Ways of Coping
Holidays 2001
Journey of Hearts
A Healing Place in CyberSpaceTM
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:

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.

Ways of Coping - the Basics

Ways of Coping with the Holidays Blues Ways of Helping Someone Else Cope with the Holiday Blues: Special Considerations for Victims and Survivors of Tragedy
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 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.
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 of depression.

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.

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.
Online Articles for More Information:
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 at: http://www.nmha.org/reassurance/holiday.cfm
Holiday Depression & Stress. 1998. Available at:  http://www.nmha.org/infoctr/factsheets/103.cfm
Highlights Holiday Blues. December 2000. Available at: http://www.mentalhealth.org/highlights/December2000/holidayblues/
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)
Phone: 202-336-5500
National Depressive and Manic-Depressive Association
Phone: 312-642-0049 or 1-800- 826-3632
National Institute of Mental Health
Phone: 301-443-4513
Depression information: www.nimh.nih.gov/publicat/depressionmenu.cfm
National Mental Health Association (NMHA)
Phone: 1-800-969-6642

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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