Suicide and the Legal Profession

By Ed Ergenzinger

Earlier this year, a survey of lawyers and staffers hailing mostly from Biglaw revealed that 19% of respondents contemplated suicide at some point in their professional careers. These results, coupled with the shocking death by suicide of attorney and former Miss USA Cheslie Kryst, contributed to a growing groundswell of attention and interest in mental health issues within the legal profession.

Suicide is the 12th leading cause of death in the U.S., yet it’s still a topic that many people are uncomfortable talking about. The stigma surrounding mental health and suicide can make it difficult for those who are struggling to reach out for help. And even when someone does seek help, there’s often not enough available.

We need to do better at breaking the silence around suicide and mental health. By starting the conversation, we can eliminate the stigma and help those who are struggling get the support they need.

Understanding Suicide

According to the Centers for Disease Control, in 2020, there were 45,979 deaths by suicide in the U.S. That’s about one death every 11 minutes. There were also 1.2 million Americans who attempted suicide, 3.2 million who planned a suicide attempt, and 12.2 million who seriously thought about suicide.

Suicide victims and those who contemplate suicide don’t necessarily want to die. They want relief from intense emotional or physical pain, or to bring an end to an extremely stressful situation when they feel there is no other solution. As author David Foster Wallace, who died by suicide after suffering from depression for years, wrote in the best-selling book “Infinite Jest”:

The so-called ‘psychotically depressed’ person who tries to kill herself doesn’t do so out of quote ‘hopelessness’ or any abstract conviction that life’s assets and debits do not square. And surely not because death seems suddenly appealing. The person in whom its invisible agony reaches a certain unendurable level will kill herself the same way a trapped person will eventually jump from the window of a burning high-rise . . . It’s not desiring the fall; it’s terror of the flames. And yet nobody down on the sidewalk . . . can understand the jump. Not really. You’d have to have personally been trapped and felt flames to really understand a terror way beyond falling.

I know. The first time I wrestled with suicidal thoughts was an associate at Biglaw. Where the price of the big bucks and the fancy perks was all of your time, accounted for in six-minute increments.

I spent six years there. I worked very hard to move up the rungs, and I got to the point where I had a green light for partnership. Then I became so severely depressed that I was unable to work. I had to take a leave for several months under the Family and Medical Leave Act.

I remember checking multiple times to see if the generous life insurance policy that the big law firm had taken out on each of its associates would pay out in the event of suicide. I didn’t have a plan yet, but it was on my mind.

Thoughts vs. Actions

Twelve years after I was fired from that firm (on the morning I returned from FMLA leave), I was caught in another deep depression that was stubbornly resistant to the various drug regimens I had been prescribed.

And I thought about suicide. A lot. Thoughts that I didn’t want to go on living. That I just wanted to escape the despair and intense anxiety that accompanied my depression. My brain felt utterly overwhelmed by every neural impulse, whether generated by the external world or memories sparked from within. The idea of being able to turn that off had some appeal.

“Do you have thoughts of suicide?”

The words hung in the air as I sat hunched over in the examination room of the emergency mental health facility.

Over the years, my psychiatrists and counselors had all made a distinction between thinking about suicide in general terms and having a particularized desire to kill yourself.

“Yes, but no plans,” I said.

“No preparations or plans for how you’d do it?”

“No, nothing like that.”

“More like, ‘Wouldn’t it just be easier if I weren’t here?’”

“Yes,” I nodded. I’d been truthful but I couldn’t help feeling like I was hiding something. No, I didn’t have a plan, but thoughts about suicide had been consistent and frequent. I wasn’t going to jump in front of a bus, but if I suddenly found myself in the path of one, I wasn’t sure I would get out of the way. That couldn’t be good.

But I didn’t volunteer this information and I wasn’t asked. I trusted that there was a reason why the trigger for emergent concern was set at “having a plan” and answered accordingly.

Suicidal Neuroscience

The reason the trigger for emergent concern is set between thought and action is because there’s a difference between someone who is actively planning their suicide and someone who just thinks it would be easier if it were all over. And it turns out that researchers are zeroing in on the neural circuitry underlying this difference.

