There has been a significant effort in recent years to address the issue of lawyer wellness. There are many compelling reasons for this. It is well known that the daily work of lawyers provides a multitude of situations that can trigger anxiety and stress. Lawyers typically devote a tremendous amount of effort and energy to provide meaningful guidance and representation to their clients, and often disregard their own needs in the process. This challenging and time-consuming work is frequently difficult and sometimes overwhelming. If the inherent stress of practicing law is not dealt with in healthy ways, it can lead to devastating consequences.
In the most comprehensive study to date, “The Prevalence of Substance Use and Other Mental Health Concerns among American Attorneys,” published in February 2016 in the Journal of Addiction Medicine, researchers found “rates of hazardous, harmful, and potentially dependent drinking and high rates of depression and anxiety symptoms.” It is important to highlight the validity and reliability of this well-done study. Almost 15,000 lawyers from 19 states, including Alabama, completed an anonymous survey addressing alcohol use, drug use, and symptoms of depression, anxiety, stress, and other mental health concerns. Of these, approximately 11,300 completed a 10-question instrument, the Alcohol Use Identification Test (AUDIT-10), which screens for problematic alcohol use. Of these respondents, 21 to 36 percent revealed a score consistent with an alcohol use disorder. The study also revealed that 28 percent reported concerns with mild or high levels of depression with males at a higher rate than females, and 19 percent reported mild or high levels of anxiety, with females at a higher rate than males. Overall, 23 percent indicated mild or high levels of stress.
In the words of Patrick Krill, lead author of the study, “The law has always been a magnet for hard-working, self-reliant and competitive people who often prioritize success and accomplishment far above personal health or well-being. On top of that, stress, unhappiness and imbalance abound, while unhealthy coping skills such as excessive drinking are the cultural norm–malignant, learned behaviors passed down through the profession with the frequency of a dominant gene.” He adds, “If you value your reputation, hide any struggles you might have, or, better yet, pretend they don’t exist. These are the messages that many attorneys hear–both formally and informally–beginning on the first day of law school and continuing throughout their careers. It is a pure and indigenous dysfunction humming along through vast corridors of the profession, often unrestrained, and culturally enabled.”
The findings of this study have resulted in a nationwide effort to directly address the issue of lawyer wellness. In a 2017 report from the National Task Force on Lawyer Well-Being, “The Path to Lawyer Well-Being: Practical Recommendations for Positive Change,” lawyer well-being is defined as: “A continuous process whereby lawyers seek to thrive in each of the following areas: emotional health, occupational pursuits, creative or intellectual endeavors, sense of spirituality or greater purpose in life, physical health, and social connections with others.” The authors go on to say that, “Lawyer well-being is part of a lawyer’s ethical duty of competence. It includes lawyers’ ability to make healthy, positive work/life choices to assure not only a quality of life within their families and communities, but also to help them make responsible decisions for their clients. It includes maintaining their long-term well-being. This definition highlights that complete health is not defined solely by the absence of illness; it includes a positive state of wellness.”
It is important to remember that some stress is inevitable in all of life, and particularly in the legal field, and the experience of anxiety is quite common. Feeling brief periods of stress or anxiety is very normal for all of us. Whether these events become debilitating or pathological often depends on how we view the situations or thoughts that are related to our experience of stress or anxiety, and the level of willingness we have to address these uncomfortable feelings and to utilize healthy coping skills.
A very useful article from the Cleveland Clinic in May 2018, “6 Signs Your Work-Life Balance Is Out of Whack,” provides an easy way to gauge our well-being at home and in the work place, and effective ways to make positive changes if needed. Here are the six signs as offered by psychologist Amy Sullivan, PsyD:
1. You stop taking care of your body. You’re staying up too late or having trouble falling asleep. You’re sitting all day and not exercising. You’re getting most of your food from vending machines, a drive-through window, or not eating at all. You have a nagging pain or health concern, but don’t feel you have time to go to the doctor.
2. Your mental health is going downhill. You’ve started noticing signs of anxiety or depression, or feeling angry or irritable. You may even experience dread, restlessness, hopelessness, panic attacks, mood swings, and maybe even thoughts of suicide.
