Newsletter

According to family legend, my great-grandfather George died of a broken heart. His wife, my great-grandmother Theodora, died of a broken heart as well. They were both in their forties.

In the early 1900's, Theodora and George fled from their home in Turkey to escape the “ethnic cleansing” of that time: the slaughter of millions of Armenians and Greeks by Turkish soldiers. Once safe in Greece , George (a doctor) volunteered his time in refugee camps, where typhoid and other diseases ran rampant. When his son went into a coma due to typhoid, George sat by his son's beside everynight. One night George thought he saw blood in his son's bedpan, a sure sign that his son would die soon. Within hours after seeing the blood, George died of a stroke.

Within forty days, his wife, my great-grandmother Theodora, was dead also. Neither George or Theodora died from typhoid or any other illness. As family folklore has it, they died of grief.

As a child, I believed these family stories of deep love and loss. But as I grew older, I became skeptical of family folklore which linked emotions and health. The body was one thing, the emotions another. It was only my old-fashioned relatives who believed such unscientific overly dramatic ideas.

However, recent medical research has revealed that emotions, especially grief and stress, can literally make you sick or even kill you. It used to be believed that the immune system was autonomous and had a mind of its own. However today's high powered microscopes reveal that our immune system and our brain are closely connected by nerve fibers. Consequently, parts of the brain involved with emotion can affect our immune system, our digestive system, our hearts and our lungs through the complex action of neuropeptides and of various neurotransmitters.

Every time we have an emotion, a cascade of neurochemicals is released throughout our body, some of which directly affect our health. For example, our limbic system, the emotion center of our brain, is linked to the part of our brain that controls our heart rate. Repeated stimulation of this part of the brain due to intense negative emotions and stress can lead to cardiac arrest and other heart problems. So can repeated surges of adrenalin, which are triggered by danger or just ordinary stress.

The loss of a loved one, living under constant stress, or undergoing a trauma, such as car accident, mugging, rape, fire, or flood, can make you suspectible to many illnesses, such as viral infections. Study after study shows that people who have or have had major stresses in their lives, tend to have more health problems than persons who have been lucky enough to escape such situations.

Research resecent studies have found that

* among the widowed, the risk of death doubled the week after the death of the spouse and the risk for cancer increased for the year immediately following the bereavement;

* people who feel isolated and lonely or who live under constant emotional stress are three to five times more likely to suffer a premature death than those who feel cared about or who report little emotional stress;

***data from WW2, Korean, and Vietnam veterans all show the same thing: the rate of heart disease, strokes, diabetes and other serious illnesses are higher among men who endured the stress of battle than those who did not.

Even the stresses of everyday life can hurt your health. For example, a recent study of accountants with usually normal blood cholesterol and clotting showed that around April 15th, the date most accountants are overwhelmed with IRS work, their cholesterol and clotting levels rose to dangerously high levels. The levels return to normal after the IRS rush has subsided. When experiencing stress, especially anger, the body tends to retain excess sodium and fluids, which, together with the constriction of muscle walls of the arteries, increases blood pressure.

So today, I pay attention to my emotions, not just to have a happier, more satisfying life, but to save it. Today I have choices: I can spend time going for a walk,or talking to a friend (another proven stress reliever) or spend three times that amount of time in a doctor's office a few years down the road. I can spend money on aerobics classes, on vitamins, or on some small item that brings me a little joy or spend a many times that amount on doctor bills ten years from now.

If you are under stress now, or have been in the past, one way to grow stronger is to have a complete medical exam and take care of any physical problem you might be neglecting. This might sound like ordinary “grandmother” type advice. But in my twenty-five years of counseling I have found that despite

all the media attention to health issues, many of my clients (especially the men) are reluctant to take the time to take care of their health. They want to talk about their love life or their crazy boss, but I urge them to look at first things first: their physical health.

The ancient Greeks believed in a sound mind in a sound body. Taking care of one involves taking care of the other.

Just for today, can you can take one small step towards improving your emotional or physical health? It could be exercise, meditation, reading a favorite book, spending time with people or pets whom you love, listening to music, or taking a nap. You don't have to do anything fancy, expensive, complicated or new. Start with something which has worked for you in the past. Make a commitment to take this small step repeatedly, for a limited amount of time, like one week. Then, after a week, evaluate whether taking that step was beneficial.

