Nurses do the work that neither hospitals nor patients could live without, which comes at an ever-increasing physical and emotional cost, as they are expected to aid sicker patients for longer hours with less support.
Otherwise, nursing could easily be the best job in the United States—the Bureau of Labor Statistics estimates more than 400,000 new jobs will be created by 2024. In five states, the average pay clears $85,000, with nursing jobs in California crossing into six figures.
Those numbers are no surprise to those who are aware of how much older the nation’s old are, and how much sicker they are, too: By 2030, there will be 70 million people over the age of 65, of which an estimated 14 million will have Alzheimer’s and more than 50 million will have at least two chronic health conditions.
But just as the need for nurses is increasing, so too is the price for devoting one’s life to the direct care of strangers. Nearly a quarter of hospital and nursing home nurses aren’t satisfied with their jobs, according to one study, and more than a third feel burned out. “Burnout is an occupational hazard in nursing,” says Jeanne Geiger-Brown, dean at Stevenson University’s School of Nursing and Health Professions. “It is hard to generate a lot of caring about other people, because you are so depleted yourself.”
Burnout, of course, is caused by overwork, but what causes overwork is more complicated and reveals how the cost-cutting priorities of hospitals force their nurses to pay an emotional tax.
“What’s causing the overwork is the increased acuity of patients,” says Susan Letvak, a professor at the University of North Carolina at Greensboro School of Nursing. “You are only in a hospital if you are so acutely sick that you can barely move. The minute you can move, you are kicked out the door.”
“The push is to get everybody out of the hospital as fast as we can,” echoes Bernadette Melnyk, dean of the College of Nursing at the Ohio State University and the university’s Chief Wellness Officer. Melnyk and her colleagues recently published a paper that shows depression among nurses is associated with both burnout and medical errors.
How does the quicker and sicker approach add up for nurses? Physically, it means the shifts themselves are much harder, especially since shifts are often twelve hours to begin with, which itself is a risk factor for burnout and mistakes in a place where patient alarms are constantly sounding. “It’s not healthy for the nurses, it’s not safe for the patients,” Melnyk says.
Emotionally, the quicker and sicker model means the long hours are engineered to be less fulfilling. “It’s not very satisfying to just put bandaids on people who are really quite ill,” Geiger-Brown says.
When the hospital is successful at turfing patients to home or anywhere else, you might expect nurses to benefit somewhat: Fewer patients on a given day could mean a slower shift and a chance for a break. But that’s not how it often plays out.
“Minimum is maximum staffing,” Letvak says. “We don’t have any easy days anymore. If the [patient load] is low, which happens all the time, they send the nurses home, instead of them having a light afternoon. How few do we need? That’s all that you’re getting. Every time you are at work, it is a bad day. There really isn’t a chance of having a lighter day anymore.”
Yet nurses should have the lightest days possible—like air traffic controllers, they do a job in which we accept no room for mistakes. Suppose you know that the ideal number of patients for a nurse is four—would you want to be number five?
While it may seem like a water is wet revelation to say nurses should care for fewer patients rather than get sent home, take a look at the work of Linda Aiken and her colleagues at the University of Pennsylvania. They have shown just how many lives are on the line when nurses are overworked. Give a nurse just one patient beyond four and the chances of that patient dying shoot up 7 percent and the chances of that nurse getting burned out climbs an astonishing 23 percent.
Overworking nurses extinguishes their lifesaving impact. Aiken and her team have shown elsewhere that every ten percent increase in the proportion of nurses with bachelor’s degrees lowers the risk of death for patients by five percent. A study by a different group found that a 10 percent increase in registered nursing staff saves five lives for every 1,000 people discharged. (If five saved lives doesn’t sound like a lot, try replacing “five” with five names of your loved ones.)
And while nurses care for a sicker and older population in an environment that is a burnout and depression generator, they may avoid mental health care for themselves, fearing that a hospital concerned first-and-foremost with the bottom line will use a mental health diagnosis against them.
“Think about the legalities,” says Letvak, who teaches on law and policy. “If a nurse made an error and something were to come out that they had depression, and then you can see the research that links depression and errors, that nurse just exposed herself to potential liability.”
Reposted from: https://tonic.vice.com/en_us/article/43nkjd/nurses-overworked-stressed-burnout?utm_source=vicefbus
By: Johann Hari
Across the Western world today, if you are depressed or anxious and you go to your doctor because you just can’t take it any more, you will likely be told a story. It happened to me when I was a teenager in the 1990s. You feel this way, my doctor said, because your brain isn’t working right. It isn’t producing the necessary chemicals. You need to take drugs, and they will fix your broken brain.
I tried this strategy with all my heart for more than a decade. I longed for relief. The drugs would give me a brief boost whenever I jacked up my dose, but then, soon after, the pain would always start to bleed back through. In the end, I was taking the maximum dose for more than a decade. I thought there was something wrong with me because I was taking these drugs but still feeling deep pain.
In the end, my need for answers was so great that I spent three years using my training in the social sciences at Cambridge University to research what really causes depression and anxiety, and how to really solve them. I was startled by many things I learned. The first was that my reaction to the drugs wasn’t freakish ― it was quite normal.
