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Episode 108
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Professional Skills
Mindgames: What Can We Do About Lawyers’ Mental Health?
Law as stated: 8 December 2023
What is this?
This episode was published and is accurate as at this date.
Friend of the podcast, Dr Phoebe Norville joins David in Curiosity to breakdown mental health in legal practice. Touching on the prevalence of mental health issues among lawyers presenting to GPs and some common sources and solutions.
Professional Skills| What area(s) of law does this episode consider? | Mental health and physical wellbeing in legal practice |
| Why is this topic relevant? | Looking at the statistics on mental health among lawyers can be grim reading. Beginning in law school budding lawyers have some of the worst mental health among their peers. In 2019, one study found 96% of law students reported significant stress, compared to 70% of medicine students and 43% of graduate students. As law school progresses, the rates of diagnosed mental health issues – like depression – skyrocket. From a base of less than 10% on entry to 40% after three years of study. And legal professionals fair little better. Among legal professionals, one US study put the rates of drug and alcohol abuse at nearly one in three. So what is the law doing to us that makes these issues so common? And what can we do about them when we spot them? |
| What are the main points? |
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| What are the practical takeaways? |
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| Show notes | Sleep and Mental Health, Harvard Medical School, 2021 Headspace app Calm app |
DT = David Turner; PN = Dr Phoebe Norville
| 00:00:00 | DT | Hello and welcome to Hearsay The Legal podcast, a CPD podcast that allows Australian lawyers to earn their CPD points on the go and at a time that suits them. I’m your host, David Turner. Hearsay The Legal podcast is proudly supported by Lext Australia. Lext’s mission is to improve user experiences in the law and legal services and Hearsay The Legal podcast is how we’re improving the experience of CPD. A lot of you listening have probably heard this before, but looking at the statistics about mental health amongst lawyers and law students can be pretty grim reading. Beginning in law school, budding lawyers have some of the worst mental health amongst their peers. In 2019, one study found 96% of law students reported significant stress compared to just 70% of medicine students and 43% of graduate students. Now as law school progresses, the rates of diagnosed mental health issues like depression and anxiety skyrocket from a base of less than 10% on entry to 40% after three years of study. And legal professionals don’t fare much better. Amongst legal professionals, one US study put rates of drug and alcohol abuse at nearly one in three lawyers. And that’s not even getting into rates of other risky behaviours that can be caused by chemical dependencies and crutches. So what’s the law doing to us to make these issues so common? And what can we do about them when we spot them in our own lives and in the lives of our colleagues? Joining us today in the Curiosity recording room is Dr. Phoebe Norville, a General Practitioner who specialises in women’s health and in mental health. Now, Dr. Phoebe has some pretty unique experience in dealing with mental health issues amongst legal professionals. Her practice is very close to the Downing Centre Court complex here in the Sydney CBD. And she brings a comprehensive perspective to the critical intersection of mental and physical wellbeing in the legal profession. Phoebe, thank you so much for joining me today on Hearsay! |
| PN | Thanks for having me, David. | |
| DT | Now, before we get into our topic today, let’s talk a bit about your background. You’re a GP? | |
| 00:02:12 | PN | Yes, I’m a GP. I’ve been working at the same clinic in the CBD for the last eight years. I’ve also worked on and off at another clinic in the western suburbs of Sydney. At my office in the city, we’re very nearby to the Downing Centre, but there’s also a lot of other law firms around the area as well. So we get a lot of criminal lawyers in our practice, barristers, judges, and then also some of the government lawyers. There’s a few personal injury firms nearby as well. So we see a lot of lawyers in our practice. |
| DT | Yeah, that sort of Liverpool Street, Hyde Park area, a lot of law firms, public, private, and of course, the court complex. Now, give us a bit of an impression of a day or a week in your practice, patients coming to you, how many of those patients are presenting to you with a mental health condition or are concerned about their mental health? | |
| PN | So in any given day, mental health presentations will be the majority of the presentations that we see. That’s true for actually most GPs in Australia these days. So some of the statistics that the RACGP have accumulated over the last few years is that mental health has now overtaken things like colds and flu being the most common reason why people will present to general practice. | |
| DT | Wow. And of those patients who are coming to you with those mental health conditions, how many lawyers, how many are in this profession that we’ve just said have pretty terrible rates of depression, anxiety, stress? | |
| 00:03:36 | PN | Yeah, it’s pretty significant. So on any given day, I’d probably see at least two or three lawyers a day with a mental health concern. |
| DT | Yeah, wow. And are they coming to you because they’ve had a kind of urgent need to speak to someone or because they have a regular relationship with you or with the practice and they’re sort of coming in to check in? | |
| PN | Most of them will have a regular relationship with me, which is great. And we’ll be dealing with various physical and mental health concerns at any given time. And the physical and mental health concerns that they present with, they’re often very interrelated. And I think often they’re pretty direct or indirect consequence of their work. | |
| DT | Yeah, I bet. And we’re going to talk about that relationship between physical health and mental health a bit later, because I think it’s something that a lot of us understand in the abstract in a kind of fuzzy “I know I should be doing better to look after my physical health” sort of way, but we don’t really talk about the specifics. Let’s go back to what’s bringing your lawyer patients to you, though, because I think you’ve got a really interesting perspective on this. A lot of our listeners, they’re lawyers or law students. And again, they kind of understand academically some of the things that might be affecting their mental health. We know a lot about vicarious trauma in practice areas like crime and family law. But I don’t think we do a very good job of recognising it in ourselves or recognising it in a situation really specifically, we understand that it happens, but that it happens to other hypothetical people rather than ourselves or our colleagues. So what are some of the things that are bringing patients to you? | |
| 00:05:10 | PN | So definitely vicarious trauma is one of the issues that we see. So I tend to find it is most common in often the criminal lawyers, but all lawyers will come across distressing material at some point in their career. And particularly if there’s been a little bit of accumulation of a lot of exposure to some pretty heavy stuff over a period of time, the lawyers that I see will tend to come in with sometimes some symptoms of burnout, so they’ll be feeling really flat, really fatigued, they’ll have poor motivation, they’ll be dreading going to work. And also from that trauma point of view, I tend to find that sleep is often one of the first things that gets affected as well with people experiencing, like nightmares, ruminations about the content of their work, difficulties getting to sleep, staying asleep, things like that. TIP: According to a report from Harvard Medical School in the United States, about 50% to 80% of individuals grappling with mental health issues are also encountering sleep related challenges at the same time. In contrast, only a small proportion, 10% of the general population, have sleep problems. Again, this highlights the relationship between physical and mental health. |
