Raging Against The Machine – Health Insurance v. Healthcare

“Insurance – an ingenious modern game of chance in which the player is permitted to enjoy the comfortable conviction that he is beating the man who keeps the table.” ~ Ambrose Bierce. 

When I was a lawyer I worked for several insurance companies in a defense capacity and got a first hand look behind the insurance company face at the actuarial reality.  Insurance is not all Good Hands and Geckos as it turns out.  Rather, insurance is about numbers, plain and simple; numbers of dollars, accidents, deaths, etc.  Insurance companies predict risk – how much it will cost when things go bad, and how much to charge customers to cover that cost and still make a tidy profit.  They are very very good at doing this.

Your insurance company knows about you because it has information on millions of other people with your same traits spanning decades.  Therefore, if you are a male aged 30-45, with a baseline of physical health and other indicators you will get quoted a certain rate for life insurance. If you are a smoker, that all changes and you get quoted a much higher rate which reflects the increased likelihood that you will have substantially higher medical expenses in the future.  It is not guaranteed, but it is enough of a statistical certainty that it justifies charging more.

Sound heartless?  Well, it is.  It’s got nothing to do with heart.  There is no room for caring in actuarial tables.   That is why, when dealing with insurance companies of any kind, we experience a startling lack of empathy.  In particular, health insurers consistently fail at relating to their customers in an appropriate way.  For most of us, health insurers are necessary evils.  They help pay for prohibitively expensive medical care when the need arises.  Frequently, when we are dealing with insurers, we are in crisis.  The last thing we want to do is wrangle with some senseless bureaucrat who couldn’t care less about the very real problems we are facing.  Add to that the bureaucrat’s institutionally mandated drive to pay the least amount possible, and the whole process leaves us balled up and shaking in the corner.

So, why do we need health insurance?  The conventional wisdom is that we need it because without it we could not pay for costly medical care.  But doesn’t this just sound like a deal between the insurance companies and the medical providers?  They charge really high prices so that no one can afford it.  Insurance companies then pay those high prices (but of course at a huge discount that regular people don’t get), and then charge their customers a monthly fee that is statistically guaranteed to cover the cost of any likely events.

But what if there was no insurance company taking its huge cut out of the middle?  If we paid our monthly premiums directly to the medical care provider, couldn’t the provider charge less?  And wouldn’t that solve the problem of insurers meddling in health care decisions?  And wouldn’t it be a system vastly more efficient?  Sadly, proponents of such a system do not have a billion dollar lobby.  The guys with the commercials do.  And so, the status quo continues even as the health care system spins wildly out of control.

Insurance companies are like the house in a casino.  The odds are always in their favor because they make the rules.  And they always win.  Consumers dutifully pay their premiums hoping that they never have to try to cash out on their investment.  When they do need it, more often than not they encounter resistance in various forms.

Probably the most significant of these is the Insurer’s right to approve treatment.  By approve, I mean dictate.  It’s right there in the insurance contract – if you want the insurer to pay for your treatment, you agree that the company gets to say if it is medically necessary or not.  And if its not, guess what…  So now, appropriate treatment is no longer only up to the patient, or the doctor, or the therapist.  It is once again up to the insurance bureaucrat.  The same one who had no empathy for the customer and who only cared about preserving his bottom line numbers for the calculation of his year-end bonus.  He gets to say whether a treatment is medically necessary, whether a particular medication should be used or whether a cheaper or generic one should be substituted, and how much treatment a patient should receive.  He gets to say that the company will pay for this treatment but not that one (that one is too expensive).  And he gets to say the company will only pay for this much treatment.  After that you’re on your own.

So what can you do about it?

1.  Know Your Plan Options.  While most people do not have a great deal of choice in the health insurance they have, any choice that is available should be examined carefully.  As a general rule, the less expensive the plan, the less it covers and the less autonomy the patient has. PPOs, for example, usually allow the patients to pick their own providers regardless of network.  So, even though that PPO may cost an extra few dollars per pay period, it could be worth it to you if it affords more autonomy in the decision making process.  Examine all options made available by your employer, but do not make the mistake of only looking at premium cost of the plan.  There is much more to it than that.

2.  Know The Type Of User You Are.  Have you and will you continue to need to see specialists?  Do you have an established set of out of network providers you want to see?  Are you likely to have recurring medical or mental health needs requiring ongoing insurance company involvement and payment?  If you answered yes to any of these questions, you may prefer to pay a little more for additional control over these decisions.  Match the type of user you are to the available plan that best suits you and your situation.  If you are a heavy user of health insurance benefits, you’ll probably be glad you paid a little more up front when it eases the hassles later on at the point of service.