Even when it seems that the fates have conspired against you to keep you frustrated and unhappy in your love life or on the job (or both !!!), you will feel empowered when you take some action on your own behalf. No matter what kind of financial or emotional stress you are under, there is always something you can do to make your life better, even if it is simply cleaning your room, drinking more water or saying “no” to an unwanted request. Just taking a few deep breaths sends electrical signals to your brain to relax your muscles, which can reduce your blood pressure and the stress on your heart.

A journey of a thousand miles must begin with a single step.

Lao-Tzu, Tao Te Ching

No one knows what he can do till he tries. Publilus Syrus. Moral Saying

He jests at scars that never felt a wound. Shakespeare, Romeo and Juliet

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#2 Growing Depression: Friend or Foe?

Aphrodite Matsakis, Ph.D.

Most of us think of depression as a curse, a terrible state to be endured or even worse, a sign of mental illness. Indeed, clinical depression can be a devastating psychological disorder, which causes relationships to fail, families to crumble, and individuals to despair to such a degree that they consider, or complete, suicide. Some people don't actively commit suicide, but kill themselves slowly through drug, alcohol or food abuse or by ignoring major medical problems or living dangerously.

Turning Inward . On another level, however, depression can be a sign that it is time to reevaluate your life and priorities. Withdrawing from your usual activities and from other people can be a way of redirecting your energies inward -- a way of focussing on yourself, rather than on other people or outside achievements. Or perhaps your depression is a simply a way to take a rest from having overly exerted yourself. Just aswise farmers periodically and purposely keep fields fallow for a season so the soil has time to renew its nutrients, so the psyche may cause an individual to slow down into a state of depression for purposes of internal regeneration.

Discovering Hidden Potentialities According to the famous psychologist, Karl Jung, depression (sometimes, not always) can indicate that a person is denying an important part of themselves or that they have yet to discover all of their potential. In this sense, depressions can point the way to new sources of inner strength and purpose. For some people, depression can be a sign that an important emotion or inner zeal may need to be awakened. In this sense, depression, when it leads to fruitful introspection rather than painful ruminations or despair, might be the first step towards the discovering important part of yourself.

Grieving for the Self . Depression is a normal part of the grieving process. If you lose someone through death or separation, it is normal to experience a period of depression. However, depression can also be an unconscious form of grieving for a lost or undeveloped part of the self.

Depression and Success in Men. The successful professional or business man who is experiencing depression at midlife may be grieving his or her lack of fulfillment in areas unrelated to work, such as sports, music, and family relationships.

Achieving success required putting aside certain parts of life and now that success has been achieved, these other parts of the self are clamoring for attention. In fact, they are putting up such a temper tantrum that they are causing the rest of the system to shut down or function at a less than optimal level so that their voices are heard. Hence depression may be a way for new or perhaps old but suppressed or undeveloped longings and talents to assert themselves. Underneath the depression may be a longing to play, to make music, draw or otherwise be creative.

For example, the computer specialist who has spent decades perfecting his skills may find himself depressed because he is a person who needs and thrives on more human connection than can be afforded by a machine. In one case, a man's depression was lifted when he braved the taunts of being called sissy, wimp, and henpecked and cut his 60 hours a week work schedule to 30 hours a week so he could devote time to his children and cooking.

Depression and Success in Women Karl Jung describes how depression can develop in those professional women who unwillingly put aside the domestic parts of themselves because, in this century and country, being a wife, homemaker and mother are devalued roles for women. Yet these women truly enjoyed baking or cooking and other aspects of the traditional female role.

Depression in such cases could be corrected by the woman acknowledging her more traditional desires and permitting herself to engage in and enjoy them, even they did not result ina promotion or bonus and even if certain others considered her “unliberated.” Similarly, the stay-at-home woman who has needs other than being a wife, mother and homemaker can develop depression in response to the stagnation of her intellectual and achievement needs.

If you suffer from depression, it may be the undeveloped artist, writer, dancer, business person, teacher, ball player, gardener, mathematician or executive in you which is mourning its lack of self-expression, The

resulting depression which is causing you to halt your normal activities and interests forces you to pay attention to these other aspects of yourself. On a more simple level, if you are someone who works very hard, your depression may reflect your inner child'srebellion against your ambitious work schedule. The depression may be a way to force you to put balance in your life and respect your legitimate needs for rest, recreation, free time and fun.

