Depression, drug use, suicide, alcohol abuse and a host of struggles that we as lawyers help clients with plague us as well. Our profession faces a disturbing and sad level of problems. We owe it to ourselves, each other (our partners, associates and colleagues) and our clients to do better.1 “The legal profession suffers from mental health impairment to a higher degree than does the general public or even the other professions. The predominant forms of impairment are alcoholism, addiction and depression.”2 Let’s explore the state of the practice of law regarding some of these issues and discover how practitioners, firms and family can help.
Case Studies
A CNN piece about why lawyers are killing themselves described the following cases:
At 58 years old, Ken seemed to have the life everyone dreams of. He was generating about $600,000 of billable hours for his law firm every year, married to his childhood sweetheart and had three amazing children. However, his wife reported the stress of his job led him to seek the help of a psychiatrist and psychologist because the depression he was experiencing began to cripple him. In May 2011, after a 6-month battle with depression fueled by the stress of his job, Ken committed suicide.3
Fifty-eight-year old Harry was also being treated for his severe depression in August 2012 when he hanged himself.
Tod’s struggle with depression ended when he shot himself inside his legal office in Kentucky. It’s unclear whether he was able to seek help prior to ending his own life.
Another lawyer, Steve Angel, survived his battle with depression and now blogs about it. He considered suicide at one point in his career as clients’ demands mounted, and they became angry when he didn’t return their calls. Eventually, he was disciplined by the Oklahoma State Bar Association for failing to represent several of his clients. The pressure mounted, and the depression increased. He locked himself in his home, hid from his life and spent his days in bed. Fortunately, his survival allows him to be a voice and advocate for other struggling lawyers to let them know they’re not alone. His website includes the following testimony, which helps to encapsulate not only the problem but also some of the solutions and what we can all do to proactively compassionately help our partners, associates and colleagues in the profession:
‘Dan gave a powerful, well-documented presentation about depression and other mental health issues for lawyers. The discussion he facilitated with management helped us plan our firm’s response to this crisis in our profession.’ Mary Kelkenberg, Director of Attorney Talent Management, Hodgson Russ, LLP.4
Unfortunately, none of the real examples appearing in CNN’s story are outliers. An alarming number of lawyers struggle with depression and anxiety. In their desperation to cope, they often turn to alcohol and substance abuse. And when things feel too unmanageable, some sadly turn to the only option they feel they have left, suicide. In the same story, CNN cites a statistic from the Centers for Disease Control that lawyers rank among the professionals with the highest rates of suicide, just after physicians, pharmacists and dentists.5
Interestingly, the research shows that incoming law students rank as one of the healthiest groups in the nation,6 but that status devolves as they go through law school and then enter their careers, and they nearly top the charts as the group of professionals struggling with the highest rates of depression, anxiety and addiction compared to both the general population and educated professionals.7 In fact, “An overwhelming majority of legal professionals believe their mental well-being is worse off as a result of their chosen career…”8 Although many individuals struggling with addiction also tend to struggle with anxiety and depression, the rates of these commonly co-occurring disorders in lawyers are exponentially greater compared to the general population. Additionally, they’re likely underreported due to shame, fear of damaging their professional reputation, denial, rationalization and social acceptance that stress and substance use are just a part of the culture. All of these factors can have incredibly detrimental effects on an individual.
The Oregon State Bar Professional Liability Fund conducted a study showing that 60% of lawyers entering a lawyer assistance program for addiction had malpractice suits filed against them while they suffered from substance abuse.9 The American Bar Association (ABA) reported 27% of disciplinary cases involve lawyer substance abuse.10 Ignoring the issues and denying help to lawyers struggling with mental health issues mean putting their lives, their clients’ lives, as well as their careers, in jeopardy. We must address this issue immediately, openly and compassionately.
