Journey of Hearts
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Coping in this Year of Change
Kirsti A. Dyer, MD, MS, FAAETS
Holidays in 2001
In the aftermath of the September 11 tragedy,
we are a country and a world forever changed. For many the initial intense
feelings of fear of other attacks and vulnerability to terrorism have abated
in the months since. However, fears were again triggered by concerns about
anthrax and calls for increased security to be alert for potential terrorist
acts over the holiday season. Because of these events many people are still
concerned about air travel security and are afraid to travel by planes.
Some are afraid to use other modes of transportation, therefore many may
be spending the holidays apart from their loved ones. We are also now a
nation at war. For the first time in a long time those in the armed services
are overseas supporting Operation Enduring Freedom during the holiday season.
Military families will be separated from their loved ones and dealing with
the uncertainty that having someone in the armed services during war-time
brings. In addition, many have been impacted by the slowing economy,
the rising unemployment and multitude of layoffs, making this season one
of financial hardship. Those isolated or estranged from friends and family
can find this a season that intensifies the loneliness. Understandably,
the 2001 holiday season will be very different; it is a season filled with
uncertainty in a year of change.
For those who lost family, friends or colleagues
in the September 11 event or those who have lost someone this year, facing
the first holiday without that loved one can be very painful. Many people
not directly affected by the tragedy e.g. losing a loved one, are dealing
with different losses in the aftermath of September 11—loss of innocence,
loss of life-style, loss of safety and security with the accompanying feelings
of fear and increased vulnerability. The loss of innocence, the belief
that people are fundamentally good, is perhaps one of the main reasons
that this event has impacted so many people. Many of us are still struggling
to make some sense of these changes that have occurred in our once peaceful
world. Some may not feel like celebrating the holidays. Others will want
to continue with their plans for the season viewing this as a time to connect
with others and celebrate the lives of those lost. Different responses
to change and to grief are normal and should be respected.
The holiday season is often viewed as a time
of joy, happiness, peace on earth, good will, celebrating with family and
friends, and hope for the future. However many may view this as a difficult
time, a time of sadness and loneliness, a time of self evaluation and reflecting
on past accomplishments and failures; it can be a time of anxiety about
what the future year may bring. During this time of year there is a high
potential for psychological, physical and financial stress. The holidays
leave millions of people feeling blue, not merry even precipitate the Holiday
Blues. Holiday blues can affect men and women of all ages with intense
and unsettling feelings ranging from mild sadness to severe clinical depression.
This time of year can be especially difficult
for those who have lost a loved one and are facing the first or the umpteenth
season without them. The joyful public celebrations and media portrayal
of the "perfect" holiday can be painful reminders of what the grieving
person is missing. The over commercialization of the Holidays makes one
think they are synonymous with "buying" and "spending" and no longer about
"caring" and "sharing." The spirit of the season seems to have been lost
in a corporate take-over, or fired in a managerial lay-off.
For those who have experienced a significant loss
or change, it is normal to feel subdued, reflective and even "blue." Merriment
is viewed as an emotion for others. Memories of holiday season's past may
surface, or thoughts of the season that will never be; these thoughts can
trigger an episode of the blues. Those isolated or estranged from friends
and family can find this is a time that reminds them they are alone. Holidays
exaggerate feelings of sadness and loneliness; this is normal.
Many different factors can cause the holiday blues
and contribute to the tension, stress, loneliness or sadness experienced
during the holidays:
People may experience a post-holiday let down with
symptoms continuing past the new year. This can result from emotional disappointments
during the holiday months combined with setbacks from the preceding months
as well as the physical reactions caused by excessive fatigue and stress.
Those who do not experience the blues may respond to the stress of the
holidays with headaches, excessive drinking, over-eating, not eating enough,
difficulty sleeping, or avoiding friends and family.
Increased demands of shopping, parties, family reunions,
and house guests causing many to feel overwhelmed by holiday tasks and
obligations with increased stress and fatigue.
Unrealistic or idealistic expectations - trying to
have the "perfect holiday."
Financial problems limiting what can be spent on
Over commercialization - media images and messages
of "the perfect party, family, or home," the need to "find that special
gift," the portrayal of the season as a "time to spend with those you love."
