Lawyers and Anxiety: Three Case Studies
By Owen Kelly, Ph.D
Although each of the lawyers in the following fictional case studies has a different story, each is affected by a very real problem—anxiety. Anxiety manifests itself in a number of different ways; it can be extremely debilitating and lead to a decreased quality of life. Given the pressures of the profession, lawyers may feel even more hesitant to seek help for their anxiety. How can lawyers know when they need to address their anxiety, what steps they should take and what help is available? Read on for answers to these questions and more.
Tom: Age 28, Corporate Lawyer
Tom, a recent graduate, has just begun his practice at a prestigious firm specializing in corporate law.
Although he was an excellent student and generally comfortable among his peers, Tom has been experiencing intense anxiety during certain work-related situations. For instance, if asked to speak unexpectedly at a meeting his face turns red, he begins to sweat and his heart begins to pound. When meeting potential clients, Tom feels extremely nervous and inadequate, and is afraid that the client will walk out of the meeting. Even during casual get-togethers with his boss, Tom feels extremely anxious and frequently jumbles his words.
Unfortunately, Tom’s anxiety has begun to undermine his confidence, as well as erode his sense of self-esteem.
Carol: Age 37, Criminal Defense Lawyer
Carol is an extremely bright and experienced criminal defense lawyer. Although her job is demanding, she has been generally happy with her career.
Recently, however, a number of close colleagues have left her firm and she dislikes her new boss. Outside of work, she and her husband constantly feud (in part, because she works longs hours) and she worries that she is not devoting enough time to her children.
As a result, Carol has been experiencing uncontrollable worry about the future for a number of months, and can’t seem to relax. She has also been feeling exhausted and has tremendous difficulty concentrating, even on the smallest tasks. As well, she’s been having terrible tension headaches and has not had a good night’s sleep in ages. Lately, Carol has been feeling overwhelmed and is wondering how she’ll meet all the demands placed upon her.
Jerome: Age 49, Constitutional Lawyer
Jerome is a constitutional lawyer who has been working for the federal government for most of his career.
Although comfortable with his job and well-liked by his colleagues, he is occasionally overcome with anxiety that begins with little warning, and that escalates to intolerable levels. During these episodes, he begins to sweat, feels dizzy, begins to shake and feels as though he can’t breathe and that his heart will explode out of his chest. He often feels he is losing control of his body, or that he may die. After the episode is over, Jerome is exhausted and unproductive for the rest of the day.
Although an expert at concealing these symptoms from his co-workers, Jerome worries about when and where he’ll have an attack; so much so that he often calls in sick to work.
What is Anxiety?
Anxiety can manifest itself in any number of forms. In Tom’s case, anxiety takes the form of a phobia or fear of a specific event or situation. Phobias can take on many forms including agoraphobia (fear of crowded, public places), aviophobia (fear of flying) and batophobia (fear of heights). In Tom’s situation, his symptoms reflect a social phobia or a fear of being evaluated negatively in social situations. Like Tom, individuals with social phobia experience intense symptoms of anxiety (e.g., heart pounding, blushing, sweating or trembling) when having to perform in the presence of other people such as in a courtroom or presentation. Not surprisingly, if left untreated, social anxiety can result in career stagnation, social isolation and depression.
In contrast, anxiety may be experienced as diffuse, uncontrollable worry that is unrelated to any event in particular. While some worry and apprehension is normal, individuals demonstrating excessive, uncontrollable worry over several months, such as that reported by Carol, may be affected by what is called Generalized Anxiety Disorder or GAD. This worry can be accompanied by a number of physical and psychological symptoms including fatigue, irritability, inability to concentrate and muscle tension. Although the worry that accompanies GAD can concern a variety of areas, the most common sources of anxiety include family, financial stability, work and health. In the long-run, GAD can significantly reduce the individual’s quality of life, and in some cases lead to depression.
Anxiety can also be experienced in the form of acute episodes known as “panic attacks”. As in Jerome’s case, individuals experiencing a panic attack may feel that they are losing control of their body. They may also experience a profound sense of doom or feel that they are about to die. As described in Jerome’s story, a panic attack is usually accompanied by intense physical symptoms including sweating, dizziness, trembling, shortness of breath and increased heart-rate. Although panic attacks are harmless, they are very troubling for the affected individual and may cause them to avoid leaving their house for fear of having a panic attack in public.
Why Do We Experience Anxiety?
Although anxiety is usually unpleasant, it is worth examining to help understand why it happens in the first place. From an evolutionary perspective, feelings of fear and anxiety are nature’s way of alerting us to possible danger. Our brain is constantly scanning our environment for potential threats.