Background Statistics
In a 2020 survey conducted by American Lawyer Media (ALM), out of 3,800 respondents surveyed for their Mental Health and Substance Abuse Survey, 31.2% of respondents expressed feeling depressed, 64% felt they had anxiety, 10.1% felt they had an alcohol problem and 2.8% felt they had a drug problem.11
In another study conducted by the ABA Commission on Lawyer Assistance Programs and the Hazelden Betty Ford Foundation, the numbers reflected even higher rates of problematic drinking: 21% initially considered themselves problem drinkers, but as questioning got more specific, the number jumped to over 36% of lawyers identifying that they struggle with alcohol abuse.12 Research indicates a worrisome level of behavioral health problems exhibited by lawyers. Rates of alcohol-dependent drinking, and rates of depression and anxiety symptoms, were 20.6% from a sample of lawyers compared to a rate of only 11.8% for a sample of highly educated workers evaluated for the same issues.13
The numbers from different studies may vary because some lawyers may not be willing to disclose their symptoms for numerous reasons, and the lawyers who are willing to be forthcoming about their symptoms may not understand the criteria for what’s considered “problem drinking” or “alcohol abuse,” as individuals typically compare their own drinking to those around them to differentiate normal from problematic. It’s not until somebody reflects on criteria and standards outside of the culture of their circle of contacts that they may begin to realize that their alcohol use isn’t normal.
To provide a comparison, roughly 7.1% of adults in the United States report suffering a major depressive episode. That suggests that lawyers may be about three times more likely to struggle with depression than the average adult in the United States.14 A report from the American Society of Addiction Medicine states that “More than 20% of licensed attorneys drink at levels that are considered ‘hazardous, harmful, and potentially alcohol-dependent.’ That’s three times higher than the rate of problem drinking among the general public.”15 Even in the realm of other high stress, high stakes professions like medicine, lawyers exhibit double the rate of problem drinking as doctors.16 That should be a concern for the profession.
The Anxiety and Depression Association of America states that anxiety impacts 18.1% of the adult population (18 years of age and older) each year.17 Based on the ALM report mentioned above, that suggests that lawyers may be 3.5 times more likely to experience anxiety than the general population. Again, that should be a concern for the profession.
Contributing Factors
There are no doubt circumstances unique to each lawyer affected, but there are some general factors in law that contribute to the issues. Lawyers often deal with highly technical issues, under tremendous time pressures, with strict deadlines and under the pressure of personal liability if an error is committed.
“Stress in law practice abound, and the stresses are unique. Deadlines are rarely under their control. ‘Failure’ is a regular outcome of their work. Financial insecurity accompanies the drive to obtain clients, law firm compensation structures, and law firm departures, mergers or split-ups.”18
Addressing These Issues
The ABA House of Delegates has adopted several resolutions addressing lawyer mental health issues. Resolution 105 supports the goal of reducing mental health and substance use disorders and improving the well being of lawyers, judges and law students and urges stakeholders within the legal profession to consider the recommendations set out in The Path to Lawyer Well-Being: Practical Recommendations for Positive Change from the National Task Force on Lawyer Well-Being. Resolution 106 amended the ABA Model Rule for Minimum Continuing Legal Education to include a requirement for lawyers to receive at least one hour of mental health or substance use disorder programming every three years.19
Why Don’t Lawyers Seek Help?
Many lawyers facing these challenges don’t seek professional help for alcohol abuse, drug addiction or depression. Some feel they’re unable to seek help because of the stigma and fear that it will have a devastating effect on their careers while others feel the pressure of being superhuman for everyone in their lives. The need to project an air of confidence and an unflappable ability to handle stress, showing “no crack in the armor” to their partners, clients and opposing counsel can be overwhelming to lawyers who are unable or unwilling to seek help. Others still are unaware they have a problem because everyone around them expresses the same sentiments, copes in the same ways and still manages to function at a high level. The pressure is crippling, and it’s become a cultural norm that everyone accepted when they became a lawyer: “Work hard, play hard.”
Dan Lukasik, founder of Lawyers with Depression, found himself spiraling into the depths of a paralyzing depression during his law career.20 He believes it was the stigma associated with mental illness that prevented him from seeking help. Additionally, he felt the pressure of being superhuman, the one everyone turned to to solve their problems, and the shame of having problems himself that he couldn’t handle on his own. Finally, Dan felt that in society’s eyes, he had no right to have problems because the general public has a misconception that if you make a lot of money and have a high powered career, then you should count yourself as one of the lucky ones. The guilt and shame fueled the depression. His story sadly resonates with many other lawyers.
In fact, in an Illinois State Bar Association article, “Lawyers and Addiction,” very few participants with evidence of problematic substance use got help, and many participants in the study cited two common barriers to seeking help—both of which share a similar concern: not wanting others to find out about their issue and protecting their privacy and confidentiality.21 Essentially, these two barriers can be summed up in one word: shame.
