Start by Taking Care of Yourself

Daniel J. Cuneo, Ph.D., is a psychologist who wears many hats throughout Southern Illinois and in the St. Louis metropolitan area. He has been active with the Illinois State Bar Association, the St. Clair County Bar Association and Lawyers’ Assistance Program (LAP). Dr. Cuneo is also active in the criminal justice and education arenas. He currently serves as president of the St. Louis County Special School District, which has a budget in excess of $450 million and is responsible for children with special needs and Career Training Education (CTE).

Dr. Cuneo has a presentation entitled: “You Can’t Take Care of Someone Else Until You Take Care of Yourself First.” This presentation focuses upon the unique and pervasive stress faced by lawyers and the profession. It provides some insight, data and anecdotes that highlight what Mental Health Month is about—awareness, cognitive behavioral tools, emotional well-being and resources to help address the complex interrelationship between cognitions, behaviors, emotions, the profession and everyday life.

Dr. Cuneo notes:

• Depression among law students is 8-9 percent prior to matriculation, 27 percent after one semester, and 40 percent after three years.
• Stress among law students is 96 percent, compared to 70 percent in medical students, and 43 percent in graduate students.
• Entering law school, law students have a psychological profile similar to that of the general public; after law school 20 to 40 percent have a psychological dysfunction.
• Lawyers are the most frequently depressed occupational group in the U.S.
• Johns Hopkins stated that lawyers rank first in depression.
• Lawyers are 3.6 times more likely to suffer from depression than non-lawyers.
• Lawyers rank 5th in incidence by suicide.

Dr. Cuneo explains some of this is related to the behavioral characteristics of those who enter the profession, the demands of the profession (perfection, hours, stress, finances, the rainmaker syndrome and deadliness), that law schools teach students to think differently (particularly with how we disassemble and rearrange facts), and the fact that, in a sense, lawyers are first responders to the trauma of others, yet like priests, often cannot disclose to others what we see or hear. This is vicarious trauma, i.e., the residue of exposure to pain, fear, trepidation and feelings of the clients we represent and the circumstances involved. Vicarious trauma is often overlooked.

Dr. Cuneo sees the signs of vicarious trauma in a variety of behaviors, including:

• Difficulty talking about feelings
• Free floating anger and/or irritation (depression)
• Difficulty falling asleep or staying asleep
• Losing sleep over clients
• Worry over inability to do enough for clients
• Feeling trapped
• Diminished feelings of satisfaction and personal accomplishment
• Feeling of hopelessness associated with work
• Dealing with intrusive thoughts of clients with especially severe trauma histories
• Blaming others
• Self-medicating.

Dr. Cuneo suggest a number of adaptive ways of dealing with trauma:

• Recognize trauma is an injury.
• Talk to someone –friend, spouse, professional. Don’t isolate.
• Be able to recognize the fight or flight condition and actively calm mind and

• body. Without these initial steps, trauma keeps people in a sense of impending
• danger, even when there is none. Bring your mind and body into the present moment (mindfulness).

• Laugh whenever possible, even if gallows humor.

Dr. Cuneo also provides a number of worthwhile practical tips:

• Set realistic and attainable goals.
• Learn to prioritize your life and work.
• Recognize mistakes are part of life.
• Be cognizant of your emotional barometer.
• Seek balance in your life.
• Learn to manage stress by finding healthy outlets, i.e., exercise.
• Take advantage of your strengths and know your weaknesses.
• Give yourself personal time.
• Know that the practice of law is inherently stressful.
• Be aware of self-medicating.
• Have someone to talk to.
• Know when to ask for help.

The major barrier is captured in the following John Kenneth Galbraith quote: “When given a choice between changing, and proving that it is not necessary, most people get busy with the proof.”However, avoidance is not the answer and isolation exacerbates the adverse consequences.

Dr. Cuneo graciously consented to the liberal use of his notes and opinions in the foregoing article.
                                                           

Next, Support Community Awareness and Equal Access to Mental Health Resources

May is recognized as Mental Health Month. It was created to heighten awareness of the pervasive impact on mental health, on the health of individuals and on our communities. One of its principal goals is to break the stigma attached to mental health and better understand it is an integral component of overall health.¹

We have experienced a year like no other. A year of disruption and, at times, despair from COVID-19. We have suffered the loss of loved ones, the disability of others and the dislocation of many. We have recognized as essential many who were previously marginalized. Many of us may work from home, but many do not have this option. Many children have lost from the lack of in-person instruction, limits on socialization, and feeling of isolation.² The underlying common denominator is the STRESS to our mental and emotional well-being.

These circumstances have given rise to increased awareness, but what has not occurred is an enhanced understanding and access to practical, evidence-based strategies of mental health that help to provide to individuals and families specific sets of tools, skills and support to address the complex interrelationships between cognitions, behaviors, emotions and everyday life.³ The importance of these issues is underscored by the Illinois Mental Health Task Force Virtual Summit convened by Illinois Supreme Court Chief Justice Anne M. Burke.⁴

COVID-19 has exacerbated many of the disparities between the haves and the have-nots. It has laid bare the instability of households, neighborhoods, schools and communities. The trauma of everyday life has been magnified in scope and depth. The following statistics can be found on the NAMI website:

Individual Impact:

• 20.6 percent of U.S. adults (51.5 million people) experienced mental illness in 2019, but only 43.8 percent of them received treatment.
• 1 in 5 U.S. adults experience mental illness each year, but less than half get treatment.
• 5.2 percent of U. S. adults (13.1 million people) experienced serious mental illness in 2019, but only 65.5 percent of them received treatment.
• 1 in 20 U. S. adults experiences a serious mental illness each year, but less than two-thirds get treatment.
• 16.5 percent of U. S. youth aged 6-17 (7.7 million people) experienced a mental health disorder in 2016, but only 50.6 percent of them received treatment.
• 1 in 6 U.S. youth experience a mental health condition each year, but only half get treatment.
• 50 percent of all lifetime mental illness begins by age 14, and 75 percent by age 24.
• Suicide is the 2nd leading cause of death among people aged 10-34 and the 10th leading cause of death overall in the U.S.
• The overall suicide rate in the U.S. has increased by 35 percent since 1999.

Community Impact:

• Lesbian, gay, and bisexual youth are 4 times more likely to attempt suicide than straight youth.
• Transgender adults are nearly 12 times more likely to attempt suicide than the general population.
• The average delay between onset of mental illness symptoms and treatment is 11 years.
• 55 percent of U.S. counties do not have a single practicing psychiatrist.
• 3.8 percent of U.S. adults experienced both mental illness and a substance use disorder in 2019 (9.5 million people).
• Mental illness and substance use disorders are involved in 1 out of every 8 emergency department visits by a U.S. adult (estimated 12 million visits).
• 20.5 percent of people experiencing homelessness in the U.S. have a serious mental health condition.
• 37 percent of adults incarcerated in the state and federal prison system have a diagnosed mental illness.
• 70.4 percent of youth in the juvenile justice system have a diagnosed mental illness.
• 41 percent of Veteran’s Health Administration patients have a diagnosed mental illness or substance use disorder.⁵

 The impact of adverse childhood experiences (ACEs) has taken on a new dimension and has increased the generational impact not only on our children, but on our families and the communities within which we live. Studies have shown that the toxic stress upon our children can physically impact the development of a child’s brain. Likewise, the absence of a nutrient-rich diet and the absence of age-appropriate social and intellectual stimuli impairs the development of not only academic, but social skills fundamental to positive interaction and success.

We can ignore the disruption and hope that the return to normalcy will resolve the underlying anxiety, frayed nerves, and depression or we can use our heightened awareness to identify best practices and means of early identification of illness, marshal resources and develop the tools needed to confront the challenges our children are facing. Telehealth has increased access to mental health services. Wraparound services are being increasingly made available and communities are re-imagining ways to collaborate. We can stand back or we can stand up for reforms in how we address and deliver mental health services. If we stand back, we wait for a tsunami. If we step forward, we can prepare our children to respond with emotional flexibility, dexterity and resilience.

The Elite Medical Center has summarized the signs and symptoms of mental illness as follows:

• Change in appetite or sleep pattern—a noticeable change or decline in personal care, sleep, or appetite.
• Having problems in thinking clearly—lack of concentration, memory loss, or lack of logical thought or speech that’s not easy to explain.
• Increase in sensitivity—to smell, touch, sound, or sight.
• Mood swings—drastic shifts in emotions, feeling low or constant depressed feelings.
• Feeling disconnected—hitting a sense of delusion (unreal), paranoia, or a vague feeling of detachment from oneself, others, or surroundings.
• Withdrawal symptoms—from friends, social circle and losing interest in meeting anyone.
• Disrupted functioning—like a sudden loss of interest in performing day-to-day activities like school, work, sports, social activities, etc.
• Changes in physical intimacy like sex drive.
• Illogical thinking like exaggerated beliefs about some ‘special’ powers or belief in imaginary life events.
• Nervousness, fear, or suspicion of others for no reason.
• Unusual behavior like excessive anger, hostility, or acts of violence.
• Problems with drug or alcohol abuse.
• Suicide tendencies.⁶

At the very least we need to identify the strengths each person has; what resources are available or are missing and what type of resources might be most appropriate and how those services might be made available and delivered.

We support the mental wellness of future generations when we seek a greater understanding of the neuroscience of developmental research, the value of safe, but unstructured play, ways to communicate effectively and the better management of emotions and behavior. Emotional intelligence (EQ) is as important as academic intelligence (IQ) and has proven to not only enhance enjoyment of life, but success.⁷

Seek first to understand all that is involved and then advocate for optimizing the future of yourself, your family and your community by adopting a positive mindset, being deliberate and focused about your sources, resources and build on your strengths. With guidance we can learn actively, not passively, identify good sources of information that will challenge us, but not overwhelm us. We can take affirmative control of our well-being by staying active, eating right and getting enough sleep. Simplify down to the 3Ms: mindfulness, movement, and mastery.

Finally, we can find peace and joy through gratitude for blessings we too often overlook or imprudently discount when they may yield more lasting joy than the fleeting pleasure of material objects which are, by nature, transient. Such objects are a poor substitute for those relationships and experiences which can be shared and celebrated with others. Self-management requires we take an active role in our quest for wellness. We can focus on that over which we control, the intrinsic. We should not fear collaboration with qualified professionals, but embrace them. Life expands when we find the guidance, motivation and greater clarity of our self-value and purpose. Mental health professionals are ideally positioned to support our mental well-being. We just need to use them and advocate for equal access to quality care by all members of the community.

Robert E. Wells, Jr., is an attorney at Pessin, Baird & Wells, in Belleville, Illinois.