The holiday blues – tinsel and tears

Summer holidays are starting. I have learnt to close my practice doors in the middle of December. Partially because of increased family commitments, but also because everybody is so out of their routines that they miss their appointments or get the times wrong. During the December holidays, routine psychiatric work falls apart and emergency work picks up.

We cannot compare holiday blues and stress to clinical depression and anxiety. It’s like comparing a cold to incapacitating flu. The emergency work I handle seems to be triggered by increased alcohol and substance abuse, less sleep than usual and financial stress. There is nothing that says “holidays” better than partying and spending with abandon. Unfortunately, these are also stressors for relapse of underlying mood disorders.

Many of the moms I know need a holiday after the Christmas holidays. Very often, they work until late in December, but their usual support systems of family, aftercare or nannies are not in place. There is a pressure to keep bored kids at least moderately entertained. There are more social commitments, with visiting family and friends. Wise moms have carefully crafted self-care slots; times when they can exercise or get their hair done. This time of year steals all those personal minutes. Many moms are left in a reactive space of service to others, grumpy and worn out.

Moms are the emotional carriers of most families. They do the family work of making sure everybody is happy and that things run smoothly. Nowhere is this magnified as much as with religious holidays. Add to this a touch of personal perfectionism and the pressure can become relentless.

Some of my patients are genuinely sad and lonely and become even more so over the holidays when they ruminate over their losses. Even when happy, some of us also have a deep melancholy for lost loved ones or broken ideals, such as with divorce. The relentless tinsel pressure to have fun when we are sad is exhausting.

In trying to find advice for my blog, my usual approach of turning towards neuroscience research for guidance failed miserably. But some of my saddest patients have offered deep wisdom for dealing with this period.

One patient who is profoundly bereaved does not try to escape her melancholy; it is not possible anyway. She uses the spirit of Christmas to help her grieve and has made new family rituals to help her and her family remember and connect. Another of my patients accepted things as they came as a result of a complicated divorce and used Christmas to forgive; striving for harmony rather than a perfect family picture that didn’t exist.

Many of my patients tell me that connecting with a place of worship, or going carolling is an antidote to all the parties and shopping.

For myself, I try to slow things down. Giving one family member my full attention is better for my soul than trying to connect with everyone. I refuse to do a shop dash for less than five items. I try to balance binge days by eating a bit less and moving a bit more. And I get out of town, even if only for a few days.

The holidays magnify expectations. We must have fun, we must party, we must host perfect dinners, our kids must get all that they desire, everyone must be happy, and we must love family members we would rather avoid. Or we can consciously choose not to and just take things as they come.