One can imagine the pressure of a young lawyer emerging from law school buried in student loan debt, fighting for a desirable but competitive entry level position in a law firm, forced to choose between their mental health and their career of long, pressured hours. The data shows that more often than not they choose their career. The risk of someone finding out that they’re struggling, and extrapolating that they’re unable to function in a high performance environment, is too risky to their job security, so they continue to suffer in silence.
In a culture that’s understood to be very high pressured, there’s also a desire not to embarrass a colleague as long as the individual is performing. This reinforces the shame felt by those who struggle as others believe it’s easier to avoid the issue than to address it. Dr. Daniel Angres, an associate professor of psychiatry at Northwestern University Feinberg School of Medicine in Chicago states that “Law firms have a culture of keeping things underground, a conspiracy of silence…”22 This culture further reinforces the notion that lawyers must suffer alone.
There’s an ethical obligation for lawyers to address any suspected “impairment” of their fellow lawyers if they feel the impairment rises to a level that may impact the lawyer’s client responsibilities. Knowing when a lawyer is “impaired” may be difficult to discern. That’s why many firms have policies and practices in place for reporting awareness or suspicion of impairment. Some law firms have even included policies regarding this issue in their operating agreements.
In the legal world, there’s a competitive rat race that may penalize those who practice self-care. To bill 40 hours a week to meet hourly billing targets for the year, a lawyer may work upward of 60 to 80 hours a week. Understandably, this puts a tremendous amount of pressure on family and personal life.23 To put this into a bigger perspective, the British Medical Journal found that “...employees who work more than 48 hours every week are 11 times more likely to abuse alcohol compared to workers who stick to the standard 40 hours. Employees who worked 55 hours a week had a 13 percent chance of developing an alcohol addiction.”24 Some law firms try to alter the expectation of working hours through creating policies restricting overtime but “...employees and their supervisors are regularly compelled (and even encouraged) to work beyond their limits, with the goal of achieving faster promotions, making more money, and making a favorable impression.”25 If lawyers are forced to work over 80 hours a week to progress in their careers, and individuals who worked over 55 hours a week have a 13% chance of developing an alcohol addiction, one can imagine the chance of a young lawyer developing an addiction while trying to make partner.
In other studies, exploring why lawyers don’t seek treatment for their addiction and mental health issues, other commonly noted themes emerged. These included:26
- A belief that they can handle the issue on their own;
- Fear of the negative impact on their reputation among peers, judges and potential clients;
- Inherent emphasis on intellectualism that negates the emotional introspection needed to recognize the value of therapy;
- Denial;
- Ego—the high achieving personality of a lawyer that can often lead them to always wanting to be “right.”
Signs and Symptoms
It can be harder to identify signs and symptoms of depression, anxiety and substance abuse when it seems as if these are merely accepted as the norms of the culture among lawyers and other legal professionals. Many in the profession endorse these symptoms, and it becomes a point of competition and camaraderie in the rat race to the top, which can make it harder to identify when it’s more problematic for one individual over another. That being said, if you notice the below behaviors in yourself or others, it’s good to check-in and ask.
Dramatic changes in:
- Sleep
- Functioning and job performance
- Hygiene
- Relationships
- Eating
- Body weight
- Communication style
- Ability to work (for example, calling out of work or missing important deadlines)
- Mood
Additionally, you may notice:
- Increased hopelessness, irritability and complaints
- Increased substance use
- Increased consequences from substance use
- Clients complaining
- People commenting that someone has “changed”
- Guilt
- Physical complaints
- Difficulty concentrating
- Change in pace
- Thoughts or comments about death
- Additional and uncalculated risk-taking behaviors
- Increased impulsivity
- Irrational thinking
- Forgetting conversations
Profits, Malpractice and More
Having a colleague in your firm who struggles with these challenges could expose the firm to unwarranted malpractice risks, reputation risk and more. Isn’t it incumbent on every firm to try to provide support? Even if these more calamitous events are avoided, what of the environment that’s fomented so many issues? Can our partners, associates and staff really be effective, creative and efficient if working in an environment that’s fostered the disturbing statistics above? Every firm wants profit growth. Raising billing rates, increasing billing and adding staff and technology to increase leverage are all common steps to enhance profitability. But perhaps improving the environment and the psychological health of our firms could represent an opportunity not only to do the compassionate and moral thing but also to enhance the bottom line.
