The reason I chose to write this story is the same reason why it's been difficult to write. There is something about writing that makes me confront my own feelings and, despite a lot that is going well for me, I'm still sad sometimes.
And I know I'm not alone.
"The holidays are always a stressful time and a time of sadness for many people who don't have family or are estranged from family," said Dr. Jill Gover, director of behavioral health at DAP Health in Palm Springs.
There's been a lot of death and isolation these past two years. And, with the politicizing of the COVID-19 vaccine, some of us are even more divided during a time when we need each other the most.
So, are the holidays to blame for the sadness some of us are feeling? And, what can we do to start dealing with these feelings and get unstuck?
Do holidays make depression worse?
In the past, news articles around Christmas and New Year's Day have reported that suicide rates are higher during this time of year but, in 2017, the Annenberg Public Policy Center found this to be false. The winter season typically has some of the lowest suicide rates of the year.
What is true, however, is that holidays can make those already dealing with feelings of depression, anxiety or another mental health issue feel worse. About 64% of people diagnosed with a mental illness reported that holidays make their conditions worse, according to a survey conducted by the National Alliance on Mental Illness in 2014.
Suicide rates in the Coachella Valley are higher than rates in California as a whole and the U.S. more broadly, according to a community health needs assessment report commissioned by the Desert Healthcare District and Foundation. In 2019, there were about 19.4 incidents of suicide for every 100,000 people in the Coachella Valley, making it the ninth leading cause of death. For comparison, rates in the state were 11 per 100,000 and 14.6 per 100,000 in the U.S.
The local statistics were "striking" to read, Conrado Bárzaga, Desert Healthcare District and Foundation CEO, told The Desert Sun earlier this year, noting that suicide had disproportionately impacted the elderly during the COVID-19 pandemic.
"We have a very unique demographic here in Palm Springs and across the Coachella Valley," DAP's Gover said this month. "We have an older adult population that, for many different reasons, often end up alone at the holidays and that can be a very difficult time, especially if they've lost a loved one recently."
"And a lot of people have died," she added. More than 800,000 people have died from COVID-19 in the U.S. And, of course, many others have died from other causes. Pandemic or not, the longer you live, the more death you'll experience.
"There are a lot of older adults, in particular, who find the holidays a time of sadness," Gover said. "Everybody on the TV is having these wonderful Christmas celebrations and I'm just home alone in my condo in Palm Springs," she said as an example.
For the many DAP patients aging with HIV, these issues may be even more exacerbated. Gover works with her patients to help prepare them for the holidays by planning out what they're going to do and by seeking connection with "chosen family."
Isolation vs. loneliness
For many, especially introverts, being alone can be a pleasant or, as Gover said, "lovely" experience. Some of us enjoy sitting, reading a book and drinking a cup of tea, yours truly included.
"Feeling lonely is completely different," Gover said. "That's an emotional state and it's a state of disconnectedness and alienation."
"When I feel lonely, I feel 'apart from.' I lack a sense of belonging and that brings a great deal of sadness — to feel disconnected from other people, that's what loneliness is," she explained.
Even introverts need to be social sometimes, she added. Connection and feeling that sense of belonging is part of the human experience and, she said, is "an essential element of good self-esteem."
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Loneliness can be difficult to describe or label. I've described it as feeling "untethered," imagining myself as a single balloon floating away.
Some people are more likely to feel lonely than others due to "risk factors," often from childhood, Gover said.
"There's a huge correlation between these 'adverse childhood experiences' and later development," Gover said. Things like physical abuse, sexual abuse, emotional neglect, physical neglect, domestic violence, parental separation and parental death can all have negative effects on well-being into adulthood.
And if you didn't have a sense of belonging in your own family growing up, it may be more difficult to cultivate this sense of belonging as an adult.
But it isn't hopeless. It just feels that way sometimes.
How to get un-stuck: changing the behavior
"There's a thought that leads to a feeling and that leads to a behavior and it becomes a cycle and, if you want to change that cycle from negative to positive, you have to intervene at some point," Gover said.
Of course, Gover recommends therapy, but there are other things to try along with, instead of or until you're ready for therapy.
"When I'm talking with someone who's feeling depressed or lonely, I'll brainstorm with them to find activities that bring you pleasure," Gover said. "That idea of taking action can actually change how you feel."
One way to do this is to remember things you used to like to do before you were depressed, Gover said.
"Maybe you can act as if you're not depressed and engage in those behaviors again and — guess what? — you might decide, after you get engaged in them, that you're less depressed," she said.
Exercise and social activities are therapeutic, she said.
And, if you can't think of any previous activities, you can think of things that you've never done but would like to try or think you might enjoy.
I didn't grow up participating in any social activities or sports, so, as an adult, I've had to explore new things as I try to find out what it is I like to do. By trying new things, not only have I met new people, but I've also built up my self-esteem.
Self-esteem, Gover said, is what it all comes down to. If we can strengthen our self-esteem, we can build resilience and, ultimately, experience more pleasure, she said.
More from this reporter: How I'm finding hope in human connection amid the pandemic
"When we have low, fragile self-esteem, then we're much more likely to experience emotional dysregulation of all kinds," Gover added.
Even tasks like paying bills can help with this if it gives you a sense of mastery or accomplishment.
"The more you do, the more you feel like doing and that can help bring you out of the cycle," she said. So, even if you don't feel like it, go to bingo, bunco or maybe volunteer and build your self-esteem and sense of belonging by giving back.
"When you do something good for someone else it makes you feel really good about yourself and it helps the other person," Gover said. "It's a win-win."
