Lawyers tend to bury themselves in work and focus solely on getting through the day. The result is that lawyers all too often ignore their own well-being and carry a sense of ambivalence about the legal profession’s problems with mental health and wellness. In recognition of World Mental Health day, host Jonathan Amarilio is joined by special guest host Stephanie Villinski of the Illinois Supreme Court Commission on Professionalism, along with guests Dr. Diana Uchiyama, Executive Director of Illinois’ Lawyers Assistance Program (LAP) and Chicago-based lawyer and wellness expert, Jonathan Beitner. The group has a candid discussion about lawyer mental health and addiction, as well as ways the legal profession can collectively cultivate a greater sense of wellness so that all lawyers can be as happy and successful as possible.
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The Keep Calm and Lawyer On Edition: A Candid Discussion about Mental Health and Addiction in the Legal Profession
Jon Amarilio: Hello everyone and welcome to CBA’s @theBar, a podcast where young and young-ish lawyers have unscripted conversations with our guests about legal news, events, topics, stories and whatever else strikes our fancy.
I am your host, Jon Amarilio of Taft Stettinius & Hollister and co-hosting the pod with me today is Stephanie Villinski, Deputy Director of the Illinois Supreme Court Commission on Professionalism.
Stephanie Villinski: Hi Jonathan.
Jon Amarilio: Stephanie, should I call you Stephanie, Deputy Director, Deputy Director?
Stephanie Villinski: Stephanie is great.
Jon Amarilio: Okay, easy enough. Stephanie, we are joined today by two guests. First, Dr. Diana Uchiyama, Executive Director of the Illinois Lawyers’ Assistance Program aka LAP. Dr. Uchiyama has a Master’s and Doctorate in Clinical Psychology as well as a JD and has extensive experience on the topic that we are going to discuss here today.
I am going to leave it hanging for the purposes of suspense for a minute.
Stephanie Villinski: Okay.
Jon Amarilio: And introducing our second guest, Jonathan Beitner, who is an attorney, certified coach and frequent speaker on topics relating to attorney development and well-being. Jonathan is also Chair of the CBA’s Well-Being and Mindfulness Committee, all of which probably ends the surprise and gives the topic of today’s conversation away to our audience, lawyer well-being, wellness, all things well.
Diana, Jonathan, Stephanie, welcome.
Dr. Diana Uchiyama: Thank you.
Stephanie Villinski: Thank you.
Jon Amarilio: Thanks for being here. So let’s start with a softball. Diana, Jonathan, let’s say hypothetically that you were talking to a lawyer who doesn’t meditate, doesn’t do yoga, doesn’t drink kombucha, doesn’t really know how to spell kombucha, doesn’t have a drug problem, likes his wine, likes his scotch, but not to access, sometime suspects that younger lawyers just talk about wellness as a way of skipping out of work early. What would you tell this totally hypothetical person about why discussing lawyer wellness is important?
Dr. Diana Uchiyama: I think that as a practicing attorney I was really ambivalent and also in denial about the problems that the legal community was facing, my colleagues were struggling and I didn’t even recognize that there were significant issues, and if I did I thought it was normal.
So I think that we can kind of embrace the normalcy of some of our maladaptive behavior. So I think engaging in a conversation about how is that attorney doing, what are they doing to cope with the negative side effects of practicing law. I mean it is an adversarial competitive process, there is a wear and tear to it, a lot of attorneys develop compassion fatigue and burn out and have mental health and substance use problems.
So I think engaging in a conversation about where are you on the spectrum of well-being.
Jonathan Beitner: Yeah, I think that was a great answer and I completely echo everything that was just said. I would just add that the extent that there is some hesitance about engaging in these topics, because you think to yourself oh, I am not someone who drinks kombucha or is a health fitness freak or something like that, appreciating that well-being is a really holistic idea and there is many dimensions to it and sort of figuring out what does it mean for you to be thriving and being at your best, because the jury is sort of out and we now know that there is such a connection between sort of these health and wellness topics and things like productivity, engagement, reducing burnout, compassion fatigue, things like that.
So it’s really about being the best attorney you can be and finding ways to make sure that the negative aspects, that wear and tear that we were just talking about doesn’t bleed over into your personal relationships and your outside of work life and things like that.
Jon Amarilio: Okay. So let’s start by defining the problem, just so we can get our heads around it. What kind of — when we are talking about alcohol abuse problems, maladaptive behavior, drug abuse problems, what kind of numbers are we looking at there? Do you guys know?
Dr. Diana Uchiyama: We are talking about law or lawyers in general?
Jon Amarilio: Yeah.
Dr. Diana Uchiyama: Yeah. So the statistics, the ABA conducted a study with Hazelden that was released in 2016 and the numbers of attorney who are struggling with depression is 28%, which is a pretty significant number. I always say when I am speaking to an audience, my assumption is out of three people, one of them is struggling with something. 21% have problematic alcohol use, 19% struggle with anxiety issues and 23% indicate that they are under chronic stress.
And coupled together, I always call mental health and substance use issue, the dynamic duo that can lead to high levels of suicidality, and depending on the study that we look at, we see that lawyers have a higher rate of suicide.
The last statistics I looked at, we are higher than doctors and dentists, who notoriously had the highest professional suicide rate among professional groups.
Jonathan Beitner: And just to add to that, so the stats that were just said were from that ABA-Hazelden Betty Ford Study. And they also had another set of statistics in that study which were, they asked respondents to just self-report whether they are struggling with issues.
Jon Amarilio: So those numbers are probably underreporting.
Jonathan Beitner: No, those don’t rely on self-reporting. Those numbers asked people to describe their current habits and beliefs and attitudes and they use the kind of diagnostic screening tools that therapists and psychologists use.
