Oklahoma Bar Journal
Lawyer Suicide and the Survivors
By Travis Pickens
The voice on the other end of the phone was one I recognized but had never heard. It was my anguished father, his voice weak and halting, calling to tell me my older brother Doug, another lawyer and someone I had followed around in one way or another since I was old enough to walk, was dead. My father had found him at his home after he had killed himself with a shotgun, having finally lost the struggle with his demons, a bipolar disorder and alcohol.
Doug was an aircraft title attorney with a good firm in Oklahoma City and had successfully been through an addiction program at a local hospital. He had been treated by a psychiatrist, was on medication and surrounded by supportive and close friends at his firm and in his personal life. The family was hopeful for a full recovery. Still, he lived alone, and one of the things you learn as a suicide survivor is that a person committed to hurting themselves most often can do so.
Doug’s story is not unique. Lawyers choose to end their lives every year. Each of them leaves a group of survivors, that is families, relatives, friends and coworkers, who must deal with the aftermath and their own emotions.
LAWYERS AND SUICIDE
Information to guide and help lawyers with mental health challenges is abundant.1 However, the reasons why lawyers are disproportionately at risk to die by suicide, and the impact on the survivors, is less well documented, as is what other lawyers should do to help. Knowing and understanding more about the unique causes and contributors to bad mental health among lawyers – and effective responses – will lead to reduced suicides.
Nationally, reported suicide rates have trended upwards since 2012, from 12.4 to 14.5 deaths per 100,000 in 2019.2
The most recent annual statistics from the American Foundation for Suicide Prevention3 reflect in the general U.S. population:
- Suicide was the 10th leading cause of death
- 132 people on average died each day by suicide
- 90% of suicides involved a diagnosable mental health condition (this is “diagnosable,” not “diagnosed.” Mental health issues have historically been under-diagnosed and undertreated)
- The rate of suicide was highest among middle-aged white men4 (although as to men and women, the rates of attempted suicide appear to be much closer)
- Firearms were involved over 50% of the time (ready access to lethal weapons increases the risk of suicide).
Depression and substance abuse are primary and well-known contributors to suicide. And, compared to nonlawyers, lawyers:
- Are 3.6 times more likely to suffer from depression
- More likely to abuse substances.5
Lawyers also routinely suffer from many of the other contributing factors for suicide including:
- Job stress
- Marital issues.
Further and less obvious, lawyers often have the additional vulnerabilities that go with higher social standing and public notice:
- Unfulfilled expectations
- Perceived sense of failure.6
Adding to the unique challenges of lawyers and suicide is simply the personality profile of many lawyers. Pessimistic thinking is common among lawyers. While that tendency may be a healthy skepticism that is helpful and effective for critical thinking, it may also go too far affecting the lawyer’s overall mental well-being and resilience.7
Lawyers also tend toward perfectionism, which is often caused by a deep-seated fear of judgment,8 and is again double-sided. It can lead to excellent work and high ethical standards, or it can devolve into feelings of inadequacy and even paranoia when impossible self-expectations (or those of a client) cannot be met.
THE NATURE OF LAW PRACTICE ADDS DIFFICULTY
In addition to psychological and emotional tendencies common within the legal profession, there are additional challenges in law practice itself that increase the difficulty in successfully navigating the risks to mental health.9 For example, many lawyers routinely work in adversarial situations, with unpredictable schedules they do not fully control.10 Reflect upon the reality of our profession that one may argue with another advocate directly, perhaps daily, and where there are consequences, sometimes very large for both the client and the lawyer, for how a matter resolves. Reflect further upon a profession where the case, transaction or amount of money at issue may be in the several millions of dollars or a family business or custody of a child may be at stake. Lawyers assume their clients’ burdens, sometimes even their freedom or lives, and are commonly expected to perform flawlessly, with no room for mistakes, and often in public.
Most lawyers depend directly upon their reputations for getting business and are naturally reluctant to reveal uncertainty or weakness for fear they might suffer in a highly competitive profession. That often leads to denial or avoidance of diagnosis or treatment.
In addition, the pressure related to being a fiduciary and the necessary oversight of lawyers that is required to protect the public can unavoidably cause lawyers additional stress. Lawyers risk being sued for malpractice and defending bar complaints and sometimes even adverse media exposure. While accountability is necessary, and ultimately a good thing, it can significantly increase a lawyer’s anxiety.