| DT | You know, when I used to practice as a barrister, one thing that I always found stressful – and I feel like I managed that stress reasonably well – but there were times when maybe I could have managed it better, was the adversarial nature of the work. It was really hard to have a good relationship with your own performance when the whole conceit of what you were doing was that someone won and someone lost. And on a long run, you were lucky to be winning more often than not. So there were lots of moments to say to yourself; “oh, I feel like a fraud, I feel like I’m doing a bad job, I’ve done a bad job by the person I’m representing. I’m intrinsically not very good at what I do if I’ve been unsuccessful, or if I’ve read something wrong“. But that’s happening in any litigated matter to one half of the people there, like every day. So do you see that relationship with the adversarial process with litigation with just the kind of cut and thrust of a very conflict-oriented profession affecting mental health? | |
| 00:07:29 | PN | I do. And I think that often presents in people with a really heightened sense of anxiety, and a lot of self-esteem issues. That kind of imposter syndrome that I see amongst a lot of lawyers, actually. Which I think is exactly because of what you just said. It’s that conflict, the adversarial, and just by the nature of it, someone’s winning and someone’s losing all the time. And if you’re the person that’s losing, and if you’re losing more than 50% of the time, then that starts to really have an impact in terms of your performance, your self-esteem, the way that your bosses speak to you as well, which for younger lawyers can often be really problematic. |
| DT | Is that a trend that you see amongst the patients? You see that they tend to be younger and you’re in the profession, or is it all the way through the profession even to more experienced members? | |
| PN | We have a real mixture, so I do see patients that are also towards the end of their careers as well. What I would say is that definitely the mental health concerns are a lot more prevalent in younger lawyers, particularly in terms of symptoms of anxiety. In older lawyers, they do seem to have mellowed out, found their kind of niche area, often developed a lot more confidence. So they do tend to have a little bit less anxiety, but I still find that some of the other particular issues that I see in lawyers with substance issues, particularly around heavy drinking, physical health problems, are prevalent throughout and sometimes even increase in older lawyers as well. | |
| DT | Yeah, I remember I read a biography of John Hughes QC. Used to be the Attorney-General, is an extremely accomplished lawyer, and he returned to practice as a silk after being the Attorney-General. And he still often confided in his colleagues that he was afraid he’d never get any work again, that one day people would just stop briefing him, they’d just decide he wasn’t good enough. And he had this anxiety despite having literally achieved the highest office he could in his profession in several different ways. He’d become senior counsel, he’d held high office in government. He still had that anxiety that he wasn’t good enough. And that’s towards the end of his career. I feel like that sort of never goes away. | |
| PN | Yeah, I think for some people it doesn’t. | |
| DT | Do you think there’s a bit of a silver lining to the presentation of more younger lawyers in that there might be a greater acceptance of the need to go and seek help? | |
| PN | Yeah, definitely. There’s a lot less stigma around mental health these days, I think, and a lot of younger lawyers are more aware of treatment options services available to them. And so they’re more likely to come in and actually talk about it with me and be a little bit more open. | |
| DT | It sounds like if we were to put the myriad experiences of all of the different people in our profession and that you treat every day into like three extremely generalised buckets, it sounds like we have challenges coming from a stressful, tense, maybe even toxic work environment where people aren’t showing one another respect or kindness or empathy, maybe because they’re experiencing stress of their own. We’ve got the adversarial nature of the work. And I think I was talking before about the adversarial nature of litigation, but transactional work can be very adversarial as well. I’ve certainly seen that working on both sides. Transactional lawyers can be just as combative and adversarial as litigators, maybe sometimes more so. And we’ve also got that vicarious trauma. | |
| 00:10:55 | PN | Yeah, I think related to that, one of the other aspects of that potentially toxic culture that certainly needs a mention is drinking culture. In lawyers, long lunches that sometimes never actually end, and involve huge amounts of alcohol are often the norm. |
| DT | My observation is that there is a culture of excessive drinking in the law. I don’t think that will surprise anyone listening. But I think the circumstances in which that arises come from, kind of, two sources. And sometimes it’s the cause of the health issue. And sometimes it’s the consequence of the health issue in that there’s a lot of weight or importance placed on relationship marketing and corporate law that the way to win work, the way to build a practice is to take people out for long lunches and to go drinking. And there’s typically a culture of entertaining through alcohol consumption. And I think that can be done to excess and that has negative health impacts. But then on the other hand, I think people drink to manage the other issues that we were just describing. So it can be both the cause and the effect. | |
| PN | Yeah, there’s a couple of studies that estimate that problem drinking or substance abuse is about two to three times the general population level in lawyers. And I agree with you that I think it’s partly drinking to cope with, again, like we talked about some of the stress of just high power environments and then some of the traumatic issues associated with the law, but then also that relationship drinking culture and relationship building and that kind of thing. | |
| DT | I want to ask you about some of the strategies we can use to manage these four themes, I guess, of mental health challenges that we notice in our profession. But before I do that, let’s talk specifically about alcohol consumption, because I think it’s a difficult thing to self-diagnose. A lot of people like to have a drink. There’s nothing wrong with drinking in moderation, but people have a hard time identifying in themselves whether their alcohol consumption is healthy or unhealthy. I don’t mind having a drink during the week, you know, after work. Is that healthy or not? What are the yardsticks we should be using to measure our own drinking and decide whether it’s safe? | |