When a source of danger is identified (e.g., an angry client), the brain activates the “flight or fight response”. This response is responsible for many of the physical and psychological symptoms we associate with anxiety, including sweaty palms, a pounding heartbeat, “butterflies” in the stomach, rapid breathing, blushing, and generally feeling “on edge”.
Thus, anxiety reflects an attempt by our body to keep us out of harms way. From this perspective, anxiety disorders like those experienced by Tom, Carol and Jerome are simply our normal response to danger on “overdrive”. While some amount of anxiety is expected and unavoidable (and may even be beneficial) in our personal and professional lives, at a certain point, anxiety can become an impediment to personal progress and growth, as well as a risk factor for other mental-illnesses such as depression. It is at this point when anxiety must be addressed.
Lawyers and Obstacles to Seeking Help
It is difficult for people in all walks-of-life to seek help for mental-illness, or to disclose to their employer that they have a serious psychological problem that will require them to be absent from work for a prolonged period of time.
However, for lawyers, the obstacles to coming forward may be especially great. Of course, the greatest deterrent is the stigma associated with mental illness and the illusion of weakness or frailty it can create around an individual. This is likely true of the legal profession where a premium is placed on confidence, competence and resiliency. Indeed, lawyers in Tom, Carol and Jerome’s position may wish that they could confide in a colleague or boss about their anxiety, but fear the impact on their career and reputation.
Outside pressures aside, a lawyer’s own belief system may also delay them seeking treatment. Given the rigors of the profession, many lawyers may look at fellow colleagues and conclude that they should be upholding a certain basic standard of performance or put in a certain amount of “face-time” at the office, despite the psychological difficulties they may be experiencing.
Moreover, they themselves may believe that mental illness is a sign of a weak-constitution and that medication and therapy should be reserved for the weak or less well adjusted. In this instance, the lawyer may be their own worst enemy when it comes to using the numerous effective, professional services available to treat anxiety.
More pragmatic issues may also prevent lawyers from seeking help in dealing with their anxiety. For instance, solo or small firm lawyers may think that they are not able to afford the time away from their practice to attend regular therapy sessions with a psychologist, visit their family doctor or a psychiatrist, or to take an extended leave of absence to assess and restore their mental health.
This may also be true of lawyers who work in large firms in which there are high expectations surrounding billable hours.
Although not specific to lawyers, psychotherapy is not covered by many provincial health care plans, and some group benefit plans do not allocate sizable funds for this type of treatment.
You’re Not Alone
Despite the stigma and stereotypes associated with anxiety and other mental illnesses, it is important to note that these illnesses are common. Twelve per cent of Canadians will be affected by an anxiety-related disorder at some point in their lives. Moreover, data collected from various lawyer and employee assistance programs across Canada indicates that mental health issues consistently top lawyers’ list of concerns. In 2004, 63% of calls placed to various provincial Lawyer Assistance Programs concerned mental illness or psychological difficulties.
The implication, of course, is that lawyers are no more immune to anxiety and other mental illness than any other segment of the population (in fact, the opposite may be true). More importantly, if you feel that you are experiencing anxiety that is interfering with your work or home life, these statistics should reassure you that you are not alone and that other lawyers are coping (often successfully with the right help) with the very same problems you are.
How To Treat Anxiety
Although anxiety disorders can be quite serious and even debilitating, the good news is that they can be treated successfully using a variety of techniques.
One approach that has proved particularly useful for dealing with anxiety is Cognitive Behavioural Therapy (CBT). CBT is administered by a registered clinical psychologist and involves identifying and challenging harmful distortions concerning the way in which an individual sees the world.
For example, in Tom’s case, a psychologist might work with him to identify his negative, automatic thoughts during anxiety-provoking situations (e.g., “I’m sure the partners think I’m an idiot!”), identify whether these thoughts are rational or not and then develop psychological and behavioural strategies to counteract his negative thoughts.
CBT is usually conducted over a relatively short period of time (1 to 3 months), with one-hour sessions taking place every week or second week. Although a proven therapy, psychotherapy is not covered by many provincial health insurance plans, thus out of pocket costs may be incurred.
Another useful strategy for treating anxiety is the use of various medications. A class of drug called the benzodiazepines (which includes the well known drug Valium), can be prescribed to help the anxious individual deal with short-lasting episodes of anxiety such as a panic attacks or excessive anxiety experienced prior to an oral presentation or important meeting. Although responsible use of these medications comprise a highly effective tool for dealing with anxiety and can dramatically improve quality of life, it should be noted that chronic use can lead to dependence and other side effects (e.g., memory impairment), thus, a degree of caution is warranted.