THE SURVIVORS OF SUICIDE
There are others who suffer from a suicide – the people who survive the deceased.11 Their sufferings are like other bereaved groups but are overlaid with intensified characteristics. The families experience higher levels of rejection, shame, stigma and sometimes the perceived need to conceal or misrepresent the loved one’s cause of death.12 As bad as these factors are to live with in the present, they also make the overall healing process for survivors more difficult and lengthy. A survivor often has feelings of failure or embarrassment as if other people are looking at the death as some sort of collapse or defeat, a failure to deal with a humiliating personal issue based on drugs, dishonesty, money or sex, for example.
Other emotions survivors may have are rejection, abandonment and anger.13
Survivors often feel they missed something with the deceased or that the suicide would not have happened “if only” the survivor had done, or not done, something. The finality of death and the mystery of its cause, the loss of the chance to fully know what drove the person to suicide, is often present, magnifying the survivor’s inevitable analysis of events. Not every suicide is explained with a note, nor is every note the full or complete story. The note may include hurtful comments or judgments of family members or others.
The manner of death may worsen these feelings as it is often violent. There is no third-party perpetrator to blame. The deceased is the perpetrator.
Others beyond the family may also suffer due to a suicide. The lawyer may have worked in a firm, agency, association, company or court. Because of day-to- day interaction, firm ties or the often intense and time-consuming nature of legal practice, strong relationships among co-workers are common. But this familial aspect, which provides so many positives to a workplace, can also result in profound heartache as the suicide of a member of a work group often has the same impact upon the others as it does upon an actual family. The impact is deeply personal and can lead to guilt, self-blaming, embarrassment, anger, shame and all the other magnified emotions that come with suicide.
GUIDELINES FOR DEALING WITH THE POTENTIALLY SUICIDAL AND SURVIVORS
Consider these guidelines14 for dealing with persons who may be at risk. Note that some of these guidelines may seem counter-intuitive:
- Pay attention to signs. A person contemplating suicide may talk about it or feelings of hopelessness or worthlessness; or may lose interest in usual passions; or may engage in risk-taking and self-destructive behavior.
- Be direct. Asking someone if they have suicidal thoughts will not make them worse.
- You usually know little to nothing about what another person is feeling. Do not assume or guess. Empathize, let them know you care.
- Remain calm. The person is emotionally fragile and needs an easy moment, not a dramatic event or escalated emotion.
- Be nonjudgmental. You will not be seen as an all-knowing God by the suicidal person, and it will lead to resentment even if you are right. Avoid arguing in a way that makes the person feel worse.
- Do not agree to be sworn to secrecy (unless you have a privileged relationship with the person, but even then, there are ethical exceptions to confidentiality)15 but do agree to be available and helpful for whatever is needed.
- Redirect thoughts. Assist the person to remove threats like guns and alcohol. Help them get professional help.
- Slow things down. Encourage the person to not make impulsive irreversible decisions while in crisis. This is an acute situation, climaxing in as few as 10 minutes. Getting past the worst moment is critical.
- Call in others or call 911. Do not leave the person alone if they are in an immediate emotional crisis. Enlist spouses, friends or caring co-workers. You want to give the sense that the crisis is temporary, passing, they are not alone, help is available and they will survive the pain.
- Realize that ultimately a decision to live must be made by the person, and you are not responsible for their decision.
In dealing with survivors, consider the following:
- For close friends, it may be difficult not to ask a survivor what happened, and survivors may feel you are owed some explanation. Accept whatever they say, and do not offer your own theory.
- Do not speak to survivors in a way that assumes they are embarrassed or ashamed.
- Realize the unique nature of suicide survivor emotions and that there may never be emotional “closure” for that person. However, that does not necessarily mean life-long fragility.
- Do not speak in hushed tones when talking about the deceased.
- Stay close and keep reasonable contact with survivors who are close to you but do not suffocate them. Ultimately, they want to successfully manage on their own.
- Avoid hollow reassurance or mentioning some sort of higher purpose at work. Even deeply religious people do not see suicide in any way as a “God thing,” and certainly not at the time. Suicide can prompt reevaluation of personal spirituality and you should not assume the survivor agrees with your world view, even if they did before the death.
- Remember suicide ends a life but does not erase it. If a lawyer, the deceased has typically led a life full of accomplishments, however short. Do not avoid reminiscing about the achievements of the person, and do not “define” them by their last act. Survivors will appreciate it.
- If the suicide and emotions are still fresh, it is sometimes best to simply do things for the survivors without being asked. Many times, the lawyer who died had ongoing files and work. If a solo practitioner, volunteering to help and close the lawyer’s practice is one way to contribute.16
What Employers Can Do for Legal Staff
Firms, governmental agencies, companies, associations, office-sharers and courts can help their legal staff by creating a supportive environment for lawyers to get help. Realize the world has changed for the better regarding mental health awareness and treatment. Still, there are remnants of the previous thinking, where lawyers ignore their own issue or that of their colleagues or see addiction treatment as a personal and professional failure. This moribund thinking is dangerous. Employers should be proactive and transparent regarding issues of mental health.