| 00:13:20 | PN | So there’s actually a great little questionnaire that you can do for free online that helps you answer this question for yourself. And it’s called the AUDIT. Or there’s the AUDIT-C, which is a much shorter version of this questionnaire, which just has three questions about quantity. But the AUDIT, if you literally Google “audit alcohol”, the first website that comes up is this questionnaire that’s designed to assess your level of risk around drinking. TIP: So the resource that Dr. Phoebe just mentioned there is the Alcohol Use Disorders Test, or AUDIT for short. We’ll leave a link to it in the show notes. Basically it’s a score sheet where the final score is a measure of risk. So 0, no risk, 1 to 7, low risk, 8 to 12, risky, and 13+, high risk. And it partly asks you about things like your quantity that you’re consuming. In terms of how many days a week, how many drinks. Which on average, anything that’s less than about 10 standard drinks a week, probably not significantly harmful. Anything that’s more than that sort of 10 to 14 is probably getting a little bit much. |
| DT | Okay, I’m good. | |
| PN | We’re doing okay here. But it also has some other questions around your alcohol use, which can be quite interesting ones, which are things relating to how you feel about your use or how the other people in your life feel about it. So whether anyone’s ever commented negatively on your drinking or suggested that you cut down, that’s usually a pretty good sign that something’s going on. Whether you’ve ever regretted anything that you’ve done in the context of drinking, whether it’s affecting your interpersonal relationships, those kind of things. So there’s some kind of more insightful questions in that AUDIT that can help to really analyse your relationship with alcohol in a little bit more depth to figure out whether you are drinking in like safe, healthy levels, or whether you do need to look into it a little bit further. | |
| DT | Yeah, it’s not just about quantity, is it? Because I suppose some of those other factors around behaviour or the way you or the people in your life feel about your drinking could highlight a risk that quantity of consumption might really increase in the future. | |
| PN | Yeah, absolutely. And whether you’re on track to being on maybe a little bit of a slippery slope with using alcohol as a coping strategy in an unhelpful way is useful to find out about. | |
| DT | Okay, let’s talk about those other three themes. And let’s start with the one that I think is universal. I don’t think it would be an exaggeration to say that almost everyone listening has probably experienced some flavour of this, whether high in intensity or very mild, at some point in their professional career, which is that kind of difficult workplace environment, difficult conversations with colleagues with superiors. Of course, we need to try and have better relationships with our colleagues and our superiors and the people that report to us, we need to try and work with one another with empathy and respect and all of those great things. But I think also, we’re going to have these experiences of difficult, stressful, uncomfortable conversations with our colleagues. And sometimes we aren’t in a position to influence that a great deal. And we’re not in a position to just walk away. So how do you recommend we manage that environment when you have a young lawyer who comes to you and says; “I love my job. I love the work that I’m doing. But I work for a tyrant. None of the people around me are very supportive. And I can’t just leave”. | |
| 00:16:26 | PN | Yeah, this is a conversation I’ve had many times. I had one patient in particular, who was a lovely lady that was in a really toxic firm, being directly bullied by the partner in her firm in quite an intense, quite a harmful way. And she came to me and she had a little bit of time off work. She did end up seeing a psychologist. She saw me frequently for a lot of really what I’d call just informal counselling as well. And we really went backwards and forwards about whether she should be leaving the job or not, like how she should be approaching the situation. Does she try and stick it out or not? Is it going to get better? And interestingly, she did work quite hard at the psychology, but she also is someone who is a regular meditator. So she was really good at meditation and started trying to rely on that quite frequently, was getting really good at using that and a little bit of yoga to try and manage some of her symptoms. And she actually got to the point where – she would also call it a little bit “luck” – because she basically got given a case that ended up being very successful for her. And it did take a lot of the strain off the relationship with her boss. But I don’t think it was just that, right? I’m sure it was also the things that she was doing in the background to try and really like help emotionally regulate, to help to just cope with the kind of difficult environment with that really difficult relationship that was really quite harmful for a long time. Like I’m talking, a couple of years actually. And she got through it and the relationship actually completely changed in the end. And now she’s still in the same firm. This is probably where four or five years on and has an acceptable, fine relationship with the boss. They might never be best friends, but you know, it’s actually going okay. And she’s doing really well. Her performance is outstanding. And that for me is just a bit of an example of how things can change. Things can improve sometimes. There’s often a bit of a temptation, I think, to have like a really nihilist view of some of the relationships and difficult bosses and things that people experience. There are ways that you can actually teach yourself to cope better so that you’re not having as much of an emotional reaction when you’re at work and in the situation. You can take less of it home with you and you can pull through basically. |
| DT | Yeah. I mean, that story brings out both the change that you can make in the external environment, limited though it may be and over time, and the things that you can do internally for yourself to cope while those things are changing. So your patient did eventually change her relationship with her boss, moved upwards, it sounds like, in the formal or informal hierarchy of the firm. And that external environment changed for her for the better. But also while in that really stressful environment, she had these tools at her disposal, like meditation, to help get her through that. Just to digress, sometimes I talk to people about how they cope with stress or anxiety and why they’re so high functioning and high performing. And they’ll say; “oh, yeah, I meditate“. And I’m like; “right, okay, let’s keep looking for a better answer“. It’s one of these things that keeps coming up and I keep thinking; “well, I can’t do that“. | |
| PN | I think everyone can learn to meditate, but it depends on how you’ve heard about meditation and what you know about meditation that’s going to basically inform whether you’re successful at learning how to meditate or not. Meditation is not sitting cross-legged in a room with your eyes closed with a totally blank mind, not thinking of anything. That’s not how you learn how to meditate, basically. | |
| DT | You don’t need candles and a gong or anything. | |