Depressions Caused by Illness, Stress and Trauma Not all depressions can be viewed in a positive way especially those arising from illness, stress, or traumas like wife or child abuse, criminal assault, war, or multiple deaths in the family. There are important differences between depressions caused by lack of fulfillment of a certain talent or part of the self and depression caused by overload, illness or trauma. These latter types of depression, where life's circumstances have literally beaten the will and life out of a person, is the focus of Newsletter #3. Newsletters #4 and #5 will also deal with the topic of depression and how to cope with it.

BOOKS by Aphrodite Matsakis, Ph.D

I Can't Get Over It: A Handbook for Trauma Survivors ; Trust After Trauma: A Guide to Relationships for Trauma Survivors and Those who Love Them ; Survivor Guilt: A Healing Manual ; When the Bough Breaks: A Helping Guide for Parents of Sexually Abused Children ; Managing Client Anger: What to Do When Clients are Angry with You; Post Traumatic Stress Disorder: A Complete Treatment Guide.

These books are available from New Harbinger Publications, Oakland , California , 1 800 748 6273 . For Vietnam Wives: Women and Children Surviving Life with Veterans with Post-Traumatic Stress Disorder , contact The Sidran Foundation, 410-825 8888.

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Growing Stronger Newsletter #3 Depression

by Aphrodite Matsakis, Ph.D.

What happens to a car that is driven cross-country 50 times without a tune-up, oil change, or tire rotation? What happens to a car that is well maintained but driven coast to coast 1,000 times? Would some parts start to wear out? Might the car eventually cease to function altogether?

People aren't cars. However what happens to a car due to overuse or inadequate care is similar to what happens when they undergo prolonged severe stress or trauma and consequently don't have the time, money or ability to take care of themselves. Under such conditions, their emotional and physical reserves become taxed to the point where they can easily develop a clinical depression. Depression can also be caused by medical problems, by a history of drug or alcohol abuse, or by genetic factors. Dieting is another leading cause of depression,

Depression is by far the most common psychiatric problem in our country. Almost one third of women and one tenth of all men can expect to suffer at least one bout of depression in their life time. Unfortunately, few people individuals recognize the symptoms. Even if they do, they often fail to get help.

Don't you be one of them. Depression is a highly treatable condition. There is no necessity for, or purpose in, continuing to suffer needlessly.

What is Depression?

Everyone has “the blues” from time to time, and when it happens we often say we're depressed. But there are important differences between the “blahs” common to most people and biochemical or clinical depression.

For example, depression is part of the grieving process. If you are depressed because someone you love has died, this is not necessarily a sign of clinical depression. In normal grieving, the depression tends to lessen over time, even though it may take years. In clinical depression, however, the depression tends to increase over time. Clinical depression also involves mixed feelings towards yourself or others, self-hatred, and physiological problems such as sleep disturbances and fatigue. Indecision, inability to concentrate, memory problems, lowered sex drive, confusion and crying spells are other symptoms.

In clinical depression, the negative feelings are so overwhelming that they impair your ability to function. You can't make it to work, or it is a struggle to get there. You stop going out. You avoid socializing. The smallest task seems like a monumental chore and you can't concentrate enough to read a newspaper article, much less a book. You have trouble meeting the most basic obligations to your family or yourself. Indecision plagues you.

Depression is not only painful it itself, but creates fear. When you can't concentrate on the task at hand, you start to feel insecure about yourself and begin to worry that you won't be able to meet your responsibilities or take care of yourself. Your self-esteem becomes damaged, which, in turn, creates additional feelings of worthlessness. In our society, self confidence is valued. It isn't “popular” to have low self-esteem. If you are depressed, you might feel you have to hide your difficulties from others in order to be accepted by others. You might even feel you have to pretend to be happier than you really are.

But pretending is exhausting. Pretending creates further stress and only increases your fatigue and sense of isolation. Hence eventually you may give up trying to pretend and simply resign yourself to loneliness. Even when you feel like being with others, you might chose to be alone because pretending takes up too much energy and, if you are depressed, your energy is limited.