But they also asked a separate set of questions that just asked self-reporting questions. So something like, have you ever struggled with depression at any point in your career, and obviously that’s going to be a much less clinical number, but those numbers were I think even more kind of staggering.
Dr. Diana Uchiyama: Astronomical.
Jonathan Beitner: Yeah, astronomical. So the numbers around those topics were 45% of attorneys surveyed, and there were almost 13,000 respondents in this survey, said they suffered with depression at some point in their career. A staggering 60% said they struggled with anxiety, and over 10%, 11.2 said that they had had suicidal thoughts at some point in their career.
So whether or not you have a clinical diagnosis obviously is important for treatment and things like that, but as a practical matter, right, if you feel like you are depressed and you are struggling to get out of bed because of it, that’s going to have the same kind of practical impact on your job and your work.
And so to me, those were sort of also very staggering numbers, to say nothing of a 28% depression rate at the time they took the survey.
Dr. Diana Uchiyama: And what we know is the suicide rate amongst the general population keeps increasing and for lawyers and judges is constantly escalating. So we have to really look at what is going on and why aren’t we doing something about it, because this isn’t something that’s new in the field of law, there has been previous studies from the 80s and 90s which suggested high levels of depression and problematic substance use. And those numbers haven’t changed. What’s increasing and it’s clearly due to technology issues is the rate of anxiety and chronic stress, because we can’t turn our brains off, we can’t be unavailable, we are always available. So those are leading to escalating rates related to anxiety and chronic stress as well.
Jon Amarilio: That reminds me of an article that Judge Tom Mulroy from the Circuit Court, former CBA President recently wrote, where he discussed how law is a profession, not a job and because of that we take it with us everywhere we go, including all of our clients’ troubles and anxieties and stresses.
Is there something about the practice of law in particular? You mentioned that all of these terrible statistics that you threw out are higher than even dentists, who are kind of notoriously known for being some of the most depressed human beings on the planet?
Jonathan Beitner: Right, that always catches people’s attention, it’s worse than dentistry.
Jon Amarilio: It’s worse than like someone who spends his or her day in someone else’s mouth.
Jonathan Beitner: Yeah, right, right.
Jon Amarilio: So this kind of raises like a chicken and the egg problem, right, is it something about the law that attracts these kinds of personalities or is there something about the law that leads people to this kind of behavior? Do we know the answer to that?
Jonathan Beitner: The answer is yes. No, because it’s both, right? I do think that there are some studies. So right around the same time that that ABA-Hazelden Betty Ford Study came out, there was a survey — a similar survey of law students and it showed similarly high rates with respect to depression and binge drinking and things like that, but what we found was — what the researchers found was that people entered law school with about average rates of mental health substance use disorder issues.
Dr. Diana Uchiyama: Often more resilient than the general population.
Jonathan Beitner: Than the general population, but even by the end of the first year of law school, those numbers start to dramatically increase, particularly with respect to anxiety and depression.
Dr. Diana Uchiyama: And alcohol use.
Jonathan Beitner: And alcohol use. And so there is — so that would suggest that there is something about what’s going on in law school or how we are — who is being attracted and things like that, and there is a myriad of different reasons for why the profession is struggling at these high rates, some of them I alluded to; 24/7 client demands, high stakes, unpredictable schedules, things like that.
But one of the things — I do a whole program that’s just titled The Profession’s Pessimism Problem, and to me one of the most — one of the explanations that really resonates with me is this idea that we are all kind of wired for pessimism through this principle called an implicit negative bias, but the way we train lawyers, huge swathes of that really exacerbates that implicit negative bias.
If you think about how law students are trained, a lot of it is, here is a fact, tell us everything that’s wrong with it.
Jon Amarilio: Well, break that down for our audience who doesn’t know what an implicit negative bias is.
Jonathan Beitner: Yeah, okay, sorry. So implicit negative bias and feel free to correct me if you have got something to add on this, because it’s kind of a big topic.
Jon Amarilio: She is a double doctor.
Jonathan Beitner: Yeah, exactly, right, exactly.
Dr. Diana Uchiyama: He is using impressive words.
Jonathan Beitner: So implicit negative bias just means that — and everybody has it, not just lawyers, it just means that we internalize and give greater weight to negative events over positive events, and this was an evolutionary trait that helped us stay alive as cavemen and stuff like that.
But basically what it does is it — we are wired to kind of survey our surroundings at all times for what might be threatening, where danger might come from, we are very societal, so how might people be perceiving us negatively, because we know that that’s important for our survival.
And that was all good when we were cavemen and the dangers we faced were really existential threats; it’s the saber-toothed tiger coming to maul us, it’s not getting stranded and lost from our cave type of thing. We don’t have that kind of stressors anymore. Right now the stressors and the threats we face are much more benign thankfully; it’s not a saber-toothed tiger coming to maul us, it’s like a looming deadline. But physiologically our body still responds to stress the same way and so we still have this implicit negative bias where we give greater weight.
And there is research that says that the ratio is something like 3:1, so it takes three positive events to offset one negative event; some say it’s 5:1, some say it’s 7:1, it’s not — what that actual number is, is not terribly important, but this idea that at exponential level we give greater weight to negative events over positive events is what’s important.
Jon Amarilio: And so you are saying that something about the way we train law students exacerbates that instinctual lack of perspective.
Jonathan Beitner: Exactly, right. And so as lawyers we are constantly dealing in kind of worst case scenarios and what’s your litigation exposure, and you mentioned it before, right, the practice of law is all about taking on other people’s problems. And so to be an effective advocate, it is important to kind of have those kind of worst case scenarios in mind, what’s our litigation exposure, how might this deal fall apart down the road so that we can advise our clients.
