Challenges associated with mental illness can be overcome with the right help. Here is one professional’s story.
Written by Mark J. Cowan, CPA, J.D.
No matter where you work, there is a good chance that depression is right in front of you: in yourself, a colleague, a friend, or a client. Most of us don't see it, and, if we do, we don't talk about it.
I write about depression not as an expert on mental health, but as an accountant who lives with it. I have the low-grade, chronic kind known as persistent depressive disorder or dysthymia. But I have also experienced major depressive episodes when the symptoms are much harder to bear. I am, reluctantly, sharing my experience because I have not seen much discussion of mental health issues within the accounting profession.
Mental illness is common (see the sidebar "Depression: A Common Mental Disorder"). In the United States, per the National Institute of Mental Health (NIMH), in 2017 nearly 20% of adults lived with a mental illness, 7.1% of adults had at least one major depressive episode, and suicide was the 10th-leading cause of death.
THE NATURE OF DEPRESSION
The World Health Organization defines depression as:
[A]n illness characterized by persistent sadness and a loss of interest in activities that you normally enjoy, accompanied by an inability to carry out daily activities, for at least two weeks. In addition, people with depression normally have several of the following symptoms: a loss of energy; a change in appetite; sleeping more or less; anxiety; reduced concentration; indecisiveness; restlessness; feelings of worthlessness, guilt, or hopelessness; and thoughts of self-harm or suicide.
Depression is a medical condition (see the sidebar "Information About Depression") that is best treated by seeking professional help in the same way you would pursue treatment for other medical conditions such as heart disease or a broken arm. Unfortunately, a stigma lingers.
Unless you have experienced depression, it is hard to comprehend what it is like. The symptoms may be different for others than they are for me. Understandability and comparability are elusive because depression affects individuals in different ways. Brain chemistry, family issues, relationship conflicts, work problems, and a variety of other issues can coalesce in myriad ways.
In my personal experience, depression arrives without warning. When it leaves, I know its return is probable, but its timing is not reasonably estimable. When I am depressed, I lose interest in things I once enjoyed, which causes me to discontinue operations and keep others at arm's length. I lose my objectivity and experience what mental health professionals call cognitive distortions — where I irrationally view everything as negative.
SILENCE, STOICISM, AND STIGMA
Discussions of mental health issues in the accounting profession are scant. A study published in Psychiatric Rehabilitation Journal by Albert Woodward, Rachel Lipari, and William Eaton found that financial-related professions ranked 19th out of 32 occupations in percentage of major depressive episodes from 2005 to 2014.
Mental-health-related discussions are easier to find in the legal and academic professions, which (like accounting) involve long hours, stress, and pressure. For example, the ABA Journal featured an article in which lawyers shared their experiences with depression (Jeena Cho, "The Many Faces of Depression," April 2019), and The Chronicle of Higher Education covered the suicide of economics professor Alan B. Krueger (Emma Pettit, "A Prominent Economist's Death Prompts Talk of Mental Health in the Professoriate," March 19, 2019). Articles like these express three messages. First, highly accomplished professionals are humans; no amount of intelligence or success can shield them from mental illness. Second, professionals need to talk more about mental health to remove the stigma and let others know that it is OK to seek help. Third, we need to watch out for one another and reach out if we think a colleague may be struggling.
Like lawyers and academics, accountants are not immune from mental health problems. So why the relative silence? It is no secret that the profession tends to attract the stoic. Even accounting students show this trait. For example, when I put students in small groups during class, they appear anxious — until I assure them they will be solving problems, not discussing their feelings. Life in public accounting reinforces that stoicism. What stressed-out new associate hasn't been told something like "that's just the way it is," "grin and bear it," "we all go through it," or "you wouldn't be here if you couldn't handle the pressure"? In our earliest professional experiences, we learn not to complain.
Embedded in a culture where mental health issues are not discussed, CPAs might assess the inherent risk of a stigma and not seek professional help — even though they can do so confidentially. Meanwhile, the high-stakes pressure of busy season has the potential to cause accountants with depression to suffer even more at certain times of the year. At any time of year, an accountant with depression might think, "No one else seems to be having troubles; I am alone." We need to make sure they know that they are not alone (see the sidebar "What to Do If You Are Depressed").