Battling the anxiety spiral: changing the thought
DAP Health launched a free therapy group ahead of the holidays to help community members learn how to combat "distorted thinking" — false beliefs we have that can lead to anxiety and distress. The workshop, "Mind Over Mood," has been going well, but it isn't a surprise because it is a strategy that therapists use all the time.
"You learn to identify the distorted thinking pattern and then develop counter-thoughts that put those distorted thoughts into a different perspective so that you have a more accurate thought," Gover said.
Catastrophizing is one example of this type of thinking, Gover said.
"Lots and lots of people do that and it causes a great deal of unnecessary anxiety," she said. "Anxious people do that all the time — they're constantly viewing life through a lens of catastrophic outcome."
Gover shared that she is having cataract surgery this month and could have easily fallen into catastrophizing. She may have considered the worst-case scenario (death!) and ruminated on it, creating more anxiety for herself.
To combat this, Gover looks at the facts: "What is the evidence that I'm going to die when I go in for my cataracts surgery? Statistics say that is highly, highly unlikely. There's very little evidence that's going to happen."
Then she asks what evidence there is that surgery will go well. In this case, the answer is quite a bit. And, by doing this, she can calm some of those thoughts and see what the most likely outcome is: that she will come out of it with better vision.
"What it helps you create is a more balanced, accurate thought rather than these exaggerated thoughts," Gover said. Challenging the thoughts reduces the intensity of the emotional distress they cause.
Then, as that distress lessens, she added, "we're able to problem-solve because we're not exacerbating our situation with high emotional reactivity."
Another example of a distortion is negative thinking. That's when, no matter how many good things happened in a day, someone stays focused (almost obsessively) on the thing they perceived as going wrong.
"You filter out all the positive," Gover said.
Real-life scenario: It's a beautiful day and you're out on a picnic with your friend. Everything was great except that the chicken was burnt. And, if you're stuck in this thought pattern, the whole day may be "ruined" because the chicken was burnt.
Other examples of distorted thinking include all-or-nothing thinking, overgeneralizing, jumping to conclusions, "should" statements, magnification, personalization and blame.
"Everybody has them — we all do it," she assured. Most people, she said, are reacting to situations without being aware of what distorted thinking patterns are happening in them.
Without knowing what it was called, I've learned to do this too. One of the common thoughts that recurs in my head is that no one likes me or wants to be around me. I've challenged myself to, like the journalist I am, look at the evidence. When I do that, despite my feelings of despair, I can see that I have several great friends and recognizing this leads me to the opposite conclusion: some people — people I love and admire — actually like me very much.
Learning this technique, Gover said, just puts things in perspective. It doesn't invalidate your feelings, it helps you see the reality that can get mucked up by emotions and fears. And it's just a start.
Holiday survival tips from Dr. Jill Gover:
Make time for yourself (downtime)
Acknowledge your feelings
Don't try to make it "perfect" because that's not possible
Don't set unrealistic expectations
Keep up with your routines
Get adequate sleep and exercise
Volunteer or give back to the community
Learn to say "no"
Visit daphealth.org or call 760-323-2118 to learn more about their services.
Here's where to find help in the Coachella Valley:
CARES Line, (800) 499-3008: The Community Access, Referral, Evaluation and Support line is available 8 a.m. to 5 p.m. Monday-Friday, with resources in English and Spanish. The phones are answered by Riverside County licensed clinicians who provide support, crisis intervention and connections to outpatient, inpatient and community resources.
Peer Navigation Line, (888) 768-4968: Not sure where to start? The peer navigation line connects you to someone who is currently recovering from their own mental health issues in Riverside County. They will talk to you about how you're feeling and direct you to resources that could help.
2-1-1 Community Connect: By dialing 2-1-1, Riverside County residents are connected to a local information hotline for individuals in crisis. Many people are familiar with this resources as a place to be connected with housing, food and income help. Resources advocates are also able to address mental health needs.
National Alliance and Mental Illness, text “NAMI” to 741741 for 24/7, confidential, free crisis counseling.
Riverside County 24/7 mental health urgent care, Palm Springs, (442) 268-7000: If you are experiencing troubling thoughts and need immediate help, the clinic is able to instantly connect you to counseling, nursing and provide psychiatric medication, if needed. Everyone is welcome regardless of insurance or ability to pay for services. The clinic is open 24/7 and no appointment is needed, just walk in. 2500 N. Palm Canyon Dr., Ste. A4, Palm Springs.
Crisis Stabilization Unit in Indio, (760) 863-8600: For individuals experiencing troubling thoughts and need immediate help, they can go to the clinic at 47-915 Oasis St., Indio.
National Suicide Prevention Hotline, (800) 273-TALK: The hotline is available 24/7.
Institute on Aging's Friendship Line, (800) 971-0016: Adults ages 60 and older or those living with disabilities 18 and older can call the "Friendship Line" 24/7 for someone to talk to for free.
Online resources: Go to 7cups.com for a free, online chat for emotional support and counseling in English or Spanish, or fee-for-service online therapy with a licensed mental health professional. Go to virusanxiety.com for pandemic-specific mental health support.
More resources: To search for more behavioral health providers and resources in Riverside County go to the county's resource website at riverside.networkofcare.org/mh/ or to the CARES line website at up2riverside.org or the national clinic search at FindTreatment.gov.
This story was written with the support of a journalism fellowship from The Gerontological Society of America, The Journalists Network on Generations and the RRF Foundation for Aging.
Maria Sestito covers issues of aging in the Coachella Valley. She is also a Report for America corps member. Follow her on Twitter @RiaSestito, on Instagram @RiaSestito_Reporter or email her at email@example.com.
This article originally appeared on Palm Springs Desert Sun: 'Happy Holidays?' It is OK to not be OK at the holidays