Clinical depression can make it difficult for you to know what is real and what is not. It is not unusual for people with depression to become hypersensitive to the reactions of others and to distort how others feel about them. Someone may say something to you, which under normal circumstances, you would hardly consider worth remembering. But under conditions of depression, you might experience that same comment as a major insult or slap in the face. Or, due to depression, you may feel utterly hopeless about situations in which there is, in fact, considerable hope.

Are you are plagued with feelings of fatigue, hopelessness, worthlessness? Are you having trouble concentrating and making decisions? Are you experiencing little pleasure in activities which used to interest you? Do you find yourself sleeping too much or too little?

If so, you may want to have yourself evaluated for depression. This would involve scheduling an appointment with your family doctor or a mental health professional, such as a psychiatrist, psychologist, social worker, or psychiatric nurse.

If you noticed a small lump on your body, you would probably make an appointment to have it checked out immediately. Perhaps you think that depression isn't as serious as all that, but it is. Left unchecked, depression grows worse over time and can not only make you feel miserable, but make you physically ill. Research has shown that depression harms the immune system and that people with depression are more susceptible to various illnesses and infections.

There is no need to go on suffering and put yourself at risk for more emotional and physical pain, when there is help available.

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Growing Stronger Newsletter #4

Coping with Depression

By Aphrodite Matsakis, Ph.D.

The following is a list of suggestions for coping with depression. Some of these techniques may work for you; others may not. Some may work sometimes, but not all the time. If you try to follow one of these suggestions and it doesn't work for you -- forget about it and try something else. Before you try any of these techniques, consult with your physician or mental health professional. Every person is so unique that what might sound like a helpful suggestion for one person may be detrimental to another. Only a physician or licensed mental health professional who knows you well can make a determination about whether a specific coping technique will be beneficial for you.

The following suggestions are based not only on my experience as a therapist and books on depression, but on the suggestions made by some of my clients who have struggled with depression for a long time.

The symptoms of depression fall into three categories: emotional, mental, and physical.

Emotional Symptoms

The emotional symptoms of depression include anger, withdrawal, feeling “flat,” “empty” or “like a dead person.”

Anger: If you can, try to express your anger in a way that does not harm you or others. Physical exercise, cleaning, gardening, carpentry, ceramics, or writing, talking, praying or drawing pictures about your anger often help to release at least some of it. Some people find it helpful to write letters to the person whom or agency which they feel is the source of their anger. If you want to try this writing technique, be prepared to write two letters. The first letter should be only for your eyes. In it, you can write whatever you feel. You can give vent to all your raw emotions of rage and frustration. The point of writing this letter is to release some of the rage. You don't have to keep the letter if you don't want to. You can simply tear it up and throw it away. If writing it has reduced your anger even a little bit, it has served its purpose.

However, if you want to write a letter to actually send to a person or agency, you need to “sleep on it” and share it with people you trust to determine if sending it will serve a useful purpose. Such a letter will take careful thought. Although it may be a strong letter, it should not contain threats of aggression. Furthermore, if you find that expressing your anger, either in writing or in other ways, only increases your anger and makes you feel out-of-control of yourself and more likely to be aggressive, then you may be one of those people who needs to hold their anger in and not express it.

Withdrawal. Depressed people tend to withdraw from others. The first step towards counteracting this trend towards withdrawing is to acknowledge its existence. You need to admit to yourself that you are withdrawing. The second step involves talking to someone about your withdrawing and feelings associated with withdrawing, feelings such as feeling “dead” inside. You need to talk to someone safe who won't criticize or reject you. Set a time limit on the amount of time you will talk about your feelings with a friend, for example, five minutes. If you keep the time short, then you need not worry about burdening the other person. Then, if you can continue to relate to that person.

If there is no one to talk to, you might consider thinking about what it means to you to be withdrawing or writing about it in a journal.

If you can (and only if you can), try to attend whatever function it is that you want to withdraw from for a limited amount of time. The “function” may be as simple as talking to your partner or someone in the family or it may be as major as a family reunion or big party. Make a deal with yourself that you will attend the function for a limited amount of time. Pick a time period that you know you can handle, not a period of time that you think you SHOULD handle. Then cut that period of time in half and make it your goal to stay at the function for that period of time. If you achieve this goal, consider yourself a success.

