Is it Stress Or Something More? Depression in Law School
Is It Stress Or Something More? Depression in Law School: In the post “Law School and your mental health” we discussed some risk factors for mental health issues and generic prevention strategies. In this post, we’re going a little deeper into one of the most common categories of mental health issues experienced by U.S. adults. This post is for informational purposes only and is not a substitute for diagnosis and treatment by a trained professional.
Is it Stress Or Something More? Depression in Law School
In the United States, nearly 1 in 10 adults meet diagnostic criteria for a depressive disorder each year. 1 in 6 will meet diagnostic criteria in their lifetime. Law school is correlated with increased rates of diagnosable mental illness. Therefore, these numbers are higher among law students and lawyers. The exact rate of increase in depression disorders is difficult to quantify for numerous reasons, including law students’ refusal to seek help because of perceived stigma, but some studies suggest it approaches and may even exceed 40% among third-year students.
What is depression?
Generally speaking, depression is a condition where a person spends extended periods of time with a diminished appetite for life. Indeed, some individual’s appetites diminish so much that they become suicidal and actively seek ways to end life. Although it is frequently characterized as sadness, depression is different from sadness which is a normal response to events such as loss of a relationship or death of a loved one.
Depression is a constellation of signs and symptoms that span across physical, cognitive, and emotional systems. Depression signs and symptoms also come in different packages for different people, so two people may both have depression, but each has a very different experience with depression. Our cultural backgrounds and early socialization can preprogram us to avoid recognizing symptoms in one of these areas due to notions of what is taboo. Our fear of the repercussions of admitting to having such illnesses can also cause us to avoid recognizing when we are laboring under the added burden of depression.
Some physical ailments also produce symptoms that look like depression. If you think you may be suffering from depression, your first stop is with your primary care physician to rule out conditions like hypothyroidism. Once you receive an all clear that there is not an underlying physical ailment, then you may be counseled on a treatment regimen that includes lifestyle changes, medication, and talk therapy. For severe cases that are unresponsive to these treatments, other therapies may be recommended at a future point.
Mere stress versus potential depression
In the earlier post, we briefly discussed stress. To recap, not all stress is bad. While stress is used often to refer to stressors that are perceived as bad, good things can be stressful too.
A stressor is anything that causes a person to react to a stimulus. Stack enough stressors together and a person experiences stress. Without stress, there is no opportunity for growth. But too much stress can cause a person to get stuck in a pattern of maladaptive thoughts and behaviors. A prolonged period of maladaptive thoughts and behaviors distinguishes a person who is clinically depressed from a person who is not as vibrant as normal due to transient stress.
Maladaptive thoughts are those that can cause a person to view the world mostly through a lens of cognitive distortions. Cognitive distortions are patterns of thinking that are false, inaccurate, and have the potential to cause psychological damages. There are many different varieties of cognitive distortions. Some cognitive distortions that tend to occur in people with depression include: polarized thinking (aka, all-or-nothing, or black-and-white), overgeneralization, mental filter, disqualifying the positive, jumping to conclusions, emotional reasoning, and many others. Maladaptive behaviors include those that may provide an immediate relief to stress, but when deployed inappropriately or excessively, create bigger problems at a later point in time. Some common examples of potential maladaptive behaviors can include things like procrastination, avoidance, self-harm, and substance abuse, among others.
Depending on the nature of a stressor, there are a wide range of normal reactions. The things listed above don’t become maladaptive simply because they occur once or twice in response to stress. They become maladaptive when they become the default response to stress or the way a person views the world most of the time.
Tipping Point Guidelines Between Stress & Depression
As stated above, depression looks like many different things depending on the person experiencing it, his or her cultural background, and the attendant circumstances of his or her life. While it is hard to talk in terms of absolutes, here are some signs that indicate it is time to consult your primary care physician or a mental/behavioral health professional as soon as possible.
1. Two or more weeks of pervasive sadness or disinterest in life without an identifiable cause.
Some periods of sadness are a normal part of a healthy emotional life. Life is full of ups and downs. Periods of sadness in response to certain events are also part of a healthy emotional life. We should feel sadness and grief in response to significant losses; humans are social animals. Social connections are part of what keep us anchored to our humanity. However, if there is no “loss” and a period of sadness or disinterest in appetites of life (food, relationships, physical contact) dominates your mood for two or more weeks, it is time to consult a professional.
2. Four or more weeks of pervasive sadness or disinterest in life with an identifiable trigger.
If you have experienced a recent loss to trigger a period of sadness or disinterest, you can wait to consult a professional for another two weeks (so after a month of pervasive sadness or disinterest). Some losses understandably take more than a month to adapt to. But, complicated grief can easily slide into the maladaptive thoughts and behaviors that characterize depression, so it is useful to consult a professional before things spiral out of control.
3. Suicidal ideations.
This is when something in your brain starts entertaining the idea that the world would be better off without you. Maybe this thing is trying to get you to believe that you’re a burden, or you’re a failure, or that things are hopeless. Whatever this thing is – it is lying! It is a manifestation of some of those previously mentioned cognitive distortions and it can’t be believed. If you are experiencing this, please go see your primary care physician or a mental/behavioral professional immediately. This is important enough to skip class for.
If this thing in your brain has gone so far as to formulate a plan of how you will step out of the world and has helped you gather the means to execute that plan, it is time for help NOW. Interviews with thousands of survivors of suicide attempts show that suicide is frequently an impulsive urge. If it weren’t for the fact that the plan and means were in place, they would not have been able to follow through on the impulse. Like all impulses, it would eventually have extinguished itself. So, if you have plans and means, discard the means in an appropriate manner so they can’t be used to hurt anyone, and call someone.
There is the national suicide prevention line (800-273-8255); project Trevor for LGBTQ+ individuals (866-488-7386); and transline (877-565-8860). If texting is your preferred modality, you can text HOME to the crisis text line at 741741. You can also do a google search for crisis centers in your area. With the rise of telemedicine, it may even be possible to get an on-demand video chat appointment with a local mental/behavioral health provider via an app.
4. Significant unplanned fluctuations in weight and sleeping patterns.
Two physical signs of depression can include fluctuations in weight and changes in sleeping patterns. If your weight has increased or decreased by more than 15lbs (6.8 kg for any international readers) in the course of a semester without your active work towards that outcome, it’s time to see your PCP. Find yourself sleeping 9 or more hours most nights of the week? It’s time to see your PCP. If you’re taking three- and five-hour naps when you used to never nap, it’s time to see your PCP.
But what about me?
If none of the above resonates with you, but you’re still concerned that maybe you’re not as resilient to the stress you’re encountering as you need to be? Go see your PCP or student health center. It has become a regular practice to administer a depression/anxiety screen as part of the intake paperwork in many urgent care and primary care offices throughout the country. You’re probably not an expert, and I can’t diagnose you without seeing you. So, get some piece of mind and consult an expert. (It’ll also be helpful later on if you do get sick and can go in as an established patient instead of a new patient).
Depression is a common, and treatable, health condition. It requires less treatment (and less invasive treatment) if caught and addressed early. Seeking treatment is also the professionally responsible thing to do because a person operating under the influence of uncontested cognitive distortions is limiting his or her analytical abilities.
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