By Ray Williams
The Christmas season can be a time of great joy and happiness for people. It can also be a time of sadness, depression, stress and loneliness for many people.
The Centers for Disease Control and Prevention’s Household Pulse Survey shows the highest percentage of adults who report symptoms of anxiety or depression are 18-29-year-olds. Between Sept. 30 and Oct. 12, the most recent dates available in the survey, 44.7% reported feelings of anxiety or depression.
The holidays can be stressful and on top of that, we’re dealing with a pandemic — which could cause even more tension, especially as we plan family events.
“We’re seeing a lot of conflict and tension between family members about how to handle the upcoming holidays,” said Susan Albers, PsyD, a psychologist with Cleveland Clinic. “What’s really important is for families to clearly communicate ahead of time, way ahead of holidays, what kind of expectations they have. Their limits, their boundaries and what they need to feel safe.”
Dr. Albers said a lot of her patients have expressed feelings of guilt about skipping family parties this year.
She adds that there’s nothing wrong with wanting to protect your personal health. The same goes for those hosting a family gathering – don’t be afraid to set boundaries for guests. If you prefer they wear a mask, just politely let them know it’s for everybody’s safety.
“We create a lot of scenarios in our minds about how the holidays are going to play out and sometimes we create the worst-case scenarios,” she said. “Remind yourself that they are possible but not probable and remind yourself about the positive things that holidays can bring you.”
Dr. Albers said the upside to everything going on, is that you can skip some of those normal responsibilities this year, like traveling or cooking a big holiday dinner. Instead, she recommends trying to focus on relaxing.
People with a mental health condition may be more prone to the so-called “holiday blues,” which are often tied to financial strain, loneliness, colder weather and other factors. Sixty-four percent of people with a mental illness report the holidays make their conditions worse, according to the National Alliance Mental Illness.
Experts say all of these factors are likely to be exacerbated during the COVID-19 pandemic, when people are feeling an unprecedented level of stress. Many are also cut off from their support networks and social outlets. Mental health professionals are anticipating a rise in suicide related to the crisis, and many help lines have been flooded with demand.
“The uncertainty of the circumstances we all find ourselves in is something our minds are not really equipped for,” said Emiliana Simon-Thomas, science director at the Greater Good Science Center at UC Berkeley. “it ultimately ends up being a chronic stressor, even for people who don’t normally feel that way.”
Older people, especially those who live in rural areas, may be experiencing chronic loneliness during the pandemic, which experts say presents a major suicide risk.
Almost as soon as coronavirus lockdowns went into effect in March, discussion turned to mental health. It’s well-documented that natural disasters, wars and other mass traumas can lead to significant increases in population-wide psychological distress. Weeks or months of anxiety, fear, sadness and social isolation can take their toll, leading many experts to fear the U.S. would face a mental health epidemic at the same time it fought a viral pandemic.
Now, a study published by the American Medical Association in JAMA Network Open offers one of the first nationally representative estimates of how severe that epidemic may be: Three times as many Americans met criteria for a depression diagnosis during the pandemic than before it, according to the paper.
A pre-pandemic survey of about 5,000 American adults found that 8.5% of them showed strong enough signs of depression (including feeling down or hopeless; loss of interest in things that normally bring joy; low energy; trouble concentrating; or thinking about self-harm) to warrant a probable diagnosis. When researchers surveyed almost 1,500 American adults about their mental health from March to April of this year, that number rose to almost 28%. Even more people—almost an additional 25%—showed milder signs of depression.
Logically, people were more likely to suffer symptoms of depression during the pandemic if they experienced “COVID-19 stressors,” including losing a job, the death of a loved one or financial distress. People who said they had less than $5,000 in savings were also about 50% more likely to suffer from depression than wealthier people, the researchers found. In keeping with usual demographic trends, women were more likely to experience depression than men, and single people were more likely to experience depression than married couples.