As partners, managing or supervisory lawyers, lead from the top and eliminate the stigma of seeking professional help. This may be the most important factor of all. Openly use counselors and therapists yourself as necessary or helpful. It is an important part of general health. Do not be embarrassed to discuss its benefits with others.
Also, realize that partners, managers and supervisory lawyers have ethical duties that must be considered. Such leaders “shall make reasonable efforts to ensure that the firm has in effect measures giving reasonable assurance that all lawyers in the firm conform to the Oklahoma Rules of Professional Conduct.” When a lawyer is experiencing mental health issues that affect their competence, for example, that becomes an ethical issue not only for that lawyer, but for the work group.17
The following suggestions could contribute toward those measures as well as a better work environment overall.
- Destigmatize mental health issues. Openly promote the benefits of counseling and good mental health practices available through the Lawyers Helping Lawyers Assistance Program and other providers.
- Encourage respect, inclusion, professionalism (the un-self-important kind) and collegiality among all attorneys and staff.
- Provide in-house education a few times a year on issues of mental health, work-life balance and wellness. There are many digital sources for this at little to no expense, g. TED talks, ABA or OBA programs, podcasts or YouTube programs.
- Require at least one hour of mental health CLE each year.18
- Provide mentors to young attorneys to assist them not only be better practitioners but to also find and use their legal “gifts.”
- Provide employee assistance coverage to your staff.
- Consider retaining a mental health clinician part-time or on an “on call” basis for your firm or work group. Make this person a known visible friend of the firm. This is becoming more common nationally.
- Reconsider minimum billing requirements and work arrangements. Look for options for lawyers to work different hours (for different compensation) and in different ways. Many younger lawyers appear to value flexibility, informality and creativity. They rightfully view overwork and debilitating stress as dangerous and undesirable. The COVID-19 pandemic has taught us there are other ways, and places, to work.
- Make it safe for a lawyer to get help. If a lawyer has an issue, help them get assistance. Do not punish them personally or professionally; if possible, help them financially to enroll in a program. Welcome them back when they have successfully completed treatment and can again perform competently.
- Realize that guns are everywhere in America but should typically not be readily available in any office other than law enforcement.
- Institute a program of periodic sabbaticals. The truth is almost everyone takes a sabbatical during their career whether they call it that or not. Lawyers get burned out or have one or more “life” crises, deal with medical issues and a host of other things. Anticipate and plan for these periods so neither the firm nor the lawyer will be financially devastated by missing work.
- Most lawyers acknowledge some sort of spirituality, whether traditional or uncommon. A workplace is not the place for worship or to proselytize, but it is also not the place to demean or disrespect religious belief of whatever kind, or none. Respect it.
Awareness of Others as a Deterrent to Lawyer Suicide
When someone is contemplating suicide, he or she is usually focused entirely on themselves, their pain, their illness, their shame, whatever the emotional driver is. They are not thinking as much about the people who will be left behind. That is understandable, but the reality is the survivors left behind will also be changed by what is done.
I have often hoped that lawyers who died by suicide had realized how much pain and loss would ensue for others – people who loved them, people who worked with them, people they had helped in life and admired them. It may have prevented the suicide.
Besides strong mental health practices, a deterrent now for those contemplating suicide should be the awareness – the certainty – that it is never a solitary act. It has been 31 years, but I can still hear the pain of my father’s voice on the phone that horrible day. As much as I loved and miss my brother, Doug, the hardest part, by far, was watching my parents grieve and suffer for the rest of their lives.
THE PROMISE OF BETTER LIVING AND LAWYERING AHEAD
The world is rapidly coming to realize the importance of mental health as an equal concern with that of physical health. Mental health advocates are more prevalent every year, and newsmakers, celebrities, sports figures, musical artists and others in the public eye are increasingly and visibly discussing mental health issues and their own challenges. Lawyers are beginning to do the same.
We help others. Let’s continue to help ourselves as well, and let’s not harshly judge (the humanity) of others or ourselves. If you are struggling, there are people and programs almost instantly available that will help you get past the worst of moments and getting past that moment often makes all the difference.
We must always remember that behind every lawyer is simply a person.
ABOUT THE AUTHOR
Travis Pickens is a civil litigation, collaborative and ethics lawyer in private practice in Oklahoma City. From August 2009 to January 2015, he served as ethics counsel for the Oklahoma Bar Association and as an OBA liaison to the Lawyers Helping Lawyers Assistance Program Committee. For many years he served as an adjunct professor of law practice at the OCU School of Law, and currently serves on the board of the Oklahoma Academy of Collaborative Professionals.