The brain areas that seem to be primarily involved in suicidal thoughts and behaviors are, not surprisingly, part of systems related to emotion and impulse regulation. One of these areas is behind and above the bridge of your nose (on both sides  —  the brain is bilateral) and is known as the ventral prefrontal cortex (VPFC). Impairments in the middle and side regions of the VPFC and their connections appear to play a role in the excessive negative and blunted positive internal states that can stimulate suicidal ideation. Above the VPFC is the dorsal prefrontal cortex (DPFC), where impairments in it and its connections with the inferior frontal gyrus have been associated with suicide attempt behaviors. And both the VPFC and the DPFC are connected to portions of the dorsal anterior cingulate cortex (dACC) and insula, which may mediate the transition from suicidal thoughts to behaviors by switching between the VPFC and DPFC systems.

Nearly all mental health conditions are associated with an increased risk of suicide mortality, but the risk is highest among those with bipolar disorder, depressive disorders, and schizophrenia spectrum disorder. These disorders, in particular, have also been associated with alterations in the VPFC, DPFC, dACC, and insula.

The hope is that the neurocircuitry can be understood well enough that more effective and targeted interventions and preventive measures can be developed. At the very least, it’s apparent that there is something more going on with suicidal thoughts and behaviors than weakness, cowardice, or any number of other moral failings or character flaws frequently (and mistakenly) attributed to those who die by their own hand.

Warning Signs

The problem of suicide and suicidal thoughts in the legal profession is apparent early on. A 2021 survey of law student well-being revealed that 11% of law students had thought seriously about suicide in the previous year. That’s almost double the number reported in a 2014 survey.

Identifying the warning signs and taking them seriously constitute the most effective prevention strategy for suicide. Once warning signs are identified, individuals can receive professional help. Warning signs of suicide (in addition to someone threatening or talking about wanting to hurt or kill themselves) include:

• Feeling unusually anxious, agitated, hopeless, or trapped.
• Feeling uncontrolled anger or seeking revenge.
• Acting reckless or engaging in risky activities.
• Increasing use of drugs or alcohol.
• Being unable to sleep or sleeping too much.
• Experiencing dramatic mood changes.
• Withdrawing from friends, family, and society.
• Seeing no reason to live or having no sense of purpose in life.
• Seeking access to firearms, available pills, or other means for killing oneself.

If you think a colleague is at risk for suicide, encourage them to seek help through the North Carolina Lawyers Assistance Program (NCLAP). NCLAP is here to support lawyers, judges, students, and other legal professionals who are at risk for suicide or who know someone at risk.

And if you think a colleague is an imminent danger to themselves, contact the 988 Suicide and Crisis Lifeline. The 988 Suicide and Crisis Lifeline provides the following recommendations if someone is threatening suicide:

• Be direct. Talk matter-of-factly and openly about suicide.
• Be willing to listen. Allow expressions of feelings and accept the feelings.
• Be non-judgmental. Don’t lecture on the morality of suicide, the validity of their feelings, or the sanctity of life.
• Get involved. Make yourself available to show interest and support.
• Don’t act shocked. It will put distance between you and them.
• Don’t be sworn to secrecy. Seek help and support.
• Offer real hope. Point out help and resources that are available, not just glib reassurance.
• Take action. Remove access to any means for killing oneself, such as guns or stockpiled pills.
• Get help. Contact persons or agencies specializing in crisis intervention and suicide prevention.

It’s taken me many years to get to the right diagnosis and the right combination of medicine and therapy to manage my bipolar disorder. Still, at every therapy session or med-check appointment, I’m asked if I have any thoughts or plans of suicide. And, at least for now, my answer is: “No.”

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If you or someone you care about is contemplating suicide, seek help immediately. For help 24/7, call or text 988 to contact the 988 Suicide and Crisis Lifeline. The Lifeline provides confidential support to anyone in suicidal crisis or emotional distress. Support is also available via live chat. Help is also available through NCLAP.

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Ed Ergenzinger, JD, PhD, is Chair of the new Mental Health Committee of the NCBA’s IP Section. He is a patent attorney, neuroscientist, adjunct professor, freelance writer, and mental health advocate living with bipolar disorder. He’s a contributor at Psychology Today, Business Insider, the National Alliance for Mental Illness, and The Good Men Project.