Coping with Grief During the Holidays
Can we feel joy, longing, and grief at the same time? For many, the holidays bring up this bittersweet mix of emotion.
The holiday season can be a particularly activating time when we are mourning the loss of a loved one. Specifically, experiencing grief (and all of its related emotions) while others are in “holiday cheer” mode may prompt us to try and match that joyful energy, even if superficially. And sometimes it feels too hard, and we feel compelled to actually isolate ourselves from others (e.g., turning down party invites). Or we might at least perceive ourselves as being isolated from them (e.g., “no one at this party understands what I’m going through.”).
Holidays can also be tied to meaningful memories and traditions with our lost loved one. And depending on where you are in your grief work, the thought of even participating in those traditions is too provocative. Additionally, trying to manage the anticipatory anxiety of various challenges these days may bring is emotionally draining and can leave you feeling further unmoored. This can also be mixed with breakthroughs of joy.
So if you are one of the many people currently coping with grief and struggling to find your footing this holiday season, here are some guiding points:
Identify and honor what works for you: Define how you want to personally navigate your holiday and entitle yourself to enact your plan regardless of what other people think you should do. Some people feel more comfortable skipping the holidays altogether, while others find it helpful to either engage in their familiar traditions, create new rituals that honor their lost loved one, or some combination of both. The bottom line is that there is no right or wrong way to grieve; decide instead what feels right to you and empower yourself to enact it.
Plan ahead to cope with the hard days: Learning when and how grief may show up for you can help you better manage your pain in a healthy way. In contrast, living in a state of perpetual anxiety about how awful your upcoming holidays might be can in fact distract you from effectively planning for them or enjoying them. As a result, you may be more vulnerable to engaging in unhealthy coping strategies that will likely make you feel worse in the long term.
Instead, by actively looking ahead at the days, traditions, memories, etc. that might be the toughest for you to experience, you are giving yourself an opportunity to navigate those challenges more adaptively. In other words, taking stock of your struggles can help you make a specific plan for how to best contend with them. By compiling an inventory of your own available coping strategies and reflecting on which situations they are most suited for, you will feel more anchored and confident in your ability to weather the stormy holiday season ahead.
3. Set boundaries: Once you have identified which holiday coping plan works best for you, the next step is to effectively communicate that plan to others. Being as transparent as possible with family and friends is an important way to ensure that your plan is respected, even if it is initially challenged. Remaining consistent about your boundaries is an important part of your grief work. Because after all, being empowered to both mourn (and celebrate!) the holidays in accordance with your own core values offers you the healthiest method of coping possible.
If any of this resonates with you this holiday season, or if you would like some support with taking any of these steps, our team at CTWPS is ready to help!
About Those New Beginnings
In the Northeast, we are pretty much programmed to anticipate new beginnings in September. We may feel a surge of inspiration and energy that catapults us out of the last vestiges of summer.
Changes in season often reflect in our mood, at least temporarily. A key aspect of managing our moods is recognizing the transience of mood. Everything - including our mood - changes. And while external factors, like a seasonal shift, might impact us briefly, we don’t always have to make a larger negative story out of it. Sometimes our meta-story about our mood is the culprit in worsening it. For example, a client might say “Every winter I get depressed”, and the result of that belief is that she feels anticipatory anxiety and dread as the winter approaches. But a further examination of that statement reveals that most winters (not all) she feels a brief but significant drop in her mood that signals her to then anchor herself in her coping skills, and shift herself out of that low mood. So a reframe of that statement could be “I typically feel a significant mood drop in late November. I am going to try to get ahead of that by being proactive and practicing my repertoire of coping skills to either prevent, or move more quickly out of a depressed mood if it arises.”
Changes in mood are inevitable. But our power lies in our willingness to directly influence the meaning we give to those changes. If you would like support in doing just that, we’d love to help!
