Trauma and Lawyers’ Mental Health: December 2019

This was a big year for me. To be honest, I'm really glad it's over. Here's a review of some of what happened for me in 2019 and what my goals are for 2020.

2019 started with me in terrible shape. The effects of my trauma history were in full force. To describe just a few of its manifestations, I was having nightmares, severe sleep difficulties, and tremendous anxiety. Sometimes, my hands would shake so much as I ate lunch in my office that I'd have difficulty getting the forkful of food to my mouth. Other times, my teeth would chatter uncontrollably.

My difficulties were (and continue to be) aggravated by the fact that I'm very isolated in my new life (having moved to a new city at the beginning of 2018). My previous type of work was far more social than my current one, and I know almost no one in my new location. Also, regardless of location, I hadn't confided my personal history fully to anyone ever before. Although I had confided many things to a few people two decades earlier, none of those people were really still in my life. None of my current friends (from the past couple decades) knew my history (apart from small hints I'd given here and there).

In February, I was overcome with the growing need for someone who knew me to know my history. I didn't have any goal beyond that--I just needed someone to know. So, with shaking hands, I typed it out (as fast as my shaky hands would permit, never looking back at it for typos, because it was too difficult to read what I'd just written) and sent it to a friend in Ontario who has known me for nearly my entire career (having asked permission first). Although the trauma in my story was plain and obvious, I feared that my friend's response would be that I was overreacting. Or that the friend would agree that it was a big deal but would think less of me for having such a history.

When my friend responded in a way that validated my experience (that's a lot to be dealing with and no, I don't think less of you), I felt empowered to take a couple further steps.

I wasn't ready for any major steps. So I made an appointment with my family doctor with the plan of simply telling him in a very general way (1) that I had a significant trauma history, and (2) it was heavily affecting me. I didn't want any help at that time. I just wanted to lay the foundation for it, so the hard part of disclosing was done and if I ever needed urgent help in the future, I could simply say, "Remember that stuff I told you about before?"

In the meantime, I also reached out to a mental health professional I felt I'd be comfortable speaking with and whose opinion I knew I'd trust (which is saying a lot, because it's very difficult for me to trust anyone that way) and shared the same typed history that I'd sent my friend. In that conversation, I received important validation. I always feared my experiences somehow didn't count, so hearing someone with expertise tell me it was a lot to be dealing with was a critical step.

It made it possible to then speak to my doctor without being too overwhelmed with the feeling that I was making too much of it. Nevertheless, the doctor's appointment was incredibly difficult. I remember studying the room before he came in as if my life depended on knowing all its features before I could speak. I had difficulty getting the words out, but somehow I did. I couldn't give specifics or correct him when he misunderstood some aspects of it, but I mostly got the point across in a general way.

Without getting into details, a lot of things have happened for my mental health this year. I received a diagnosis for the first time (PTSD, w/ associated depression and anxiety). I started seeing my doctor regularly to monitor my condition and I had regular supportive conversations with the mental health professional I trusted. Although I had hoped to avoid it, having worked without any medical leave my entire career, it became clear that time away from work was necessary, so in May I went on a short-term medical leave.

In early June, without describing my own experiences, I wrote an article (here) about how I believe our profession needs to do a better job of acknowledging that trauma isn't just something that happens to those we serve: many of us have histories too. I explained why it's so important for us to acknowledge and address this, especially when we are having conversations about vicarious trauma and lawyers' mental health.

I then started this blog. At first I opted not to directly identify myself as someone with a history (although it was heavily implied). Then I eventually spoke out about my own story to some extent (which was incredibly difficult to do at first). Nevertheless I kept almost all the details of my underlying history private.

Speaking out has been good for me in some ways, not so good in others. In some ways, it enabled me to be my true self and connect to a few like-minded people (long-distance) who truly "get it," something I never had before and treasure immensely. However, it also had the effect of revealing many of the friendships I'd previously believed in as not being what I thought they were. Not only did many of my friends not respond in a supportive and validating way, they (with a few exceptions) simply stopped acknowledging that I existed altogether. It wasn't so much an outright rejection. I just became invisible. I was no longer worth acknowledging.