Unable to be with one's family or loved ones - being
separated by circumstance, distance, or death.
Recent loss or unresolved grief - filling the holidays
with memories of better times or those who have died and are no longer
present for the holidays.
Family conflicts - during the holidays emotions can
run high and result in misunderstandings or conflicts. This is not the
time to solve past problems or sort through old grievances and differences.
Leave it for later.
Ways of Coping - the Basics
Ways of Coping with the Holidays
Maintain a normal routine, or as close as possible.
Try and continue doing normal activities.
Be sure to get enough sleep or at least rest if sleeping
Regular exercise, even walking, helps relieve stress
and tension and improve moods following a loss.
Maintain a balanced diet. Watch out for the temptation
to eat "junk" foods and high calorie comfort foods.
Alcohol should be used in moderation, not to mask
Take things one hour at a time, one day at a time.
Do those things, or be with the people that comfort,
sustain, nurish and recharge you.
Remember other times in the past when you have experienced
loss and the strategies used to survive the loss.
Ways of Helping Someone Else Cope
with the Holiday Blues:
Establish realistic goals and expectations for the
holiday season. Don't expect that everything will be perfect—the food,
decorations, parties, family behavior or presents.
Keep expectations manageable. Set realistic goals,
determine the priorities, decide what can be comfortable handled,
what cannot be done. Delegate responsibility to others—spouse, children.
Plan a calendar or "To do list" for shopping, baking, visiting and other
events. Let your family and friends know about your limitations.
Maintain a balanced diet. Eat and drink in moderation.
This will help avoid the post-holiday depressing weight gain. Excessive
drinking can contribute to feeling blue or depressed.
Remember to make time for yourself—for solitude and
Laughter can be very healing. It is not a sign of
disrespect to laugh and enjoy oneself. One should remember the French Proverb
"That day is lost on which one has not laughed."
To minimize financial stressors, know your spending
limit, set a budget and stick to it.
Most often the best gifts come from a sincere desire
to make someone happy, not the price tag. Gifts given from the heart can
bring much joy. Many cannot be purchased—gifts of time e.g. baby-sitting
or volunteering, visiting and reminiscing with loved ones.
Enjoy free holiday activities: driving around to
look at holiday decorations; window shopping without buying; making a snow
person with children; participating in community activities such as tree
decorating or lightings; listening to free holiday concerts; enjoying Christmas
Those who have experienced a death, romantic break-up,
tragedy or significant loss, need not be obligated to feel festive or try
to be all things for all people. Feelings of grief, loss or sadness should
be acknowledged, not ignored or repressed.
Limiting contact with activities or avoiding the
holidays may the best option for some.
Spend time with caring, supportive, nurturing people.
Limit the amount of time spent with people that are difficult to be around.
Call, visit, write or e-mail a long-lost friend,
someone who is house-bound, or an elderly relative.
Reaching out and reconnecting with old friends or
making new ones is one way of dealing with the loneliness experienced during
this season. Don't wait to be invited—invite someone over.
Altruism is a way of remembering the spirit of giving
and helping those who may have less. Donate money or volunteer time to
a homeless shelter, battered women and/or children's shelter, hospice,
nursing home, cancer association or other non-profit, hospital, church,
SPCA or Humane Society.
Consider doing something in memory of departed loved
ones or creating a new remembrance ritual. Some suggestions include: light
a special candle; play a favorite song; hang a certain ornament or stocking;
listen to music enjoyed by the loved one; donate to a homeless or animal
shelter; adopt a needy family; donate the money that would have been spent
on a gift to their favorite cause; buy a tree and plant it in memory of
a loved one departed.
Traditional reunions and past rituals may no longer
be possible as children grow move away and families change. Instead of
keeping old holiday traditions, find new ways to celebrate the holidays
by creating new rituals, traditions or remembrances.
The holiday season does not eliminate the reasons
for feeling sad, depressed or lonely. In fact the season can heighten feelings
of sadness or loneliness; it is not unusual or abnormal for these emotions
to surface at this time of year.
Special Considerations for Victims
and Survivors of Tragedy
Invite the person to join in holiday activities.
Even if the answer is "No," leave the invitation open in case they decide
to come at the last minute.
