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In April 2024, eNCA reported that a recent UNICEF report revealed that 60% of young South Africans have sought mental health assistance in the past year (eNCA ‘South Africa ranks highest in mental health disorders’ (www.enca.com, accessed 3-8-2024)). Even if you have never suffered from a mental health issue, it is likely that you may know, socialise or work with someone who is so suffering in that way. It may also be possible that you may have an undiagnosed or untreated mental health issue yourself, which you prefer to hide or ignore to avoid a diagnosis or being stigmatised.
Mental health issues arise when a person’s thinking, emotions and behaviour become unhealthy, to the extent that they may harm themselves, their relationships, their personal progress and/or functioning at work. Mental health issues can occur for a reason or a season, similar to suffering flu in winter, or become chronic, depending on the cause, treatment, your genetics or related health issues.
According to entertainment media, a successful lawyer is mostly presented to the public as a healthy professional and attractive person with fearless behaviour who acts emotionally confident and is cognitively fast and sharp. This fictional image of a perfect lawyer who always wins is very unrealistic and may add a lot of unconscious pressure, especially to young legal practitioners. It is, therefore, understandable that many lawyers will never admit or disclose if they are suffering from a mental health issue, fearing that it will not always match the image of a successful lawyer.
It should further be borne in mind that details of health and medical conditions are personal and confidential information. This means that, as in the case of any illness or health condition, it should not be appropriate for legal practices to demand staff or clients to disclose such struggles, if it does not interfere with work and if they are not comfortable to do so. However, any person suffering from a mental health issue, on a temporary or chronic basis, should be encouraged to seek treatment and support from specialists and confidants they choose and trust.
In the event that your mental health condition may interfere with your work obligations, it is recommended that you take at least one other person at your workplace into your confidence in order to support you. Legal practices could also consider appointing a specific empathetic and non-judgmental member to be available as a mentor on emotional wellness issues. Alternatively, legal practices could consider involving an external coach for support.
The terms ‘mental health issues’, ‘mental health conditions’, ‘mental health problems’, ‘mental illness’ or ‘mental disorder’ are generally used interchangeably by the public, although global psychiatrists and psychologists may differ about classifications and make more specific differentiations. As I am an admitted attorney and accredited SA Business Coach, and not a doctor familiar with psychiatric classifications, I may also use the aforementioned terms interchangeably, bearing in mind that these health conditions may differ in severity and seriousness. Please note that this article does not contain medical advice and cannot be used to make any diagnosis.
There are many different mental health disorders and conditions. The purpose of this article is merely to make legal practitioners aware of the four most common mental health issues, based on my experience working with others, as a former legal practice owner, attorney, and full-time professional coach to lawyers. This article’s intention is also to share suggestions with legal practitioners on how to help manage mental health issues as they may become relevant to themselves, staff or clients in course of practising law or managing a legal practice.
We all experience anxiety or fear from time to time as it is a normal human emotion and the brain’s way of warning us of danger. Anxiety triggers one of three responses, namely, fight, flight or freeze. It may feel like a severe stress response with symptoms affecting our mind, emotions and bodies. Common signs of anxiety in our bodies may include an increased heart rate, rapid breathing, sweating, trembling, tiredness, sleeping problems and/or gastrointestinal problems. Other common symptoms of anxiety are feelings of fear, panic or non-stop worrying and/or irrational or catastrophic thoughts.
Generally speaking, anxiety could become a disorder, if fears, worries, thought errors or related physical symptoms intensify and become uncontrollable and intrusive in daily life, affecting work or social commitments. According to the Mayo Clinic, there are several types of anxiety disorders, including General Anxiety Disorder (GAD), panic disorders, social anxiety disorders and phobias (Mayo Clinic ‘Anxiety disorders’ (www.mayoclinic.org, accessed 3-8-202)). A person may suffer from more than one disorder at the same time. Treatments may include talk therapies, breathing exercises, use of interactive mental health Apps (for example, see www.headspace.com) and/or medications.
According to a survey published in 2024, 19% of lawyers indicated that they suffer from anxiety (Gitnux Blog ‘Alarming Lawyers Mental Health Statistics Revealed in Recent Study’ (https://gitnux.org, accessed 22-8-2024)). Practising law can be a very stressful career and it is well-documented that stress can also trigger anxiety.
However, legal practitioners who suffer from anxiety disorders, and know how to manage their symptoms, may often rise as top performers, as they tend to be consistent, well-prepared, detail orientated and perfectionistic. Coping strategies for stress and anxiety may include getting structures and routines in place, planning ahead, practising good self-talk and relaxation exercises.
If you are experiencing an episode of acute anxiety or suspect your stress may have developed into an anxiety disorder, it is recommended that you reach out to a health professional. It may also help to talk to a confidant at work for support. The website of the South African Depression and Anxiety Group (SADAG) at www.sadag.org also provides 24-hour toll free helplines to assist. Remember most symptoms of anxiety conditions can be treated, managed or reduced.
