The holidays are a joyous time for many. But they can also be incredibly stressful. Some people are particularly susceptible to holiday strain and depression because many try to achieve the impossible—the perfect holiday. Hallmark movies, endless happy social media posts and visions of past perfect holidays can haunt these individuals; pushing them into dangerous and obsessive behaviors. There are other triggers as well. Fortunately, there are ways to overcoming holiday stress, according to Dr. Ken Duckworth, Chief Media Officer for the National Alliance on Mental Illness. He spoke to WellWell recently about how to cope with the stress and keep it at bay. It starts with being gentle with yourself.
Is the holiday season the most stressful time of year for many people?
I have met people who absolutely love the holidays. They start decorating the day after Labor Day. For them, it’s a joyous opportunity. For some people, the hardest days are the anniversary of the death of someone they loved. And I have found that people who’ve lost people around the holidays, Thanksgiving, Christmas, it’s common to feel those losses during those holidays. The holidays are stressful for some people. But I do think it’s relevant that you can learn from your prior experience of holidays. So, you keep getting a chance to attend to this year after year. If you’ve learned that you drink too much at holiday parties and that hasn’t gone well for you or if you learned that Uncle Bobby is not the kind of guy you want to engage with for a lot of time, you can learn from that too.
I think fundamentally the problem comes from living in a society that has idealized how a happy family should be. And many of us fall short of that. And many of our lives are imperfect, not all relationships meet hallmark criteria. But I ask people to remember that the Hallmark movies are made with people who aren’t related to each other. They are actors and actresses. They’re total strangers playing parts primarily to sell items related to the holiday season. So, I think it’s important not to buy into an idealized version of what the holidays are.
Is the main cause of holiday stress dealing with the loss of a loved one?
I lost both my siblings to cancer and the holidays are still not a great time for me because I adored them. I have a nice life. I have many other people in my life. The holidays can be positive for me. But both of them happened to have been born in November. So, I feel the loss around this time and some of these things are just inherent to the stress. Some of them are due to factors like people have had ruptures in their relationships or they don’t communicate with someone they care about. And the holidays are the idea that you should be able to give things to people. You should be able to have beautiful holiday moments with people. That’s not always possible, but it doesn’t mean it will never happen. It’s an opportunity to raise your expectations for yourself about how things should be. But if you can let that go.
Another thing I would say is in the northern latitudes, the northern part of the country, it corresponds to shorter days. And that does add to people’s vulnerability for seasonal affective disorder if that’s a thing you live with. Shorter days do generate less activity in your little pineal gland. Some people experience that as depression. So, it’s a depressive disorder with a seasonal component, much less common in Key West than in Boston. I went to Alaska in the dead of winter to do a consultation. Virtually every person I met there had lights. These are special lights designed to replicate the brightness of the sun.
So, the holidays have a couple of different cross-cutting patterns. For me, it’s grief and loss. For the next person, it’s this idealized version of how they should be. For the next person, it’s seasonal affective disorder vulnerability in northern climes. I think it’s different things for different people. And I think it’s okay to respect that this may be a time of vulnerability for you, but there are other vulnerabilities in life. The day you get laid off, right? The day you lose someone, these are big hits in life. And I think that it’s important to acknowledge them and then also develop coping strategies for yourself as you come upon the anniversary of them.
Is the stress around the holidays getting worse or better?
I think that people who don’t have resources and who do watch Hallmark movies experience a lot of stress. We live in a consumer-driven culture. You’ve never listened to an economic podcast or conversation without them saying the consumer is holding up the entire economy. Well, that consumer is you, and that consumer is largely through the holiday season. And if you don’t have the capacity or you’ve lost your job or some medical thing has befallen you and you have a series of bills, there’s not a ton of Hallmark movies about the person who didn’t give any presents and didn’t create any magical transactions. Now, you can do other things. You can bake for people, you can create songs, you can have all kinds of fun. But we live in a pretty commercial society. And I think it’s just important to recognize that, particularly if you’re at a place where you don’t have a lot of resources.
Does social media also play into this?