| 00:20:08 | PN | You don’t. But if you start trying to approach meditation in a way where you’re trying to empty and clear your mind, you’re not going to succeed. So at first, when you first want to start trying any kind of meditation practice, really what you want to be doing is starting with focusing on your breath, even if that’s doing some counting breath work. And then it’s starting to just observe your thoughts in a way that you step back from them a little bit and a little bit more objective and see your thoughts as happening maybe separately to you rather than latching on to one, going down a whole spiral and then going; “oh, gosh, I’m supposed to be meditating. Hang on. Let me go back”, right? Now, it’s normal at first when you start learning to meditate, but you will end up with a thought and running down a thought spiral and then going; “oh, what? This is what I’m meant to be doing. Hang on. I’m meant to be breathing, and I’m meant to be going back and looking at my thoughts more objectively“. And stuff like that. Sometimes having a visualisation for what your thoughts look like in like pictures or words or things like that helps you get a bit of distance from it. And literally, if you start meditating for 30 seconds to begin with, or a minute or two minutes at a time, and gradually trying to build that up over time, that’s when you’re going to start to notice the effects. And in fact, a lot of the literature says that kind of genuinely therapeutic meditation, so meditation that is going to actually result in improvements in your mental health or your physical health and general well-being, you probably need to be meditating for about 12 minutes, okay? Which is actually quite achievable over time to build up to 12 minutes. And it’s the sort of thing that you can do on a commute even if you’re catching public transport. Don’t do it in your car. If you’re catching public transport, you can sit quietly with your phone away for 12 minutes. You don’t even have to close your eyes. You don’t have to make it look obvious that you’re meditating, but you can have a little bit of a moment of quiet stillness. And that can result, we know, from medical literature in significant improvement in your physical and mental wellbeing. TIP: There are a lot of different resources that you can access to try and improve your stress levels and the way stress affects you. Even a 5 minute yoga video on YouTube can begin to help reduce stress. Now some of the most popular apps to help you tackle stress are the Calm and Headspace apps. You’ve probably heard of them, you’ve probably seen them on the app store. You can just download these apps on your phone for free to try and then if you’re happy with them you can sign up to a subscription version. Now both apps teach stress reduction strategies, mindfulness, meditation, even some cognitive behavioral therapy techniques. And these are proven psychological therapies to help reduce symptoms of depression or anxiety. As usual, we’ll leave links to these resources in the show notes. |
| DT | Yeah, thank you for explaining that. I feel like every time I’ve tried to meditate, I’ve just ruminated instead. It’s a very different practice, less helpful. So is that idea of getting some distance between yourself and your thoughts a bit like that Cognitive Behavioral Therapy practice of naming thoughts? | |
| 00:23:19 | PN | It’s a little bit different. It’s more like a mindfulness practice. So mindfulness often is more about things like having very good awareness of your body and yourself and your physical environment rather than ending up in ruminating thought spirals. And there are things that you can’t quite get to the point where you’re meditating. Then you can start with like brief mindful activities. So I think one of the good ones for mindfulness is where you create a little list in your head of five things you can see, five things you can hear, and five things you can feel. And you list through the five things for each of those three categories. And you redo the list and you do four things for each, three things for each, two things, one thing. You can use the same things each time. You don’t have to come up with four or three or two or one brand new things, but you might notice new things when you go through. If you do those three lists, five, four, three, two, one, it actually takes a good couple of minutes to get through. And it’s a moment where you haven’t been thinking about other stuff. You’ve had that awareness of your body, your senses, and it does often just help to bring you out of that really heightened sympathetic nervous system mode to a more relaxed, calm state. So that can be a good sort of strategy from like a mindfulness point of view. In terms of naming thoughts and emotions and things like that, that’s a different psychological strategy, but that is also really helpful in terms of particularly understanding where some of your feelings of depression or anxiety are coming from. And also for patients who’ve got a lot of particularly like past trauma from early in life, it can often be really hard to name emotions and starting to practice naming emotions can often help you get a better understanding of why you’re feeling the way that you are and what good ways of coping with that are. |
| DT | Got it. Well, maybe on the commute home, I might try this secret eyes open undercover meditation. Just going back to our theme of kind of dealing with a difficult workplace or even a toxic workplace. That story you told reminds me that I think when you’re in one of those environments, you do have this very, use the word nihilistic, you can have this very fixed mindset about how that situation might resolve. I remember there was a time in my career where I didn’t feel very satisfied with my work. And I felt like that was a reflection on my suitability for the profession I had chosen, that the problem was intrinsic to my profession. And since my profession was intrinsic to my identity, it was a problem with who I was. And you get into this mindset, you’re like; “well, I’ve got to leave the profession. If I’m not happy in my workplace, or I’m not happy with the work I’m doing now, I’ve just got to go and I’ve got to do something else and escape” – that fight or flight response. But your patient made a pretty modest change, right? Didn’t even change the workplace that she was in and had an enormous improvement in her mental health. So how do you step back from that precipice of; “I’m feeling uncomfortable in the place I am now. And for that reason, I need to change everything in my life”. And do you see that a lot? Do you see people who spiral or inflate the problem to the size of their whole chosen career path or their identity? | |
| PN | Sometimes, although I have to say, I feel like sometimes it’s actually more common for me to go the other way around with the patient in that I’m the one that’s identifying that maybe the career path – not necessarily law as a whole, right? – but that the job that they’re in, is the thing that’s contributing to so much of the mental or the physical health issues that they’re experiencing. And that even a little shift in terms of a slightly different subtype of law or work environment or a more like legal adjacent role, even if it’s just a temporary thing for a couple of years, could be the thing that really helps people to reset. I have seen people manage to step back from the precipice. Again, it’s usually with sometimes a little bit of counseling or even I’ve got a few psychologists that I refer to that do a lot of life and professional work coaching and things like that. And sometimes that can be the source that helps people just maybe take a little bit of a sidestep and find a place that they’re a lot happier. I’ve got another patient who was working in personal injury and, again, in what I would say is a more typically toxic work environment with the like very late hours, staying at work until like 11 o’clock at night. Absolutely no flexibility in terms of being able to work from home or anything like that. No availability to ever take sick leave, even when you’re basically on your deathbed culture, and has literally just moved to basically somewhere that’s on the other side of personal injury and has a really great relaxed work environment, lots of flexibility, much healthier work environment, lots of healthy meals provided by the firm for the workers so that people’s diet is better and things like that as well. And such an improvement in work-life balance and mental health as a result. | |