For me, depression slows everything down: walking, talking, thinking. I had depression for years but didn't know it. Through childhood, college, public accounting, private industry, and academia, I would frequently feel down. I was never sure why; I just thought it was a personality trait. For years I would not even talk about it with my doctor, afraid of the stigma. Eventually, things got so bad that I decided to speak up during a checkup. I was prescribed an antidepressant, and within a few weeks my life changed. It was as if someone had turned the lights on. I felt better. And I felt fortunate; medications don't always work, and sometimes the first medication prescribed doesn't work, but another medication might.
Although I was feeling better, I still felt embarrassed about having depression and taking the pills. I told hardly anyone. In hindsight it seems absurd, but I was even self-conscious when I would visit my pharmacy. Once, my doctor had called in a refill, but the pharmacy had no record of it. As I was discussing the issue with the pharmacist, a neighbor — a wonderful but nosy person — came up behind me and joked with the pharmacist: "Don't believe him! He's just trying to score drugs!" Before I realized my neighbor was there, the pharmacist mentioned the name of the medication. Foolishly, I felt ashamed.
Still, I was feeling better than I ever had. It didn't last. A few years later, I experienced some stresses and losses that resulted in a major depressive episode.
It came in the summertime. My flexible summer schedule sometimes made it easier to deal with the depression, but the lack of distractions sometimes made it more difficult. When the episode failed to pass after a couple of weeks, I clung to the illusion that I could keep it a secret and deal with it on my own.
Despite being exhausted, I could not sleep. I lost my appetite. For the first time in my life, my emotions were out of control. So much so that, while working, I sometimes had to retreat to the restroom or go outside to calm myself. I should have stuck to the former; when doing the latter, someone would inevitably ask me for directions. While sunglasses hid my red eyes, there was no cover for my brittle voice when I dutifully explained how to get to a local park.
Like all CPAs, I knew the importance of both disclosure and confidentiality. I chose the easier path of confidentiality. I was embarrassed and didn't even want to discuss my troubles with my closest friends. When walking into work one day a colleague asked how I was doing. I gave the boilerplate answer: "fine." I must have done a poor job hiding the substance beneath the form because she then asked, "Are you sure you are OK?" I assured my colleague that I was. In reality, I was not.
Desperate, I finally called a trusted friend. It was painful to reveal what I had been going through, but my friend was incredibly supportive. His assessment was blunt: "Mark, you are in need of care." I was thunderstruck. But hearing the truth put so starkly induced me to take action.
I reluctantly started therapy. While the self-examination that was part of the process was challenging, the therapy, combined with a change in medication, gradually helped me improve. Because of therapy, I have a new perspective, and I am better equipped to understand and manage my depression.
PROFESSIONAL SKILLS FAIL US
I learned the hard way that a CPA mindset is of no use in fighting depression. My therapist frequently told me to "stop thinking like a tax accountant." CPAs are habituated to seeing tangible results from hard work. The harder we work, the more billable hours we generate, the more problems we solve, and the more knowledgeable we become. We are rewarded with raises, bonuses, promotions, job offers, and the esteem of our clients, colleagues, and community. Furthermore, CPAs are adept at using procedures, flow charts, frameworks, worksheets, rules, and checklists to solve problems and make sense of chaos. We sift through shoeboxes of receipts to extract relevant documents and discern meaning. We translate the messy world of commerce into the language of business.
It is easy to see why many CPAs believe, as I once did, in the myth that analytical people can solve their own problems. As if depression were a new accounting standard to apply, a deal to structure, a tax return to prepare, or a messy problem to solve. Depression cannot be cured by following a checklist. It does not follow a linear path or adhere to the periodicity assumption. Cognitive distortions will thwart efforts to work, will, or reason our way out. We cannot recover from depression by leaning on our professional skills.
If you often feel down or otherwise think something is wrong, talk to a trusted friend and to your doctor. Don't put it off like I did. Don't be afraid to seek help. Doing so may not seem ordinary, but it is necessary.