3.  Know Your Rights.  When you do settle on a plan or if you already have one you are established in, read the policy.  It’s that thick booklet the insurance company sends you at the beginning of each enrollment year.  If you are like most people, you flip through it, realize that most of it is incomprehensible then file it away for safekeeping and prosperity.  Even though it is difficult reading full of archaic lawyer-created language, it is worth the time to slog through it.  Once you get the hang of the language, it becomes much easier to understand.  Go through it with a highlighter and mark passages or terms you don’t understand.  Then call the 24-hour customer service line and ask them what it means.  It is a lot of effort, sure, but you will be much better informed about what your plan does and does not cover at the end of it.  You will also figure out what the company will and will not do for you under the policy.  Perhaps most importantly, the policy will contain provisions regarding disputes, how those disputes are settled, and options regarding appeals, and external legal rights.  Then the next time you find yourself arguing with a company adjuster, you will be armed with more than just your rage against the machine.

4.  Get Your Providers To Help You.  Usually providers have been through it before with insurance companies.  Indeed, did you know that most hospitals have huge departments often of 100 or more people whose sole job it is to negotiate with insurance companies, patient by patient, treatment by treatment, 24 hours a day, seven days a week?  And we wonder why health care is so expensive when huge administrative costs like that must be built in?  Suffice it to say they’ve seen what you’re experiencing before.  And if you’re lucky they’ve figured out a way around it or through it that will minimize your frustration.

5.  Opt Out.  Ultimately, you do have a choice of whether to use your health insurance in any given instance.  Unfortunately, for most of us, the cost of what we need is usually beyond the range of affordable.  But not always.  Sometimes it may make more sense to try to pay out of pocket for certain services.  Often providers will work with patients and slide their fees downward if they are paying cash.  And, as of right now, paying out of pocket remains the only way to maintain complete control over healthcare decisions.

In the mental health area, there may be additional reasons for deciding not to use insurance.  For instance, the “medically necessary” analysis usually requires that your provider issue a medical diagnosis of a particular mental illness or condition, together with an evaluation of severity and a specific plan for treatment of the condition.  Although this might not seem unreasonable on its face, it can have other consequences for patients down the road.  The patient will be obligated to disclose such diagnoses in the future if applying for life insurance, for example.  Like for the smoker, a person with a history of depression is likely to be charged a higher amount.  And, of course, any diagnosis causes the creation of a record that follows the patient.  Those worried about the stigma of receiving mental health treatment beware.  Because health plans are often administered through the workplace, it is remarkably easy for supposedly protected confidential information to get back to the company, particularly where disputes over coverage or payment arise.  Where such sensitivities exist, or where it’s not worth the risk, the only real solution is to pay out of pocket and keep the insurance company (and your employer) out of the health care decision all together.

What do you think?   Do you have effective techniques for dealing with insurance companies?  Have you opted to pay out of pocket for more control?  What has worked for you?

Andrew D. Kang, JD, LICSW, is a former attorney turned licensed psychotherapist.  His practice, Boston Professionals Counseling, LLC, focuses on helping attorneys and professionals with the issues they face and is located in Boston, Massachusetts.  Contact him at andy@bostonprofessionalscounseling.com or visit his website at www.bostonprofessionalscounseling.com

Boston Professionals Counseling

Fallacies In The "Wisdom" of Psychopaths

“Indifference to me, is the epitome of all evil.”
– Elie Wiesel.

In the new book, The Wisdom of Psychopaths: What saints, spies and serial killers can teach us about success, by Kevin Dutton, we are informed that CEOs and lawyers are among the professions with the most psychopaths. This is taken as evidence that psychopathic traits aren’t that bad. “Any situation where you’ve a got a power structure, a hierarchy, the ability to manipulate or wield control over people, you get psychopaths doing very well,” Dutton said. One successful lawyer who spoke to Dutton says, “Deep inside me there’s a serial killer lurking somewhere, but I keep him amused with cocaine, Formula One, booty calls, and coruscating cross-examination.”