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Shining a Light on Perinatal Mood and Anxiety Disorders
As a clinician whose practice focuses on all aspects of maternal mental health, I was motivated to write June’s blog after reading a tragically resounding story that recently made national news. Among other reactions I had, this story reminded me that the information I hold as a specialist in this area is not common knowledge for the majority of women in this country. As such, through this month’s blog I hope to educate, normalize, and destigmatize a disorder that affects so many American mothers and their loved ones.
Arianna Sutton had a history of postpartum depression after the birth of her first child. But after her second pregnancy, her symptoms returned more quickly and stronger. Nine days after giving birth to twins, Arianna died by suicide. Tragically, Ariana’s story is not uncommon. Moreso, it underscores the importance for awareness of and knowledge about the most common pregnancy related complication: perinatal mood and anxiety disorders (PMADs).
What are PMADs?
PMADs include a variety of disorders and symptoms that a woman may experience during both her pregnancy and the year following birth. Postpartum depression is the most commonly known among them, but it is just one experience that fits under the PMAD umbrella. Specifically, additional disorders include anxiety, panic disorder, postpartum bipolar disorder, obsessive compulsive disorder, post-traumatic stress disorder, and postpartum psychosis.
According to Postpartum Support International, approximately 15 to 20% of women (or approximately one in seven) will experience symptoms consistent with PMADs. Additionally, women with a history of clinical depression or anxiety are at a significantly greater risk for developing PMADs, and those who have experienced PMADs during pregnancy are more likely to experience recurring symptoms in subsequent pregnancies. But important to also note is that a woman can be diagnosed with PMADs even if she did not experience symptoms during previous pregnancies.
Although it captures most of the PMAD-related headlines, postpartum psychosis is a rare experience that occurs in 0.1% of women with onset two to four weeks postpartum (Postpartum Support International). Symptoms include, elated high mood, overactivity, racing thoughts, confusion, mania, suicidal or homicidal thoughts/actions, hallucinations and delusions. Though postpartum psychosis is a medical emergency that often requires hospitalization and medication, with early intervention, symptoms can typically resolve within weeks (Postpartum Support International).
In contrast, the so-called “baby blues” is a very common postpartum experience that occurs within two weeks of birth and whose symptoms include weepiness, fatigue, anxiety, and difficulty sleeping. Though the baby blues are typically resolved with simple self-care practices, if symptoms persist beyond three weeks postpartum, a diagnosis of PMADs may be considered.
Additional PMADs symptoms to be aware of include
Feeling sad or depressed
Irritability or increased anger
Difficulty bonding with your baby
Feeling high or elated above and beyond what is typical
Reduced need/desire for sleep
Anxiety of feeling panicky
Upsetting thoughts that you can’t get out of your mind
Feeling as if you are “out of control” or “going crazy”
Feeling like you should never have become a parent
Worries that you might hurt your baby or yourself
Treating PMADs
As many women feel shame, struggle to ask for help, minimize their symptoms, are fearful that they will lose their babies, or have limited support and awareness of PMADs, they often suffer their symptoms in silence. Fortunately for those affected, with proper intervention, PMADs are in fact highly treatable and have a favorable prognosis, often with a combination of medication management and psychotherapy.
Cognitive-behavioral therapy (CBT) is a highly effective form of psychotherapy treatment for PMADs, as it empowers sufferers to work in the “here and now” - as opposed to focusing on family of origin dynamics that are likely not helpful to the crisis at hand - to experience symptom relief. CBT works with the interplay of a patient’s mood, thoughts, and actions, to provide a patient with alternative perspectives and experiences of her situation, healthy practices that can support her mood, as well as providing immediate coping strategies to the patient.
At CTWPS, the specialized training our practitioners have into the specific challenges of women with PMADs makes us uniquely qualified to work with affected individuals. We strive to not only provide our patients with effective symptom reduction strategies, but also to normalize, educate, decrease shame, and improve their quality of life. If you, or someone you know, may be experiencing a PMAD, we at CTWPS are here to help and provide support. Reach out today!