The problem is when that type of modality of thinking and that mindset kind of permeates our whole live and we exacerbate it. By the way, we train lawyers, this idea of issue spotters and things like that. And I do think that there is also this kind of self-selection problem. Lawyers are notoriously cerebral and analytical and very smart and we want to know the answer. So when we have gaps in our information; we always have unknowables and imperfect information, we usually fill in those gaps with kind of that worst case scenario reading. And because we are so analytical and because for the most part we are very smart, the stories we tell ourselves hold together, and it’s easy to kind of — we fall prey to these common thinking errors.
So we do things like catastrophize things, we kind of engage in all-or-nothing thinking or we overly-personalize things, and all of these things are contributors to stress, anxiety and ultimately can lead to depression.
Dr. Diana Uchiyama: I mean I work directly with lawyers, judges and law students, so I think I can simplify it in that people who go to graduate school, to professional schools are built differently than people who aspire to other careers.
So first of all, we generally are Type A. We are competitive. And then law school, like Jonathan talked about, teaches us to think about all the what-ifs, which is anxiety inducing and provoking, but it’s teaching you this analytical framework for looking at the world.
But if you are already predisposed to some anxiety issues, then it can increase some of those kind of feelings of anxiety. And what we know now is the World Health Organization conducted a study last year that was released across eight different countries, including the United States, and the age of onset of mental health disorders is now between the ages of 14 and 15. One in three college students now has a chronic mental health disorder. These are the people who feed into the professional schools.
When I got my master’s and doctorate it was all about, how do you work with people who are troubled and keep yourself intact? I don’t ever recall a class in my law school that taught me that the adversarial nature, the incivility that takes place within the profession would cause me to develop any symptoms that might encourage me to develop some maladaptive coping mechanisms.
The other thing is we live in a secret world; meaning that if I am struggling, for me to share that with other people makes me feel weak and vulnerable and the profession as a whole is not good at addressing vulnerabilities, because if we are supposed to be these very tough-minded adversarial people, being vulnerable doesn’t really kind of creates — it doesn’t create room for that to kind of be negotiated, and it may inhibit our personal growth, our professional growth.
So I think that the practice of law is something that we have to recognize creates and increases mental health and substance use issues and that we have to become more aware, so that we can monitor ourselves and recognize, even though that we view ourselves as the problem solvers, that we too can have problems and can seek help.
Jon Amarilio: Do you think everything that we have been discussing has contributed to a growing phenomenon that a lot of practicing lawyers have observed in the law, including friend of the pod, Alexis Douglas, who recently wrote me and asked whether we thought that increasing levels of incivility in the law contribute to the problem — all the problems that we are discussing today.
It seems like on a year-by-year basis more and more lawyers are attacking each other personally and questioning each other’s motives, which I imagine would, A, as you just said Diana, make the problem worse; but also B, act as some kind of like negative feedback cycle, encouraging you to engage in those behaviors all the more. I don’t know if there is any data on this, but just allegorically, do you think there is any truth to that?
Dr. Diana Uchiyama: Oh, absolutely. I think that the world is increasingly becoming more incivil. As we sit here today, we live in a divisive culture that has become more polarized as time goes on and so oftentimes what you see is permission to engage in incivil behavior and acts because of the culture that you live in.
So I don’t think incivility is only a legal problem; however, it is happening at dramatic rates in the legal profession, so that monitoring — we are supposed to monitor ourselves individually and collectively as a group, I think that’s broken down to some extent.
I meet with lawyers all the time who tell me they can’t do it anymore, that the adversarial nature of the profession has just worn them out and they don’t know how to recreate themselves, because law is all they know. So we have to do a lot of work to kind of determine, is this just compassion fatigue or is this burn out or is this a combination of both, and can you still remain in the law despite the incivility that you will be exposed to on a continual basis.
So it’s almost like determining whether you can stay in a relationship when you know your partner is unkind to you on a regular basis, and I think we are starting to see that some people are saying I can’t do it anymore, that they have done it for so long. And that’s not an unusual scenario. I see that every day at LAP, people come in talking about that.
Stephanie Villinski: We obviously talk a lot about incivility and professionalism at the Commission on Professionalism. How do you two see well-being as — what’s the connection you guys see to well-being to professionalism and how can a better well-being system have greater civility?
Jonathan Beitner: Well, what came to mind as we were having this discussion is one of the big things in the attorney well-being movement that we try to promote and get people to like internalize is the first step to like making progress on these issues is that lawyers are just people, and these are all just people issues and the humanizing, the rise of incivility is kind of the opposite and leads to a lot of the kind of the dehumanization of the profession. And approaching people as adversaries, in like larger firm context, looking at associates as billable units and stuff like that.
Jon Amarilio: So I sense that’s wrong.
Jonathan Beitner: That’s wrong, yeah, it’s not helpful. There are no rights and wrongs. But it’s funny, I was at a conference last week and somebody brought this up, sort of the dehumanizing aspect of the profession, and in particular when he heard someone referring to like a more junior associate as a billing unit, how kind of troubling that was.
And so I think when it comes to civility, like just a greater appreciation that we are all people, we all have issues that we are dealing with, and I do think that because of the rise in the adversarial nature of the profession, I feel like I can’t ask for an extension or deadlines being major drivers of anxiety and pressure in our jobs, not feeling like you can have like a meaningful sidebar with opposing counsel to like deal with a personal issue that maybe has come up or things like that.
So I think kind of appreciating that these numbers are what they are and more likely than not people you are working across from might have issues and being — having some compassion towards that idea I think is a way that we can both lower the rates of incivility and help bolster people’s well-being.
