Surviving the Holidays with Mental Illness

For many, the holidays are a time of love, joy and celebration. Filled with smiles, family, and good food. For me and many people with mental illness, it can be the worst time of year. Full of expectations, reflecting on the past year and having therapists on vacation.

I've always struggled with the holidays. I am a child of divorce meaning I would go back and forth between mum and dad for the holidays; if I spent Christmas with mum, I'd have to spend New Year's with dad and vice versa. I hated the switch but even when I stopped going back and forth every year I still had a rough time. The year that things got worse was 2013. I was 14 and that was the first holiday season where things got life-threateningly bad. My year leading up to Christmas had been pretty shit and the New Year was a great reminder of that. I decided I couldn't live through another year like that one so planned to end it on December 28th. I took a small overdose, not enough to be life-threatening but enough to be scary. The next year, 2014, I went through the same extreme depression and suicidality. I contemplated the worth of my life and once again planned to end it, this year on December 30th. A lot of tears were shed that night but no attempt was made. The next memorable year was 2017. I was 18 years old and struggling with the transition out of youth mental health programs into adult programs. I was withdrawn and spent the majority of that holiday season crying, sleeping or self-harming. Last year, 2018, was a different kind of depression. I finally had a good therapist but was very dependent on weekly sessions. I didn't plan properly for the holidays and ended up in the hospital on New Year's Eve getting several sets of stitches.

From all this, I have learned what works and what doesn't when it comes to making it through the holidays in one piece. Here are some tips for the upcoming holiday season.

1. Start talking with your therapist about the holidays a few weeks before they happen. Give yourself plenty of time to prepare and discuss your feelings and concerns. When talking with your therapist, be realistic and honest. If you are worried about dealing with family, talk about that. If you are worried about being judged or receiving unwanted comments, come up with go-to responses in session. Role-play situations if that helps. If you are worried about your safety, come up with a plan to ensure you stay safe.
2. Safety Plan. With your therapist, come up with a plan for when you feel distressed. This plan should include a few lines of defence for different levels of distress. The easiest way to do this is to use a 1-10 scale; 1 being mild distress and 10 being extreme distress. For levels 1-3, find activities that keep your distress low, maybe doing a breathing exercise or self-validation. For levels 4-6, find activities that can lower your distress level such as taking a break from the situation, reviewing skills used in therapy or do something more distracting like listening to music. Levels 7 and 8 indicate more substantial steps need to be taken. If you can, talk to someone you trust, try to slow down and validate your feelings. Do something physical to relieve distress. This can be tapping or singing along to a song, using sensory objects, journaling or drawing. Level 9 means serious intervention is needed. The best way to alleviate high distress is to shock your system; my preferred method is using the showerhead to spray my face with ice-cold water. This shocks your system back into a more reasonable state. Level 10 means professional steps should be taken. If all other things have been tried, this is the time to text or call a professional, a therapist or a crisis line. Put this plan somewhere you can see it every day, maybe on your wall or on your phone.
3. Let your family and friends know this is a difficult time. If you are unable to do that or they are insensitive, use interpersonal skills and be direct. Be assertive and tell them what you need. Don't let them guilt you out of doing something you need to do. For this, the DBT skills DEARMAN and FAST work well.
4. Take breaks. This is SO important. The holidays are stressful for everyone. If you feel yourself becoming overwhelmed or distressed, take time out. Whether it's excusing yourself to go to the bathroom or going to take a nap for a few hours, do what you need.
5. Be gentle with yourself. It's easy to judge yourself and the past year. Don't get stuck in the past. Try and remember things you were proud of this year. At the very least, remember that despite everything that happened this year, you continued.
6. Reward the little things. In really rough patches, I found it helpful to set rewards for myself. For example, if I get out of bed before 12 PM, I can get new paint. Being reasonable and bargaining is also important. For example, if you get out of bed, try to stay up for 20 minutes. If after those 20 minutes you still need to go to bed, do it and try again later.

Happy Holidays and Mental Health!