Isn’t this just self-aggrandizement? Is there really any wisdom here? Aside from the ridiculous fallacy that monetary success equals wisdom, this idea that success results from psychopathic thinking is the height of hack psychology. If you have any doubts about this, check out the author’s website. Indeed, psychopathy is no laughing matter, though it’s probably not what most of us think. In the most general terms psychopathy is characterized by extreme self-centeredness and lack of empathy for others. This can be divided into specific behavioral constellations of traits: interpersonal deficits (grandiosity, arrogance and deceitfulness), affective deficits (lack of guilt and empathy, etc.), and impulsive and criminal behaviors (including sexual promiscuity and stealing). For a good lay description of psychopathy read this Scientific American article.

When the reviews of this book hit the interwebs a few weeks ago, my lawyer colleagues were all a twitter about it, eagerly forwarding links around, accompanied by tag lines like, “Sound like anyone we know?” And unfortunately, we could all probably answer yes to that question, as the legal profession does seem to have its fair share of people with psychopathic traits. What worried me about those missives, and what worries me about this book, is that they glorify psychopathic traits. They glorify bad behavior. The gossamer thread of justification for such glorification is that they help people get ahead, to be successful in their fields. Self-centeredness and lack of empathy helps one to climb over others to make more money. The implied corollary is that a person who does care about others will not be successful.

I just don’t think this is true. It may help not to feel for a witness during “coruscating” cross examination, but what happens when court adjourns for the day? Lack of empathy for others and complete focus on the self usually just means you’re an asshole and doesn’t gain fans. No one likes Gordon Gecko. But still people want to be him. Why is that? Is it simply the allure of power and wealth? Is it the twisted romantic notions of those who do not have power and wealth? I don’t really know. But what I do know is that the lawyer who thinks he has a serial killer inside him being placated with drugs, fast cars and sex isn’t doing himself or anyone else any favors. In fact, I don’t want to be anywhere near that guy when he snaps.

Sadly, that is what many of us recognized in this report. We recognize the assholes that we do not want to be around. Worse, we acknowledge that we work for them and have to do what they tell us. We witness first hand the destruction they leave in their wakes and the feel the toll it takes on us. Part of the problem is undoubtedly cultural. We are a society that elevates the aggressive pursuit of self-interest to a virtue. We put the individual first, and we encourage the use of force to achieve our aims. We coined the term “by any means necessary,” and live by it as an ethic. These are all ideas that are self-centered and lack empathy. They are psychopathic. So maybe it’s not just the CEOs and lawyers. Maybe it’s all of us. Or maybe we can do something about it.

Let me know what you think. Do we glorify psychopathy? How do you deal with the psychopath in your life?

Andrew D. Kang, JD, LICSW, is a former attorney turned licensed psychotherapist. His practice, Boston Professionals Counseling, LLC, focuses on helping attorneys and professionals with the issues they face and is located in Boston, Massachusetts. Contact him at andy@bostonprofessionalscounseling.com or visit his website at www.bostonprofessionalscounseling.com


How To Talk About Therapy II – Confronting The Fear

“Fear is only as deep as the mind allows.” – Japanese Proverb.

I got a lot of really great feedback about my recent post, I’m Not Saying You’re Crazy – How To Talk About Therapy.  Thank you all for reading and for your insightful comments.  Much of the sparked conversation related to the difficulty people have talking about therapy, not just for others, but also for themselves.  These discussions had me thinking about why people come to therapy.  Of course, they come to help themselves through a hard time or troublesome issue, or to deal with particular symptoms or behaviors.  This assumes that they have gotten to the point of recognizing that these things indicate a need in the first place.  For many people, this recognition is the hard part.  We tend to go through life thinking that when something is wrong, we should be smart enough or strong enough or brave enough to figure it out on our own.  It is the American way after all.  Pull yourself up by your bootstraps, quit complaining and do something about it!  Just work harder, and you will be too tired to worry about “issues.”  But this denies the fundamental nature of many people’s issues, which tend to lie at the core of their being and personality.  In order to reach some of those things, the critical recognition of a need must come first.  Many people never make it that far.

This led me to approach things from a different angle and ask a different but related question – why do people say no to therapy?  As I have previously discussed, there are the issues of stigma and misunderstanding of what therapy actually is.  And then there is there is the associated belief that only crazy people need therapy.   I’ve had this discussion with many people, and those who are most resistant tend to live with a lot of fear.  Their stated fears are about therapy, and being analyzed or judged, or worse, someone finding out.  But again, as we’ve discussed before, these are projected negative self-judgments.  There must be something deeper than worrying about what someone else thinks.  What keeps a lot of people from therapy is the very real possibility that they might find out (and then have to deal with) what they think about themselves.  Isn’t this really just the ultimate form of fear of the unknown?  The people who willingly come for treatment are already aware of why they are there and what they want to work on.  The unknown is largely known for them, and thus the resistance is lowered.  That is not to say that there is no resistance or that certain things may be hidden from them, but that is for the therapy process to uncover, and they are willing participants.

