Physician, heal thyself, but leave the lawyers behind? In a December 2023 article, Alberto Nunez-Elvira, an economist at Imperial College London, used UK Annual Population Survey data collected during the pre-covid era to examine the impact of professional roles and hours worked on subjective well-being. Relying on a single question, “How anxious did you feel yesterday,” Nunez-Elvira provocatively concluded that lawyers are more anxious than physicians. So are lawyers more anxious than doctors? At the risk of over-lawyering this question, the answer rests on how we define a few terms.
Confusingly, people seem to use the terms stress and anxiety interchangeably in reference to both normative and pathological experience (for example, see Blaemire, 2023).
This is understandable as stress, anxiety, and anxiety disorders all activate the sympathetic nervous system. The sympathetic nervous system pushes our bodies above our baseline level of arousal to help us respond to the demands of our environment. As a mechanism, the sympathetic nervous system triggers biological (e.g., increased heart rate, elevated blood pressure, rapid breathing), behavioral (e.g., vigilance, aggression, avoidance), and cognitive (e.g., narrowed attention) changes that focus our energy on our problems.
Since stress, anxiety, and anxiety disorders all activate the same biological system, they manifest similarly within the body and we can’t always feel the difference between them. Counterintuitively, to clarify what we are experiencing, we must identify the source of our activation or the stressor.
Stress is the activation experienced when a stressor threatens to overwhelm our capacity to respond.
Whereas anxiety is the activation caused by the anticipation of a stressor.
Anxiety escalates to a disorder when our expectations are unrealistic and interfere with life in a meaningful way. For example, when my brother was very young he’d refuse to get into bed until our father latched the gate to the fence surrounding our house. Why? He was convinced that if the gate were left open a shark would sneak into the house at night and make a snacky wacky out of his toesy wosies (#toddlersare10-ply).
With that preface, let’s circle back to the question of whether lawyers are more anxious than doctors. It seems that, in the pre-covid era, British lawyers endorsed higher levels of “anxiety” than British doctors, however, since people often conflate stress, anxiety, and anxiety disorders, what does that mean? It would be overly literal to conclude that lawyers actually feel higher levels of anxiety than doctors.[1] Yet, we can’t ignore that lawyers reported higher levels of distress-related arousal.
Given the life-and-death stakes of medicine, the results are hard to explain. Could they be the byproduct of labor market dynamics associated with socialized medicine? Would the results generalize to the US? Do higher levels of arousal translate into higher rates of anxiety disorders?
Listokin and Noonan (2021) provide oblique answers to some of these questions using data from the US-based National Health Interview Survey (NHIS). The NHIS includes both employment data and the Kessler 6 (Kessler et al., 2002), a measure of psychological distress used by epidemiologists to estimate the prevalence of mental illness. Listokin and Noonan compared Kessler 6 scores from lawyers and medical professionals (medical doctors, veterinarians, and dentists) and concluded that lawyers did endorse slightly higher distress scores than doctors, yet they found no statistically significant difference in the rates of mental illness between the two groups.
Unfortunately, Listokin and Noonan did not conduct sub-analyses for individual Kessler 6 items so they don’t provide data directly comparing how nervous and restless/fidgety doctors and lawyers felt.
So are lawyers more anxious than doctors? Maybe. Even if lawyers are more anxious, that doesn’t mean lawyers exhibit higher rates of anxiety disorders. Why does any of this matter? Transient stress and anxiety are inevitable but chronic stress and anxiety disorders merit clinical attention. And that brings us to rule number two: if you feel chronic physiological arousal, it’s a sign that you need to build self-regulation skills or change unrealistic beliefs.
For those of you who stuck with me to the end, I'll throw in a preview. In my next entry, I’ll be providing a report on the annual economic burden of terrestrial galeophobia. #closethegate
Blaemire, J. R. (2003, Feb. 3, 2023). ANALYSIS: Well-Being in Law School—Law Students Aren’t OK. Bloomberg. Retrieved 2/16/24 from https://news.bloomberglaw.com/bloomberg-law-analysis/analysis-well-being-in-law-school-law-students-arent-ok
Kessler, R. C., Andrews, G., Colpe, L. J., Hiripi, E., Mroczek, D. K., Normand, S.-L., Walters, E. E., & Zaslavsky, A. M. (2002). Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine, 32(6), 959-976.
Listokin, Y., & Noonan, R. (2021). Measuring Lawyer Well‐Being Systematically: Evidence from the National Health Interview Survey. Journal of Empirical Legal Studies, 18(1), 4-46.
Núñez-Elvira, A. (2023). Association between hours of work and subjective well-being. How do physicians compare to lawyers and accountants? PLOS ONE, 18(12), e0295797. https://doi.org/10.1371/journal.pone.0295797
[1] Since anxiety is activation caused by the anticipation of a stressor, to conclude that lawyers exhibit more anxiety than doctors, it would mean that: (1) lawyers either anticipate more numerous or severe stressors than doctors; or (2) experience greater sympathetic nervous system activation in response to comparable stressors.