| DT | Yeah. Well, let’s talk about one of our other themes that we identified earlier, which is vicarious trauma, speaking of personal injury, I suppose. But although, as you said, that’s a challenge that lawyers in lots of areas of practice have to deal with, it’s certainly not limited to personal injury or crime. How do you see your patients managing vicarious trauma? | |
| 00:28:48 | PN | So I guess a lot of the time, unfortunately, my patients are managing vicarious trauma poorly, often with, again, alcohol as a crutch, particularly in the evenings to try and help them get to sleep maybe a little bit inappropriately and often withdrawing as well from their social lives, the people around them, family and friends and things like that, and getting a little bit stuck in the heavy content. And I think in terms of trying to improve that to get out of that sort of space, it’s really important that people do try and foster good relationships with their family and friends, preferably with some non-lawyer family and friends so that you’re not always having conversations that end up winding up being about some aspect of the law. |
| DT | That’s such a good point. I feel like, yeah, lawyers tend to gravitate towards one another. And I know I’m guilty of that. I have a brother-in-law and a sister-in-law who are lawyers. And yeah, you just can’t help it. Even at family functions, you end up talking about some matter that one or the other of you have going on, and it ends up being a work conversation again. | |
| PN | Yeah, look, doctors are exactly the same. We’re heavily guilty of this kind of behaviour. In fact, I think we’re probably actually often worse than lawyers when it comes to ending up in just purely work conversations, even in a social setting. But I have to say that when I reflect on it, I’ve got a couple of doctor friends who, when we get together, it always descends into medical talk, always, always, always. And then I’ve got a few who we don’t actually. So we might talk about some work-related stuff really briefly, but we’ll end up having normal, appropriate, connected conversations about our lives, our families, everything outside of work, politics, sometimes interesting things. And I think if you kind of reflect on who the people in your life are that you can do that with, that you don’t end up just having those narrow conversations about work and trying to make sure that you’re actually connecting, catching up with those people, and also trying to connect in ways that don’t always involve food and drink, basically. So if you can go for a walk with someone, or go for a run, and have a chat or sit in a park or something like that, that can be a great way to connect with people in a slightly healthier way. I’ve got a friend that we do jigsaw puzzles together. Which, again, is a bit of a niche hobby for us, but it’s a great way of connecting, catching up, socialising, relaxing a little bit in quite a healthy way. | |
| DT | That feels like the sort of thing that would lend itself well to a bit of meditation, although it might take a bit longer than 12 minutes. | |
| PN | Yes. And it’s a good way to get into that, like, what we call flow state. | |
| DT | Yeah. I guess an important thing to draw out of this is it’s not a bad thing to talk about your work, especially if you really love it and it’s part of you expressing a passion for what you do. I think what we’re talking about here is if you’re struggling to establish an appropriate distance between yourself and your work, including some of the content you deal with at work that is causing you to ruminate and have bad sleep and feel anxious, then talking about your work all the time, even if you’re not explicitly talking about that thing, is probably not helping you to establish that distance. | |
| PN | Yeah, I agree. I think that’s a great way of putting it. | |
| DT | And then the last theme that we established earlier was this idea of conflict in the work. And I’m looking forward to talking about this one because I feel like I’ve been fortunate to not work in toxic workplaces. I’ve been fortunate to not have to deal with really distressing content in my work very often. But conflict does feel like it’s everywhere. Whether that’s in litigation work, in transactional work, I feel like when I’m practicing, I’m always surrounded by conflict. And it does weigh on you. It does feel a little exhausting sometimes. And sometimes you get off the phone or you receive an email and you think; “why are we doing this? Why do we have to argue about everything? Why can’t we just afford one another the sort of respect and empathy that we would afford in any other situation?“. Although in saying that, sometimes I feel like it does bleed out of work sometimes. And I’ve observed that in myself where you’re a little bit more combative in personal relationships, in social settings, in how you talk to someone at a restaurant or how you talk to someone at a supermarket because you’re just primed for argument. | |
| 00:33:13 | PN | Yeah, that’s something that I definitely notice with all lawyers, both the ones that I meet at work and also socially as well. That’s certainly a bit of an issue. Even in GP consulting room, sometimes patients come in in that combative vibe, almost like they’re preparing to have a fight, even though sometimes I haven’t even met them yet. And we haven’t even talked about why they’re here yet. But I can already sense that there’s some aspect to what they want to bring up that they’re already feeling really agitated, aggressive about. And sometimes, yeah, I just have to use a lot of laughter and a lot of very relaxed casual vibes to try and tone down the whole conversation. |
| DT | It feels like they’re waiting for a criticism. | |
| PN | Yeah, waiting for a criticism or waiting for me to say; “no, I don’t think that’s what’s going wrong with you” or “I don’t think that test or that referral is appropriate” or something like that, even when that’s not the case at all. And sometimes that might be informed by experiences they’ve had with other doctors. But a lot of the time, I think it’s actually because, as you said, you’re so embedded in that conflict, those typical relationships that are so combative that you struggle to turn it off when you’re outside of a work context. | |
| DT | And how do you help your patients to turn that off, to get out of that combative mindset? Well, I suppose there’s two elements to that, isn’t there? On the one hand, we need to get out of that combative mindset when we’re out of work. That would certainly help improve our relationships with our loved ones and with our friends and with our family and with the waiter at the restaurant. But also, we kind of need to be less combative in our work, right? It’s not necessary all the time. | |
| PN | Yeah, you’re right. It isn’t necessary all the time, but that does sometimes become a bit of a bad habit. I think I tend to focus on turning it off more at home with my patients, trying to have a lot less anger, try to be a lot more present with family. And I think, in part, again, it depends on what type of work you’re in and what culture and things like that. But trying to switch off from emails a little bit and not be responding to emails 24/7 can be a helpful way to, again, have just that little bit extra distance between you and your work. But also, again, some of the stuff we’ve mentioned like about little mindfulness activities, even a quick breath exercise can be the sort of thing that can bring someone back to a little bit more of sort of a calm present state. There are some other strategies that can help people to enter a more calm state of mind, which includes journaling or practicing gratitude exercises, literally even just doing a quick one-minute exercise where you think of three things that you’re grateful for. That can often change your mindset from that by-conflict, agitated, stressed-out zone to being a lot more calm, a lot more joyful. Having those feelings of gratitude wash over you can be really helpful. | |