The people who reject therapy as a whole are more likely afraid of what they might learn about themselves.  With that knowledge comes the obligation to do something about it, including changing behaviors, and ultimately changing the way they feel about themselves.  With that knowledge, the excuses and rationalizations they have used to keep them in place, frequently to their detriment, fall away.  With that knowledge, the adaptive defenses, which have provided comfort and governed behaviors for so long must also be acknowledged and change.  The pattern goes something like this:  therapy leads to knowledge, which leads to change, which leads to fear, which leads to resistance to therapy.

Maybe the person does not want to change.  Maybe they think that it is others who need to change, not them.  Therapists see that a lot.  “It’s not me, it’s them.”  In another form, fear of change is stated, “That’s just the way I am.”   These internal structures tend to be rigid and strictly adhered to.  But a rigid structure can be quite fragile as it lacks the flexibility to deal with any amount of change.  The fear actually protects the structure by preventing and avoiding movement.  And when a person is pressed into a potentially changing situation, they become excuses avoid change and keep things the way they are.

So, given that fear is frequently at the base of resistance about therapy, how can we talk to people to allay their fears?

1.             Make the Unknown Known.  When I talk about therapy, I begin with an explanation of what therapy is and what it isn’t.  When I meet with first time clients, I go over the process of therapy, which is basically just talking and listening.  I try to establish that my office is a safe place for the client to say whatever it is they have to say.  I also address some of the misconceptions of therapy, starting with the fact that there is no couch, that I am not going to “shrink” their head (still not sure where that one comes from – readers can fill us in), and that I am not going to judge them as people for what they think, say or do in session.

2.         Put The Client In Control.  Another source of fear is that once the process begins, the client will be sent inexorably down a path from which there is no return.  And while it is true that a client cannot un-ring the bell (something discovered cannot be undiscovered), I assure the client from the outset that this is their therapy and that they are in control of it.  The client has the power to determine what we talk about, as well as what we don’t talk about.  She has the power to determine the direction of the discussion.  And she has the power to stop at any time.

3.         Use Regular Talk.  Lastly, I try to communicate with all clients like a regular person to another regular person.  Just about everyone who comes in does so with a preconceived idea about therapy.  Frequently those ideas come from other experiences in the medical community as well as from the media.  Their medical experiences may have left them feeling helpless as they struggled to understand medical jargon bandied about by blissfully unaware doctors.  And the media tends to inflate and complicate the nature of the therapeutic conversation.  When people come in, we just start talking – like regular people.  We have a nice conversation.  And when we are comfortable enough, we can begin to talk with greater frankness and depth.

To me, its not that scary, but it is hard to know that until you try.  Let me know what you think.  Have you been fearful of therapy?  What helped you overcome that fear?  For clinicians, what techniques have you used to demystify the process?

Andrew D. Kang, JD, LICSW, is a former attorney turned licensed psychotherapist.  His practice, Boston Professionals Counseling, LLC, focuses on helping attorneys and professionals with the issues they face and is located in Boston, Massachusetts.  Contact him at andy@bostonprofessionalscounseling.com or visit his website at www.bostonprofessionalscounseling.com

Think Like A Lawyer – To Feel Like a Human Being Again

“The ultimate authority must always rest with the individual’s own reason and critical analysis.” – Dalai Lama

In my last post, I talked about how lawyers are trained to think.  Objectively.  Analytically.  Unemotionally.  And, while it is true that such thinking helps to narrow the scope of argument in a legal discussion, it also tends to separate us from the underlying meaning of the dispute.  For the lawyer it is not relevant that her client has passionate feelings about a dispute because those feelings generally will not help to win the case.  Indisputable facts supported by watertight argument and uncontroverted case law does that.  Lawyers are very good at putting these things together to help their clients.  Lawyers hone their craft by practicing this mode of thinking and perfecting its presentation to others.