Many leading scientists believe the whole idea that depression is caused by a “chemically imbalanced” brain is wrong.
Depression is often measured by scientists using something called the Hamilton Scale. It runs from 0 (where you are dancing in ecstasy) to 59 (where you are suicidal). Improving your sleep patterns gives you a movement on the Hamilton Scale of around 6 points. Chemical antidepressants give you an improvement, on average, of 1.8 points, according to research by professor Irving Kirsch of Harvard University. It’s a real effect – but it’s modest. Of course, the fact it’s an average means some people get a bigger boost. But for huge numbers of people, like me, it’s not enough to lift us out of depression – so I began to see we need to expand the menu of options for depressed and anxious people. I needed to know how.
But more than that – I was startled to discover that many leading scientists believe the whole idea that depression is caused by a “chemically imbalanced” brain is wrong. I learned that there are in fact nine major causes of depression and anxiety that are unfolding all around us. Two are biological, and seven are out in here in the world, rather than sealed away inside our skulls in the way my doctor told me. The causes are all quite different, and they play out to different degrees in the lives of depressed and anxious people. I was even more startled to discover this isn’t some fringe position – the World Health Organization has been warning for years that we need to start dealing with the deeper causes of depression in this way.
I want to write here about the hardest of those causes for me, personally, to investigate. The nine causes are all different – but this is one that I left, lingering, trying not to look at, for most of my three years of research. I was finally taught about it in San Diego, California, when I met a remarkable scientist named Dr. Vincent Felitti. I have to tell you right at the start though – I found it really painful to investigate this cause. It forced me to reckon with something I had been running from for most of my life. One of the reasons I clung to the theory that my depression was just the result of something going wrong with my brain was, I see now, so I would not have to think about this.
The story of Dr. Felitti’s breakthrough stretches back to the mid-1980s, when it happened almost by accident. At first, it’ll sound like this isn’t a story about depression. But it’s worth following his journey – because it can teach us a lot.
When the patients first came into Felitti’s office, some of them found it hard to fit through the door. They were in the most severe stages of obesity, and they were assigned here, to his clinic, as their last chance. Felitti had been commissioned by the medical provider Kaiser Permanente to figure out how to genuinely solve the company’s exploding obesity costs. Start from scratch, they said. Try anything.
One day, Felitti had a maddening simple idea. He asked: What if these severely overweight people simply stopped eating, and lived off the fat stores they’d built up in their bodies – with monitored nutrition supplements – until they were down to a normal weight? What would happen? Cautiously, they tried it, with a lot of medical supervision – and, startlingly, it worked. The patients were shedding weight, and returning to healthy bodies.
Once the numbers were added up, they seemed unbelievable.
But then something strange happened. In the program, there were some stars ― people who shed incredible amounts of weight, and the medical team ― and all their friends ― expected these people to react with joy, but the people who did best were often thrown into a brutal depression, or panic, or rage. Some of them became suicidal. Without their bulk, they felt unbelievably vulnerable. They often fled the program, gorged on fast food, and put their weight back on very fast.
Felitti was baffled ― until he talked with one 28-year-old woman. In 51 weeks, Felitti had taken her down from 408 pounds to 132 pounds. Then ― quite suddenly, for no reason anyone could see ― she put on 37 pounds in the space of a few weeks. Before long, she was back above 400 pounds. So Felitti asked her gently what had changed when she started to lose weight. It seemed mysterious to both of them. They talked for a long time. There was, she said eventually, one thing. When she was obese, men never hit on her ― but when she got down to a healthy weight, for the first time in a long time, she was propositioned by a man. She fled, and right away began to eat compulsively, and she couldn’t stop.
This was when Felitti thought to ask a question he hadn’t asked before. When did you start to put on weight? She thought about the question. When she was 11 years old, she said. So he asked: Was there anything else that happened in your life when you were 11? Well, she replied ― that was when my grandfather began to rape me.
As Felitti spoke to the 183 people in the program, he found 55 percent had been sexually abused. One woman said she put on weight after she was raped because “overweight is overlooked, and that’s the way I need to be.” It turned out many of these women had been making themselves obese for an unconscious reason: to protect themselves from the attention of men, who they believed would hurt them. Felitti suddenly realized: “What we had perceived as the problem ― major obesity ― was in fact, very frequently, the solution to problems that the rest of us knew nothing about.”
This insight led Felitti to launch a massive program of research, funded by the Centers For Disease Control and Prevention. He wanted to discover how all kinds of childhood trauma affect us as adults. He administered a simple questionnaire to 17,000 ordinary patients in San Diego, who were were coming just for general health care – anything from a headache to a broken leg. It asked if any of 10 bad things had happened to you as a kid, like being neglected, or emotionally abused. Then it asked if you had any of 10 psychological problems, like obesity or depression or addiction. He wanted to see what the matchup was.
Once the numbers were added up, they seemed unbelievable. Childhood trauma caused the risk of adult depression to explode. If you had seven categories of traumatic event as a child, you were 3,100 percent more likely to attempt to commit suicide as an adult, and more than 4,000 percent more likely to be an injecting drug user.