Listen to their grief story as often as they need
to tell it. Let them know you are there for them.
Sometimes being present and sharing the silence with
a reassuring touch on the arm or a hug may be all that they want.
Become familiar with resources—physicians, clergy,
mental health centers, counseling centers, and hotlines, in case they decide
to seek professional help.
Be aware that the grieving may not wish to be festive.
Take cues from the grieving as to how they want to deal with the holidays
and remember or honor (or not) their loss.
There is no right or wrong way to deal with the holidays,
anniversaries or special occasions. Each person has to decide what will
work and then let others know.
As caregivers, relatives, friends of those grieving
a loss, we can not change the situation, but we can acknowledge it, listen
and be supportive.
For victims and survivors of tragedy holidays,
anniversaries and other special occasions are often painful reminders of
times past. These days can be filled with heartache and anguish. Memories
of holiday's past can surface often without warning upon hearing a special
song, smelling a holiday scent, discovering a treasured ornament or garment,
or attending traditional services. The evoked feelings of grief can be
just as painful as when first encountered as memories trigger the intense
emotions of loss to be experienced anew. Adding to the grief is the
media portrayal in advertising or shows of the "perfect" family celebrating
the "perfect" holiday; this can be painful for those whose families have
been disrupted by tragedy. Holidays are a time when survivors of
tragedy are understandably often "blue."
It is important to recognize that people are coping
with the events of September 11 in many different way. Some may want to
talk to whomever will listen. Others may want to keep the intense feelings
and emotions to themselves. Still others have turned to creative ways of
expressing their grief, fundraising, or advocacy as their means of coping.
These differences in coping will also be expressed as diverse ways of dealing
with the holidays. Some may choose not to celebrate as a sign of respect,
others will decide to celebrate as a way of remembering. It is important
to remember that people cope with loss very differently and to allow them
their diverse coping styles. Victims and survivors should decide what feels
right to them, what will work for them, and then let friends and family
One important thought for victims and survivors
of tragedy to remember is that while we cannot control the loss, we can
control our response to the loss or in other words:
and situations do color life.
But you have been
given the mind to choose what the color shall be.
John Homer Miller
Coping Suggestions for Victims
and Survivors of Tragedy
While it is normal for the holidays and other special
occasions to intensify feelings of sadness and loneliness, we are also
entering the time following the events of September 11 when the diagnosis
of depression or Post Traumatic Stress Disorder could be made. See the
next section on "When to Be Concerned" for more information on symptoms
People respond to tragedy in different ways.
Each person's experience of the loss, like each grief experience, will
Everyone has their own way of coping. Recognize the
differences in coping styles and allow people to have their own way of
expressing grief unless their methods become self-destructive (See "When
to Be Concerned" below). It may be helpful to explain to family and friends
how you are choosing to cope.
Be aware that it can be difficult for spouses and
families experiencing the same loss to understand how different grief responses
can occur. Respect the differences.
Allow yourself to feel and express sadness, anger
or loneliness. The holidays do not eliminate the reasons for feeling these
For most people it is important to find a balance
between honoring past traditions associated with the lost loved one while
developing new ones reflecting adapting to the change. Some traditions
may be too painful to continue. One way of dealing with whether to celebrate
past traditions is to begin new traditions in memory of the loved one lost,
or start entirely new traditions of their own.
It is important to think through any changes in traditions
and make conscious decisions about how to handle them. If appropriate make
it a family decision. Explain the changes to other family members and friends.
Plan a remembrance or find a special way of remembering
the loved one lost:
Share favorite stories about the person who has died.
Serve that person's favorite food or holiday dish.
Make a toast.
Hang a special ornament.
Hang a stocking for the loved one. Let people include
notes of remembrance.
Look at photos or videos from past holidays.
Plant a tree.
Establish a scholarship.
Listen to their favorite music.
Light a candle.
Dedicate a bench or plaque.
Adopt a needy family or donate to a homeless or animal
shelter for the holidays.
Donate the money that would have been spent on a
gift to their favorite cause.
Publish an ad in the local paper.
Write letters or a journal to the loved one to express
Find a new way of celebrating—celebrate in a new
Volunteer. Helping others can be very healing. Donate
your money or time to help those who may have less.
