Ed Ergenzinger :
The shocking suicide of attorney and former Miss USA Cheslie Kryst has prompted renewed attention to mental health issues in the legal profession. I know the pressures of the job. I used to be an associate attorney at one of those big law firms where the price of the big bucks and the fancy perks is all of your time, accounted for in six-minute increments.
I spent six years there. I busted my ass to work 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. At the time, I didn’t know I had bipolar disorder. Although my psychiatrist had flirted with the idea, the mental illness du jour was major depression.
I remember checking 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 to do anything, but it was on my mind.
I mentioned in an earlier blog post that there is a reason why the trigger for emergent concern is set at “having a plan.” That’s 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.
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.”
(Ed Ergenzinger, J.D., PhD is a patent attorney, neuroscientist, adjunct professor, and writer).
