lawyers.”

There are treatment programs specifically designed for legal professionals, and Hazelden has found that lawyer participants in those programs have at least slightly more success as compared to their success in programs not specifically designed for lawyers. Insurance programs often offset some of the expense of the treatment. If an attorney fears that confidentiality presents an issue, the attorney can always pay for therapy out of pocket and not utilize the firm’s insurance.

Conclusion

Law firms must recognize that a team of mentally, emotionally, and physically healthy attorneys will prove more productive and more able to give clients the best possible service. Lawyers must recognize that each individual has charge of his or her own mental health. Often, it takes working with a mental health professional for people to see how their thoughts and actions can sabotage their well-being. Such treatment can help an individual learn and implement skills to improve life. If you don’t do it, who will? And what will be the cost?

I have been a mental health therapist and substance abuse counselor for almost 15 years and have had law students, lawyers, district attorneys, and public defenders as clients. They have suffered from depression. They all have had acute anxiety. Some had suicidal orientations. All have had concerns about treatment and confidentiality and worries that public knowledge of their mental health challenges could damage or ruin their careers. Some have had drug addictions. All have had issues with alcohol. All have had problematic intimate relationships. All came with high levels of intelligence and ultimately proved a joy to work with. Even with this experience, when I began to research this article, I found the prevalence of poor mental health in the legal profession shocked me, and the lack of support and services readily available to most attorneys caused me considerable concern and dismay. I hope that the legal profession continues to work systemically to shift this paradigm.