Part of my role and responsibility as a psychologist is to help dispel stigma. I was therefore delighted to be invited to moderate a panel about stigma at the 2019 Connecticut Legal Conference, representing the Connecticut Bar Association task force on lawyer well-being. The panel was sponsored by members of the Quell Foundation, a nonprofit group that seeks to decrease stigma by encouraging people to share their personal struggles with mental health issues. This experience led me to think more deeply about forces which have served to promote and maintain stigma surrounding mental health and well-being in the legal profession.

The Origin and Functions of Stigma

Over time, the meaning of the word “stigma” has shifted away from the literal reference to a mark, spot, scar or branding to reflect a shameful trait, such as mental illness. Erving Goffman (1963) wrote that stigma is “an attribute that is deeply discrediting” which diminishes a person “from a whole and usual person to a tainted, discounted one.” Brian Ahmedani (2011) defined stigma as “stereotypes or negative views attributed to a person or groups of people when their characteristics or behaviors are viewed as different from or inferior to societal norms.”

Stigma and bias result from the brain’s tendency to create categories in order to facilitate processing of large amounts of information. Cognitive science has shown we all categorize in this way. Categorization is adaptive, helping us deal with the otherwise overwhelming load of information we continually receive and process (Roach, 1978).

Stigmatization Surrounding Mental Health Concerns

Stigma around mental illness functions in two ways. For onlookers, stigma creates social distance from stigmatized individuals by positing that mental illnesses reflect moral or character failings, weakness or laziness. Such social distancing is self-protective; blaming the person with mental illness makes the concept less threatening (Mannarini & Rossi, 2019). The myth persists that “the mentally ill” are more dangerous than “normal” people, even though research suggests they are more likely to be victims of crime. (Varshney, et al., 2016). Stigma also elicits shame in those individuals who believe others know about their stigmatized condition, leading them to come across as more tense and less likable, and also impairing their performance (Farina, et al., 1971).

Character and Fitness to Practice Law

The legal profession is particularly prone to being affected by the shunning and shaming effects of stigma. As 1L’s, law students are taught that experiencing strong emotions reflects weakness, and such emotions must be avoided or suppressed in order to “think like a lawyer.”

In addition, beginning in 1984, the Connecticut Bar Examining Committee (CBEC) began asking questions about mental health. By the early 1990s:

“Applicants were required to reveal whether they had ever received treatment for any mental, emotional, or nervous disorder; whether they had ever been hospitalized or committed to an institution (voluntarily or involuntarily) for mental illness; whether they had ever been addicted to alcohol or other drugs; and whether they had ever been treated for substance abuse. An affirmative answer to any of these set the machinery of character and fitness screening in motion.” (Bauer, J, (2001) “Character of the Questions and the Fitness of the Process: Mental Health, Bar Admissions and the Americans with Disabilities Act,” 49, UCLA Law Rev. 93, 104.)

This March, however, the U.S. Department of Justice and the CBEC reached a settlement regarding ADA complaints brought against the CBEC. The CBEC agreed, beginning with the past July bar application, to remove all questions “regarding an applicant’s health diagnosis, treatment or drug or alcohol dependence,” and such questions will not be asked of an applicant’s employers or personal references. CBEC also agreed to remove its specific regulation titled “Mental Health Inquiry,” and further agreed “not to place applicants on a conditional admission status based solely on the applicant’s health diagnosis, treatment or drug or alcohol dependence.”

What Does All of This Mean for Attorneys?

I believe this history of bias and discrimination leads many attorneys to shun efforts that target their well-being. For many attorneys, the vulnerability that comes with sharing emotions is too risky in the largely adversarial profession, and this has traditionally been compounded by both the law school learning experience and the bar admission process.

Stigmatization of mental health needs among legal professionals is so deeply ingrained that any professional intervention may be perceived as reflecting a deficit or weakness. The experience of negative emotions (e.g., fear of failing, anxiety, impending depression, burnout) is often accompanied by a strong sense of shame, which prevents the sufferer from seeking professional assistance. Health-promoting initiatives may further be viewed as contrary to the emotional learning from law school and its reinforcement in practice.

As a result, attorneys have looked to various less adaptive ways to deal with internal distress. Alcohol or drug use may become a habitual “quick fix” for suppressing or avoiding emotional discomfort, with potentially high risk. Shame also inhibits seeking social support from colleagues, leading to further feelings of stigmatization and social isolation in a vicious downward spiral. Quite tragically, the inability to seek help to address mental health and addiction has led too many attorneys to view suicide as the only way to get relief. (See Cassens Weiss, ABA Journal, April 30, 2009.)

Changing Perspectives

We can think of mental health as a continuum, which varies by person over time. We all have experienced fluctuations in our physical health over the years, whether it be viral or bacterial infections or more serious conditions. Similarly, fluctuations in stress levels, mood and anxiety occur throughout our lives. Paradoxically, even positive life events can trigger negative emotions and anxiety.

Recent research highlights the importance of being in tune with your internal experience, finding that people who reported stress levels consistent with their internal physiological stress markers (i.e., heart rate) also experienced better overall levels of well-being, including psychological health and decreased inflammatory markers. (Sommerfeldt, et al., 2019). You might begin by simply striving to become more attuned to your psychological experience, while keeping it separate from your professional activities.

Seeking Assistance

Seeking help reflects internal strength and is something to be commended as an effort toward self-improvement, which can translate into improved productivity, improved work relationships and a better work environment.

Consider seeking professional assistance if you experience chronic internal distress or external maladaptive behaviors such as irritability, substance abuse or unproductivity at work.

Therapy does not have to be long term. Many people benefit from just a few sessions, and I often suggest thinking of it as a “tune-up.” A therapist is your ally and finding a professional with whom you are compatible is important. The best predictor of successful therapy is the quality of the relationship with your therapist. Researchers (Strupp & Binder, 1984) have identified three relationship factors which are known to lead to optimal outcomes. When evaluating a therapy experience, ask yourself whether your therapist respects you, likes you and has the skills to help you. Two or three meetings is sufficient to develop a good sense of this alliance.

A Time of Positive Change in the Legal Profession

Fortunately, it appears the culture of stigmatization is changing, as evidenced in Connecticut by the removal of mental health questions from the bar application, the establishment of the CBA task force on lawyer well-being, the increase in wellness programming in CE offerings, at conferences, and within law firms, and the many recent articles in legal publications devoted to lawyer mental health and well-being.

If you are experiencing difficulties, don’t hesitate to reach out to LCL or a mental health professional, to address your situation in a context of privacy, confidentiality, and support.

Traci Cipriano, J.D., Ph.D., is a psychologist and former practicing attorney with a passion for promoting well-being, emotional intelligence and positive communication in the workplace. She is a member of the CBA task force on lawyer well-being.