Although originally developed for treating depression, antidepressants are also effective in treating anxiety. In particular, a group of antidepressants called the Selective Serotonin Reuptake Inhibitors or SSRIs appear to be highly effective in alleviating symptoms of anxiety. A well-known example of this type of drug is Prozac; however, others include Paxil, Celexa and Lexapro. Unlike benzodiazepines, SSRIs don’t take effect immediately; they often take a month or two to begin working, and they must be taken daily. Although the side effects of SSRIs are generally mild, they can cause some individuals to experience sexual difficulties.
Clinical studies suggest that psychotherapy and drug therapy are equally as effective in treating anxiety (in fact, the effects of psychotherapy may be longer lasting). Ultimately, the decision to take a drug or to begin psychotherapy (or a combination of both) is a personal decision that has to be made on an individual basis, with the guidance of medical professionals.
Some individuals may not be comfortable taking a drug for a variety of reasons, and therefore psychotherapy may be the best option for them. Others may be convinced that their anxiety has a “biological” origin, or they may not want to put in the work that CBT requires, therefore they may prefer to take a drug. Whichever route the individual takes, it is essential that they become as informed as possible and perform their due diligence.
Finally, there are a number of “self-help” options available that can used either alone, or in conjunction with one of the above therapies. A valuable resource is the numerous self-help books that have been published on coping with anxiety. Many of the books have been written from a cognitive behavioral perspective and may come with an additional exercise manual that outlines “homework” assignments that are designed to help you overcome your anxiety.
Additional self-help strategies include relaxation techniques (e.g., slow, deep breathing, yoga), regular exercise, keeping a daily journal and finally, participation in activities or hobbies that provide a distraction. While self-help options can be quite helpful and are a good starting point for many individuals, if you feel your anxiety is severe and limiting your quality of life, do not hesitate to seek additional assistance.
When and Where Do I Seek Help?
Unfortunately, there is no magic formula for determining when you should seek help for anxiety—what may constitute intolerable levels of anxiety for one person may be quite bearable for another.
Generally however, if your anxiety is causing significant distress or is impairing your normal social or work-related functioning and decreasing your quality of life, you should consider seeking assistance. The following are good places to start:
- Family Physician – Your family doctor is a vital resource for dealing with your anxiety, as he/she can provide you with information, resources and treatment. When appropriate, your family physician can refer you to a psychiatrist who specializes in the treatment of anxiety disorders.
- Clinical Psychologist – An appointment with a registered clinical psychologist can usually be arranged without a referral, however, as mentioned, your provincial health insurance plan may not cover this service (although your group benefits plan may allocate funds for psychotherapy). Clinical psychologists can provide effective, empirically proven treatment for a variety of anxiety disorders.
- Legal Profession Assistance Conference (LPAC) of the CBA – LPAC provides professional support and assistance to lawyers, including confidential counseling, and information services, as well as personal support and peer group volunteers.
- Employee Assistance Programs (EAPs) – Your firm or company may have retained the services of an EAP provider (you can ask your human resources department if you are unsure). You can contact your EAP anonymously to gain access to a variety of services, including counseling and other forms of treatment.
Although each of the lawyers we met in case studies presented above suffered from an anxiety-related problem, all faced slightly different challenges. Similarly, each lawyer chose to address their anxiety in a manner that was tailored to their needs.
In Tom’s case, as his anxiety was confined to specific situations at work, he didn’t feel that he needed to be on a drug all the time; instead he opted for eight sessions of cognitive behavioural therapy and practiced relaxation techniques before presentations or meetings with his boss.
Carol also opted to attend cognitive behavioural sessions; however, she initially combined this with an antidepressant for six months. When she felt that she had regained control over her anxiety, she and her doctor agreed that she should wean herself from the drug and continue with the occasional CBT session.
Finally, Jerome elected to read a few self-help books on panic disorder and got a prescription from his family physician for a short-acting benzodiazepine (Ativan) for use only when he would feel a panic attack coming on.
Although each lawyer chose to address their anxiety in a different way, each of them experienced a substantial decrease in their symptoms and a marked increase in their overall quality of life.
Owen Kelly, Ph.D, is a researcher in social neuroscience at the University of Ottawa Institute of Mental Health Research, and the Department of Psychology, Carleton University. He is also a partner in Stress Biometrica, a consulting group specializing in the assessment and evaluation of organizational stress. http://www.stressbiometrica.ca