There’s a lot of FOMO (fear of missing out), a lot of look at me, a lot of, I’m just waiting for a person to put on Instagram their worst day, their worst moment, their flat tire, their projectile vomiting. You just don’t see a lot of that. And we don’t have idealized lives. I had a student tell me that she got off of social media. She realized it was adverse to her mental health because I was comparing myself with people who were presenting amazing things. And all I was doing was studying to get a master’s degree and I wasn’t living an amazing life. I wasn’t in the Caribbean. I wasn’t on a sailboat. I don’t look great in a bathing suit anymore. Whatever it is this was her experience. She was the first person who gave me insight into this window about the adverse impact of seeing more idealized transactions for people. I want to remind you they too are flawed. They too have vulnerabilities. They too have made mistakes. They too have had failed relationships. These are human beings. They’re not an idealized version of you. They’re not a better version of you. They’re just making a decision to post 17 seconds of a 24-hour day that went particularly well or funny or creative. I’m not against an adorable Instagram pic of a dog or a video of a baby doing something. But it’s not the same thing as that person has it together and I don’t.
I took my social media active daughter with her sisters on a trip down the Colorado River in the Grand Canyon and she had no access to a phone for a week. And I asked her what it was like, and she said this was the best week she’s ever had. Because she didn’t feel the pressure to participate in it. But certainly, social media and how much you consume is a source of great interest in terms of teen mental health crisis right, which was already happening before COVID.
It’s not just teens who face pressure from social media, correct?
That’s right. So, I encourage people to lower their dose. This is just like Uncle Bobby at the holidays. Lower your dose. If you ask him an open-ended question about vaccines and conspiracies, you might get a long answer from Uncle Bobby. But if you talk about other things that are, of shared interest, and hopefully you have something, whether it’s craft beer or football or the inadequate quality of turkeys today, whatever it might be. Find something else to talk about and limit your dose of something you know may not be good for you to discuss.
Is there a demographic that you’ve seen that may be particularly susceptible to holiday stress?
I think it depends on the social inputs of a consumer society that you take in. If you’re the parent who loves Christmas and you’ve decided you’re the person who starts decorating the day after Labor Day and you’ve decided everything has to be just so and you’re going to get all the right presents and all the right things, many people would find that stressful. I would ask them about that. They may say, I love this. I live for this. My mother did this for me. So, it’s a connection to an idea in the past. I don’t think it’s easy to generalize about that. But I think just remembering that we live in a consumer society and it’s one more thing for busy people to attend to. If you can imagine this, my parents, when I was a boy, used to put up the tree, decorate the tree, put the lights on the tree and have all the presents for Christmas morning. Somehow they had incorporated this idea that they had to provide a perfect experience. And so, they were pulling all-nighters every Christmas. I don’t do this. I don’t recommend people do this. Involve the kids in picking out a tree if you celebrate Christmas. Find some other way to involve the kids in decorating it if this is something you want to do for your particular holiday. But overall be gentle with yourself. I encourage people to make more connections with real people and less social media. Take a long walk in the woods and calm yourself. But if you do have a vulnerability to a mental health concern and it does get worse around the holidays, bipolar disorder and alcohol vulnerability and people around you drink and you know that’s going to be hard for you, plan for that. Think that through, right?
Obsessive Christmas Disorder is a term we use to reference the perfect Christmas. Tell us more about it.
It is not a mental health disorder. This is a common, very treatable mental health condition where people have recurrent obsessive thoughts and then they discharge the anxiety through an action. The action could be washing or checking or something like that. I think you could imagine perfectionism and expectations leading to distress around big events in life like the holiday. But I think in general, this reflects the fact that conscientious people want to do things for other people. So, think of it through a lens of strength. And just remember that a lot of the magic moments aren’t because of the presents you bought. They’re because of the interactions you’ve had, the jokes you told or the football you threw in the backyard. You can’t actually perfect things. Complications happen, somebody’s flight will get delayed and somebody will lose their luggage. This is called life.
How do we know when this type of stress becomes serious? What are some of the symptoms there may be a deeper issue?
That’s a good question. One of the things that you can say about most mental health conditions is if you were sleeping through the night, you are unlikely to have many mental health conditions, including depression and mania. That’s just the most simple thing. If you go to bed at 10 o’clock at night, you wake up at 6:30 in the morning, pretty much every day without interruption, without problems, you’re likely to not have clinical depression. If you have symptoms that are associated with major depression, lack of interest in things, inability to get going, suicidal thinking, concentration problems and if you’ve had a history of, let’s say depression, you have a 50 percent chance of having another episode in your lifetime. People who have had a true depressive episode could include suicidal thoughts, sleep problems, appetite problems, energy problems, concentration problems and guilty negative thoughts. This is one of the reasons that cognitive behavior therapy, which works on your thinking, is helpful in treating depression. The idea would be if you’re having persistent thoughts like that, contact your primary care doctor and check in with them. For most people, these experiences pass. But if you have a history of a depressive episode that was diagnosed and treated, you should know that you have a vulnerability in this area. And if some confluence of life events contributed to you being incredibly stressed and falling into another episode, you wouldn’t be the first person. So, knowing those symptoms, and knowing what you went through the previous time, people with bipolar disorder are very likely to have very similar symptoms.