After I had one of my long, probing conversations with Dr. Felitti about this, I walked to the beach in San Diego shaking, and spat into the ocean. He was forcing me to think about a dimension of my depression I did not want to confront. When I was a kid, my mother was ill and my dad was in another country, and in this chaos, I experienced some extreme acts of violence from an adult: I was strangled with an electrical cord, among other acts. I had tried to seal these memories away, to shutter them in my mind. I had refused to contemplate that they were playing out in my adult life.
Why do so many people who experience violence in childhood feel the same way? Why does it lead many of them to self-destructive behavior, like obesity, or hard-core addiction, or suicide? I have spent a lot of time thinking about this. I have a theory – though I want to stress that this next part is going beyond the scientific evidence discovered by Felitti and the CDC, and I can’t say for sure that it’s true.
If it’s your fault, it’s — at some strange level — under your control.
When you’re a child, you have very little power to change your environment. You can’t move away, or force somebody to stop hurting you. So, you have two choices. You can admit to yourself that you are powerless ― that at any moment, you could be badly hurt, and there’s simply nothing you can do about it. Or you can tell yourself it’s your fault. If you do that, you actually gain some power ― at least in your own mind. If it’s your fault, then there’s something you can do that might make it different. You aren’t a pinball being smacked around a pinball machine. You’re the person controlling the machine. You have your hands on the dangerous levers. In this way, just like obesity protected those women from the men they feared would rape them, blaming yourself for your childhood traumas protects you from seeing how vulnerable you were and are. You can become the powerful one. If it’s your fault, it’s ― at some strange level ― under your control.
But that comes at a cost. If you were responsible for being hurt, then at some level, you have to think you deserved it. A person who thinks they deserved to be injured as a child isn’t going to think they deserve much as an adult, either. This is no way to live. But it’s a misfiring of the thing that made it possible for you to survive at an earlier point in your life.
But it was what Dr. Felitti discovered next that most helped me. When ordinary patients, responding to his questionnaire, noted that they had experienced childhood trauma, he got their doctors to do something when the patients next came in for care. He got them to say something like, “I see you went through this bad experience as a child. I am sorry this happened to you. Would you like to talk about it?”
Felitti wanted to see if being able to discuss this trauma with a trusted authority figure, and being told it was not your fault, would help to release people’s shame. What happened next was startling. Just being able to discuss the trauma led to a huge fall in future illnesses ― there was a 35-percent reduction in their need for medical care over the following year. For the people who were referred to more extensive help, there was a fall of more than 50 percent. One elderly woman ― who had described being raped as a child ― wrote a letter later, saying: “Thank you for asking … I feared I would die, and no one would ever know what had happened.”
The act of releasing your shame is – in itself – healing. So I went back to people I trusted, and I began to talk about what had happened to me when I was younger. Far from shaming me, far from thinking it showed I was broken, they showed love, and helped me to grieve for what I had gone through.
If you find your work meaningless and you feel you have no control over it, you are far more likely to become depressed.
As I listened back over the tapes of my long conversations with Felitti, it struck me that if he had just told people what my doctor told me – that their brains were broken, this was why they were so distressed, and the only solution was to be drugged – they may never have been able to understand the deeper causes of their problem, and they would never have been released from them.
The more I investigated depression and anxiety, the more I found that, far from being caused by a spontaneously malfunctioning brain, depression and anxiety are mostly being caused by events in our lives. If you find your work meaningless and you feel you have no control over it, you are far more likely to become depressed. If you are lonely and feel that you can’t rely on the people around you to support you, you are far more likely to become depressed. If you think life is all about buying things and climbing up the ladder, you are far more likely to become depressed. If you think your future will be insecure, you are far more likely to become depressed. I started to find a whole blast of scientific evidence that depression and anxiety are not caused in our skulls, but by the way many of us are being made to live. There are real biological factors, like your genes, that can make you significantly more sensitive to these causes, but they are not the primary drivers.
And that led me to the scientific evidence that we have to try to solve our depression and anxiety crises in a very different way (alongside chemical anti-depressants, which should of course remain on the table).
To do that, we need to stop seeing depression and anxiety as an irrational pathology, or a weird misfiring of brain chemicals. They are terribly painful – but they make sense. Your pain is not an irrational spasm. It is a response to what is happening to you. To deal with depression, you need to deal with its underlying causes. On my long journey, I learned about seven different kinds of anti-depressants – ones that are about stripping out the causes, rather than blunting the symptoms. Releasing your shame is only the start.
One day, one of Dr. Felitti’s colleagues, Dr. Robert Anda, told me something I have been thinking about ever since.
When people are behaving in apparently self-destructive ways, “it’s time to stop asking what’s wrong with them,” he said, “and time to start asking what happened to them.”
A lot can happen in 12 hours. It’s crazy to think this is what my life is going to look like, i’ve never learned so much in anything prior to my first 12 hour clinical experience. The mental, physical and emotional high you ride through your shift. As a second year we don’t typically get 12 hours shifts, but because of the disruption to our clinicals we had last term, I was lucky to get three 12 hour shifts and the rest being the regular 8 hours.