It is normal for your mood or emotional state to change, depending on your circumstances or immediate situation. For instance, temporary feelings of depression may be a normal emotional reaction to a loss of a loved one, or difficult circumstance, such as receiving a negative health diagnosis, bankruptcy or losing a big court case!
However, according to the Cleveland Clinic, if a person experiences long periods of extreme sadness, spike in happiness, or both, especially if there is no obvious reason or circumstance, it is possible that a mood disorder may develop (Cleveland Clinic ‘Mood Disorders’ (my.clevelandclinic.org, accessed 3-8-2024)). A recent study further reported that lawyers are 3.6 times more likely to suffer from depression compared to other professions (Gitnux Blog (op cit)).
Clinical depression is characterised by feelings and thoughts of sadness or hopelessness persisting over the duration of a few weeks or longer. Persistent emotions of anger and irritability may also be associated with depression, depending on the temperament of the person.
Depression may cause difficulty with thinking, memory, eating and/or sleeping. Other symptoms may include feelings of sadness, worthlessness or hopelessness most of the time or nearly every day, lack of energy, lack of interest in usually fun activities, thoughts of suicide and/or difficulties focusing or concentrating.
Not all depression conditions are the same or last for the same periods. In this regard, there are different types of depression categorised as disorders, including major depressive disorder (MDD), persistent depressive disorder, postpartum depression and seasonal affective disorder (SAD). Depression disorders may have different causes and risk factors, including stressful life events, genetic history, personality type, substance use and/or illness.
Many symptoms of depression, if properly diagnosed and treated, can be managed and reduced. Many people with depression can be high functioning and good at their work, as structure and routines are supportive for this mental health condition. In some instances, work may also be a good distraction, if the work environment helps support positive emotions.
Bipolar disorder (BD) is further a rare mood disorder which causes periods of intense fluctuations in a person’s emotional state between symptoms of depression, mania or hypomania. According to SADAG bipolar disorder only affects up to 1% of the South African population. As life unfolds and emotions arise, everyone is likely to experience grief or mood changes from time to time. I think that many legal practitioners suffering from diagnosed mood disorders do not share their struggles with others, as they may still be learning about their condition, it does not necessarily affect their work, it may only be temporary and/or they do not know if others will be empathetic or non-judgemental. However, if you suffer from a depression or mood condition, try not to isolate yourself but instead reach out to a health professional or confidant for support. Talking about how certain legal cases, work circumstances or life events emotionally impact us, is healthy and helps us adjust, process and move forward. (Also remember that the www.sadag.org website provides specialised 24-hour tollfree helplines for support.)
Generally, trauma occurs when an individual is overwhelmed by an extreme threatening or horrific event, or series of events, such as a death, physical or emotional abuse, injury, sexual or physical assault. Studies show that most South Africans are exposed to trauma in pandemic proportions, as we have high levels of criminality, poverty, unemployment and poor governance. Increased gender-based violence, other violent crimes, human trafficking, gang violence, political unrest and aggressive motor vehicle usage all contribute to the burden of trauma in South Africa. We also all share a traumatic political past and continued socio-economic inequalities.
When you experience something traumatic or highly stressful, it is normal to have a strong reaction and short-term effects, such as heightened alertness, shock, or emotional numbness. However, it should be noted if the effects of a trauma or stressor persists long term, or suddenly arise later, it may cause anxiety, trouble sleeping or intrusive thoughts interfering with daily activities.
Trauma-and-stressor related disorders generally develop as a result of traumatic experiences or changes in circumstances which may cause severe stress. Sometimes we experience these events directly, for example, being in a motor vehicle accident or going through a divorce. Other times trauma may be triggered by exposure to physiologically devastating news in the media or by witnessing someone else experiencing traumatic events.
According to the Merck Manual, there are many different types of trauma-and-stressor related disorders, including PTSD (post-traumatic stress disorder), acute stress disorder and adjustment disorders. They differ in the severity and the duration of symptoms (John W Barnhill ‘Overview of Trauma and Stressor-Related Disorders’ (www.merckmanuals.com, accessed 3-8-2024)). A wide range of symptoms may be experienced, which may not obviously relate to the traumatic event or stressor but heightens when the trauma/stress is triggered. ‘For example, people may act aggressively, be unable to experience pleasure, and/or feel restless, discontented, angry, numb, or disconnected from themselves and others’ (Bridge Clinical Psychology ‘Trauma and Stress Disorders’ (https://bridgeclinicalpsychology.com.au, accessed 3-8-2024)). Anxiety and depression may also be prominent symptoms or related mental health conditions.
