Mysteries of depression

Four years ago, one of the best students I’ve had in 24 years of law teaching killed himself, a year to the day after graduating. This suicide, and what I eventually discovered about the events that led to it, played a key role in pushing me toward first educating myself regarding, and then trying to do something about, the law school crisis.

One thing I learned is that depression is apparently epidemic among both law students and lawyers. As I’ve written elsewhere:

(1) Law students are no more prone to depression than anyone else before starting law school. In the course of law school they develop both clinical and sub-clinical depression at extraordinarily high rates, so that by the time they are 3Ls they are roughly ten times more likely to be in these categories than they were prior to entering law school.

(2) Rates of depression among practicing attorneys are also very high. For instance, a 1990 Johns Hopkins study looked at depression in 104 occupational groups. Lawyers ranked first.

(3) These findings are remarkably consistent across studies, and have remained so for several decades.

(4) Although there is as of yet little work on what effect recent changes in the legal profession are having on these outcomes, the primary environmental cause of depression appears to be stress, which suggests an already serious problem is likely to be getting worse.

Why are law students and lawyers so prone to develop depression? The literature suggests numerous causes, most of which have something to do with the effects of an intensely hierarchical, competitive, emotionally cold, and high-stress environment, in which people are socialized to obsess on external status markers and to minimize or ignore things such as learning for its own sake, doing intrinsically valuable work, and maintaining healthy personal relationships.

Depression is a mysterious disease, and for me that mystery was if anything deepened by reading recently William Styron’s Darkness Visible: A Memoir of Madness, his harrowing account of how an episode of deep depression took him to the brink of suicide. Styron’s account is both powerful and eloquent, but ultimately it left me with more questions than answers about this terrible illness. One very useful aspect of the book, for me, was that it conveyed what an inadequate and ultimately misleading word “depression” is to describe the phenomenon, at least in its more ferocious forms.

“Melancholia” would still appear to be a far more apt and evocative word for the blacker forms of the disorder, but it was usurped by a noun with a bland tonality and lacking any magisterial presence, used indifferently to describe an economic decline or a rut in the ground, a true wimp of a word for such a major illness. It may be that the scientist generally held responsible for its currency in modern times, a Johns Hopkins Medical School faculty member justly venerated–the Swiss-born psychiatrist Adolf Meyer- -had a tin ear for the finer rhythms of English and therefore was unaware of the semantic damage he had inflicted by offering”depression” as a descriptive noun for such a dreadful and raging disease. Nonetheless, for over seventy-five years
the word has slithered innocuously through the language like a slug, leaving little trace of its intrinsic malevolence and preventing, by its very insipidity, a general awareness of the horrible intensity of the disease when out of control.

As one who has suffered from the malady in extremis yet returned to tell the tale, I would lobby for a truly arresting designation.

“Brainstorm, ” for instance, has unfortunately been preempted to describe, somewhat jocularly, intellectual inspiration. But something along these lines is needed. Told that someone’s mood disorder has evolved into a storm- -a veritable howling tempest in the brain, which is indeed what a clinical depression resembles like nothing else-even the uninformed layman might display sympathy rather than the standard reaction that “depression” evokes, something akin to “So what?” or “You’ll pull out of it” or “We all have bad days.” The phrase “nervous
breakdown” seems to be on its way out, certainly deservedly so, owing to its insinuation of a vague spinelessness, but we still seem destined to be saddled with “depression” until a better, sturdier name is created.

For someone who, at least until now, has been lucky enough to ponder serious depression strictly from a distance, but who wants to understand it as best he can, Styron’s book was both of great value, and a spur to try to learn more. I’d appreciate any suggestions commenters might have regarding other resources for helping to encourage a qualitative, as opposed to a merely statistical, understanding of this illness.