Jon Amarilio: Okay, I think that’s probably a perfect lead-in to our second segment, so we will take a break right there.
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Jon Amarilio: And we are back. Okay, so guys, we have defined the problem. Let’s talk about solutions. A lawyer who is suffering from depression or anxiety, a lawyer who thinks he or she has an alcohol or drug abuse problem or has been told he or she has an alcohol or drug abuse problem, which is probably more likely, what resources are out there? What can they do?
Dr. Diana Uchiyama: Well, as the Executive Director of LAP, I mean I would promote LAP very heavily, just because we are mostly attorney/clinicians and so we understand what the problems facing people in the legal community are. We work with judges, lawyers and law students, and because of our experience and kind of our boots on the ground concept of working directly with the people who are suffering, we are very aware of resources within the community, resources at LAP.
So at LAP, we can do evaluations and assessments, we do old-fashioned interventions as well when people are not open to getting the help they need. We have counseling with the therapists on staff, including myself, and we have peer support mentors in the community that we train to kind of buddy up with people.
We are also creating a mentoring program with older attorneys who are retiring with younger attorneys, because mentoring within the legal community is at an all-time low, very few people have mentors that they can turn to for assistance and help and we have all been through that poser syndrome when we first start the practice of law where we are supposed to feel competent and be competent, but we aren’t, but we are afraid to let anyone know that we are vulnerable and that creates all sorts of stressors and anxiety for people.
So we are an all-encompassing kind of agency, where we are able to kind of, if we feel that the needs are greater than what we can provide, we have resources within the community that we have professional relationships with.
We have treatment assistance funds for people who have no ability to pay; many solo practitioners don’t have insurance. We have connections where we can try to find funds for people and providers who will see people at reduced rates. So really we never let anyone walk away without services, we will always find someone to help someone in need.
Stephanie Villinski: Thanks Diana. I will just add from the Commission on Professionalism’s standpoint, with the mentoring program, so we actually in 2011 started a Lawyer-to-Lawyer Mentoring Program in Illinois, and it is a year-long program. Each mentee is one to five years out of law school; each mentor is five plus years out of law school. And it’s focused on professional responsibility issues and those issues are in addition to ethics, professionalism, civility. It’s also focused on diversity and inclusion and then mental health and substance abuse. So that is a great program to get yourself paired with on mentor and mentee.
So that is throughout the state. So you can go to 2civility.org to find that out, but that’s a great point about the mentorship.
Dr. Diana Uchiyama: Thank you.
Stephanie Villinski: No, sure. As far as with — just a follow up with LAP, how does someone get in contact with LAP and when they do, what is the process they have to go through with that?
Dr. Diana Uchiyama: Well, we really streamline the process. We have a Get Help email. We have a Get Help phone number that people can contact. Our cell phone numbers for Tony and myself are available on our website. So you can always get in contact with someone. Obviously if it’s a crisis, if it’s a life-or-death situation, we ask that you go to the hospital or contact the police, but for all other occasions, LAP is available.
We get back to people within a 24 to 48 hour window and we see people within the first week of contact, all in an effort to streamline the process, because we know how hard it is for people to reach out to help.
We have increased our CLEs throughout the state in an effort to kind of put LAP out there for people to recognize and to let them know that we have options available for them.
We opened an office in Geneva last year that I staff on Mondays, all in an effort to capture people outside, in Kane, DuPage, DeKalb, Rockford area, because those people don’t access services. Our main office is at 20 South Clark. We have an office in Park Ridge as well to capture McHenry and Lake. And then we also have satellite offices throughout the State of Illinois.
We are creating LAP locals throughout the state. We are doing judicial training, so judges become the face of LAP as well in communities where we aren’t as readily available in person.
We run groups every week at LAP downtown, women’s, men’s, parenting and young lawyers groups, and we run two AA meetings a week for judges, lawyers and law students only.
So we try to create diversity in some of the opportunities for people to engage so sometimes people aren’t ready to go see an individual counselor but are willing to engage in group or start going to an AA meeting where they feel a comfort level.
Jon Amarilio: What does that process look like? Let’s say I come to LAP and I have a drinking depression anxiety issue, I don’t, I’m one of the rare happy lawyers, but let’s say that’s the case.
Dr. Diana Uchiyama: That’s fantastic.
Jon Amarilio: What can I expect not like a play-by-play, but what’s done there?
Dr. Diana Uchiyama: So we put you in contact with one of our clinicians, we divvy it up depending on the need, depending on the specialty or what they’ve reached out to us for. So I do want to say that a lot of people eventually reach out to LAP because we are confidential with immunity under Supreme Court Rule 1.6 meaning that we are the Las Vegas of the law, what comes to LAP stays at LAP unless someone wants us to release that information.
Jon Amarilio: It’s a really interesting comparison of substance abuse but, all right.
Dr. Diana Uchiyama: For those you who are gamblers out there.
Jon Amarilio: No, I like the irony, go with it.
Dr. Diana Uchiyama: Yeah, so, the one thing I do have to say is that there’s a tremendous amount of stigma in the field of law still related to people accessing services. So even though we are confidential with immunity, people still fear coming to LAP and so my office out in Geneva is in a place where there are no lawyers, downtown, many of us meet clients at locations of their choice because of the stigma of them being afraid of coming in and being recognized by their peers.
And so we really accommodate people to the best of our ability we meet them where they’re at. Obviously, ideally we can’t meet everyone outside of the LAP office but so we do a thorough evaluation to determine what the needs are, if the mental health issues are pretty prominent and unrelenting we may indicate that they need a psychiatric evaluation. We ask their insurance, we try to find and partner people up with services that are appropriate. We do see a lot of trauma victims where especially the female population or the LGBTQ community where they are disclosing trauma for the first time. So we have trauma providers because that’s a long-term process that we refer people out to, but we do see people for brief therapy.