- For Oklahoma lawyers, the best place to start is the Lawyers Helping Lawyers Assistance Program, 800-364-7886 or www.okbar.org/LHL. Deanna L. Harris, LCSW, is the primary contact. The OBA Office of Ethics Counsel, Richard Stevens, is helpful in navigating ethical issues that may arise. Mr. Stevens’ article “Change is Hard, Not Changing is Even Harder” in the November 2020 issue of this journal is an excellent general background regarding lawyers’ mental health and efforts by the ABA and lawyer assistance programs. For more specifics, see the 2017 ABA National Task Force Report entitled The Path to Lawyer Well-Being: Practical Recommendations for Positive Change found at www.american-bar.org/content/dam/aba/images/abanews/ThePathToLawyerWellBeingReportRevFinal.pdf.
- America’s Health Rankings’ Annual Report for 2019. p. 26, www.AmericasHealthRankings.org.
- American Foundation for Suicide Prevention www.afsp.org and Centers for Disease Control and Prevention Data and Statistics Fatal Injury Report for 2018, as of March 1, 2020.
- Id. Women may attempt suicide as often as men but survive the attempt more often according to the American Foundation for Suicide Prevention.
- Jeena Cho, referencing the American Psychological Association in www.abajournal.com/magazine/article/attorney_suicide_what_every_lawyer_needs_to_know, p. 2.
- Id. at p. 2. Alex Yufik, clinical rehabilitation coordinator for the State Bar of California’s Lawyer Assistance Program. Being a lawyer typically means higher social standing and potential public exposure.
- Id. at pp. 2-3. Rachel Fry, clinical psychologist, Birmingham, Alabama.
- Deanna L. Harris, LCSW, Oklahoma City, OK, interview Nov. 10, 2020.
- As a lawyer and suicide survivor, I have my own experiences and insights, some of which are included here.
- See endnote 5, p. 3.
- In addition to the insights of mental health experts, I have my own experiences and insights as both a lawyer and a survivor of my brother’s suicide. Some of them are included here.
- Sween CA, Walby FA,“Suicide survivors’ mental health and grief reactions: a systematic review of controlled studies,” Suicide Life Threat Behav. 2008; 38 (1):13-29 as referenced in Yasgur, Batya Swift MA, LSW, Those Left Behind: Working with Suicide-Bereaved Families, www.psychiatryadvisor.com/home/topics/suicide-and-self-harm/those-left-behind-working-with-suicide-bereaved-families.
- Id. at pp. 1-3. Dr. Sidney Zisook, MD, professor of psychiatry, University of California, San Diego, as reported in Psychiatry Advisor.
- In addition to the sources listed in these endnotes, information was obtained from R. Murali Krishna, M.D., President and Co-Founder, James L. Hall Center for Mind, Body and Spirit; Founder, Health Alliance for the Uninsured; Distinguished Life Fellow, The American Psychiatric Association; Member, Oklahoma State Board of Health; Co-Founder Arcadia Trails Addiction Recovery Center at Integris Health. Dr. Krishna was an early advisor and supporter of the Oklahoma “Lawyers Helping Lawyers” program and has been on the forefront of a wholistic approach to health. Also, Deanna L. Harris, LCSW, Oklahoma City, OK and Harvard Medical School, Harvard Women’s Health Watch, “Left behind after suicide” published July 2009, updated May 29, 2019.
- See Oklahoma Rules of Professional Conduct, Title 5, Appendix 3-A, Rule 1.6.
- A suicidal lawyer may become incapacitated. Oklahoma Rules Governing Disciplinary Proceedings, Title 5, Appendix 1-A, Rules 12.1 et. seq. addresses the legal duties of those aware of the incapacity and sets out a framework for assistance of the impaired lawyer.
- The Oklahoma Rules of Professional Conduct, Title 5, Appendix 3-A, Rules 5.1 et seq. address the responsibilities of partners, managers, supervisory lawyers and their subordinates regarding compliance with the rules. Essentially, the obligation to ensure compliance extends down from the partners, managers and supervisory lawyers to the subordinate lawyers to the nonlegal staff.
- There is an additional ethics requirement in Oklahoma, effective Jan. 1, 2021. The total required credits are still 12 hours, but beginning then, two of the 12 credits must be approved for legal ethics. And, in addition to programs on legal ethics, legal malpractice prevention and professionalism, presentations dealing with mental health and substance abuse disorders can now be approved. OK MCLE Rule 7, Regulation 3.6.
Originally published in the Oklahoma Bar Journal -- OBJ 91 No. 10 (December 2020)