Trauma counsellors and psychologists can help with processing trauma and stress, while medications may often become necessary to help treat anxiety and depression symptoms. Unresolved emotional trauma could limit a person’s ability to enjoy life, interfere with work responsibilities and affect personal relationships.
Most clients seeking legal assistance may themselves be experiencing some trauma or stressor. Although legal practitioners should certainly show sympathy for their clients, it is important to bear in mind that legal practices are not hospitals or therapy rooms which can deal with trauma. If your legal practice attracts matters with high emotional demands, consider how to be intentional about professional boundaries and develop a network of other professionals to which to refer clients for counselling or further emotional support. As no legal practitioner is immune to stress and trauma, be mindful of how clients’ stress and trauma may affect your own emotional state and seek support if you feel you are not coping well.
Some families may carry genes making them more vulnerable to addiction and other mental health disorders. A person struggling with addiction may also have other mental disorders. People struggling with other mental disorders, may also struggle with substance use by abusing, for instance, alcohol as a form of self-medication.
Most experts distinguish between chemical addictions and behavioural addictions. Chemical addictions (substance misuse) could include addiction to, for example, alcohol, cannabis, medicines, cocaine, opioids or nicotine. Behavioural addictions could include addiction to, for example, social media, Netflix, shopping, online gambling, pornography, sex, eating or work!
Addiction is a serious mental disorder, as it interferes with normal brain function, in particular, the reward system which helps releases the hormone dopamine (Crystal Raypole ‘Types of Addiction and How They’re Treated’ (www.healthline.com, accessed 3-8-2024)). Dopamine is released when the brain makes associations with substances we take, or our behaviour, that make us feel great. The more you use the substance or repeat the behaviour, larger amounts of dopamine are released in the brain, which leads the brain to produce less dopamine in response to normal triggers. As the brain is unable to release dopamine to motivate you to do your normal tasks, you develop cravings/urges and feel you need more of the addictive substance or behaviour to feel motivated. Addiction can become very serious, as the inability to control or resist the substance use or specific behaviour, may lead to unemployment, problems in relationships, health issues, financial issues and even death.
In many professional environments, alcohol is commonly used as a way to socialise, unwind and cope with the stress of the job. The most recent study revealed that 36.4% of lawyers reported drinking alcohol at a level consistent with hazardous drinking or possible alcohol abuse (Lindner (op cit)).
Alcohol and substance abuse are regrettably regarded as serious problems in South Africa. Governing legislation relating to alcohol and substance abuse in the workplace includes the Drugs and Drug Trafficking Act 140 of 1992, the Medicines and Related Substances Act 101 of 1965, the Occupational Health and Safety Act 85 of 1993, the Employment Equity Act 55 of 1998 and the Labour Relations Act 66 of 1995.
Legal professionals may find it especially difficult to seek addiction treatment for fear of losing their professional status or relationships with others. Some lawyers suffering from addictions may be high functioning, keeping their struggles secret, as they may use certain substances to temporarily boost their confidence, or as a reward, or as self-medication to cope with stress. Legal practices should be aware of such risks and avoid making, for instance, alcohol abuse, part of office culture.
Addiction is not a mental disorder to manage on your own and can be affected by peer pressure. If you notice a colleague suffering, take the courage to ask about possible alcohol or substance abuse to show you care. If you are someone struggling with an addiction, the first step is to accept that it is an issue and seek support from a confidant or professional. Treatments may include therapy, medications or hospitalisation in rehabilitation centres.
If you are not ready to consult your doctor, and feel strongly about staying anonymous, consider contacting the Substance Abuse helpline operated by the Department of Social Development on telephone number 080 012 1314 or SMS 32312. Alternatively, in the event of concerns relating to alcohol addiction, consider contacting Alcoholics Anonymous on 086 143 5722.
Assuming we should care for our mental health on the same basis as our physical health, it should follow that we will be able to do so better, if we are prepared to learn details about specific common mental health disorders to broaden our understanding and determine our own behaviours and attitudes.
For instance, if it is your intention to support your sick friend, will you support them differently in the event that they have the common flu compared to when they are having a heart attack? I suspect information about your friend’s specific health issue may help you decide how to take the best approach.
We should further be careful to generalise mental health issues or be judgemental, as life happens, and mental health challenges can affect any person at any time.
I appreciate that studying mental health issues may not be of interest to most lawyers. However, considering that many experts regard lawyers more vulnerable to some of the above common mental health issues due to the high stress nature of the job, I hope that awareness of the above discussed issues may be helpful for legal practitioners to take better care of themselves and members of their legal practices. I hope more discussions about these aspects will open in legal practices, as we all will do better work if we support each other to live mentally well!
Emmie de Kock BLC LLB (cum laude) (UP) SA Business Coach is a Business Coach and legal practitioner at LawyerFirst – Coaching Lawyers online.
This article was first published in De Rebus in 2024 (Sept) DR 18.