Reasons for Hope
Perhaps an unexpected benefit of the COVID-19 pandemic will be heightened awareness of the need to address stress-related issues in the workplace. A Harvard Business Review article reported that “In a recent survey of 1,200 employees almost 70% of employees said that the pandemic has been the most stressful time of their careers.”27 Because so many people expressed their struggles in coping with depression, stress, etc., as a result of the pandemic, the stigma of seeking help has been reduced. If an impaired lawyer is hesitant to admit that they have a substance abuse issue, they may come forward to admit they’re struggling with depression related to COVID-19, and they’ll receive the help they need. Firms are beginning to form Mental Health Employee Resource Groups (called by the acronym “ERGs”) as a way to show support for employees coming back into the workforce. ERGs provide a safe, confidential environment for employees who want to discuss and promote mental wellbeing.
How to Help
Although it’s easy enough for someone to give the typical advice: get outdoors, maintain a work-life balance, exercise, engage in mindfulness and seek professional help,28 the truth is that true change can’t happen until we advocate for an overhaul of the system and change the unrealistic expectations put on lawyers to be successful. Lawyers are put in a position in which they’re forced to choose among their mental health, their families and their personal lives and progressing in their careers. Exhaustion, working over 80 hour weeks, sacrificing family, alcohol-infused networking with clients and other lawyers, constant stress and pressure to win shouldn’t be the necessary sacrifice for a promotion. We need to stop rewarding the things that are killing people, have the courage to intervene when we see other lawyers struggling and reconstruct what it takes to be successful in a legal career before it’s too late.
In the meantime, law firms and bar associations can provide ERGs and access to confidential resources for lawyers to seek help if they’re struggling and don’t feel their law firm is a safe place to confide in someone. Law firms can also invite experts to navigate more vulnerable conversations and provide education around substance abuse and mental health problems. Senior associates can also decrease the pressure to drink in social settings by leading by example and providing alternative options. Firms can increase awareness of already available resources. Most state and local bar associations have lawyer assistance programs. These programs provide free and confidential mental health resources and addiction recovery support to their members. See “Resources for Lawyers,” this page.
Firms should continue to offer alternative career paths to young associates. Not every lawyer entering private practice has the desire or ability to meet the common 2,000-hour-per-year billable hour requirement or the desire or ability to be on “partner track.” Firms are finding that they have room for and find value in lawyers who want to work in a “career associate” role or in a permanent part-time role.
A firm will only benefit from promoting healthy habits to its employees. A few examples on how to accomplish that goal are:
- Hire speakers and provide materials about wellness and balance.
- Provide education for all employees covering stress, depression, anxiety, alcoholism, sedatives and burnout.
- Host events that are nonalcoholic.
- Host retreats where participants focus on learning stress reduction, relaxation, meditation and team building.
- Set a maximum for billable and non-billable hours and lower the minimum.
- Enact specific policies that will allow employees to seek treatment for addiction or mental health issues without fear of losing their positions.
- Create and enforce a back-to-work policy that will keep the employee accountable throughout their recovery.29
The New York State Bar created a “Model Policy for Law Firms” that addresses these issues. In part it requires that the firm pledge “to assist any lawyer who voluntarily seeks assistance or are directed to do so due to poor performance.” Firms will do well to work with their HR professionals to promote a culture of trust and confidentiality and to ensure that there’s a safe space for impaired lawyers to seek assistance and for anyone who suspects or becomes aware of a lawyer’s impairment to assist the lawyer by bringing it to the firm’s attention.
More can and should be done. Take estate planning as an example. In a typical estate plan, the client may obtain an appraisal of a family business, which is then gifted to an irrevocable trust. The client’s CPA will prepare tax returns reporting the transactions. The client’s wealth advisor may handle investments of marketable securities in the trust. The client’s insurance consultant may sell life insurance to support this plan. The appraiser and CPA commonly limit their liability exposure to the fees paid. They also commonly limit the time period during which suit can be brought against them. The wealth advisor and insurance consultant will have significant caveats, disclosures and limitations on liability appended to documentation sent the client. It’s only the lawyer who’s prohibited from limiting their liability. If the profession were serious about addressing the stress that contributes to the depression and addiction issues, it might perhaps consider modifying ethical rules governing lawyers to permit them to protect themselves similar to other professions.30
Another consideration is the manner in which law is practiced. Profits are generated in part by lawyers billing more hours. Technology offers opportunities to increase profits without adding to the stress of hourly demands, perhaps even with the reduction in hourly requirements.31 Yet many of us are uncomfortable adopting technological changes that alter how we’ve traditionally practiced. Perhaps a greater emphasis on technology and practice management (for example, value billing) in CLE requirements and at conferences might help more of us become comfortable with change that might help transform the profession in a positive way and indirectly help address the stress we all experience.