But trends only go so far. Anyone—regardless of race, gender, relationship status or income—can experience mental health issues during something as traumatic as a pandemic
The Pressure to be Happy at Christmas
Many people are unhappy at Christmas and according to the National Institute of Health, they can experience mental health problems. One North American survey reported that 45% of respondents dreaded the festive season.
Psychiatrists, psychologists and other mental health professionals report a significant increase in patients complaining about depression. And there is conflicting evidence regarding an increase in suicides. According to the Centers for Disease Control and Prevention, US suicides (at more than 40,000 per year, the 10th–leading cause of death) are at a nadir in December, and peak in the spring and fall. Nevertheless, some research has found evidence to bolster the Christmas-suicide idea. A 2014 study in Queensland, Australia, looking at the years 1990 to 2009, found a statistically significant increase in suicides on Christmas Eve and New Year’s Day.
Forty-five percent of Americans would prefer to skip Christmas, according to a survey from Think Finance and reported on www.nbcnews.com. Nearly a quarter of Americans reported feeling “extreme stress” come holiday time, according to a poll by the American Psychological Association. Holiday stress statistics show that up to 69 percent of people are stressed by the feeling of having a “lack of time,” 69 percent are stressed by perceiving a “lack of money,” and 51 percent are stressed out about the “pressure to give or get gifts.”
At least one study suggests that stress during the Christmas season can literally give you a heart attack. Obviously, many people have good reason to not like Christmas, be it estrangement or loss of their own family or friends, trauma experienced during the festive period (with all the context cues constantly bringing the unpleasant memories flooding back) and so on.
Why Does the Christmas Season Cause Such Distress?
While images of love and joy fill storefronts, TV screens and magazine pages, for many people, the reality of the holidays isn’t so cheerful. Between stressful end-of-year deadlines, family dysfunction and loss, poor eating and drinking habits, and increasingly cold and dark winter days, it’s easy for the holiday season to feel not so merry and bright.
Constant reminders of others’ happy seasons can additionally serve as a painful reminder of the happiness and love that’s lacking in our own lives. For this reason, the month of December can be a particularly difficult time of year for those dealing with family conflict, loss, break ups, divorce, loneliness and mental health issues.
During holiday time, stress is ratcheted up by a number of factors: lack of money, shopping decisions and deadlines, parties, strained family relations, pressures to please family and friends and have “the perfect” holiday, and the media bombardment of happy, smiling families and friends enjoying holiday festivities. There’s also the increased vulnerability to succumb to recent personal losses—the death of a spouse, child, relative or close friend; a divorce; or the breakup of a relationship. Patients treated by emergency psychiatric services during the holiday season reported that their most common stressors were feelings of loneliness and “being without family,” according to a 1991 Canadian study.
People who suffer from anxiety and depression, for example, can have their already fragile emotions strained to the breaking point from all the stress of meeting holidays obligations. And if there has been a sorrowful event during the year, the end of the year can revive the trauma. “If there has been a loss in the family, whether it’s a death or the first year going through a divorce, the holidays are always extra hurtful and sad. People don’t know how to get through it, how much they should do to celebrate.
The traditional image of Christmas is incredibly optimistic. Nearly every portrayal shows a cosy cheerful, tastefully decorated home, surrounded by pristine snow, in which a happy family gathers to share a large dinner cooked to picture-postcard perfection.
Life is just too complex and messy to ever guarantee the mainstream portrayal of a perfect Christmas. And yet, we still expect it. The human tendency to expect the best is the result of a well-known optimism bias, something seemingly inherent in our brains. This, coupled with the planning fallacy (a related phenomenon where we repeatedly underestimate how much time and effort tasks will take despite previous experiences) would lead to many people expecting a fun, pleasant, relaxing Christmas and ending up with a messy, chaotic, stressful one.