We try to engage them in the group process when they feel comfortable and if they are substance use issues, we try to get them into the AA/NA meetings. So we really are all-inclusive kind of agency that tries to look at the person individually and then determine what the needs are and figure out the best treatment plan moving forward.
Stephanie Villinski: And Jonathan, I know there’s a lot that Bar associations are doing on this issue, can you talk about what the CBA has been up to?
Jonathan Beitner: Yeah, so the CBA has a, well, there was a mindfulness committee and a wellness committee and that’s now being combined into the attorney well-being and mindfulness committee and just kind of streamlining the process and we put on programming and we partner with institutions like the Commission and LAP, and May is Mental Health Month and so we last year, we put on a lot of programming, lots of CLE opportunities.
Jon Amarilio: Do you serve kombucha?
Jonathan Beitner: We have not served kombucha but it’s – we’ll have to take it under consideration.
Jon Amarilio: No one, I don’t know. No, no, no.
Stephanie Villinski: 2020.
Jonathan Beitner: It’s a hot topic, yeah, right.
Jon Amarilio: I still don’t really know what it is, but —
Jonathan Beitner: No, me neither, I’m not a kombucha fan, but yeah, but we’re available and we’re relatively new committees, so we are looking for ways to engage and partner with other existing committees to try to spread the word and disseminate information to the rest of the Chicago legal community.
Stephanie Villinski: Excellent and then is — are you mostly doing education or is it — are you doing any regulatory things at this point on the issue?
Jonathan Beitner: There is no regulatory initiatives at the moment. I have been involved with Lawyers Assistance Program, and in that capacity, we’ve worked with the Commission with the relatively new mental health and substance use disorder, CLE requirements. So on the regulatory front I feel like that was a big step forward and for those that aren’t familiar with that requirement, every reporting period all attorneys need to have at least one hour of continuing legal education around these topics.
And that was a big push and a huge win as far as de-stigmatizing programming around this issue not just admitting people who have issue with it but just putting on educational opportunities for these topics as really raised awareness, and moves like that coupled with the recent research like the ABA Hazelden study that we were talking about before has really, it’s an exciting time to be working in this space because there’s really been sort of an explosion of interest and initiatives and programs at the city, the state, national level, kind of across the board.
So I do think really meaningful steps have been made to reduce that stigma, because people are now realizing. I always say the ABA study showed sort of unsurprisingly shocking data, and what I mean by that is, we’ve always known that the practice of law is a difficult one to operate in, but it’s one thing to kind of talk in platitudes about it, that’s just kind of high stress and high demand, and it’s another thing to see a 28% depression rate and over 10% of the professions had suicidal thoughts.
Those are the kind of data points that lawyers in particular kind of very evidence-based, very cerebral, like we were talking about before, those are the data points that are really moving the needle and you’re seeing law firms and legal employers across the country kind of investing a lot more resources, Bar associations, and so it’s not just the Lawyers Assistance Programs fighting this fight because they’ve been doing it for decades now and really in the last half a dozen years or so people are really sort of waking up to these issues.
Stephanie Villinski: And I will head on the requirement for mental health and substance abuse CLE, the Commission will have by the end of 2019, a free online program on resiliency as well, so check that out.
Jon Amarilio: What are we talking about when we say “resiliency”?
Stephanie Villinski: So that is a great question. I would like Diana, can you talk to that a little bit as far as I will just say studies are showing that lawyers are terrible at resiliency but can you talk about why that might be and what it is?
Dr. Diana Uchiyama: What’s interesting if you take a poll? And I often ask people when I do CLEs and I do a lot of them. I say how many of you think lawyers are resilient bunch and most of the people in the audience raise their hand and I am like wrong, eh, wrong. Actually we’re really thin-skinned, we take things personally, we get really defensive at criticism and those are all things that lead to whether a person is resilient or not.
The resiliency studies actually come out of the military, that’s where the basis of resiliency is, and it really took place after the Vietnam War when they looked at people and why some people thrived after the war and why some people didn’t. And what they looked at were factors that contributed to resiliency or a lack of resiliency and those are personal attributes.
So people who come from a strong family support system, who believe in self-efficacy meaning that you have control over your own destiny, who have positive coping skills in place, tend to do better even under extreme duress and stress, than those who lack kind of supportive mechanisms to kind of try to keep them together.
They looked at education as a buffer but clearly lawyers are some of the most educated people on the planet. So what is going on in the field of law that makes lawyers less than resilient despite coming usually from higher socioeconomic class and not all the time but also from intellectual levels that sometimes buffer stress and anxiety issues.
So what we have determined is the incivility, adversarial nature, the law school process. When you look at what Jonathan talked about is when people come into law school the people who apply are technically more resilient and healthier than the average population of individuals their age.
And then by the end of the first year, it’s kind of like they’ve been decimated and their mental health and substance use issues have increased dramatically. The rate of suicidal thinking has increased in a dramatic fashion. So what is it that’s happened over the course of that year, is it the pressures?
Jon Amarilio: So it’s law professor’s fault?
Dr. Diana Uchiyama: No, I think we have to kind of take a look, kind of teaching people about pessimism. If you go in and you’re already pessimistic like Jonathan talked about and then you’re teaching them to be more pessimistic then overall, your level of negativity and pessimism will increase.
But we also have to recognize that people who are generally more compassionate and empathic people are at a higher risk of compassion, fatigue and burnout, which leads to less resiliency, but we don’t know that as a profession.