This is great for a courtroom or a brief, but it is not always the best way to handle civilian life.  I hear this a lot.  Lawyers often have trouble being people instead of lawyers.  They want to apply the same strategic thought process to their personal lives in an effort to win their own cases.  Unfortunately for them, most of the world does not operate like a courtroom, and other people, especially those closest to us, are not opponents.  It can be very difficult for lawyers who spend their days battling other lawyers to step out of that mode when they finally make it home.

I recall many occasions in which a family member would say, “Stop trying to lawyer me,” or “You’re being such a lawyer.”  At the time, I would take that with some pride and think that’s right, and that’s why you shouldn’t bother fighting and just agree with me.  But really, they were just pointing out that I was being argumentative and obstinate and willfully ignorant of the bigger picture.  One time, the person I was arguing with said something that stopped me in my tracks, “What are you trying to win?”  I had to confront the fact that I was simply trying to get my way and that I had not thought about anything else other than how to construct and set forth the most forceful argument to get it.   I was fighting because that’s what I always did, all day long, and all night long too.  I realized that there was nothing to win in a personal matter.

But that doesn’t mean there is no victory to be had.  Now, I work with lawyers to channel their analytical strengths, to look inward at their own thought processes and behaviors.  Logic does not go away, but its strictures are instead directed towards constructing watertight arguments for why behaviors should change.  For instance, if it is for the greater good of a marriage that a person be more emotionally present in the relationship, there is no longer a need to argue who is right or wrong about a particular incident.  And isn’t this where we all tend to get bogged down?  A lawyer is trained to take minutia and make it into a competitive advantage.   A lawyer’s spouse hates it when they do that!  That is because the relationship shouldn’t be a competition to be won.  It is a collaboration to be worked on in concert.   The relationship wins and the people in it are both victorious.

To appeal to the lawyerly mind, we start with a set of facts.  Key among facts in therapy is that emotions exist, that they are not good or bad (especially not bad), and that they always have a function and serve a purpose.  We veer away from the factual circumstances (i.e., who did what to whom) and look at what lies beneath them.  We try to avoid taking positions based on those facts, but instead understand motivations.  The analytical piece is to determine what emotions are at play in a given situation, where those emotions come from, and how they are affecting behavior.  When broken down in this way, even a lawyer can usually point to certain feelings that have led to behaviors, circumstances and positions.

In this way, we are “drilling down” to the metadata in a conflict.  We create an argument for change that is based, not on facts and circumstances or arbitrary notions of right and wrong, but rather on motivational foundations.  In other words, once a lawyer (or anyone) is able to understand what she wants and why she wants it, she presents a much more forceful reason for getting it.  If the goal is greater happiness, breaking down exactly what happiness means, the causes of unhappiness, and possible means to increase happiness, leads to logical analytically supported steps to take in order to obtain improvement.  It provides reason for change.

When I take a lawyer through this kind of analysis, it becomes easier to accept that change is necessary.  He becomes less wedded to a position and more willing to compromise for the sake of achieving an ultimate goal.  He can then go about making the necessary changes to solve problems and meet goals.  And that is what therapy is all about, for anyone.

What do you think?  Have you been told to “Stop being such a lawyer?”  How did you react to that?  More importantly, what was that person saying about your behavior?  As always, all comments are welcome and encouraged.

Andrew D. Kang, JD, LICSW, is a former attorney turned licensed psychotherapist.  His practice, Boston Professionals Counseling, LLC, focuses on helping attorneys and professionals with the issues they face and is located in Boston, Massachusetts.  Contact him at andy@bostonprofessionalscounseling.com or visit his website at www.bostonprofessionalscounseling.com

Boston Professionals Counseling

Think Like a Lawyer (But Don’t Feel)

Think Like a Lawyer (But Don’t Feel)

“Don’t think… Feel.”  – Bruce Lee

Recently, I attended my 15th year law school reunion.  It was great to see old friends, renew lost connections, and make new ones.  I struck up a conversation with a classmate about her career path through law after law school.  I recall her as being extremely accomplished in school, confident, and ultimately finishing at the top of our class.   We both noted that, while we learned a lot in law school, we did not learn how to practice law.  Knowing how to practice only came after doing it. And doing it, and doing it.  Then she said, “Well, law school did teach me to think like a lawyer.”  I had heard this sentiment before.  What we learned in law school was not the nuts and bolts of practice, but a certain analytical framework.  We learned to take an issue, deconstruct it, examine it objectively from all sides, and come up with well-reasoned arguments for or against a particular position.  Logic governs the analysis.  Each argument follows from the last, which follows from the facts.  It is a simple framework with simple rules.  As students, we then opened up the old casebooks and applied those rules to old facts and used our new lingo in an effort to be persuasive.  After emulating enough Learned Hand and Louis Brandeis, we eventually learned to think like lawyers.