Origins of the “Christmas Problem”
It was James P. Cattell in 1955, a Harvard and Columbia trained psychiatrist and psychoanalyst, coined the term “the holiday syndrome,” describing it as a reaction in some patients that manifests itself beginning around Thanksgiving and ending a few days after January 1st. It is characterized, he insisted, “. . . by the presence of diffuse anxiety, numerous regressive phenomena including marked feelings of helplessness, possessiveness, and increased irritability, nostalgic or bitter rumination about holiday experiences of youth, depressive affect, and a wish for magical resolution of problems.”
Writer Olga Khazan speculates the 1946 film It’s a Wonderful Life—with its famous scene in which Jimmy Stewart’s character George Bailey contemplates suicide—and the way in “which basic-cable networks put [it] on heavy rotation as Christmas nears” prompted many people to associate Christmas with suicide.
Certainly those may be some reasons, but it appears to have more to do with unrealistic expectations and excessive self-reflection for many people. And as happiness expert Sonja Lyubomirsky argues, the holiday season is a time rife with “Pollyannaish” expectations.
For some people, they get depressed at Christmas and even angry because of the excessive commercialization of Christmas, with the focus on gifts and the emphasis on “perfect” social activities. Other get depressed because Christmas appears to be a trigger to engage in excessive self-reflection and rumination about the inadequacies of life (and a “victim” mentality) in comparison with other people who seem to have more and do more.
Still others become anxious at Christmas because of the pressure (both commercial and self-induced) to spend a lot of money on gifts and incur increasing debt. Other people report that they dread Christmas because of the past expectations for social gatherings with family, friends and acquaintances that they’d rather not spend time with. And finally, many people feel very lonely at Christmas, because they have suffered the loss of loved ones or their jobs.
Here are some of the other risk factors that can contribute to unhappiness or depression:
- Being unable to be with family and friends because of the COVID-19 virus, and the threat of it spreading through contact. While the CDC has indicated being with loved ones who are in your restricted “bubble” who live in your home may be safe, extending a gathering to include others is not.
- Setting up unrealistic expectations. Hoping for a picture-perfect White Christmas holiday is setting yourself up for not only disappointment, but potentially symptoms of “People have this anticipation or fantasy of the holiday that you would see on TV,” psychiatrist Mark Sichel, author of Healing from Family Rifts, adding that his practice gets much busier after the holidays. “Actually, it’s never exactly as people anticipate and it’s often disappointing. There’s often strife within families that comes out at holiday times. “Especially when it comes to family especially, it’s important to manage expectations during the holidays and not hope for things to be perfect. If holidays tend to be a time of conflict in your family, or you’ve recently experienced the loss of a loved one, putting pressure on your family to all get along or to be cheerful could lead to disappointment and additional anxiety.
- Focusing too much on what you don’t have. Being mindful of what you do have to be thankful for ― your sister who always makes family gatherings bearable, getting a week off of work, or just the promise of a fresh start with the beginning of the new year ― can help combat feelings of deficiency and lack. “Realize that the holidays do end ― and take stock of what you can be grateful for,” says Sichel. “Having gratitude is probably the best antidote against depression.”
- Trying to do too much. At the holidays, the pressure of trying to do everything ― plan the perfect holiday, make it home to see your family, say yes to every event, meet those year-end deadlines ― can be enough to send anyone into a tail spin. And if you’re prone to anxiety and depression, stress (and a lack of sleep) can take a significant toll on your mood. A heightened pressure and fear of not getting everything done are some of the most common triggers for the holiday blues, according to Sichel. “Being bogged down by perfectionism” can contribute to feeling down, says Sichel. “Many people feel they just can’t do the right thing, that family members are always disappointed in them.”
- Comparing your insides to someone else’s outsides. Both in real life and on social media, it can be difficult to avoid comparing yourself with others around Christmastime. If you have a less-than-perfect family, a past trauma from this time of year, or just a less-than-full holiday dance card, comparing your holiday experience with other peoples’ is a recipe for increased sadness and isolation.
What to Do If You Find this Christmas Season is Too Difficult
First, if you’re among those who become very unhappy overly stressed or depressed you should seek the help of mental health professionals.