So I consider empathy one of my strongest virtues but it also leaves me vulnerable to kind of being decimated by the legal process by the kind of ambiguous endings that happen in cases by the win or lose kind of philosophy and then hanging my hat and my identity on whether this win at all costs kind of mentality is really working for me personally.
So resiliency is about the ability to kind of pick yourself up despite some of the negative consequences or things that happen in your world and to perceive the world in a positive way despite what’s happened and we’re seeing that lawyers don’t do a really good job of that.
Jonathan Beitner: And it’s so important because and there’s been such a push for it of late because we know, resilience at its core is like your ability to bounce back when you experience adversity and we know we’re going to experience adversity like that’s a fact of life and that’s not unique to the legal profession but it is particularly true in the legal profession.
And it’s funny that you bring up this topic as I’m literally leaving this recording to give a presentation on titled “Four ways to bolster and build resiliency” and just very kind of one off, sort of the things and the techniques that you as an individual can do to bolster your own rates of resiliency so to speak are kind of at a high level foster more optimism and positivity in your life, because that will help you bounce back from when you hit that low practice mindfulness, engage in cognitive reframing, which is simply the ability to look at and analyze one situation in multiple different ways.
Jon Amarilio: Which good lawyers should be doing anyway.
Jonathan Beitner: Which all good lawyers should be doing, right, you’d think that this would be — right, so there are some things about the legal mind so to speak that contribute to these poor mental health and substance use rates, but there are a lot of things about lawyers that were particularly well suited to combat the same things and so something like engaging in cognitive reframing is a perfect example of that, because a lawyer mind should be able to argue both sides of the coin so to speak.
Jon Amarilio: What was the fourth one?
Jonathan Beitner: And the fourth one is practice self-compassion, because one of the other issues in the legal profession is there’s high rates of perfectionism, and maladaptive perfectionism and part of the problem is those perfectionist tendencies helped us when we were law students and as we were going through our academic career to be high achievers and to push ourselves to do well. But it can become maladaptive when we kind of get overly concerned and have unrealistic expectations and we’re thrown into a profession that sort of excellence is the standard and —
Jon Amarilio: Just the excellent all the time.
Jonathan Beitner: Right exactly, it’s as simple as that, right. So —
Jon Amarilio: It’s my personal motto.
Jonathan Beitner: Right, right and all of these things kind of — all those topics we just — I was just mentioning, fostering optimism, positivity, practicing mindfulness, engaging cognitive reframing and self-compassion, they all kind of feed in with one another and so really the kind of the overarching one is, is how do you kind of foster more positive in optimism in your life because that’s really going to be the best buffer against kind of the detrimental effects to your overall well-being when you experience low points, when you have setbacks because we know those are going to happen.
Dr. Diana Uchiyama: And from a psychological perspective Type A personalities who are perfectionists tend to be rigid, and so the more rigid we become, and you see that sometimes with the aging process is that you get set in your ways, you want to control things that are not within your control and so that lack of internal flexibility kind of sets the tone for the possibility of developing maladaptive coping skills.
So if I can’t force you into a position, if I can’t be flexible about the way I view the world and the problems in my world, if I lack insight into my own capacity for understanding what is happening and why things are becoming less than optimal, then it sets up kind of the perfect storm to developmental health or maladaptive coping skills including substance use. And lawyers although alcohol is their favorite drug of choice, they use any and all substances. There isn’t one that I haven’t seen that we’re seeing prescription drug use and opioid use and marijuana use, that’s very problematic and cocaine is on the uptick again. I have clients who have crack addictions, crystal meth. So we’re not immune as a population of individuals to not experiencing the same problems that the general population is facing, but I think we create this concept that because of what we do we are slightly immune to it and so I think that insight that comes into recognizing our problems is sometimes fairly low.
Jon Amarilio: So that’s really interesting, if I’m hearing you both correctly a lot of the very traits that help lawyers succeed and become lawyers eventually start eating away at their mental health.
Dr. Diana Uchiyama: It’s a blessing and a curse, right?
Jon Amarilio: Right.
Dr. Diana Uchiyama: Yes.
Jon Amarilio: And then but some of those skills can then be turned around to help them dig out of that hole.
Dr. Diana Uchiyama: They make us excel, right? They make us — fear of failure is a huge driver for perfectionist and competitive A types, right. So something’s always nipping at our heels but when is enough, enough, right? What is our definition of success is it always about achievement and that goes to that self-compassion and loving kindness, that mindfulness thing, it’s like we need to — it’s not just about the law, it’s like where are we filling up our buckets, because if it’s just based on whether we win a motion or did well at a deposition or argued good case law or won a trial, we’re really setting ourselves up for failure, because that’s not what defines successful people. Money, titles, that doesn’t create happiness.
And so I think it’s like the dog chasing its tail kind of phenomena that we engage in the same kind of behaviors hoping to kind of achieve that level of happiness and satisfaction and not being able to get there.
Jonathan Beitner: Well, it’s interesting. Well, so first of all I totally agree with everything that was just said, but just to speak to your point about, well, how does kind of — let’s take the way lawyers are trained as sort of — we talked about how that contributes to a little bit of the problem, but it can also be the solution, right? So often when I’m speaking or helping people through whether it’s coaching or mentoring or whatever, various kind of what I referred to as thinking errors, right/ So overly personalizing things, catastrophizing things, having this perfectionism, unrealistic expectations and the unreal ideal, you know, because of that implicit negative bias and that inherent pessimism that we were talking about our first reaction to a situation may not be objectively accurate, and so we’ll take a situation.