After you have stayed or engaged in the activity for the time you set for yourself, you may want to leave as planned or you can stay a little longer.

However, if you find you don't have the energy to relate to others, then don't beat yourself up over it. Find your safe place and enjoy being alone with no one or nothing making demands upon you. Although depression can be painful, it can also be thought of as a “time-out” for you to re-evaluate your life and priorities. [It's also a great time to work on projects of activities that require solitude -- if you have the energy or interest.] Some psychologists like to think of depression as positive in that it gives people time to center themselves. Instead of thinking, “I'm a social failure or a psychological wreck,” tell yourself, “I'm recharging my batteries.” Criticizing yourself for being depressed is a waste of precious energy.

Feeling “flat.” If you don't mind feeling flat, don't be concerned about it. If you don't feel comfortable feeling “flat,” then you can try to activate your emotions by listening to music, watching a movie or favorite television program, helping someone in need, or reading. Remember, the goal is to feel more alive, not more numb. If watching t.v. enlivens you, continue watching it However, if watching television or videos lulls you into a state of numbing, you are no longer achieving your goal of feeling more alive.

Mental Symptoms: Confusion, slowness of thought, memory loss, and other mental dysfunctions

If your brains feel like molasses, make a list of what you need to do that day. Include only important activities which must be done and rank order them. If there is a time you have to have a certain activity, like picking up children at a certain hours, write that time down next to the name of the activity.

This list can be your guide when you get confused or can't remember.

Perhaps you feel ashamed at having to make a list like this. “If I was ‘normal' I wouldn't have to this,” you might be telling yourself. Perhaps if you weren't depressed, you might not need to make a list. However, many non-depressed persons, even high achievers, make and use lists. Wealthy people hire secretaries to make and tend to their “lists.”

Unless you are severely depressed, keep in mind that depressive episodes come and go. Just because you need a list during a difficult time, does not mean that you will always need a list and that you will be making lists forever. This is a temporary coping device, that will help you to feel more competent and help you do what you need to do or be where you need to be, which will improve your self-esteem.

Reduce your goals. If you usually can read a three page article when you aren't depressed, your goal when depressed should be smaller. Keep the goal of reading, but shrink it. For example, make your goal one paragraph or on page. Your difficulties with concentrating and other mental difficulties may be temporary. Even if they are not and you must live with them for a long time, denigrating yourself for something you can not change and never chose for yourself is counter-productive. Putting yourself down uses up valuable energy which you need to function in life. When you're depressed, every ounce of energy counts. Don't waste it reminding and chastising yourself for having symptoms of depression. You didn't chose to have clinical depression, did you?

Physical Symptoms

Fatigue: If you're depressed, the last thing you'll want to do is move your body. Yet it may be the thing you need to do the most. Any movement helps. Simply getting out of bed and taking a shower is a start. Your physical movement will help your mental problem. The more you move, the more your brain can work. Physical movement, especially exercise, activates the mind and releases a natural anti-depressant.

If you can't exercise as much as you used to when you weren't depressed, then consider doing a fourth of what you used to do and consider yourself a success. Perhaps once you get started, you will find you have enough energy to do more. In most cases in life, motivation comes before action That is, you are motivated to do something, then you do it. If you are depressed, action precedes motivation. You have to act, then you get motivated --- maybe. Suppose you try some exercise or some other type of action in hopes of helping your depression to lift, and you find yourself not only unenergized, but more fatigued then ever. In that case stop, if you want. You tried. For now your degree of depression may not allow you to proceed. But that doesn't mean that you should stop trying. Depression is unpredictable. Maybe on Tuesday when you forced yourself to go for a walk, you had to turn around and go home because you were so tired. But perhaps on Wednesday, when you force yourself to go for a walk, the walk will achieve it's purpose of “waking you up.”

Distraction. Some people find that distracting themselves, by driving reading, talking to others (not necessarily about the depression), watching tv or a movie, or helping others may help shake the fatigue. Others, however, find that watching tv or a movie, fatigues them even more. Judge the worthiness of an activity by its fruits: does the activity enliven you or deaden you? If it enlivens you, then it may be worth pursuing. If it deadens you, then you know it is not helpful in counteracting depression.