Per the NIMH, approximately 57% of adults with a mental illness don't receive professional help. In this respect, many CPAs are fortunate that at least one potential barrier to care is removed. Many of us have financial security, insurance plans, and employee-assistance plans. In many cases, those of us who need help have the means to pay for it. And in the case of urgent distress or a crisis, the National Suicide Prevention Lifeline (800-273-8255) provides free, confidential support.
IT'S TIME TO TALK
The profession as a whole needs to talk more about mental health in general and depression in particular. Doing so would help remove the stigma and help CPAs who are suffering in silence know that they are not alone. The reality that CPAs get depressed and sometimes need help must become generally accepted.
At the individual level, we need to be looking out for one another. Although our professional skills won't help us address our own depression, they can enable us to help others. CPAs pay attention to detail, exercise skepticism, and notice what others don't. When it comes to the well-being of our colleagues, we all must become auditors. We must listen and watch to see the pain behind the smiles and encourage those who are struggling to get professional help.
The truth is there is no accounting for the darkness of depression. The professional toolkit that has helped us succeed in our careers will fail us. But if we seek help when we need it, and help others do the same, we can find a path to the light and ensure that each of us remains a healthy and thriving going concern.
Depression: A common mental disorder
Depression affects people of all ages and all circumstances, according to the World Health Organization, which has published the following information about depression:
- The risk of becoming depressed is increased by poverty, unemployment, life events such as the death of a loved one or a relationship breakup, physical illness, and problems caused by alcohol and drug use.
- Depression causes mental anguish and can affect people's ability to carry out even the simplest everyday tasks, with sometimes devastating consequences for relationships with family and friends.
- Untreated depression can prevent people from working and participating in family and community life.
- At its worst, depression can lead to suicide.
- Depression can be effectively prevented and treated. Treatment usually involves either a talking therapy or antidepressant medication or a combination of these.
- Overcoming the stigma often associated with depression will lead to more people getting help. Talking with people you trust can be a first step toward recovery.
Information about depression
- Common mental disorders are increasing worldwide, according to the World Health Organization (WHO). Between 1990 and 2013, the number of people suffering from depression and/or anxiety increased by nearly 50%. Close to 10% of the world's population is affected by one or both of these conditions.
- Lack of treatment for common mental disorders has a high economic cost: New evidence from a study led by the WHO shows that depression and anxiety disorders cost the global economy more than $1 trillion each year.
- The most common mental health disorders can be prevented and treated, at relatively low cost.
For more information, visit who.int.
What to do if you are depressed
Depression is a common illness that fortunately can be treated. Here is what you should do if you think you are depressed, according to the World Health Organization:
- Talk to someone you trust about your feelings. Most people feel better after talking to someone who cares about them.
- Seek professional help. Your local health care worker or doctor is a good place to start.
- Remember that with the right help, you can get better.
- Keep up with activities that you used to enjoy when you were well.
- Stay connected. Keep in contact with family and friends.
- Exercise regularly, even if it's just a short walk.
- Stick to regular eating and sleeping habits.
- Accept that you might have depression and adjust your expectations. You may not be able to accomplish as much as you do usually.
- Avoid or restrict alcohol intake and refrain from using illicit drugs; they can worsen depression.
- If you feel suicidal, contact someone for help immediately.
About the author
Mark J. Cowan, CPA, J.D., is a professor at Boise State University, where he teaches graduate and undergraduate courses on tax law.
To comment on this article or to suggest an idea for another article, contact Ken Tysiac, the JofA's editorial director, atKenneth.Tysiac@aicpa-cima.com or 919-402-2112.
- "A 4-Point Plan for Reducing Stress," CPA Insider, Sept. 23, 2019
- "Know a CPA in Need?" CPA Insider, Aug. 26, 2019
- National Suicide Prevention Lifeline, 800-273-8255
- Suicide Awareness Voices of Education, SAVE.org
This article originally appeared in Journal of Accountancy. ©2020 Association of International Certified Professional Accountants on 2.1.20. Used by permission.