3. You just don’t care anymore. Your work no longer feels meaningful. You don’t feel connected to your colleagues or clients. You’re just going through the motions.
4. You feel incompetent. No matter what you do, it feels like it is never enough. You’re always behind and the quality of your work may suffer. You worry constantly about your job performance. You fear (but in many ways fantasize about) being fired.
5. There are no clear boundaries between work and home. You’re working longer and longer hours. You can’t take time off without getting calls, texts, and emails from work. You feel like you have to be available around the clock.
6. You’re lonely. Although you may have people around you all the time and you’re constantly connected electronically, you no longer have the time or energy for meaningful interactions with family or friends. Your relationships begin to suffer.
Dr. Sullivan offers the following suggestions:
1. Disconnect when you are at home. Put down the phone! You don’t need to be available 24/7. Constantly checking and responding to texts and emails raises stress levels, makes it difficult to connect with family members, and negatively affects your sleep.
2. Be more efficient at work. Focus on one task at a time, and keep working on it until it is complete. Don’t try to multitask. Close your email and turn off your phone to minimize distractions. When we are more efficient at work we are then able to go home and spend time with our families.
3. Prioritize self-care. Make a decision to set aside time for exercise. Choose and plan for nutritious meals and quality time with friends and family. Make those things non-negotiable in your schedule.
4. Get professional help. If stress is impacting your emotional or mental health, don’t hesitate to talk to a therapist.
Dr. Sullivan adds, “Although hard work is prized in our culture, and especially in the legal profession, you don’t have to let your job take over your life. It’s OK– and necessary–to take care of you first.”
There are many other practical methods of stress management that can be readily utilized. A very good way to start would be to identify the sources of stress in your life by keeping a stress journal, and then track how you are currently coping with it. This would enable you to identify those coping skills that have been effective and those that you need to eliminate or replace. Simple techniques such as goal-setting and time management can be very effective in combating procrastination and increasing productivity. Other immediate techniques that can be powerfully effective include deep breathing, progressive relaxation, and meditation. There are many self-help books and guides to learn how to incorporate these very useful methods of stress management.
Other approaches that can be very effective include cognitive therapy and mindfulness meditation. Both have been found to provide significant and positive improvement in mental and emotional health, as long as the simple techniques are practiced and utilized on a regular basis. Most mental health professionals are trained to explore thought systems and, in particular, to look for patterns of thinking that are distorted and negative. It is a well-established fact that our moods are determined, to a significant extent, by our thoughts rather than people or events, though most do not believe this! Cognitive therapy and/or mindfulness meditation can release us from the bondage of our own negative ruminations and help us begin to realize that our thoughts will always be distorted and negative when we are in a low mood. Mindfulness meditation can help us disengage from this negative pattern, and cognitive therapy can teach us simple and effective ways to recognize and challenge our negative and distorted thinking with objective reality. These therapies can be utilized as self-help or with the assistance of a trained therapist.
Some of the most powerful and effective ways to maintain or improve mental, emotional, and physical health have been widely known for a great many years. These include regular exercise, eating a balanced and healthy diet, reducing caffeine and sugar, avoiding alcohol or drinking moderately, and getting adequate sleep. Of equal, or perhaps greater, importance is ensuring that we have set aside adequate time for fun and relaxation.
Regular exercise prolongs life and reduces the risk of disease such as hypertension, diabetes, cancer, and heart disease. It has also been shown to be very effective in reducing stress and improving our mood. Exercise has a powerful and positive impact on the brain’s neurotransmitters such as serotonin, the endorphins, and dopamine–the brain chemicals that are directly involved with the physiological creation of our moods.