It was daunting entering my first shift yesterday. Having spent the week prior in the UK for my Master’s graduation I missed the transition day of having a partner to manage one patients and get acquainted with the unit. I was nervous to be alone with a patient and not be in a familiar environment, but I SURVIVED. I am incredibly grateful to have had a pleasant patient who was understanding and the help of the fellow upper year student nurse who pulled me aside to teach me new things and help keep me on task. I am even more grateful to have had a tutor who believed in my capabilities of managing my own patient and who was there any time I needed them to double check my medications or answer my questions.
Post shift, I must say it is daunting. HOW DO NURSES DO IT? I only had one patient to take care of for the day (my first solo patient ever and first shift in my new hospital) but even just doing a head-to-toe assessment, vitals, charting, and preparing his medications took me until 9am. Let alone the full-time nurses who have 3-4 patients each and have to have all those tasks done by 9 am so the healthcare team can do rounds. It doesn’t help when most of the patients are in isolation because of the flu/MRSA/VRE and you have to gown up each time you leave and enter their room (better remember everything the first time!). Black. Magic.
It’s crazy how much nurses have to keep on top of things, whether it’s 0800, 1200, 0500 medications, charting (can’t bring papers into isolation room), addressing emergencies that pop up or concerns, dressing wounds, health teaching, meeting with family to talk, accompanying patients to appointments on different floors, bathing them and other personal hygiene measures, having everything ready for report, keeping on top of new orders/lab results, taking swabs, in some cases feeding patients by hand, getting them up and around, arranging a patient’s day and keeping on top of what goes on (how much they drink and output). It doesn’t seem like much, but when you actually see what goes on behind the scenes it’s baffling. By the end of my shift I was scrambling to chart everything, change dressings, and helping others with tasks like trying to get an IV into a patient who was delirious or finding a manual bed alarm for a patient who almost fell out of bed. I can see why nurses have such a high burnout rate or why moral distress is such a prevalent issue in the field.
I think one of the most important things that i’ve taken out of my Master’s degree is recognizing issues that don’t align with my values and how to slowly start to address them. More importantly i’ve come to realize the need for patient advocacy and my role as a nurse to help patients have their voices heard. I came across a patient yesterday who had a nephrostomy bag in which when I walked into their room during the start of my shift was in a bath basin floating in urine. I had never come across one of these bags, but I knew it wasn’t normal. What made me even more sad was after my assessments I was planning my day of how to get the patient up and out of bed and they mentioned wanting to go for a walk. Seeing the situation as a whole, it made me sick to my stomach to think this individual would have to lug this container of urine because the bag had been leaking, out in public, and not only feel uncomfortable with people watching them but also the fact that it was simply a hazard both physically (ie. slips) and health wise (ie. a super highway for infection). When I brought up my concerns to the overseeing student nurse she stated that in rounds they simply played it down to a behavior issue and blamed the individual for tinkering with it rather than making any effort to find a new bag somewhere else in the hospital. I’m incredibly grateful for my nursing tutor who came in to check on me and believe me when I mentioned that this was not normal and that he needed a new bag ASAP. Even to get a new bag was a mission and a half with one hospital unit complaining it would come out of their budget. Since when has it become acceptable to withhold healthcare from individuals? UTIs are prevalent in the hospital setting and seeing the state of this bag (which had been tapes with wound dressing rather than waterproof tape) was unacceptable. I can’t imagine how the situation would have looked had my tutor not been around to help me advocate for the patient in addressing the situation and scavenging the hospital for a new bag. Thinking of it was someone I loved being the in the patient’s position I would feel disgusted and angry to not have a voice in the care I receive because of my age or health condition (ie. depression, dementia).
Honestly in 12 hours, a lot can change. From patients developing delirium and becoming confused to patients dying. I experienced my first death yesterday and let me tell you it’s nothing as how the television perceives it to be. It’s cold, lonely, and in a way mechanical as in the steps are set out in hospital policy. It’s a strange feeling to look at a patient and see them lifeless especially when you had seen them in a better state the week prior, I mean as a healthcare professional we want all our patients to go home happy and healthy but the reality is some don’t and for many who do go home not at a optimal quality of life. I can’t really explain what the death process is like, but I learned a lot about how I can help make it the best it can be. Simple measures like washing the body, closing the eyes, putting on a pair of briefs and providing privacy are things I can do to help. Visiting the morgue was surreal in it’s blandness, it’s kind of unsettling to think about in that at the end of life you end up alone in a cold fridge waiting to be taken to a funeral home or be released for other measures.
It’s eye opening to how many people are death-phobic, I had a great discussion with a professor today about this phenomenon in nursing and how nursing schools do a poor job at preparing nurses to deal with death. Even within my own group a couple students found the patient’s death hard to deal with. I think nursing schools need to do a better job to improve our own awareness and understanding of the dying and death processes. How we can sort out or feelings from our professional duties and have them work together. I think death in itself is powerful, it’s inevitable, and the only I can do in the process is to respect the being that once filled that body and help transition it to the next phase. I can’t control or stop death (when medical interventions fail or are futile) but I can help by being respectful and giving the individual a respectful send off to the next realm.