And it does seem the case that lawyers tend to think in a certain way.  Non-lawyers frequently point out the propensity to argue, to take the other side of any debate just for the sake of it, and the tenacious desire to be right, as common aspects of the lawyer personality.  There is also the cool objectivity encouraged by the nature of the analytical framework itself.  We are taught to look at things dispassionately, and to argue from a place of logic rather than emotion.  The framework teaches that our arguments are more persuasive if they do not rely upon inherently unreliable emotions.  Another way to look at it is that emotions cannot be trusted; that because they feel so, well, emotional, they are dangerous to a watertight logical argument.  And so we are taught that it is improper, and indeed bad form, to make emotional arguments in a legal context.  It just isn’t done.

This applies just as much to the way that lawyers comport themselves.  Again, it is bad form to become emotional in court or with opposing counsel.  I used to think that if I got my opponent mad, I had won.  I had exposed a weakness and I could exploit that weakness, even if it was just by making me feel stronger.  Accordingly, we learned very quickly in practice, to keep a tight lid on our emotions.   None of it, after all, is personal.  It’s just business.  Emotions are the purview of clients, not lawyers.  We pride ourselves on being emotional rocks upon which clients can lean when they are filled with stress and anxiety about the outcome of their conflict.  It assists the client to have a counselor who is able to look at things objectively and formulate the best-reasoned course of action.

But aren’t we really just kidding ourselves here?  Isn’t it personal?  Don’t we get fired up and emotional about our cases?  Isn’t that why lawyers say all the time that “we fall in love with our cases?”  Aren’t we emotionally invested? Of course we are.  We are human beings.  And therefore, we are emotional creatures.  Attempting to completely remove emotion from what we do is no more possible than completely removing reason.  Yet, we think that is what we are doing.  Maybe that just makes it easier for the logically oriented lawyer personality.  Many lawyers have difficulty with the messiness of emotions because it cannot easily be reduced to or dealt with through logical argument.  Rather than try to predict the outcome, better to avoid it all together.

The best lawyers, in my experience, are the ones who are not afraid of emotions, but who use them to their advantage.  The best closing argument makes an impassioned plea for a certain human outcome.  The winning case is the one that has woven not just the most logical arguments, but also strikes a chord of truth on an emotional level with the jury.  And good lawyers know very well that every jury is made up of thinking AND feeling human beings.  They know that an emotional connection can be even more powerful than a logical argument.  When a jury is charged with “doing what is right,” it is much more of an emotional gut check than logical analysis.  Good lawyers know this and use it to win.

So, why do so many lawyers seem closed off from emotion?  Why does our training emphasize logic over emotion?  Is there a way to integrate both?

In my next post, I will discuss how, in my practice, I take the analytical thought process and help lawyers critically analyze their own emotional states to gain insight into their issues, and eventually solve them.

Andrew D. Kang, JD, LICSW, is a former attorney turned licensed psychotherapist.  His practice, Boston Professionals Counseling, LLC, focuses on helping attorneys and professionals with the issues they face and is located in Boston, Massachusetts.  Contact him at andy@bostonprofessionalscounseling.com or visit his website at www.bostonprofessionalscounseling.com

Boston Professionals Counseling

Hello, My Name Is Lawyer – How Identity Is Wrapped Up In What We Do.

“First say to yourself what you would be; then do what you have to do.”  – Epictetus

“What do you do for a living?”  It’s a simple enough question; one we hear nearly every day.  We know what is meant by it.  It means what is your job, or what do you do to make money.  But the question creates a usage of the term “living” which assumes that doing a job or making money is the sum total of what is necessary to live.  Even in it’s frequently reduced form, “What do you do?” the question has a pretty huge assumption built into it – that what we do is who we are.  They might as well ask, “How shall identify you in my head?”  That I shall forever after think of you as: Lawyer.  The thing of it is, it’s not just the person asking the question who creates this equivalency – we all play along.  Rather than answering, “I practice law,” we usually just say, “I’m a lawyer.”  The ubiquity of the question and it’s automatic reply is a testament to the degree to which we identify ourselves by our chosen professions.