A lot of junior attorneys, particularly in the law firm setting, they’ve little confidence. They are told the standard is excellent, but at the same time they’re told you don’t know anything, law school hasn’t really prepared you for the practice of law, it’s a very common refrain.
Jon Amarilio: Which is true.
Jonathan Beitner: Yeah, which is true, to a certain extent. So people stress out about that, even though it’s perfectly normal, there’s nothing wrong with them, blah, blah, blah, and so they think themselves, all right, I got some negative feedback let’s say, it’s like, oh my God, I’m going to be fired. It’s amazing how many your first year associates jumped, I’m going to be fired when the economics of the firm structure render that almost an impossibility. But we get that way, because of this negativity, this pessimism. And so, okay, how do you avoid these kind of thinking errors, these kind of cognitive traps, you use something called Socratic Ideation where you kind of challenge your own thinking, and so you ask yourself and this is a lot of what coaching is. It’s like, oh, how true is that thought, where does that belief come from, where is the objective kind of, you think you’re going to be fired, why is that. Well it’s just because I have all this insecurity.
And so lawyers are particularly well-suited to engage in that kind of exercise. Socratic Ideation, Socratic method —
Jon Amarilio: Questioning your own assumption?
Jonathan Beitner: Exactly, right, and so that, that are kind of hyper-analytical mind and cerebral nature, it makes us well-suited to kind of push back on what might be an inaccurate thought, or a thinking error? And so the key is just being aware of it and getting a little bit of education about what the issues are, because once you know about it, and you have like can articulate the problem, it’s so much easier to spot it, it’s so much easier to avoid it going forward.
And so, I totally agree that it’s this weird kind of chicken and egg and circular thing, but as much as legal training and kind of the attributes that the legal profession self selects for hurts us in some ways and also are the same tools we can use to kind of work through and avoid kind of these issues at the onset before they kind of manifest into more clinical depression, anxiety, substance use disorders.
Jon Amarilio: So random and probably oddly specific question, but when I’m discussing these issues like with my friends and I also saw an article recently that was written by Brian Cuban, friend of the pod, former guest, one of the things that comes up is what seems like the skyrocketing use of Adderall in law school and how that drug in particular and other ADHD drugs that are either overprescribed or obtained without prescription seems to be making all of these negative traits come out all the more in law students producing like — using this in a non-scientific and pedestrian way but almost like borderline psychotic behavior, because they use it so much. Is there any validity to that perception because it is widespread?
Dr. Diana Uchiyama: I think we have to be cautious of accusing one prescription medication of causing the problems, because cocaine is rampant among college students and law school students and among professionals, legal professionals as well. It’s being imported into this country at record numbers more than when I was fighting the drug wars in the early 2000s. So I think we have to be really cautious.
Prescription drug use is definitely a problem. Anytime a medication is used for wrongful purposes then we have to kind of look at that as a potential substance use problem, but I think clearly we have to also look at marijuana as a tool that we have to really look at closely because the THC concentrations are at such high levels, the smoker bowls go up to 28% and the edibles up to 80% TSA.
Jon Amarilio: But those drugs — and let me just push back a little bit. I know you are the expert, but those drugs they’re used more recreationally whereas ADHD drugs are used to enhance performance and the perception is I’ll get some kind of edge if I pop this Adderall before the final.
Jonathan Beitner: And I think more than that I will — if I don’t — if I don’t pop the pill I —
Jon Amarilio: I will be behind.
Jonathan Beitner: I am at a 00:44:37.
Jon Amarilio: Right. If I am not cheating and I am a sucker.
Jonathan Beitner: Right, totally, because how can I study ten hours straight, all that kind of stuff. So — I’m sorry I didn’t mean to interrupt you.
Dr. Diana Uchiyama: Yeah — no, I — I — it’s not that I’m just agreeing with you, but I think we need to be cautious because what we see is much more complicated than that.
Jon Amarilio: Sure.
Dr. Diana Uchiyama: That people are also using — with the legalization anytime something becomes legal people think of it as harmless.
But what I say is we see high levels of addiction issues with marijuana and we’re seeing a lot of psychotic and delusional disorders and people who aren’t predisposed to those kinds of disorders in the past.
Jon Amarilio: Because of the drug use?
Dr. Diana Uchiyama: Because of the high THC content. So I just saw someone for an assessment last week who has a delusional disorder that’s forming from high rates of using dabs in a vape pen because the concentration levels are so high. So I would like to just say that it’s not just Adderall, yes, even college professors who are writing papers, people look at prescription drugs is the kind of in road to being more successful, it’s just we really have to look at the overall picture of what people are doing.
Cocaine can be said in the same way, it’s not just recreational, it creates an edge and it creates that same stimulant effect, and so, I think we need to be cautious because it’s not one thing, it’s not just Adderall, and frankly, the use of Adderall as an abuse of thing is something we see less than other kind of substance use at LAP.
Jonathan Beitner: And just on the substance use, back to that ABA Hazelden study, when I was going through it, it was very interesting because the numbers related to cocaine use, marijuana all those things were really low. And it was until years later after the study, maybe two years later that I read in a New York Times article that noted that 75% of the respondents from that ABA study opted out of this the drug use section, okay, because it’s self-surveying whatever. So 75% opted out and it’s not because none of them were taking drugs, right?
Jon Amarilio: It’s because all of them were taking drugs.
Jonathan Beitner: Right, right, right. So I think that highlights what we were just talking about it how prevalent not just ADHD and Adderall and things like that but sort of the whole canopy of substances and I think I’m not a mental health clinician so I can’t speak to it but to me, it doesn’t matter what your substance of choice is whether it’s alcohol or cocaine or weed or Adderall.
