Depression And Christmas

Christmas is the only event that I can think of that is imposed upon us whether we want it or not. Christmas now plays an enormous role in our economy.  Schools close, shops extend opening hours, all for a religious festival, in which these days, the majority of the population worship elves, reindeer and that snowman.  In point of fact, even for the religious among us, Jesus didn’t have much to do with Christmas at all.

We over-spend, over-eat and over-drink, but we all must take part.   A heady combination of excessive expectations for yourself, seasonal affective disorder, spending time with in-laws you don’t much like, or, even worse, loneliness.  Debt, feeling guilt about over eating, self-hatred because you cannot fit into that party frock; the full hit really.

Tell your family that you don’t want to celebrate your birthday this year and you might be met with a bit of grudging acceptance, tell your family you don’t want to celebrate Christmas and they will be asking you “what is the matter, are you depressed?”.  I adore Christmas, but I have at least one good friend who does not.  She avoids as much of the festival as possible and frequently has her sanity questioned, but she is not depressed and she isn’t Festivalisophobic either (yes that is a word).

At Christmas, most people are fortunate enough to have friends and family to share this special time.  Most families have some rituals that take place at Christmas: the decoration of the tree, the carol service, the cooking of the mince pies, the time and place that presents are opened, the watching of a favourite movie.  We know, as psychologists, that these rituals are important for maintaining the health and wellbeing of families because they bring stability during times of stress and transition.   We all need to feel that we have a place in this world and that people value, respect and love us and Christmas provides that symbolic communication.

Christmas reinforces to your family and the outside world the identity of your family is as a group.  No matter what problems you have during the year with your family and friends, the rituals and routines you perform during Christmas provide continuity and security across generations, which perhaps do not exist throughout the year. There is a forgetfulness of wrong doing for a few days; good will to all men.  Even the binge eating and drinking, which normally promotes self-loathing, is forgiven because it is built into the ritual of Christmas in the January detox diet.

The clever folks at Google have a search trends index, aggregated cheerily last year into a “misery index”: an index of search terms which illustrate when we are all more likely to be searching words like, depression, pain and anxiety.  According to the misery index we don’t much search for those words at Christmas. Either Christmas day is the least miserable day of the year, or those of us, who are particularly miserable, are unable to escape our formidable families and seek help online.   The most miserable times of the year are the autumn and spring. Day-to-day fluctuations suggest we are most anxious on a Monday.  Stress and depression doesn’t appear until Tuesday, followed by fatigue on a Wednesday. By the weekend we are happy again, demonstrating how our moods and emotions are really only transitory experiences that we often attach far too much importance to.  Sadness and
unhappiness is an inherent and unavoidable part of life.  Every moment of sadness is just that, a moment that need not become a whole life gone wrong.

Despite what some people believe, Christmas doesn’t have much of a relationship with depression and neither does a less than ideal childhood or a traumatic event.  If you suffer from depression, it doesn’t mean you are going to be depressed at Christmas. Depression isn’t that straightforward and those who are depressed probably have some degree of additional protection from their families during the festive season.  In fact the worst times of the year for chronic depressive episodes are the spring and autumn.

There is any number of possible triggers for a depressive condition; pain, giving birth, loss of a partner, getting older, thyroid disorders, head injury, family history.  Depressive symptoms include a poor sense of self-worth, anger, feeling overwhelmed, anxiousness, sleeplessness and reckless behaviour.  Sufferers may struggle with issues of shame, guilt, low self-esteem and worthlessness. In attempt to escape this self-hatred, their emotional lives may become unmanageable.  Sufferers may be unable to maintain close relationships, isolating themselves or becoming clingy and possessive. Feelings can become so deadened that the depressed may distrust the intentions of those around them.  Others may crave the esteem of others, flaunting superiority and demanding attention.  Covert hostility and passive-aggressive behaviour manifests in sulking, withdrawal, forgetting to do things, insults delivered as complements, self-pity and blaming others.  The negative words and actions of the
depressed can drive those that love and care from them away and they end up feeling, or even worse being, socially isolated at the very time of the year when families are publically cementing their identity.

We are all different and psychologists know there are as many triggers for depression, as there are ways in which depression manifests itself.  Yet not everyone, after a major life event experiences depression, so what then causes depression?   The answer seems to be in the propensity to dwell, ponder and ruminate over life’s events, because those who dwell and ruminate are more likely to suffer depressive symptoms. In 2013, over 32,000 people took part in a study at University of
Liverpool.  Those who did not engage in rumination over difficult events and experiences where much less likely to experience depression and anxiety, than those who continually rehearsed the play-by-play of what took place.  This is fairly damming evidence of the role that rumination plays in creating the depressed mind.  Hyperfocus, whether it be on a childhood experience, a bad day at work, or a fall out with your friends, intensifies and prolongs distressing emotions because, in your mind, you are able to conjure up all sorts of images and sensations that are hard to describe with just words.

The words and pictures we create for ourselves, when we re-run that damming inner monologue, when we revisit playground bulling or that terrible meeting with our boss, influence the operation of our brains because it actually re-shapes the neural structures.  This is called, in science speak, neuroplasticity.  In ordinary language, we can physically change our brains, by changing our thoughts.  The depressed brain has modified the neural pathways in a way that does not serve us well. Dysfunctional pathways have been strengthened through negative thoughts, which trigger and reinforce maladaptive emotions and behaviours.  Therefore by changing our thoughts we can tame and regain mastery of our brains, and then, it is entirely possible for you to steady your mind and direct your brain to where you want it to go.   There is some truth in the quote from movie Frozen, “The heart is not so easily changed, but the head can be persuaded’.