| DT | I used to do that. I used to do that gratitude exercise. I wrote them down before bed. So I didn’t do it at work when I felt like I was being too combative in the way I was speaking to people. But I did it every day. And I do feel like, well, for me, doing it before bed, it helped me not to ruminate on all of the things that I had said and done at work that day. So I definitely think it helps. I stopped doing it at some point. I should start doing it again. That’s one I can recommend from personal experience. | |
| 00:36:30 | PN | Yeah. One of my colleagues also used to have this little exercise that he would do at work that I think often could be really helpful for lawyers, which is when you’re having a difficult conversation with someone or when you’re in a conflict and you’re not sure how to resolve it and you’re getting more and more aggro, irritated, frustrated with the person in front of you. Stopping for a moment and just thinking to yourself very slowly; “I hope this person has a wonderful day”. It can be a really useful strategy. You should try it. It works fantastically. It just stops that whole kind of angry, irritated, emotional feeling where you’re very much focusing on you and your thoughts and your reactions to this person, and you’re not seeing them as a fellow wonderful great human being, right? You’re stripping them of their humanity on purpose a little bit to have this kind of difficult conversation or have this conflict. |
| DT | Interrupts that thought of “this person is my enemy”. | |
| PN | Yeah. This person is the problem and they’re causing all these problems to me. | |
| DT | Because I think I’ve said that conflict’s all around me and I say it all the time when I’m practicing. But my favourite moments from my career in legal practice have been where we’ve been able to sort of have that healthy adversarial process without the conflict. I loved being at the bar and having a really forceful, but respectful and focused on the issues hearing, on a matter and irrespective of how it ended, myself and my opponent shook hands, said some kind words to one another and then left. I mean, I guess I wasn’t saying it in my head but there was this sense of “I hope this person has a wonderful day”, right? They’re not my enemy. We’re both just doing a job and the job is actually done better when we are making appropriate concessions on one another’s behalf and helping one another to do the job in a way. It’s not entirely adversarial. | |
| PN | Yeah, I think it helps as well, like sometimes particularly with barristers, if they are friends with the opposing team’s barrister. I think you’re more likely to end up in that kind of moment where you’re able to be respectful, still see that person as a person and not just the enemy and have a really joyful experience even though ultimately you are still in conflict with them. | |
| DT | The consistent theme that I’m picking up when we’ve talked about all of these three issues, vicarious trauma, toxic or difficult workplaces and conflict in our profession is that the salve, the remedy is the same. It’s getting some distance from our work or at least from the patterns in our work that are making us feel anxious or stressed or depressed. TIP: Again, there’s a few more resources that you can access if you’re experiencing any of the issues that we’ve discussed in the episode so far. These are more involved psychological programs online that are a bit more like a traditional psychological therapy session except they don’t require you to make the time to actually see a psychologist and they’re a lot cheaper. One of the more evidence-based online programs like this is called This Way Up which was started by some of the doctors at St. Vincent’s Hospital right here in Sydney. There’s also a website that’s run by one of the local primary health networks called Head to Health, which essentially you do a questionnaire about the types of mental health symptoms that you’re experiencing and the program then directs you to other mental health services that are available, both online and local, so that you can get some better support. Again, links will be included in our show notes for both of those. We’ve talked about a few ways we can get that distance. We’ve talked about meditation, talked about gratitude exercises, we’ve talked about being careful around our drinking, the way we eat. Exercise is really important as well. I think I can speak from experience that I feel a lot better when I’m exercising. I like to go for a run a few times a week and I feel like when I get that opportunity, I feel a lot better at work. A lot of people listening will say; “well, when I’m in a toxic or difficult workplace that makes me work until 1PM, and I don’t get time off even when I’m sick, how the hell am I supposed to go and do some exercise?”. | |
| 00:40:45 | PN | Yeah, look, it can be really hard to find time and acknowledge that’s a potential issue. But the impact of exercise on one’s physical and mental wellbeing is so profound that I can almost guarantee that if you prioritise exercise and make the time to exercise, your performance and productivity will improve to such a point that it will be easy to find the time to continue exercising. So exercise is probably one of the most powerful tools that we have in a mental health context. There are studies that show quite definitively that people with even moderate or severe cases of depression, if they start regularly exercising within a couple of months, sometimes even weeks of experiencing symptoms can go into complete remission. It’s more powerful than any antidepressant that is on the market at all. If I could put exercise into a pill form, I would prescribe it to everyone because it’s so powerful. And what a lot of people don’t realise is that when you’re in that really high stress environment, when you’re working constantly, you’re working really long hours, you’re not getting quite enough sleep, all of that sort of stuff, it becomes a little bit of a vicious cycle because your performance actually starts to decline. So there’s a beautiful graph of this that’s called the Yerkes-Dodson curve, which basically shows your stress levels against your productivity or performance. And as stress increases a little bit, your productivity and your performance does in fact improve, okay? |
| DT | This is eustress, the opposite of distress. | |
| PN | Yeah. So this is a little bit of good stress, right? We need a little bit of cortisol to get up in the morning and function and go about our day. But this is something like, for instance, in an exam, when you’ve been studying, you’ve been preparing, kind of thing, you’re a little bit stressed, not too overwhelmed, but you go in and that stress does help you actually sometimes perform and do better and you actually come out of that exam going, “yeah, I think I nailed that“. | |
| DT | You’re kind of focused and aware of the gravity of the situation, but not overly so. | |
| PN | Yeah, exactly. And for someone, say, it would be equivalent to like a professional athlete. They’re more likely to get some of those PBs or records or things like that when they’re actually in an event rather than just in training because that little bit of pressure and the stress and things like that is enough to actually perform better. But once stress levels keep going past that point, your performance starts to decline pretty dramatically. So at that point, your productivity is getting worse. And what’s probably happening if you’re in a situation where you’re staying at work late every single night is that actually every minute that you’re there, you’re probably not actually that effective or that productive. And if you took a little bit of time to actually focus on going home and cooking yourself a healthy meal or actually doing some exercise at least a few days a week to begin with, preferably most or every day of the week, ideally, then you’re going to actually have much better productivity and you’re going to be able to manage time a lot better as well. | |