References
https://www.today.com/parents/family/mom-dies-suicide-twins-rcna88579
https://www.postpartum.net/learn-more/
Our Boys
My son, a freshman at a large university in the midwest, called me early this week to share the tragic news that a friend of his had died by suicide while on campus. I write this post still struggling with grief for my son’s friend, his family, my son, their community, and for the many young men struggling with their mental health in seeming isolation. My son was profoundly shocked by his friend’s suicide, and saw no warning signs, no signs of distress, no drug or alcohol use, or any form of self-harm by his friend. He is unable to wrap his mind fully around this, nor am I, even as a psychologist and therapist. What I often believe about suicide is that the suicidal person is in a profoundly altered state. But of course, I can’t really know that to be true.
While we all have heard the statistics on the mental health crisis facing young people, it is important to acknowledge that young men sadly are more apt to commit suicide than young women, perhaps partially because they typically use more aggressive means to do so. Per the CDC, men die by suicide nearly 4 times more than women. While the mental health of young men and women is deeply concerning, young women may be better at expressing their high risk ideation and seeking help as compared to young men.
I mourn the seeming mental isolation of my son’s friend, but also the many young men in the world who may not be able to find a way to share their suffering with others. I write this not to provide a psychoeducation on suicidality, but to encourage us all to reach out and connect more to the people that matter in our lives. To talk more, to open up all sorts of conversations - especially with our boys and young men. The conversations don’t have to be serious, psychological, or profound, I think it’s ok to start with the silly, the mundane, the playful.
But however it is that we connect, are we willing to connect some more?
Craving Community
As inherently social beings, connecting to others and establishing a sense of belongingness are among our strongest driving forces. Over the last year-and-a-half, our opportunities for social connection, as well as the ways in which we seek it out, have drastically shifted. During this time, not only has there been a reduction in our regular exposure to groups of people (e.g., seeing co-workers once a week vs daily), but many of us have also re-evaluated our existing relationships and have made the conscious decision to limit our engagements accordingly.
As a result, many of us have relied (perhaps too heavily) on social media and technology for some semblance of connection to others. But social media and connection may not meet the bar for quality connection. People are seeking community membership that fosters meaning and purpose, possibly more so now than ever before.
So where do we start? Feeling isolated or untethered from community can already feel vulnerable enough, and figuring out how to create or build community within the throes of a global crisis can feel even more daunting. A silver lining in our current predicament is that we are not alone in this call for community; that with these shifts in the frequency and types of social opportunities, there is a stronger collective goal to feel more connected.
Building community is a step by step process that requires some work, and the steps below outline ways to start this process.
Define community for yourself
A helpful first step is to look inward and reflect on what you are seeking from community. Are you seeking more friendships, or a core group of friends? Do you want to be connected to a group that shares your same values, goals, or interests? While it would probably feel ideal (or at least easier) to have one core group that satisfies all of your community needs, it is also important to recognize that fostering community in our lives is a process that can develop and deepen over time. Engaging in multiple streams of community can still meet those connection needs, while also keeping doors open for stronger relationships and core communities to develop.
Saying “yes” to opportunities for community
If you have an idea of what your community needs are, but are feeling overwhelmed by how to actualize them, this next step might serve as a useful jumping off point. For example, if you’re seeking a community that can help elevate you to the next stage in your career, are there any specific professional or personal organizations you could join? Or would you be more interested in volunteering for an org (versus joining it), taking virtual group lessons or classes, or starting a book club with a couple of colleagues? If a colleague invites you to join an event, will you say yes (even if it doesn’t sound THAT engaging?) Being open and willing to try new or different experiences, even if they feel uncomfortable, can provide opportunities to continue weaving your web of social connections.
Show Up!
While the above two steps outline some logistical ways to identify the “what” and “where” of community, this step defines how to show up in these communities to actualize the goal of feeling connected. Simply joining an organization will not foster belongingness in a community - we need to participate in an intentional and authentic way. Brene Brown (2017) defines belongingness, in part, as a practice in vulnerability to actively participate as your authentic self in relationships, rather than passively waiting for others to invite your participation.