But isn’t there so much more to each of us?  Aren’t we also people, human beings?  Aren’t we mothers, fathers, sons, daughters, and siblings?  Aren’t we also made up of the things we do when we are not practicing law?  For some of us, that might not amount to much more than being sleepers.  (If this is you, call me – we need to talk).  These questions lead to the deeper question of identity.  Identity is defined in the loosest terms as who we believe we are.  This can encompass how we perceive ourselves, how others perceive us, how we perceive others perceive us, and many other aspects of our thought processes combined with our experiences.

According to developmental psychology, from birth we begin to take in data about the world.  Somewhere around the age of 2 years old, we begin to form our notion of self (as distinguished from others) and start to apply the incoming data to ourselves.  Our identities continue to form through our primary relationships –usually our parents and siblings.  When a parent expresses love for a child, that love is incorporated into the child’s sense of self.  Conversely, if a parent does not express love, or expresses hate or dislike, the child incorporates that into its identity, usually one that is fundamentally lacking and unstable.  Through these processes we naturally become who we are.

Psychology calls what we commonly think of as identity, self-concept – the sum total of a person’s knowledge, understanding and beliefs about his or herself.  The self-concept is comprised of several components including the physical (our bodies, our senses), the psychological (our thoughts and feelings), and the social (our interaction with the world and people around us).  Included in the self-concept are subcategories such as self-awareness and self-esteem.

These abstract concepts most often manifest themselves in the form of categorizations, labels and internal and external precepts.  So, when someone asks, “What are you?” instead of saying, human being, we say lawyer.  This represents the mind’s natural tendency to distinguish.  An identity must by definition be different from others.  Being a lawyer implies a lot of things about a person.  It is prestigious, it implies intelligence, and it implies high socioeconomic status, among other desirable characteristics.  That is why many are motivated to become lawyers in the first place – a desire to possess those qualities.  Of course, anyone who has practiced law knows that those qualities can be partially or entirely lacking in lawyers just like in anyone else.  Nevertheless, in terms of labels to strive for, being a lawyer isn’t a bad one, Shakespeare and dead lawyer jokes notwithstanding.

But this becomes a problem is when a lawyer, or anyone for that matter, is subsumed by the label and becomes lost within the category.  When a person defines himself only as a lawyer, other critical elements such as human being, parent, friend, etc. get lost.  We probably all know someone like this.  Completely consumed by work, will do anything to get ahead, working one hundred hour weeks to the exclusion of everything else.  This also brings to mind the old saying, “if you don’t know who the fool in the room is, you’re it.”  Living in such a way is the basic mode of existence for many young lawyers, which explains the incredibly high burn out rate and the startlingly low levels of personal satisfaction.  But hey, at least you can call yourself a lawyer!  At first, that may be enough to get by.

It’s not healthy.  Surprise!  It’s not balanced.  Surprise again!  And it’s probably not the way most people would choose to live their lives if they knew what it would be like ahead of time.  Sadly, most don’t know.   Many of us were lured by romantic notions of Trials of the Century, billion dollar mergers, and Law & Order (or to date myself, LA Law).  We then got to find out what it’s really like, frequently unbalanced and often unhealthy.  Sure we can deny it for a while, while we rack up debts against our own health and mental stability.  And we can go for a long time before the lack of self-care catches up with us.  But eventually it does.  It always does.

And then it is up to us to fix it.  One way to start that process is to detach from the lawyer identity.  There is more to us than what we do.  Try to think back to the things we used to do when we measured time in months and years, rather than billable hours (or six minute increments thereof).  Remember the kinds of the things that made us laugh other than an adversary’s gaffe in Court or an inappropriate work e-mail.  What kind of things did we used to read before our Crackberries became our electronic leashes and primary sources of information?  Remember what life was like before the law?  It may be hard, but it’s in there somewhere, waiting to be rediscovered and reconnected with.  Those things are part of who we are too, even if we are still lawyers.

What is your identity?  How do you define yourself? Is being a lawyer (or any job) enough to define your identity?  Let me know your thoughts.

Andrew D. Kang, JD, LICSW, is a former attorney turned licensed psychotherapist.  His practice, Boston Professionals Counseling, LLC, focuses on helping attorneys and professionals with the issues they face and is located in Boston, Massachusetts.  Contact him at andy@bostonprofessionalscounseling.com or visit his website at www.bostonprofessionalscounseling.com.