| DT | I feel like I saw that a lot in some of places I’ve worked in the past where people would work really late hours, they’d come in the morning, they’d spend a lot of the morning or even the afternoon not doing very much because, well, I worked so late last night. | |
| PN | They’d take a while to switch on in the morning, you know, it’s a few cups of coffee. | |
| DT | “Oh my God, I’ve got so much to do before I can leave” and then the cycle would begin all over again. And that brings me to a really important question, which is we’ve been talking about what individuals can do about their own health and about their own situation and about their own coping with their environment and their workplace environment. But a lot of our listeners are business owners, they run firms, they’re in a position to create that environment for their employees. So what’s the role that law firms, and we should be broader than that, in-house teams, in corporate employers, legal counsel, in government departments, what are their responsibilities and what can they be doing? Because, look, I think responsibility is pretty clear, right? We want to have mentally healthy, relatively stress-free workplaces where people can do their best work and go home and be happy. What can we do to make that a reality? | |
| 00:45:12 | PN | So I think, to begin with, starting to get a little bit more flexibility in terms of work, particularly in terms of things like work hours, right? If you’re contracted to do eight hours a day, and someone wants to do that from, say, 7.30 to 3.30, I think that’s a pretty reasonable approach because it gives that person a bit more flexibility to do things like whether that’s school pickup or whether that’s exercising, cooking a healthy meal in the evening, that kind of thing. And I’ve seen firms where, because the partner wants to work 10 till six, everybody else ends up working 10 till six, even if it’s not necessarily the thing that’s going to suit their lifestyle the most. I think a little bit of working from home in terms of a little bit of flexibility is helpful. I think too much working from home is also really unhelpful and really toxic. |
| DT | I was going to say we’ve had such a sharp turn towards virtual work, remote work. I’ve heard stories of some employers, not so much in private practice, but certainly in-house teams, who are virtually entirely remote work now. They don’t have any sort of face time with their colleagues. I imagine that’s causing wholly new problems. | |
| PN | Yeah, I would agree that it’s mostly the in-house teams where I see a lot of people that are either five days remote or maybe four days remote. In traditional, particularly mid or above tier firms, there’s still a lot less working from home. | |
| DT | And I suppose a concerted effort over the last 12 months to actually bring people back into the office and get them to stop working from home. | |
| PN | Exactly. But people who are working from home four or five days, I tend to find, are often struggling a lot with anxiety and social isolation, even if they don’t realise it. They’re losing their social skills. They’re losing their ability to manage small conflicts around the office. I feel like people since COVID are not coping as well with having a little bit of disagreement with a colleague and kind of expecting that they’re best friends with your colleagues. You have to be able to work with them in a respectful and professional way. But frankly, if you don’t like them a lot as a person, you’ve got to learn how to deal with that. And I think people used to be better at that. And since COVID, coming back into the office, I think it’s a little bit of a struggle for people. And I think a lot of that is we just have to get more exposure. People just have to start spending more time talking to the barista, talking to cashiers in supermarkets, getting a little bit more of those kind of day-to-day social interactions that helps you manage your relationships appropriately. | |
| DT | I guess for the first time, there’s an alternative to just having to manage that conflict appropriately. Like before COVID, there wasn’t a choice. If you didn’t get along with Bob at the office, like tough, you’re going to see him five days a week. So it’s time to put it aside. But now, I hate Bob, so I’m not going to go in on any day he’s in. So I’m not going to be in Monday, Wednesday or Thursday. In fact, you might be in Tuesday, so I won’t go on Tuesday either. You get to run, you get to exercise your flight response. | |
| 00:46:43 | PN | Exactly. And then when you do see Bob, you feel an even more heightened sense of anxiety and stress on the day that he does happen to be in the office the same day as you. Whereas if you had to see Bob five days a week, you’d probably get to the point where you’re not as bothered by Bob anymore because he’s just there, whatever. |
| DT | Yeah, absolutely. Do you see a big difference in the way men and women present when they come to see you about a mental health concern? | |
| PN | Yeah, I do actually. I think women, particularly young female lawyers in particular, tend to present with a lot more of that anxiety and the kind of imposter syndrome, those sorts of things. But the other thing that I tend to find is quite specific to women is often quite intense fatigue, which is often related to that cumulative stress, feelings of burnout. But the fatigue feels very physical. It feels not like it’s just part of a mental health presentation. And I tend to find that women will come looking for a physical cause for that fatigue, be it a thyroid problem or an iron deficiency or something like that. And sometimes those things are there and we test for them and we check. But often in my patients that are lawyers, we do tests and things and find that actually physically there’s nothing specific going on. And often that really deep sense of a lack of energy is actually related more to that cumulative stress and build up with time. And with men, I actually tend to find that the mental health issues often present at the same time with other physical health problems. And their mental health often tends to present more with kind of symptoms of depression or even like a low-grade sort of depression. But at the same time, I’ve been picking up a lot of physical health problems, even in young male lawyers, like in their 20s and 30s, which is getting pretty concerning, like fatty liver, high cholesterol, obstructive sleep apnea, actually. I’ve diagnosed a lot of young lawyers with obstructive sleep apnea recently. | |
| DT | That does feel like one of those kind of stereotypical older male diseases, right? | |
| PN | So yeah, that’s where we normally associate it with, right, is like an older guy that’s gained weight that’s maybe in his 50s or 60s, snoring very heavily, his wife’s getting annoyed with him, nags him to go to the doctor. | |
| DT | That’s kind of the truth, yeah. | |
| PN | Yeah. But yeah, a lot of guys in their 20s and 30s who, again, aren’t necessarily at the point that they’re severely overweight or obese, but they’re still carrying a little bit too much fat around the middle, often again, because of some of the lifestyle stuff that we’ve been talking about. Their diet is not the best. They’re not as active as they should be. And it’s actually serious, potentially life-threatening physical health condition. And it’s just surprising to see that in guys that are so young. | |