For others who find it difficult but may not need professional help, consider these strategies:
- Set personal boundaries regarding the money spent on gifts.
- Don’t accept any “perfect” representation of Christmas that the media, institutions or other people try to make you believe.
- Lower your expectations and any attachment to what it should look like.
- Be present and enjoy each moment as best you can.
- Become involved in giving in a non-monetary way through charities and worthwhile causes that help less fortunate people.
- Be grateful for what you have in your life, rather than focusing on what you don’t have.
- Avoid excessive rumination about your life, particularly the things you think are missing;
- Focus your thoughts on all the good things about the holiday season–the opportunity to engage in loving kindness, generosity of spirit, and gratitude for others in your life.
- Focus on the things you can change in your life and take action on those, rather than ruminating over the things over which you have no control.
- Be kind to yourself and self-compassionate. Do something for yourself as kind and considerate and generous as you would do for others.
- Handle potential stressors early-on. Holiday planning is hectic, so get stuff done early, and refrain from going over the top. Be realistic about which tasks and obligations are possible and which are not. “It’s important to stay within your budget [over the holidays] and plan your gifts in advance.
- Get enough sleep. Both can cut down on stress, and will help you feel healthy and have less guilt about all the parties and dinners you can’t have
- Even if you are isolated at home, try to keep to a regular schedule as much as possible. While loneliness can feel like it will never end, trying to make these days feel as “normal” as possible will help you to get through.
- Start each day with a plan of a few things that you will do, keep a daily diary about how you are feeling and what you are doing, and keep a symptom log if you are managing illness. All of these tracking systems will help you to feel like you are being proactive about the situation.
- Stay Informed. In a 2020 study published in the International Journal of Environmental Research and Public Health, an online survey of 1210 respondents from 194 cities in China showed that people who had up to date health information and advice on precautionary measures had better psychological functioning and resilience.
- Limit your media consumption. Watching too much news, reading too many articles, and consuming too much content can be overwhelming. You might decide to check the news twice a day. Or you might decide to limit your time on social media if everyone is talking about the virus. Make sure you seek sites that give factual information about what you can do to stay healthy, such as the CDC and WHO.
- Stay physically active. While it’s easy to focus exclusively on how to manage your mental health and loneliness directly during a crisis, we sometimes forget that our physical and mental health are delicately intertwined. If you spend weeks of isolation not getting any exercise, this will have a detrimental effect on your ability to cope mentally. Below are some ideas of at-home activities that you can keep doing to stay active. Practice Tai Chi, yoga, or at-home low impact workouts by following Youtube videos. Go for walks around your neighborhood (or walk on a treadmill if you have one and are concerned about going outside)
- Do something meaningful. Another contributor to feelings of loneliness can be a loss of sense of meaning. If you are finding that you feel not just bored, but also as though you are losing your sense of self, then a loss of meaning might be affecting you. All of us want to feel like we belong and that our life has importance, which is why incorporating meaningful activities into each day is important. Doing something meaningful each day, even if only for a short period, will give you a sense of purpose and identity. Only you know what will create meaning in your life, but below are some ideas to get you started: Sign up for an online course and do a bit of work each day; create a family tree using genealogy websites; sign up to be an online volunteer through the United Nations.
- Connect with others. Connect frequently via Facetime, phone, Zoom and other technological means with loved ones and friends and co-workers who you won’t be able to see personally during this Christmas season. Or even send a handwritten letter or postcard;
- Find sources of comfort and self-care: Give yourself a foot massage or use a foot spa; focus on your pet; cook healthy comfort food; read favorite books; have a cup of herbal tea (chamomilewill help you to relax); listen to your favorite music.
- Start a writing project. Write in a journal each day; yake up hand lettering or calligraphy; write poetry or Haiku; write short stories or start the novel.
An additional article that you may find helpful is on the Choosing Therapy website: “15 Tips for Dealing with Difficult Family Members During the Holidays.”
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