Eating a healthy diet is also essential for those of us who truly desire to be intentional about our well-being. Our pattern of eating, whether it is healthy or unhealthy, has a powerful and profound impact on our physical and emotional health. Learning to eat in moderation, instead of binging as a way of dealing temporarily with stress, can yield immediate and positive results. Almost all of us have experienced the misery of over-indulging when we feel stressed, or if it has simply become a habit. What almost always happens immediately afterward is that we not only feel “stuffed,” we are also filled with remorse for having eaten far more than we should have, and for having eaten food that we know is unhealthy. For those who have developed a pattern of overeating, this can lead to obesity and an increased risk of a multitude of health problems, including gastro-intestinal problems, diabetes, hypertension, and cancer. Stress-eating also leads, paradoxically and tragically, to a deepening of our negative moods and depression, and to low self-esteem. The way we choose to eat has a powerful effect on our physical health and our moods. A healthy diet, eaten in moderation, will dramatically improve our physical and emotional health and help to ensure a state of well-being.
It is essential to ensure that we get adequate sleep. While we sleep, the brain rests busy neurons, and forms and repairs neural pathways so that we’re ready to face the world in the morning. The immune system produces infection-fighting antibodies and cells. Without adequate rest we will have difficulty with concentration and attention, and creativity and problem-solving skills will deteriorate. Long-term and short-term memory will suffer. Equally important, we will be far more prone to “moodiness” and more emotional and quick to anger. Sleep deprivation is a constant threat in the legal profession. Sadly, it often leads to lost productivity and negative outcomes for clients. Tragically, it has been strongly linked to an increased risk for anxiety and depression.
It is important to discuss the dangers of relying on alcohol or other mood-altering substances as a way of dealing with stress, anxiety, and depression. There is nothing wrong with having a drink or two after a hard day’s work. However, if you have come to rely on alcohol (or some other legal or illegal mood-altering substance) as a way of coping with life, it is very likely you have crossed an unhealthy line. Once this dependence on alcohol is in place, it becomes our one and only coping skill and effectively blocks us from being able to acquire healthy ways of coping. This often leads to full-blown alcoholism and all the tragic problems that come with it: broken relationships, decreased productivity at work, formal complaints to the bar, loss of license, legal problems such as DUI or public intoxication, and so on. If this pattern has become operative in your life, or if you know someone who is struggling with alcoholism, it is imperative that you contact the Alabama Lawyer Assistance Program so that we can provide assistance.
Then, there is the matter of faith. For those who belong to a particular religion or denomination, or who espouse to a more “spiritual” way of life, practicing the tenets of your faith and reaching out to likeminded people can provide tremendous strength and guidance during a time of stress. Living a life based on spiritual principles can bring about the genuine courage needed to face the inevitable challenges and difficulties that come our way.
In his brief but excellent article, “Up Your Gratitude,” John Kralik describes a very specific and highly effective spiritual technique for expressing gratitude that transformed his life. He explains, “On New Year’s Day 2008, I went for a hike, feeling at an all-time low. I was overweight. I owned a law practice, but it was losing money. Entangled in a divorce, I lived in a depressing apartment. The woman I’d been dating had recently ended our relationship. On my hike, I heard a voice. It said I shouldn’t focus on what I wanted or had lost, but should be grateful for what I had. The idea of a year of ‘thank-yous’ popped into my head.”
He realized that he had been blessed by many people in a multitude of ways, large and small. He began writing thank-you notes. He provided this specific thank you note that he’d written to a Starbuck’s employee named Kimber: “Knowing that you had to work on Thanksgiving, of all days, I thought I’d express my gratitude that you have taken the time and made the effort to learn my name and greet me each day in a way that makes me feel like a person and not a number. It is a small thing, but on any given day, it can make all the difference. Thank you!” He describes how, on the following day, when he entered the Starbucks, the employee, nearly breaking down, told him that his note made her realize that what she does really counts. It was his 260th thank-you of 2008, the year he vowed to send one to a different person every day.
This simple but profound project has resulted in a complete transformation of his life. He states, “After I thanked colleagues for directing cases to me, they referred more. When I expressed gratitude to clients for paying promptly, they began doing so even more quickly.”
He wrote a book in 2010, A Simple Act of Gratitude. Just days after its release, he received his first thank you note from a reader. Within a few weeks, he had received a whole box of them from his publisher. His readers have demonstrated how the effects of gratitude continue to ripple out.