So 2019 dramatically increased my feelings of isolation. While on medical leave, very few people reached out to check in about how I was doing. I wasn't angry, but this was at odds with what the mental health pep talks in our profession suggest will happen. I had always been skeptical but here I was experiencing the unacknowledged invisibility that can sometimes result from speaking out on an uncomfortable subject. I know it's not that way for everyone: many are supported, especially if they happen to be surrounded by genuinely supportive people already. But I was isolated to begin with, and identifying myself as someone suffering from this issue further isolated me.

One thing I'd like to note: an important part of the struggle for me this year was maintaining my sense of autonomy when treatments I didn't feel ready for (or didn't want at all) were sometimes pushed on me by well-meaning people. I'm glad I maintained my boundaries in that regard. Asserting my autonomy is an important part of healing for me. I've opted for therapy rather than medication for my own non-capricious fully-informed reasons, and am glad I remained firm in that boundary even when I felt a lot of pressure to opt for medication. The few times I caved in and tried medication against my better judgment, the experience was terrible for me, even more so because it felt like an intrusion on my control over my own body and mind. That's not to say that medication might not be preferred by others for good reason, or may even be essential for some mental health conditions. I'm not writing this to suggest medication shouldn't be considered by those for whom it is an option. I can't speak for everyone. It was just important for me personally as a trauma survivor to get a say in the kind of treatment I'd try rather than succumbing to pressure by others trying to make my decisions for me, thereby replicating the sense of helplessness I felt as part of my traumatic experiences. Maintaining my ability to say no to things I didn't want was important treatment in itself for me, and I was lucky to have a trauma-informed mental health professional who supported my right and ability to do so. If that support wasn't available, I would have (1) had my autonomy undermined in a way that further traumatized me (which would have been difficult to recover from); and/or (2) would have withdrawn from treatment altogether and concealed my symptoms, so as to be able to retain my sense of control over the care of my own body and mind, and possibly never trusted another professional again. Because my autonomy was truly supported, I was able to receive help that wouldn't otherwise have been possible for me. There are no words sufficient to describe my gratitude for having received this kind of assistance.

In October, I returned to work, initially on a part-time basis, which increased to full-time a month later.

Now it's the end of the year and I look back at the year with some pride and also a sense of great sadness and loss.

It needed to happen. I couldn't have carried on the way I was. But it confirmed in a painful way what I already knew: we have a long way to go as a society and a profession before stigma and discrimination regarding trauma and mental health are truly understood and addressed. The stigma is real. The discrimination is real. It was (and remains) upsetting to have to experience it, but I'm glad I finally named and embraced what was affecting me for so long, even if it was in many ways a demoralizing, isolating, discriminatory, and stigmatizing experience. It's a difficult fight but I want to be part of it. I lost my sense of fitting in (to the extent that I ever had it), but I found my true sense of identity and community (in a general sense at least). I know now who I want to speak for. I know who I want to be there for. Even when it's painful and difficult.

So with all that in mind, here are some of my 2020 goals:

I want to continue speaking up about trauma and lawyers' mental health. In doing so, I know I'm going to be a bit of an "outsider" voice. As a result, I probably won't often be invited to be part of the mainstream conversation. I want everyone to be mentally healthy in the profession but I don't see myself primarily as a voice for the wellness movement in the profession. I definitely support that aim. I want everyone to be okay and I know that everyone is at risk (even those who start out fine), but my goal is to be a voice for those who might be left out of (and even harmed by) that more general "wellness movement" if we fail to acknowledge the different ways in which we might be affected, given our differing histories and circumstances. I want to be a voice for those already affected by trauma-related and/or mental health vulnerabilities.
In doing so, I want to maintain and improve my own humility. I want to be an outsider voice in the ways I can based on my own experiences (as someone with substantial trauma/disadvantage preceding my admission to the profession, and as someone with a chronic mental health issue that can't easily or quickly be "fixed"), but my goal to be a voice for outsiders mandates that I know that my voice should never stand alone. It is just one among many. There are many ways in which I'm less privileged than my colleagues but there are also numerous ways in which I benefit from substantial privilege despite my suffering. So in addition to speaking from my own experience, I need to make the effort to listen to and amplify the voices of others who speak about this issue from other perspectives, especially those who have also been marginalized, silenced and excluded in different and intersecting ways.
I want to try to find ways to help those who may not be directly affected to understand that they should be listening and paying attention to this issue too. Those of us who are affected can't do it on our own. We need allies who make the effort to understand.
More generally, I want to try to brainstorm and help implement ways that we can improve our professional culture by decreasing isolation in the profession. I envision a movement to promote wellness, social and professional connection, and meaningful dialogue in the profession in a way that consciously strives to be inclusive. As an outsider voice, I'm not quite sure how to do it, but I'd like to try. I know how painful isolation and exclusion can be and I know I can't be the only one affected...
I want to continue to speak up as someone very vulnerable in many ways, but also strong and capable of speaking for herself. I don't want to have to sacrifice one aspect of my identity in exchange for the other. I can be strong and vulnerable at the same time, and until the profession truly embraces this (beyond mere lip-service) nothing will improve. I want to ensure that the profession realizes that including those who have disabling mental health conditions is about both (1) respecting the rights of those affected,and (2) acknowledging how important their contributions to the profession are (and how these contributions could be supported so those of us affected could contribute even more, if we were actually meaningfully included, listened to, and accommodated).
Personally, I intend to continue with therapy. In addition to specifically addressing my trauma, I plan to work to (1) find ways to increase my sense of meaning by contributing as much as I can to society and to my profession, (2) mourn my considerable losses, and (3) reduce my sense of isolation by creating new connections. Despite the stress of the profession, I know I also need to find ways to care for my physical health, because I've learned how critical that is for my mental health.

I'm not going to be dishonest and say that I'm entering 2020 with great hope and optimism. The steps I took in 2019 were important and necessary for me, but there was also a lot of pain and loss. In some ways, I'm stronger than I was before. In other ways, 2019 has left me vulnerable. I have no idea what 2020 will bring. But I'm willing to approach it with an open mind.

As always, please note that I am a lawyer, not a mental health professional of any kind. I have no expertise in trauma or mental health. Also, please note that any opinions and views expressed in this blog are solely my own and are not intended to represent the views or opinions of my employer in any way. For more information about the purpose of this blog, please see here and for a bit more information about my personal perspective on this issue, please see "my story" here

I am very grateful to have received a "Clawbie" Award for this blog (which reflects the importance of this topic): https://www.clawbies.ca/2019-clawbies-canadian-law-blog-awards/

For some of my external writing on this topic, see:

As I've said many times, when it comes to issues of trauma and mental health in our profession, everything is complicated, which is why we need to talk about it.

One issue that I have particularly mixed feelings about is this: on the one hand, we need to practice self-care, which includes acknowledging and addressing the impact that exposure to traumatic stories may have on us. Yet, on the other hand, this should never be used as an excuse to silence or exclude those whose lived experiences include trauma/injustice that might render our self-care more difficult if we had to face it too.

I firmly believe we have to do all we can to care for ourselves and create a supportive environment that nurtures individual and collective self-care, rather than simply demanding "toughness" from each other. But I also believe that we don't get to ask those whose experiences may trouble us to conceal themselves and their current and past circumstances from view. In other words, we shouldn't practice discrimination in the name of our own self-care (especially if we hold important positions in society). Asking people to conceal the parts of their experiences that trouble us leads to those burdens being disproportionately borne by those who have no choice but to carry them. It also means that the injustices that created those burdens in the first place (or were created or aggravated by them) will go unaddressed. It means some people won't be free to speak of their own realities the way others can, to seek justice in a meaningful way, to be genuinely understood and cared for, etc., with the result that stigma and discrimination will continue to be perpetuated and amplified.