Eating. Overeating as a way to pleasure yourself and “wake yourself up” will ultimately put you to sleep. Try not to overeat -- or undereat. Either one can add to the fatigue of depression.

Pain. If you have physical pain, call a doctor or nurse. At least keep a record of the pain -- how severe it is, when and where you experience it.

Drugs and Alcohol . Like food, they can be used as a “pick me up” but in the long run they let you down. Both alcohol and drugs drain the nutrients out of your body, diminish your mental capacities, alienate important people in your life, and hence, in the long run, contribute to increased depression.

Medication

The right anti-depressant in the right dose can work wonders -- if you can tolerate the side-effects. Although there have been great strides in research on anti-depressant medications during the last few decades, sometimes even the most competent and caring doctor can not prescribe the right dose of the right medication on the first try. You will need to be in frequent contact with your psychiatrist or physician to assess your response to the medication.

Some of my clients can not tolerate some types of anti-depressants, but have found found relief in others. This involved a process of experimenting with one drug, then another, that was time-consuming, costly and frustrating. “But I'm worth it ... and I have no choice. If I can find a drug that helps me, then it's worth all the trouble,” explains a client. This man was lucky. He eventually found the right combination of anti-depressant and anti-anxiety drugs that gave him energy and helped him repair his marriage and his finances. But not all people are so lucky. I've had clients who have tried ever single medication on the market, including herb remedies, to no avail. Some of these persons became ill from the medications. Others found that the medicine helped lessen their depressions, but that certain side effects of the medications were intolerable.

The side effects of medication must always be weighed against the benefits. Once again, each person is an individual. The medication which helps one person may not help another. A side-effect which is a minor nuisance to one person, may be unbearable to another.

Taking care of your depression by seeking psychiatric help can sometimes feel like a part-time job. It takes energy and effort to keep the appointments, monitor the effects of the medication, and call the doctor when there is a problem. You must keep calling your doctor if you have a negative effect from any medication.

Managing depression takes work:mental emotional, and physical work. And it takes energy -- what depressed people lack.

If you are on medications, realize that it is your responsibility to take the medication as prescribed, not just when you feel like it. You also need to report side-effects to your doctor and be assertive enough to tell the doctor the truth -- the whole truth -- about your reactions to the medication.

The doctor can't do it all. You have to take an active part in telling your doctor what works and what doesn't

Clients with depression offer the following suggestions in coping with depression. Since everyone is unique, the same activity or coping strategy will have a different effect on each person. Only you can judge, from your own experience, what helps to feel more alive than more dead.

Talking, walking, getting in touch with nature, helping others, eating something special that isn't harmful or against food plan, exercise, medication, listening to soothing takes, reading or learning something, being alone, being with others, resting (or the opposite, exercise); medication, fishing, fantasizing about good times; staying with routine, gardening, driving in country.

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Growing Stronger #5 Those Holiday Blues

by Aphrodite Matsakis, Ph.D.

“It was the best of times – it was the worst of times,” wrote Charles Dickens in his famous novel, A Tale of Two Cities . And so the holidays can feel for many people – like both the “best of times” and the “worst of time.” The holidays are the “best of times” because we are still alive to enjoy them and have the chance to contact and reunite with people whom we love. But they can also be the “worst of times” if we are mourning the loss of a loved one or a failed relationship, such as a separation, divorce, or an alienated child or parent.

As the “best of times” holiday are intended to direct us, regardless of our faith, towards spiritual and humanitarian concerns. But they are the “worst of times” because, like birthdays, these end-of-the year holidays mark the passage of time and remind us of our mortality, and the morality of those whom we love.

The practice of making New Year's Resolutions forces us to consider our life goals and makes us aware of any objectives we failed to meet the previous year and of any discrepancies between our wishes and reality. This type of awareness is uncomfortable at best, and torturous at worst, for it confronts us with “million dollar” questions such as, “What do I want out of life? What are my priorities and life goals? What do I want to change in my life? What do I hope will never change?”

Unfortunately – or fortunately – there are no easy or pat answers to such questions. Also, these are questions we can only answer for ourselves. Although the advice and perspective of others may be sought and may be quite valuable, ultimately we all have to take responsibility for those parts of our life where we really do have choices – and that can be a frightening proposition! So often when we look inside, we find self-doubt and confusion rather than clear cut answers.