| DT | It sounds like both men and women in the legal profession aren’t very good at seeking help for their mental health conditions. It’s good that they’re coming to see you. But it does sound like often for women, they’re coming because they think there’s something physically wrong. And for men, they’re coming because there is something physically wrong. And then the root cause is a mental health condition. | |
| 00:51:33 | PN | Yeah, that’s very common. And I think it’s partly because sometimes it’s easier to hide a little bit from what’s going on with your mental health. And it’s a little bit more challenging to look at it upfront and realise where some of your mental health symptoms are coming from, particularly if there is a lot of work stress going on. But also it’s that people in general, I think, just have a relatively poor understanding of the connection between physical and mental health. You basically can’t separate them. There’s a lot of evidence coming out in the last few years that in depression in particular, there’s often high levels of inflammation in the body. And it might actually be that elevated levels of inflammation, particularly in the context of lifestyle factors. So people who are eating a diet that’s high in like ultra processed foods that are very inflammatory, much more likely to actually get depression as a result of that. |
| DT | Wow. I think also we’ve said earlier in the episode that there is this stigma that’s eroding around mental health. But I think still for a population that is feeling imposter syndrome, that’s feeling like they can’t make a mistake, that prides themselves on this perfectionist personality trait, it feels like a character flaw to admit to having a mental health condition. | |
| PN | Yeah, I think in particular with young lawyers, they’re much more likely to be open to talking about their mental health with their doctor or their friends or family members where they don’t feel as judged. But I feel like the stigma in the workplace in law is still very much present, and that most of my patients would not be comfortable talking to their bosses about the fact that they’re experiencing a mental health problem, exactly like what you say, because they think it will be seen as a deep character flaw or a sign that they’re not fit to do the job. | |
| DT | Before we finish up, we’ve talked a lot about the kind of self-help you can exercise, including exercise, but also meditation, gratitude, eating better. What if you need some external help? What are some of the resources, the places that our listeners can go if they’re struggling to manage their mental health, including going to their GP? | |
| PN | Yeah, so the GP can be a great place to start, but there are a lot of other resources out there for lawyers as well. So if you’re a member of the Law Society, which many lawyers are, obviously, they do actually have on their website a list of webinars, podcasts, things like that, that you can go to for a lot of information, assistance, things like that about mental health. There is also a service called the Solicitor Outreach Service, which basically offers 24/7 crisis counselling, particularly obviously in that context of vicarious trauma, like we were talking about. But this Solicitor Outreach Service also offers three free psychology sessions as well, which can be a great thing to access. A lot of firms these days also have Employee Assistance Programs where they actually provide free psychology services. Now, depending on your company is going to depend on how many services you actually are going to have available under that kind of program. Sometimes they’re very generous, sometimes not so generous. But I’ve had a lot of patients use those with great efficacy. Some of the psychologists that are attached to employee assistance programs are really high quality. Again, because it’s free, it’s easy to access, there’s usually not delays in terms of being able to chat to someone. So that can be a really great service. | |
| DT | And those are confidential, we should say. I think sometimes people feel this concern that somehow HR might be aware of who’s accessing the Employee Assistance Program. That’s not the case. | |
| 00:55:17 | PN | No, that’s not the case. It’s exactly the same as any other medical service that you would access, the same doctor-patient confidentiality in our case. Or in the case of EAP programs, it’s that psychology-patient-client confidentiality as well. Literally, it has nothing to do with your HR or your work or anything. They’re just footing the bill, basically, which can be really helpful because, again, then the next point of call would be coming to your GP considering getting something like a mental health plan to get Medicare rebated sessions to see a psychologist. But even with those Medicare rebates, there’s still often some pretty significant out-of-pocket costs, and so sometimes exploring those options specifically available to lawyers first can be more accessible to people. And then, of course, potentially talking to your GP about medications and things like that as well. And I think, again, based on what we were also just talking about before is that it’s also probably reasonable to see your GP and look at having actual physical health checkups as well so that we can start to find some of the other underlying things that can often be going on or can be connected to your mental health as well. |
| DT | It sounds like a modest recommendation, but I think just having a GP that you see regularly who knows your history and can observe if something’s going on with you is a huge benefit. | |
| PN | Yeah, absolutely. And it makes a huge difference for the GP as well. Having that regular relationship with you means that we can handle things as they come up in an easier way. Having someone that you’ve already developed a bit of rapport with so that if you start to have a bit of a struggle with your mental health, it’s easier to be a little bit more open about it. Your GP knows a lot about you and your history and is going to be able to give you recommendations that are much more personalised and much more appropriate than if you’re just meeting them for the first time. | |
| DT | Absolutely. And we’ll include some links to those Law Society of New South Wales resources in our show notes. A lot of those are available to non-members as well. And for listeners outside of New South Wales, your own law institute or law society will have their own resources as well. Dr. Phoebe Norville, thank you so much for joining me on Hearsay. | |
| PN | Thanks, David. | |
| 00:57:27 | DT | As always, you’ve been listening to Hearsay, the Legal Podcast. I’d like to thank my guest today, Dr. Phoebe Norville, for coming on the show. Now, if you want to listen to more content like this, episode 97 from this season with legal tech evangelist Fiona Kirkman is all about resilience in the law. Or, for something completely different, episode 93 with Raymond Sun is all about the nascent regulation of AI, both here in Australia and around the globe. If you’re an Australian legal practitioner, you can claim one continuing professional development point for listening to this episode. Whether an activity entitles you to claim a CPD unit is, as you well know, self assessed, but we suggest this episode entitles you to claim a professional skills point. More information on claiming and tracking your points on Hearsay in all jurisdictions around Australia can be found on our website. Hearsay the Legal Podcast is brought to you by Lext Australia, a legal innovation company that makes the law easier to access and easier to practice, and that includes CPD. Hearsay is recorded in Sydney on the lands of the Gadigal people of the Eora Nation, and we would like to pay our respects to elders past and present. Thank you for listening, and see you all on the next episode of Hearsay. |
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