So that's the source of my ambivalence. I see the value of trigger warnings for self-care (especially for those who are vulnerable due to their own history and/or mental health conditions), but as someone with a personal history that includes things that would trouble others, it deeply bothers me to not be permitted to share anecdotes and experiences the way others can. I shouldn't have to offer a trigger warning before sharing my own life story. There's a huge privilege in being able to casually share one's own experiences without having to pause first and ask if people are okay with being exposed to them: to not have to worry that who you are will be "too much" for those around you, and people will suddenly impose all kinds of automatic boundaries because you are inherently just too troubling to even exist in a tolerable way in their social space. Speaking for myself at least, it doesn't feel good to feel I have to hide who I am for the sake of protecting everyone else's need for self-care: their need to not have to be disturbed by the things I've personally experienced and have no choice but to be affected by.

I fear the self-care movement becoming a mechanism used by the more privileged in the name of their psychological well-being to exclude, marginalize and silence those who have experienced severe harm and are therefore just too troubling and disruptive to the tranquility of the majority, thereby leaving those who have been most harmed to cope with the harshest realities life has to offer all on their own because it's just "too much" for the well-being of the dominant group. I see this happen in my own personal life, when people just can't handle knowing what's going on with me because it is simply "too much" and "too personal" for them to allow into their space. They could handle someone else's struggles, but it has to be calibrated to their level of tolerance. Consequently, people like me have dramatically limited opportunities for connection, which greatly affects our psychological well-being. I also see it in the self-care movement in the profession sometimes. I'm not saying it's intentional but it's something we have to be on guard for, as I wrote about here.

So my view is this: we need to attend to our self-care, but the goal in doing so must not be to shield ourselves from the troubling things in the world, but to strengthen ourselves (through self-nurturing, self-care, and supportive spaces) so we can meaningfully face the harsh realities that others have lived through and continue to live through. And so we can do so with compassion and empathy.

The answer isn't to be "tough" in the first place. Someone who can dispassionately hear about the deep traumas and injustices that profoundly affect others, without being at risk of being personally affected by those stories, is not someone who (in my view) is truly engaging with those stories or likely to be well-positioned to redress the injustices they contain and reveal. Empathy and compassion are key, yet those qualities involve vulnerability on the part of the listener, which in my view is a skill that we need to learn and embrace. To really get how horrifying and unjust the experiences of some are requires being able to feel that horror and injustice, which isn't--and shouldn't be--easy. So without self-care, there can be no lasting meaningful engagement.

Moreover, if we simply require "toughness" and non-feeling, then we risk leaving out those that have the most to contribute: those who have been personally affected, and therefore truly understand and are in a position to help guide us in navigating these realities.

So let's practice good self-care not because we want to hide from the harsh realities of the world but because we want to hold space for others to be able to be truly visible to us. So we can sincerely empathize with their suffering yet not be rendered helpless by it.

I do acknowledge that some of us may already have carried too much suffering (especially those from affected groups), and there's no shame in needing to step back and nurture oneself (perhaps by creating safe spaces and carefully calibrating exposure to stories that trigger personal wounds) for those who have greater vulnerability. I think our discussions of this issue need to be nuanced enough to allow for those unavoidable needs/boundaries to ensure that we are inclusive. But my view is that our collective goal should be to enhance our resilience and self-care so we can include everyone in our social space. That means the profession must provide support and proactively nurture the courage and resilience of its members and of the culture in which those members practice. It means that demanding "toughness" and non-feeling is not only not the answer, but is an abject failure. The more we support and care for each other, the greater our collective strength and resilience will be. And we need that resilience because this stuff can't and shouldn't be easy. We need every ounce of strength and support to face it.

As always, please note that I am a lawyer, not a mental health professional of any kind. I have no expertise in trauma or mental health. Also, please note that any opinions and views expressed in this blog are solely my own and are not intended to represent the views or opinions of my employer in any way. For more information about the purpose of this blog, please see here and for a bit more information about my personal perspective on this issue, please see "my story" here

I am very grateful to have received a "Clawbie" Award for this blog (which reflects the importance of this topic): https://www.clawbies.ca/2019-clawbies-canadian-law-blog-awards/

For some of my external writing on this topic, see:

Trauma and Lawyers’ Mental Health

Sunday, December 29, 2019

2019 Reflections and 2020 Goals

Sunday, December 22, 2019

Aiming to be "Strong Enough" to Handle the Things that Are "Too Much"