I’ll be honest leasing the hospital that night, I now know what it smells likes and I also now appreciate sleep more. Being ‘on’ for 12 hours straight is a lot, but the learning experience I had yesterday was incredible. I didn’t think I would enjoy general medicine, but the variety of patients (age, health conditions, tasks) has been eye opening and a much more enlightening experiencing than my first placement at another local hospital. Honestly, i’m looking forward to my weekly clinical now and how much I will grow as a nurse through the term.
While entering the hospital before the sun rises and leaving long after it sets has it’s downsides, the work nurses do fills my soul, while the smell of hospital fills my hippocampus and nares. There’s nothing that I would change though or that a good night’s sleep, shower, and strong laundry wash cycle can’t fix.
I’ve been pretty fortunate in people being able to turn to me in times of distress and i’m happy to have helped a few people work on their mental health over the past couple months. I know for many people opening up about their struggles with depression and anxiety can be tough, but I have always and will always be there to support anyone in need and I have a number of resources to direct people to. I think I will therefore make a goal for 2018 to to take part in Mental Health First Aid and be able to offer support to those around me.
I must say, the final exams I wrote so far for last term were highly discouraging. I know I am not alone when I say that, but regardless it does take a pretty big hit to your self-worth as a student when you write exams that are seemingly much harder than what you were prepared for. I must say, despite writing some pretty awful exams (and I mean 60s) I still managed to pass last term with and am surprised I even managed to pull off a B in pharmacology.
I’m moreso proud of myself for successfully passing my first clinical rotation. There aren’t any words to really describe your first clinical experience except you feel lost, confused, and like you don’t know anything especially when given your very first solo patient assignment. Let alone when patients are looking at you and watching what you’re doing and nurses are talking to you about your treatment plan. I was given some pretty challenging cases by my preceptor (generally not given to second years) but managed to pull it together and learn quite a bit. Losing out on 5 weeks of a strike in the big picture isn’t a lot, but in the moment it felt worse than it was. Having so many disruptions really takes a toll on my groups (and other classmates) ability to practice our skills and discover and address our learning gaps. However, i’m incredibly proud of the people I had in my group for creating a supportive environment for all of us to grow and success and pass our rotation.
Over the term I grew not only as a student nurse but as an advocate for my patients. I’m grateful for my experience pursuing my Master’s and believe that it’s really helped me to gain a better understanding of my patients as a whole and seemingly it was evident in post-conference talks and the work I turned in. It was even more rewarding to sit down with my tutor for my final evaluation and be recognized for the issues I brought up and the work I put into helping the rest of my group. I feel empowered and encouraged to continue on the path i’m on and to know others have recognized my passion for making a difference in not only healthcare but within my community. I’m grateful to have had such a supportive tutor to guide me through the term and firmly believe that in time I will help change the face of nursing in the role of policy advising to the top levels of government even when it was hard for me to gauge where I was at.
While my next rotation in general medicine will help me build my foundational skills, it still sucks that I lost out on such a great opportunity being in a chest unit. I know in time these rotations help us figure out where we want to do our final consolidations, but i’ll be even more excited (if things go well this term) to get into peds and maternal units.
I must say with this terrible bone-chilling cold weather I am excited to head back to England in a couple weeks to see some good friends and walk across the stage to collect my degree. Hard work has slowly paid off and i’m even moreso excited to see where 2018 will take me in my nursing journey. Therefore, I think a second goal I have for 2018 is to get more involved in community and nursing advocacy through the RNAO, ONA, and CNA as a student member.
Hopefully i’ll get over this cold and actually start the new year on a fresh foot soon. I know it’s cold and flu season, so I remind everyone to practice that HAND HYGIENE.
IT’S THE MERRY CHRISTMAS season, a holy time, joy-to-the-world days, happy Chanukah, the heartiest and most beautiful holiday of the year — except that it often doesn’t work out that way. And the only way to deal with this paradox is to understand how and why it works.
The truth is, few people get through these gala days without feeling decidedly annoyed by the season. With some, it’s only a flinching reaction to the insistent jollity. Others, particularly those suspended in the middle years between taskless childhood and self-indulgent old age, are harassed by shopping, wrapping, mailing, cooking and debts — and the notion that what started out to be a gentle religious festival has been hoked out of shape by the vendors.
Quite a number of people have an old grudge against Christmas: it is a regular reminder of disappointment, suffering or isolation in some less-than-perfect Christmas past. A proportion of these have what amounts to an annual breakdown at Christmas, one that is now being investigated by psychiatrists who call it either the Holiday Syndrome or Christmas Neurosis. Their main symptoms are depression and deep anger, though they may conceal them gallantly under the requisite degree of ho-ho heartiness.
These individuals are gloomy because of the idealized warmth and sweetness of the season, not in spite of it. Since they cannot, for various reasons, experience all the elation that seems to abound, their private desolation is the mark of failure, and a bitter one.