For people who already suffer from depression, the holidays can increase those terrible feelings of emptiness, fatigue, sadness, indecision, and hopelessness. For people who are lucky enough to have escaped this crippling illness, the holidays can create some symptoms of depression, especially fatigue, indecision, and hopelessness.

Who among us has not become indecisive in trying to decide who should be on their shopping list, what type of gifts to buy and how much to spend? And who among us has not become exhausted from the sheer work overload of shopping, preparing for parties and social events and attending them? The holidays present us with dozens, if not hundreds, of additional details to attend to. The holidays often result in considerable expenditures of money, and time, and even people who love the holiday season will admit that the preparations and activities, as delightful as they may be, take their toll.

The holidays can create feelings of emptiness and hopelessness in some people, when they compare themselves to the happy smiling pictures in the media and wonder why they don't feel (or look like) the models in the ads. Ironically the very time when we are “supposed to be happy” and full of the holiday spirit, many of us are especially conscious of our losses and feeling tired from all the many tasks involved in celebrating the holidays. The depression is greatest among people who have been traumatized, people such as survivors of family violence, criminal assault, combat, or the suicide or homicide of a loved one, especially if traumatic events associated with the holidays.

“Christmas day I picked my buddies brains off my uniform,” remembers a combat veteran. “I was beaten under the Christmas tree,” remembers an abused child or wife.. “I tried to save two children from a burning building, but couldn't,” remembers a fire-fighter. “My dad committed suicide on New Years Eve,” recalls a child. When such traumas occur on or around the holiday season, the holiday season can never be the same for the survivors. In fact, the pain experienced by such survivors is made worse by the fact they are (or feel they are) expected to show joy and happiness and often pretend to be happier than they really are so as not to negatively affect their loved ones. But such pretending takes energy, and drains the survivor even further of his or her limited energy.

Some people feel “fine” during the holidays, but get “blue” afterwards. The holidays may officially end on January 1 st , but many people continue their holiday blues, or just begin to experience the holiday blues, after the holidays are over. Following January 1 st , there can be a “let down” following all the anticipation and preparation for the holidays. The holiday events that became the focus of attention are now over and life is back to “normal.” The everyday problems that were forgotten due to the holiday season return, in addition to any exhaustion or disappointments as the result of the holidays.

In some cases, people get so caught up in the holiday preparations and social calendars, they don't have time to attend to their feelings. But after all the commotion has ceased, the feelings emerge. Feelings of disappointment, sadness, fear, and longing are common. Also, people tend to underestimate how much money they spend and may feel unhappy when they receive their bills in January which tabulate holiday expenses. Because the holidays occur in the winter, people with SAD (seasonal affective disorder) can be negatively affected by the lack of sunlight.

Some people become so anxious and unhappy around the holidays season or after, they wonder if they are suffering from true clinical depression or simply a case of the holiday “blues.” Keep in mind that no single symptom, such as fatigue, sadness, difficulties sleeping, feeling overwhelmed and hopeless, having trouble concentrating, signals depression. You must several of these symptoms and they must persist for several weeks in order to be clinically depressed. The symptoms may come and go, or they may be ongoing, but if they persist for more than two

weeks, they may signal depression. Also keep in mind the symptoms must interfere with your everyday activities in order to be signs of true depression, rather than the all-too-common holiday or post-holiday “blues.”

Remember, you are not alone. Even people with no history of emotional disturbance feel “blue” around the holiday season. Suicide crisis hot lines are busiest around holiday time – and afterwards– and emergency room staff expect to see many cases of suicide or suicide attempts around this time of the year.

If you do feel “blue” around the holiday season, try to figure out the causes of feeling so down. Is it the weather, the emotional or economic overload, the extra activities and responsibilities, old memories, grieving the loss of a loved one, the passage of time, or feelings of aloneness which contribute to your feeling so bad? Once you have identified some of the causes, ask yourself, is there anything you can do to improve the situation? If there is, then do it. If there isn't, then the painful process of acceptance may begin. Acceptance involves grieving, especially when acceptance involves an unacceptable reality. However, if there is nothing you can do to make things better, then there is no choice but to feel the pain of accepting unalterable realities.

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