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The Holidays 2001:
Coping in this Year of Change & Uncertainty
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.

Holiday Blues
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:

• 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 the holidays.
• 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

• 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 is difficult.
• 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 the pain.
• 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.

• 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 relaxation.
• 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 carolers.
• 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.

• 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.

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 know.

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:

Circumstances and situations do color life.
But you have been given the mind to choose what the color shall be.

Coping Suggestions for Victims and Survivors of Tragedy

• People respond to tragedy in different ways.  Each person's experience of the loss, like each grief experience, will be unique.
• 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 emotions.
• 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 your feelings.
• Find a new way of celebrating—celebrate in a new place.
• 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 service.
• 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:

• 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 sex
• Irritability or restlessness
• Difficulty thinking, concentrating, remembering or making decisions
• 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:

Reasonable expectations and goals. Be realistic about can and cannot be done. Get plenty of rest.
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.

Organizations
American Psychological Association (APA)
Phone: 202-336-5500
www.apa.org
National Depressive and Manic-Depressive Association
Phone: 312-642-0049 or 1-800- 826-3632
www.ndmda.org
National Institute of Mental Health
Phone: 301-443-4513
www.nimh.nih.gov
Depression information: www.nimh.nih.gov/publicat/depressionmenu.cfm
National Mental Health Association (NMHA)
Phone: 1-800-969-6642
www.nmha.org