Most people can bask in Christmas as children do, frankly relishing the food and drink treats, the conspiracy of gift hiding, the expectancy of wish-fulfillment, the tumult of parties and gaudy decorations, the simplicity and sentiment of a baby Saviour. It’s a mass regression to untroubled pre-adolescence, and the pleasure seeking can be atoned for neatly by New Year’s resolutions.
But there are flickers of doubt. Carol singing can grow tedious, week after week, outdoor decorations are competitive and oath provoking, gift-shopping is exhaustion and frustration in a pure form. The relatives gather, not always a happy sight. A lot of people accordingly plan trips to remove themselves from Christmas, only to find themselves sourly marking the oddity of Christmas lights in a palm tree or the cheeriness of strangers in a ski lodge.
“Not being joyous during the Christmas season is much more common than most of us realize,” observed a report by four psychiatrists at the University of Utah, who recently completed a study of psychological complaints at yuletime.
Dismay, in a mild degree, is universal. Sociologists have been noting that ordinary conversations during the pre-Christmas rush are rarely luminous with goodwill. Women complain of weariness, anxiety while shopping, the greediness of their get; men are uneasy over expenses and drinking too much. “There are few spontaneous exclamations about how wonderful it all is,” comments a noted Canadian psychiatrist, Montreal’s Dr. Alastair MacLeod. “There seems to be a great deal of hostility and anger over being impelled into something.”
The tender concepts of the season, in the Christian religion of the Nativity and in Judaism the candlelight memorial to freedom, are hard to confront under the smothering of carnival commercialism. There is a resultant loss of tranquillity felt by everyone.
One of the world’s most distinguished psychoanalysts, Ernest Jones, once wrote that Christmas represents psychologically “the ideal of resolving all family discord in happy reunion.” It’s an excruciatingly vulnerable ideal, since distance, divorce and death can shatter it, while old grievances within the family can make success chancy.
There is a sharp rap of despair when the family can’t be together, or when it can and the gathering tends to stir up old irritations rather than erase them. The disappointment can be so acute that rage breaks out readily — murders are not uncommon at Christmas, or accidents involving a violent mood and family dissension on a monumental scale. In some countries,o notably Germany, the suicide rate climbs at this season.
Scientists became intrigued some twenty years ago with the special depression that Christmas creates, with glancing attention to the lesser blues that sometimes attend vacations in the summer or even Sunday afternoons. Comparing notes, doctors discovered that many of their psychiatric patients suffered severe setbacks during the Christmas season. Succeeding studies of normal people revealed a vast, subsurface ocean of unrest, a distress that seems so ill-timed that its victims usually hide it under a pseudo-enthusiastic and tiring kind of gaiety.
The United States psychoanalyst J. P. Cattell describes the Holiday Syndrome as extending for more than a month before Christmas to a few days after New Year’s Day. It is characterized, he reported in 1954 to the American Psychoanalytic Association, by the “presence of diffuse anxiety, numerous regressive phenomena including marked feelings of helplessness, possessiveness and increased irritability, nostalgic or bitter rumination about holiday experiences of youth, depressive effect and a wish for magical resolution of problems.”
That’s a wordy nutshell. Many people bear with year-long humiliations and misery but cannot avoid the futile hope that Christmas morning will cure it all. The season brings forth an inner child, a loitering Peter Pan who wants coddling and gets instead a hatful of bills. The knowledge that Christmas is an expensive cheat, with only a flash or two of lovely lustre, creates a general jangling of nerves that silver bells cannot quite cover.
Some people have a clear idea why they are unhappy at Christmas. One famous Canadian writer, for instance, was deserted by his wife on Christmas Eve and another buried his only daughter shortly after she had helped decorate the Christmas tree. A young mother of three whose critical in-laws visited her for six weeks before every Christmas, bulging the facilities of a small apartment, eventually detested the entire season. A Montreal engineer felt a chill every Christmas until he was nearly forty, a residue of his mother’s insistence that he open all his gifts alone in his room. A man who was raised in an orphanage doesn’t feel comfortable watching his children receive their presents — they’re never grateful enough.
Some experts feel that the North American accent on gift exchanging is causing a good deal of Christmas blues. To a child’s mind — and many an adult’s as well — the quantity and quality of gifts received is tangible evidence of his valuableness in the world. Friends who receive more and better gifts are assumed to be better loved, a brother or sister getting more lavish presents is a catastrophe. For this reason even mature people feel a droop in spirits as the last gift is unwrapped, while children are inclined to protest violently.
The emotional involvement in gift-giving is such that people who are unable to love their families, or who feel inadequate in some way, tend to give luxurious presents, beyond their means, as a conscience calmer.
Christmas, accordingly, can be an economic disaster and many heads are filled at this season with a dance of debts. The financial demands of gifts, decorations, tips and entertainment is a strain that creates panic, making tempers snappish.
Dr. MacLeod, the Montreal psychiatrist, is reminded at this time of the year of the potlatch customs of some British Columbia Indian tribes, who destroy their enemies by loading them with gifts and food. The guests of honor are expected to give an even more sumptuous feast and gifts in return, wrecking their resources if they comply and disgracing themselves if they don’t. Christmas gift-giving can also be persecution: there is a mutually ruinous trend on this continent to give back a slightly better gift than was received.