I interviewed people who did this for NAMI’s first book. I wrote a book where I asked real people who use their names what they did to deal with mental health problems in their families and in themselves. Incredibly, John, no psychiatrist had ever asked real people what they had learned. My dad had bipolar disorder and I felt like I learned a few things from loving him and in our relationship. I went to become a psychiatrist in part to help him but also to maximize what I could learn in traditional scientific ways. But I will never forget this idea that real people and NAMI is full of real people, the National Alliance on Mental Illness. Seven hundred 700 all across the nation, wherever you are there’s undoubtedly a NAMI group. You go to nami.org and you put in your zip code, it’ll tell you your local group. But what you’ll do is you’ll find a group of people who’ve been through this experience of having a mental health condition or having a family member who has a mental health condition. And feeling alone, feeling like you’re the only person this has ever happened to, is very hard on people. This is the idea why going to our support groups or our education programs is so helpful to people.
What are the consequences of not dealing with these issues, maybe just saying, I’ll just get through this?
That’s still an approach in many other societies. Men tend to do that more than women. So, let’s say you live with a depressive disorder, some of the coping strategies that people might use involve alcohol substances. These are short-term fixes that typically lead to a worse outcome. Brute force denial can be useful if that’s coupled with some kind of outlet. It could be pastoral counseling if you don’t believe in therapy, finding a place where you can talk about some aspect of your distress in a place where you feel safe. And, of course, seeking a NAMI group. You don’t have to be in treatment. You don’t have to be taking meds to be part of our community. Sooner or later, there may be a consequence, a relationship injury or a challenge with a professional role. And more and more employers are encouraging people to get help. There are employee assistance plans actively working on the problem to make it so that they know, employers know, that people with depression are the number one cause of people who don’t show up and people who show up and don’t work. They know that. So, employers are coming around to the idea of making it easier for people to get help.
What can be done on a societal level to improve this or to lessen holiday stress? What would you recommend individuals do?
You could decrease your dose of a difficult person who you find activating or upsetting. Reduce your dose. If social media makes you feel that you’re missing out, reduce your dose. If being in nature is soothing to you, make sure you get that in, no matter how crummy the weather is. If you have children or grandchildren that you could enjoy, find a way to be with them at some point. Lower your expectations. Go easy on yourself. Learn from your prior holiday experience. And if you have a mental health vulnerability, particularly a mood disorder like bipolar disorder or major depression, which can be activated by shorter days, make a plan for that. Talk to your caregiver. You can buy a lightbox. There are a number of proactive measures you can take to limit your stress.
What do you see as the biggest misconception when it comes to stress triggers around the holidays that make it worse?
Well, you should know yourself. As an adult, you’ve had chances to learn things. Dialectical behavior therapy called DBT is largely a rehearsal of your best coping strategies. And this treatment, which saved lives, was designed for people who are quickly dysregulated. But I like this idea of creating a coping strategy playlist that you find soothing. Have a park you go to, have a buddy you connect with whether it’s your mahjong group or your book club and maintain your support. Don’t give up on things.
We’re very social creatures and most of these experiences are shared by others. And respect the idea, that holiday stress, grief anniversary stress or whatever could impact your mental health. And then just use the coping strategies that you’ve developed to attend to that. And if you need professional help, please try to get it.
About Ken Duckworth, MD
Ken Duckworth, MD became a psychiatrist in part to help his father. He currently serves as Chief Medical Officer and medical director for the National Alliance on Mental Illness (NAMI). He is triple board certified by the American Board of Psychiatry and Neurology in Adult, Child and Adolescent and Forensic Psychiatry. Dr. Duckworth also is currently an assistant clinical professor at Harvard University Medical School and an adjunct clinical assistant professor at Boston University School of Public Health. He recently authored NAMI’s first book, You Are Not Alone: The NAMI Guide to Navigating Mental Health.
Please visit The National Alliance on Mental Illness to learn more. You Are Not Alone: The NAMI Guide to Navigating Mental Health can be found here.