Take time to care for yourself to be alone with your
thoughts, in remembrance or in prayer.
Many find solace in their religious beliefs and/or
spiritual connections. Talk with clergy, spiritual counselors. Attend a
Try to stay in the present and look to the future
rather than dwelling on the past. It is important to remember we can control
our response to the loss.
Reflect on what is important and still good in life.
Remember the Basics (See above)
When to Be Concerned
The Holiday Blues, as the name implies, tend
to be short-lived lasting only a few days to a few weeks around the holiday
season. The emotions—sadness, loneliness, depression, anxiety—usually subside
after the holidays once a daily routine is resumed. If the symptoms of
hopelessness and depression last for more than two weeks, persist past
the holidays or intensify during the season, a simple case of the blues
may in reality be a serious case of depression. Symptoms of depression,
to watch for include:
The person experiencing the "blues" over a period
of several weeks should seek professional help—physicians and mental health
care providers, clergy, crisis lines, support groups, and mental health
centers. Talking with a professional or taking a mental health screening
test can help assess whether it's the "blues" or depression. Those with
suicidal thoughts or ideation need to seek immediate care with their physician,
crisis line or the nearest hospital emergency department.
Persistent sad, anxious, or empty mood
Sleeping too much or too little, middle-of-the night
or early morning waking
Reduced appetite and weight loss or increased appetite
and weight gain
Loss of interest or pleasure in activities, including
Irritability or restlessness
Difficulty thinking, concentrating, remembering or
Fatigue or loss of energy
Thoughts of death or suicide
Feeling inappropriate guilt, hopelessness or worthlessness
Remember to REST
The key to coping with the Holiday Blues is understanding
them. Setting realistic expectations for the holidays, knowing what people,
events, thoughts or memories can trigger feeling sad, blue or depressed
and developing ways of responding to these feelings can all be helpful
in coping with the holidays. Most of all it is important to remember to
get your R-E-S-T:
and goals. Be realistic about can and cannot be done. Get plenty of rest.
Online Articles for More Information:
Exercise, even walking daily.
Eat and drink in moderation. Enjoy free activities.
Simplify to relieve stress.
Set a budget for time, social obligations and gifts. Simple gifts can bring
happiness - giving service coupons, spending time together, donating to
charity, calling a friend.
Take time for yourself for
relaxation and remembrance. Give time to others—volunteer. Spend time with
caring, supportive people. Keep in mind that Traditions can be changed.
Center for Disease Control
Preventing the Holiday Blues. Last Updated October
31, 2001. Available at: http://www.cdc.gov/safeusa/blues.htm
National Mental Health Association
Coping During This Holiday Season 2001. Available
Holiday Depression & Stress. 1998. Available
Highlights Holiday Blues. December 2000. Available
Journey of Hearts
Dyer KA. Basics about the Holiday Blues. December
9, 1998. Available at: http://www.kirstimd.com/blues1.htm
Dyer KA. More Suggestions for Dealing with the
Holiday Blues. December 13, 1998. Available at: http://www.kirstimd.com/blues.htm
National Organization for Victim Assistance
Spender S. Surviving the Holidays after September
11, 2001: Ten Thoughts on Coping. October 27, 2001. Available at: http://www.try-nova.org/holidaycoping_september11.html
American Association for Geriatric Psychiatry
Holiday Blues or Depression. Available at: http://www.aagpgpa.org/p_c/blues.asp
Good Assessment for Depression.
American Institute of Preventive Medicine
Powell DR. Defeat the Holiday Blues. American
Institute of Preventive Medicine. February 1999. Available at: http://cbshealthwatch.medscape.com/cx/viewarticle/150090
American Psychological Association (APA)
National Depressive and Manic-Depressive Association
Phone: 312-642-0049 or 1-800- 826-3632
National Institute of Mental Health
Depression information: www.nimh.nih.gov/publicat/depressionmenu.cfm
National Mental Health Association (NMHA)
Last updated December 7, 2001
This article started
as an update to our "Ways of Coping with the Holiday Blues." The initial
revised version was used as a handout for physicians at the Medical Grand
Rounds I presented in November on "Identifying Loss(es) and the Grief Response
in Our Patients." Additional material was added after contemplating just
how different this year, this season is than in recent years past.
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