But worry over debt is only one of the many factors which disturb people at Christmas. Some scientists, notably Ernest Jones, suspect that a primitive identification with the sun affects mankind, so that the waning of the winter sun rekindles a primitive fear in everyone that human powers are weakening as well.
Some of the responsibility for Christmas depression would then lie with the early Christians who somewhat arbitrarily chose December 25 as Christ’s birthday, usurping the date of the most widely celebrated of pagan festivals. Ardent sunworshippers believed that the winter solstice, the shortest day of the year, was the date on which the old sun died and a new one was born. They celebrated giddily: plentiful food and drink, their best attire, fires lit to support the burgeoning young sun. The Romans ornamented their homes with wreaths and exchanged gifts and visits. The Druids gathered mistletoe and the Saxons holly and ivy.
More than three hundred years after the death of Christ, many of the new church’s followers were distressed that the teachings of the forgiving, love-honoring Son were being overshadowed by the harsher tenets of the Father. To elevate the importance of the Son, they decided to establish His birthday as a festival. Since the actual date was debatable (many modern scholars place it in the spring), the symbolism of the pagan feast to the newborn sun made it the most apt choice of several that were tried.
Bawdy beginnings of holy days
It was a technique of the time to smooth the way for conversion by supplanting pagan ceremonies with Christian likenesses. The Feast of the Epiphany, for instance, takes place on the day that Egyptians marked the virgin birth of their god Aeon. The festival of the goddess Diana was replaced with the Assumption of the Virgin and the Celtic Feast of the Dead became All Souls Day.
(Occasionally Christians grow fretful at the bawdy beginnings of some of their holiest days: An act of English parliament in 1644 abolished Christmas as a “heathen festival”; it was reinstated promptly when the Merry Monarch, Charles II, took the throne. )
Similarly, the Jewish ceremonial lighting of candles during Chanukah bears the imprint of pagan sunworshipping. The eight days of Chanukah have some points of resemblance to the Roman Saturnalia, also a festival of goodwill and rejoicing which was observed originally on December 19 and later extended for seven days. Chanukah, the happiest of all Jewish ceremonial days, celebrates the victory of a Jewish tribe, the Maccabees, in history’s first war of conscience.
The selection of deep. dark, cold winter for determined merrymaking sets up an inevitable conflict that many experts blame for some of the despondency of the season. Days of brief sunshine produce their own melancholy. And so does the imminence of the year’s end — the dying of time, years running out, life running out.
In addition to this, for many North American Jews Chanukah has become a period of painful yielding. Their holiday pales beside the more widely and conspicuously celebrated Christmas, a comparison which causes Jewish children to feel bereft. To offset this, some Jewish parents decorate a Christmas tree — calling it a Chanukah bush — and put presents beneath it. These concessions shame the devout. both those who practise them and those who observe their fellow Jews practising them, and thus contribute to holiday depression.
But the deepest and most serious depressions at this time, bordering on a temporary mental illness, are believed to be a legacy of jealousy in childhood. Some doctors have reported in scientific journals that some adults under psychoanalysis even demonstrate an unconscious and corrosive envy of the Infant who receives so much love and attention at Christmas and cannot be competed against.
Other experts are examining a theory that problems arise at Christmas because reality is suspended by the childish pursuit of pleasure. Dr. Cattell observed that most people are healthy enough to manage the intoxication of tinsel, spruce and incense without losing sight of maturity, but others regress firmly into childhood and find a chamber of horrors awaiting them.
The Christmas-Chanukah observances. however, cannot in themselves create an untypical mood. They only exaggerate feelings which during the rest of the year are simmering but kept repressed by the thumb of conscience. At holiday time the conscience relaxes and releases whatever malice and envy it has been hiding.
Sandor Ferenczi, a brilliant Hungarian psychoanalyst, believed that the loosening of external and internal restrictions, which accompanies a holiday-inspired release from routine, is frightening to some people, causing them to grow alarmed, despondent, restive and ill. Among the side-effects of festive easing of the conscience are an aroused sexual appetite and an interest in aberration.
The period surrounding Chanukah, Christmas and New Year’s Day is not only the most chaotic of the year but the most permissive of exuberant behavior. As a consequence it can exert a most disastrous effect on people who are confident only when they are under the control of a routine-filled life. Dr. Jules Eisenbud, a New York psychoanalyst, observed in a paper, Negative Reactions to Christmas, that this season permits “social sanction to forms of enjoyment which at other times must be held to a judicious minimum.” Another psychoanalyst, Dr. L. Bruce Boyer, added, “It is to be expected that the degree of neurotic response to such an intense holiday release would be frequent and severe.”
Psychiatrists arc collecting an interesting dossier of Holiday Syndrome case histories. One of them describes a woman engineer who was exhibitionistic, aggressive and convinced she was unwanted. At Christmas she always felt especially forlorn. “I used to feel that if I didn’t find something wonderful that Christmas, I’d find it another,” she told her doctor. The “something wonderful” was proof that her parents loved her, a gift that was perpetually withheld.