Start Early
Perhaps more important than asking how we help lawyers once they’re in a dark place, we should ask how we use and preserve the natural qualities of incoming law students to transform what’s historically been in some ways a toxic culture and prevent the suffering of future lawyers.
Endnotes
1. Brandon Vogel and David King, “Suffering in Silence No More: Will Lawyers’ Stories Lead To Change?” (Jan. 3, 2022), https://nysba.org/suffering-in-silence-no-more-will-lawyers-stories-lead-to-change/?utm_campaign=MCI&utm_medium=email&_hsmi=199928288&_hsenc=p2ANqtz-_u5KfC2j1enoxkb3sQ4L7DsFwjd_EMC1gcKzK2Vvg5t4PSH703MTu7j7-8ojyLwPHpugohWcnp1X3AzsbZyJjozCJZlA&utm_content=199928288&utm_source=hs_email.
2. See David M. Wooldridge, “Dealing With Partners And Associates Impaired By Alcohol, Substance Abuse & Mental Health Problems: Lawyer & Law Firm Ethics, Liability & Responsibilities,” Limestone County Bar Association, Athens, Ala. (April 30, 2013), www.huntsvillebar.org/Resources/Documents%20CLE/2013/lawyer_responsibilities.pdf.
3. The case studies discussed appeared in a CNN piece, “Why are lawyers killing themselves?” www.cnn.com/2014/01/19/us/lawyer-suicides/.
4. Seewww.lawyerswithdepression.com/articles/tag/lawyer-steve-angel/.
5. www.cnn.com/2014/01/19/us/lawyer-suicides/.
6. https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.555.7527&rep=rep1&type=pdf.
7. www.mycase.com/blog/survey-results-2020-lawyer-well-being-statistics/.
9. Lynne Pregenzer, “Substance abuse within the legal profession: A symptom of greater malaise,” Notre Dame Journal of Law, Ethics & Public Policy (2014).
10. Butler Center for Research (2014).
12. Patrick R. Krill, Ryan Johnson and Linda Albert, “The Prevalence of Substance Use and Other Mental Health Concerns Among American Attorneys,” Journal of Addiction Medicine (February 2016).
14. www.clio.com/blog/dealing-with-lawyer-depression/.
15. www.washingtonpost.com/news/wonk/wp/2016/02/05/americas-lawyers-have-a-serious-drinking-problem/.
16. Ibid.
18. See supra note 2.
19. www.americanbar.org/groups/lawyer_assistance/policy/.
20. www.lawyerswithdepression.com/.
21. www.isba.org/ibj/2017/09/lawpulse/lawyersandaddiction.
22. www.nytimes.com/2017/07/15/business/lawyers-addiction-mental-health.html.
23. www.abajournal.com/voice/article/attorneys-addiction-and-covid19.
24. www.bmj.com/content/350/bmj.g7772.
25. Ibid.
26. Todd C. Scott, “Lawyer seeks treatment, boss seeks assurance,”GPSolo, Vol. 26, no. 7, American Bar Association, at pp. 24–29 (2009), www.jstor.org/stable/23630159.
27. Jen Porter, Bernie Wong and Kelly Greenwood, “How to Form a Mental Health Employee Resource Group” (May 2020), https://hbr.org/2020/05/how-to-form-a-mental-health-employee-resource-group.
28. See https://shenkmanlaw.com/webinars-details/?id=3058.
30. Martin M. Shenkman, Sandra Glazier and Howard Zaritsky, “Raia v. Lowenstein Sandler LLP—Thoughts on a Recent Malpractice Case,” Steve Leimberg Estate Planning Newsletter #2724 (May 16, 2019).
31. Mary Vandenack, Martin Shenkman and Jonathan Blattmachr, “Managing the Remote Law Practice and Other Practical Administrative Considerations during Coronavirus,” Steve Leimberg's Estate Planning Newsletter #2789 (April 17, 2020).