It’s about thinking why are you taking it right and is it to self-medicate, is it to get this performance edge, and if that is the reason, why do you feel like you need it and the ways in which that that impacts your overall well-being whether that’s you’re taking Adderall or you’re on high on cocaine, you’re not getting any sleep or you’re engaging in other substances and you’re blowing deadlines or you’re neglecting familial relationships or whatever it is, we know that well-being is a very — it’s important to take a holistic approach to in a kind of multi-dimensional approach to your overall well-being and so to me, the better — an important aspect of the drug use question is sort of why are people using it and what are the underlying issues that are kind of driving the usage.
Jon Amarilio: Law professors.
Dr. Diana Uchiyama: Well, I get on to say this related to law students that LAP has put a tremendous amount of effort into being available in every single law school in the State of Illinois; so there’s nine law schools in the State of Illinois. We have office hours in every single law school once a month in an effort to kind of manage some of the problematic behaviors before they manifest themselves in the law.
And what we see is that 40% of the people, the clients that we see at LAP are coming out of the law schools now and that number is increasing because we started with the law school session starting in September, our numbers have exceeded the levels of last year at a dramatic rate.
Jonathan Beitner: Well, I was just going to jump in and say on a more hopeful note. I think that what that shows more than anything is sort of the push that younger attorneys are making for prioritizing these issues, de-stigmatizing these issues, and really saying like, we know that the practice of law again unsurprisingly shocking data, we know the practice of law is going to be difficult.
People are so excited to be lawyers and there’s not going to — I think there’s going to be any real shortage of lawyers anytime super soon. But I do think that there’s a growing clamor particularly from law students, particularly from more junior attorneys that we want these issues prioritized and that’s why you’re seeing kind of this explosion of interest and programming.
And so, the fact that there’s such a high percentage of LAP’s clientele is from law students I don’t see that as law school being so much harder but more — kind of more optimistically that people are waking up to this and being more open about it and wanting to seek help because LAP really is the first stop that I would recommend any lawyer who is dealing with these issues to kind of check out.
Jon Amarilio: And with those sobering and optimistic thoughts, we’ll go to our second break.
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Jon Amarilio: And we are back. So like every episode, we’re going to close out today with a game we call Stranger than Legal Fiction, the rules are really simple. I’ve done my research and found one strange law that is on the books somewhere in the world, but probably shouldn’t be. I’ve made another one up and I’m going to pull all of you to see if you can distinguish strange legal fact from fiction.
You are ready to play?
Jonathan Beitner: Absolutely.
Dr. Diana Uchiyama: Yes.
Jon Amarilio: Diana, why don’t we start with you?
Dr. Diana Uchiyama: Oh dear.
Jon Amarilio: All right, so number one, option number one I should say in the Venetian suburb of Mestre, Italy, it is illegal to sweep streets without a permit or other form of prior government authorization. Don’t guess yet, that’s option number one.
Option number two in Delaware, using whistles is prohibited and subject to a fine of six months in jail or $1,000.
Jonathan Beitner: Using a whistle, that’s it?
Jon Amarilio: Using a whistle like how you use that old little annoying thing.
Dr. Diana Uchiyama: I thought there was your guess that was with us.
Jonathan Beitner: Yeah — No.
Jon Amarilio: So, Diana, why won’t we start with you? Which one’s real? Which one’s fake?
Dr. Diana Uchiyama: I’m going to go the real one is the whistle because of whistleblower.
Jonathan Beitner: Yes and everybody is fine. There you go.
Jon Amarilio: Because of the persecution of whistleblowers in the American Society.
Dr. Diana Uchiyama: I am happy to say those words, I’m just saying because everyone’s talking about whistleblowing and you 00:51:52.
Jon Amarilio: And same for you, it’s okay.
Dr. Diana Uchiyama: Yeah.
Jon Amarilio: I think we’re on the same page. Jonathan, what do you think?
Jonathan Beitner: I’m going to take the Venetian anti-sweeping rule.
Jon Amarilio: Why?
Jonathan Beitner: You know, canals, I could see it being a real issue, getting too much stuff clogged up in there, it’s a real nuisance.
Jon Amarilio: Okay, that makes sense. Stephanie?
Stephanie Villinski: I’m going to go with the Venetian as well, I like — I like — I have been there, I could see well —
Dr. Diana Uchiyama: The channels are very dirty.
Jon Amarilio: So, Diana, don’t let this get to you and your competitive streak as a lawyer but unfortunately you were incorrect.
Dr. Diana Uchiyama: But it was a good tying to the whole lot.
Jonathan Beitner: Yeah, it was great.
Dr. Diana Uchiyama: So it made for a much more interesting kind of topic.
Jon Amarilio: It was a great tying, actually it comes I found this from my mom who sent me an article, hi mom, of a migrant who in Italy who didn’t want a Panhandle and couldn’t find work. So he began sweeping the streets in Venice to help his new community and just asking residents if they wanted to pay him for his service and he was fined nearly $400 —
Dr. Diana Uchiyama: Wow. That seems unfair.
Jon Amarilio: — by the local police. It does seem unfair, thankfully that fine was withdrawn by the police after quite a few protests by people who are 00:53:09.
Jonathan Beitner: Prevailed.
Jon Amarilio: Urging local government officials just to be decent human beings.
Jonathan Beitner: Let’s back to the civility.
Jon Amarilio: Yeah, there you go. And that’s our show for today. I want to thank our guest Dr. Diana Uchiyama and Jonathan Beitner for this hopefully healthy and thankfully kombucha conversation. I also want to thank my co-host, Stephanie Villinski, and everyone here at the CBA who makes this machine run including our executive producer Jen Byrne, Ricardo Islas on sound, and everyone at the Legal Talk Network family.
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