In my clinical practice, I'm usually quite aware of when a festive occasion is approaching, and not just because of the hospital decor. Sometimes, patients request for discharge or home leave to celebrate the holidays and sometimes they want to reschedule appointments because they are travelling or are busy. I've even encountered patients (usually the elderly ones) who refuse to allow their families to bring them to the hospital for treatment until that all-important gathering has occurred (#reuniondinner).
The holidays can make for a nice change in pace. We can plan vacations, not think about work and spend precious time with family. Some holiday periods, such as Chinese New Year, Hari Raya Puasa and Deepavali, are of special significance to us.
The flurry of activity
Yet, it comes as no surprise that public holidays and festive seasons can be a burden. The holidays can be stressful because of the sheer amount of preparation that goes into getting things ready, what with buying food and cooking it all, wrapping presents and counting out how much ang bao (red packet) money to give to that relative. Then there's the part about having to spend time with people you don't necessarily enjoy interacting with, hosting guests, and dealing with family feuds and downright awkward questions of well-meaning aunties and uncles. Pretty much a logistical nightmare.
Oh yes, there's also Valentine's Day. 'Nuff said.
And for those thinking of getting away from it all instead? Don't get me started on travelling with kids.
For those without kids, you know you aren't the only one thinking of travelling, right? Just think of the hordes of like-minded people trying to siam (Hokkien for "avoid") the holidays as well!
A time of isolation
But on the flip side, the holidays can be especially isolating for some. A patient of mine once shared her distress whenever the weekend or public holidays came around. Years ago, her only family member in Singapore, her husband, passed away. It then became a struggle for her to deal with periods of time outside her regular work. She felt lonely, she said, with tears in her eyes. She could cope when there were things to do and colleagues to interact with, but the holidays were painful for her – she would be off work, her friends would be with their families and even the community centres were closed. And then there were the memories of how she used to spend the holidays with her late husband. What was she to do to pass the time?
The sad thing is that she probably isn't the only one with such thoughts.
The term "holiday blues" (or "festive blues") remains rather ill-defined. But intuitively, it probably refers to the mental health toll that festivities can bring for various reasons – too much to do, the absence of things to do or perhaps memories that might trigger grief and sadness, or anger and resentment, as well as regret.
What makes things awkward and difficult for the individual who is experiencing the "blues" is that they're "supposed" to feel happy because it's a joyous and auspicious time. However, just because someone appears joyful doesn't mean that they aren't experiencing negative emotions on the inside. The stigma of being unhappy during the festive period can prevent people from even acknowledging how they feel, much less talk about it. Not to mention the constant reminders of whatever festive occasion that is approaching. Decorations galore and piped-in music in shops and supermarkets, as well as the buzz on the radio, television and social media – it's hard to get away from all that.
As with the patient above, the absence of loved ones, either through a breakup, family estrangement or death, can lead to distress during the festive season. What makes things worse is that certain occasions become a time of self-reflection, longing and reminiscence. All of these emotions can lead to depression and suicidal thoughts prior to, during and after the special occasion.
That being said, it must first be recognised that feeling stressed, tired, lonely or down during a festive season can be a normal experience, for whatever reasons. Therefore, it's also alright to voice out such emotions rather than bottle them up inside.
It is the occasional patient for whom the passing of the holidays becomes especially difficult. These are the ones we should take extra care to look out for. It may manifest in someone who is a bit more withdrawn and teary-eyed, or looks more stressed and frazzled than usual. The patient may complain of having difficulty sleeping, poor mood or irritability. Some delicate prodding may elicit the cause of these emotional changes, after which it would be prudent to do a risk assessment.
A few Western studies have looked into the use of mental health services and suicide incidents around the holiday season. A 2011 North American study found an increase in mood-related issues during Christmas, with higher use of psychiatric services.1 That study, together with another one from the Netherlands in 2018,2 found an increase in suicides after Christmas, though not before.
There aren't any local studies on this phenomenon, but I can imagine that to many folk, taking one's life during a festive season would be seen as morally wrong (ruining other people's fun) or even wrong from a superstitious/spiritual perspective (ie, pantang).
As with any suicide screen, it is important to keep in mind the usual risk factors – depression, social isolation, chronic illness and pain, and gender – for a start. Once these patients are identified, management which would best address their needs, such as medications, referrals to specialists and/or enhanced community support, should then occur.
A timely reminder
Let's not forget our own friends and family members, and those in our community and neighbourhoods, who may not be as immersed in the season's festive cheer. I wouldn't under-estimate the practical support that our loved ones could use amid the busyness of preparing for a celebration, such as assistance in running errands or cleaning the house. Then there is the emotional aspect of things, such as paying an elderly relative a visit, especially if they live alone. A simple act of kindness can go a long way.
One final word – look after yourself. Oftentimes, the more conscientious (let's not use the word "perfectionistic") among us may shoulder all the responsibility of preparing for festive occasions. Resist the temptation to do that. Yes, it would mean delegating responsibilities or not worrying about the finer details, but it's probably better for one's mental well-being in the long run.
So as we gear up for the holiday that's approaching, let's remember that 'tis the season to be jolly.