Of course, his circumstances have improved immeasurably since the decision he made on that hike. He is now in great shape (he has been intentional about exercise and diet), he has found a small but “lovely” house, and was appointed to his dream job, superior court judge. As of this article, he had written his 860th note. He says, “I keep learning that gratitude is a path to the peace we all seek.”
All of these suggestions for wellness can be remarkably effective. Each one of us, though, must become willing to self-search and identify those areas that we need to improve, and we must be willing to make an honest commitment to improve our lives. In order to truly experience significantly improved mental, emotional, and physical health, we must be deliberate and intentional about taking action. For those of us who do, we will reap the benefits in every area of our lives, including our marriages and families, friends and social connections, and our work.
For those attorneys who have relied on unhealthy coping skills, and who remain unwilling to improve their lives, the risks to their chosen profession run high. It is well-known that a significant proportion of attorneys with malpractice cases or formal complaints to the bar have ongoing problems with substance abuse and/or undiagnosed and untreated mental health issues, such as depression or anxiety. Some of the most commonly violated Rules of Professional Conduct are:
Rule 1.1: Competence: A lawyer shall provide competent representation to a client. Competent representation requires the legal knowledge, skills, thoroughness, and preparation reasonably necessary for the representation.
Rule 1.3: Diligence: A lawyer shall not willfully neglect a legal matter entrusted to him. Rule 1.4: Communication: A lawyer shall keep a client reasonably informed about the status of a matter and promptly comply with reasonable requests for information. (b) A lawyer shall explain a matter to the extent reasonably necessary to permit the client to make informed decisions.
Rule 1.5: Safekeeping Property: This is a very lengthy and comprehensive rule that carefully covers the obligation to properly handle and safeguard property and monies.
Attorneys who are abusing alcohol or drugs, or who are in need of evaluation and treatment for depression or anxiety, will inevitably run afoul of one or more of these rules. It is our hope that the emerging nationwide focus on the importance of wellness in the legal profession will cause all of us to be mindful, not only of our own needs, but also of those colleagues who are clearly struggling and need our assistance.
The Alabama Lawyer Assistance Program can help. If you or a colleague are struggling with pathological stress or anxiety, or coping with it in ineffective or unhealthy ways, we urge you to contact us. Our program is completely confidential. We have a committee of dedicated attorneys who have courageously faced their own challenges and who stand read to provide assistance and guidance.
It is important to once again mention the remarkable efforts of the National Task Force on Lawyer Well-Being. Their hard work and dedication have resulted in the publication of “The Path to Lawyer Well-Being: Practical Recommendations for Positive Change” and the “Well-Being Toolkit for Lawyers and Legal Employers.” These can easily be found on the ABA’s website. I highly encourage all of us to carefully read and then review this very important work. There is a wealth of information that can be utilized to bring about a positive revolution in health and wellness throughout the legal profession. This transformation can only begin with each one of us.
1. “The Prevalence of Substance Use and Other Mental Health Concerns among American Attorneys,”Krill,Patrick r. Jd. LLM; Johnson, Ryan Mt; Albert, Linda MSSW; Journal of Addiction Medicine; February 2016; Volume1-Issue1-pp 46-52.
2. “Landmark Study: U.S. Lawyers Face Higher Rates of Problem Drinking and Mental Health Issues,”Joe Forward, Wisconsin Lawyer, February 2016.
3. “The Legal Profession’s Drinking Problem,”Patrick Krill, CNN Opinion, February 2016.
4. The National Task Force on Lawyer Well-Being, “The Path to Lawyer Well-Being: Practical Recommendations for Positive Change,” initiated by the ABA Commission on Lawyer Assistance Programs, the National Organization of Bar Counsel, and the Association of Professional Responsibility; August 14, 2017.
5. Cleveland Clinic, Health Essentials, May 23, 2018/ Mental Health,“6 Signs Your Work-Life Balance Is Out of Whack.”
6. “Up Your Gratitude,”by John Kralik; January 1,2012; Parade Daily
Robert Thornhill, MS, LPC, is the director of the Alabama Lawyer Assistance Program of the Alabama State Bar. Contact him at (334) 517-2238, or email him here.