This process involves self-regulating our thoughts, by paying attention to, but not being dragged into, self-hating inner monologues. Through self-regulation we can master our malleable brains and find some peace and happiness.  Self-regulation is not achieved through thinking positively or distraction. Nor is it achieved by forcing happy thoughts into our heads and dancing around like Julie Andrews singing “Cream colored ponies and crisp apple strudels, Doorbells and sleigh bells and schnitzel with noodles”. Rather, to develop self-regulation we need to stop all the time travelling, learn to pay attention, real quality attention, to the current moment.

Such ‘mindful’ based approaches are based on a combination of Eastern meditative traditions and an approach known as cognitive behavioural therapy, which seeks to reduce the links between the obsessive thoughts and the brains reward systems.  Mindfulness is quality awareness to the things around us.  Mindfulness is accepting without criticism or judgement, an awareness of the mode of mind to which we have become accustomed to, but which is not serving us well.  This is the opposite of rumination. Rumination drags us to a place far removed from current experience.  It takes us back in time, or projects us far into the future, worrying about the next day at work, paying for the family
holiday or budgeting for Christmas.

This holistic approach, which treats both mind and body, is the most effective approach to the management of depression, but in the absence of a qualified psychologist, pills have sadly become the most popular, cost effective, therapeutic course of action.   These ‘mothers little helpers’ even had a song written about them by the Rolling Stones, “and although she’s not really ill, there is a little yellow pill”. People find it very difficult to deal with those around them that are depressed.  The blanket of myths and stereotypes that surround depression is a convenient way of managing our individual anxieties and lack of knowledge about what to do and how to act.  This is called ‘cognitive bias’; a kind of mental shortcut the brain has developed to help us manage problems, in a practical, but not perfect way.   People cannot really help it until they are aware that they are doing it, and the press do a sterling job of reinforcing formulaic ideas about depression at Christmas. Which soap character will this year will attempt to destroy their existence, to the tune of “I wish it could be Christmas every day”?

There is no doubt about the relationship between depression and suicidal behaviour, but lets be clear, suicide has a few more friends than just depression.  Robin Williams’ widow bravely announced that depression was one of Robins many problems, but it had not killed him, it was his fear of the mental decline he was suffering as a result of the condition Dementia with Lewy Bodies, which has a life expectancy of 5-7 years accompanied by among other things, loss of language, judgement and hallucinations. I was stunned to see some of the cruel comments on social media in response to Susan Williams’ announcement. How could she understand or know for sure if she doesn’t suffer from depression?  In one sense this response is unsurprising. Around 15% of people in developed countries have been diagnosed as suffering from depression at some time or another, and depression is responsible for 850,000 suicides each year.  When a public figure is identified as depressed this act draws an important spotlight towards our beleaguered mental health services.  Yet the angry and misinformed missed the point.  What Susan Williams was stating was life affirming; depression isn’t a death sentence; it is a treatable manageable disorder.  Robin was living with and managing his depression.  What he could not live with was the reality of losing his mind.

The journalist Anthea Rowan once described depression as a dog always sulking around her back door, casting long, gloomy shadows.  Her ‘depression dog’ had wallowing jaws and a stealthy tread, but sometimes she managed to give it a well-placed kick and send it reeling outwards and downwards to wherever it came from in the first place.   Depression can be, at least temporarily, kicked into touch and it doesn’t have to come sniffing around at Christmas. If however, you have historically experienced depressive bouts at Christmas, or you are concerned that you might this Christmas, there are things you can do to help yourself.  Minimising contact with people, staying indoors away from sunlight and fresh air are the very things that will perpetuate the cycle, but simply relying on your motivation to get you up and moving isn’t any more likely to be successful.

Social pressure is enormously effective in getting you moving.  Scheduling meaningful things to do over Christmas makes it much more likely that you will get up and out of your home and be active.   Being active will help you break out of the negative cycle of thoughts and lethargy.   Be honest with people around you what your needs are.  We all need other people to meet our needs, but many of us have a difficult time recognising, acknowledging and expressing what it is that we need.  Find someone to talk to, express your emotions and worries and perhaps schedule some ‘me’ time to start practicing Mindfulness.  If spending time at Christmas with a particular individual really upsets you, stop doing it.  Spend time with people you like.

Worried about the financial cost of Christmas?   Money worries keep people up at night, but they will still spend money at Christmas.  It sounds trite, but talk to your family and make a plan based on the reality of your circumstances.  Next year does not need to start out with an overdraft, payday loan or unpaid bills.  Money management is critically important in managing depressive episodes in the months following Christmas.   Discussing your money management within the frame of managing your depression is not a sign of weakness or letting people down; rather it is a sign of strength because you are taking responsibility for your own health and wellbeing.   A few less gifts on Christmas day will not be as difficult to manage as days and weeks of low mood.

If you find it hard work preparing Christmas lunch, don’t give yourself such a hard time.  We are not all a Nigella or a Jamie and remember that the whole point of the Christmas dinner ceremony is to be together, not carry out a critical review of the gravy or the temperature of the plates; something my mother-in-law did one year.  Most of all, find or create and focus on your own Christmas rituals and cherish them, even if that means you just don’t do Christmas much at all.

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