Another woman expressed hatred of her preferred brother only when Christmas approached, a malevolence that always surprised and terrified her. A psychiatrist drew out the underlying cause. As a child, the woman had always felt that her parents favored her brother. This feeling became particularly poignant at Christmas, and in later years, although she had long since forgotten the supposed favoritism, the coming of Christmas revived the hurt.
A department store buyer who also grew up with a much-favored brother became savage in her business relationships with men during the Christmas season and twice was fired because of it. Her doctor discovered she had once asked Santa Claus to change her into a boy so her parents would like her better. The collapse of this confidently expected miracle left her with an annual vendetta against the masculine sex.
A salesman who loathed Christmas traced it to an event when he was nine years old. He discovered a new bicycle hidden behind his house and assumed it was intended for his Christmas gift. When it went instead to his younger, handsomer and more clever brother, he formed a distrust for Christmas that thirty years of living hadn’t healed.
A strongly religious woman went to a psychiatrist when she realized she hated Christ every year at Christmas. She was blaming the Baby, it turned out, for her own emotionally barren childhood. A beautiful young girl began to quarrel viciously with her boy friend at Christmas, becoming demanding and petulant. Her father had deserted her mother, an absence the girl felt most acutely at Christmas and which ever after prodded her apprehension that all men eventually desert their wives.
The Utah psychiatrists studied the case of a man who was so wretched in his home town at Christmas time that he fled to a nudist camp. One father, otherwise a responsible citizen, passed bad cheques every Christmas. Another, who delighted his family with his choice of birthday and anniversary gifts, always refused to do any Christmas shopping at all. A divorcee who felt sentimental about Christmas couldn’t endure being alone then — she cried and broke out in hives.
“Some of the ordinary unhappiness at Christmas is related to the turbulence in the family,” explains Dr. MacLeod. “Quite a few people are sensitive to the strain of household upheaval and are upset by it. The home becomes unfamiliar, which disturbs and worries everyone. You’ll notice that children react by contracting some kind of ailment. We now know there is a definite connection between emotions and the body’s ability to defend itself against some of tile causes of illness.”
Whatever causes it — lack of sunshine, childhood jealousy, confusion, old wounds or apprehension because the lid is off — the Holiday Syndrome is now drawing considerable medical attention. The chief benefit so far is that those who endure the strange malady of loneliness in the midst of gladness, ire instead of awe, know at least that they are not oddities, but members of a substantial group.
They have some practical solutions to ponder. Some families have stopped sending Christmas cards and others exchange few gifts or none at all, investing the resultant saving in CARE packages or local givings. Some individuals have overcome their aversion to Christmas by rooting out their prized collection of old injustices. There is an evident trend toward quieter, sweeter family celebrations, a tendency to savor that has been accelerated by current portents of doom. With the hustle out, it’s astonishing what remains — a sense of holiness, for one, and peace, and even joy.
For those who are grieving, the holidays are hardly “the most wonderful time of the year.” Not only are they navigating their pain, they’re doing it during a time that’s supposed to be joyous.
1. “Smile, it’s the holidays.”
While this is a good intentioned way of trying to cheer someone up, it may come across as invalidating.
2. “Next year will be better.”
Grief often makes the future look foggy.
3. Any questions about the details of the death.
Curiosity should be stifled in this case, according to Nancy Marshall, a licensed professional counselor and author of Getting Through It: A Workbook for Suicide Survivors.
4. “Let’s try not to think about them right now.”
“People have a hard time being around someone who is sad and grieving, so they often try to take their mind off it or somehow make it better and the reality is that sometimes it just can’t be better,” Reidenberg said.
5. “They’re in a better place.”
It’s easy to default on cliches, but they often come across as impersonal. Phrases like “everything happens for a reason” and “they’re in a better place now,” can often make a person grieving feel even more isolated if they aren’t at a place where they can accept what happened yet, Reidenberg said.
Reposted from: http://www.huffingtonpost.com/entry/what-not-to-say-to-people-who-are-grieving-at-the-holidays_us_585be878e4b0de3a08f448e1
The most decorated Olympian of all time wants you to know he has bad days — some very bad days — just like so many people. “I’m not a superhuman,” Michael Phelps tells LIVESTRONG.COM. “I’m a human being who was very fortunate to find something that I love and find something that I’m good at and really never give up. But, really, that’s it.”
While he made success in the pool look easy, a shadow hung over the star athlete for years as he battled depression. Now Phelps is sharing more about his mental health issues. “These are things that have been a part of me for so long,” he says. “I just decided it was time to open up and talk about some of the struggles I’ve had in my life. Just being able to get out and talk about it and communicate about it — almost become vulnerable — I think is something that will help a lot of people,” Phelps, who will appear in a new documentary titled “Angst” to talk about his depression and being bullied, tells LIVESTRONG.COM.
Since retiring from swimming with 23 gold medals after the Rio Olympics in 2016, Phelps has had to readjust his routine and figure out what’s next for him. “For a long time, swimming was that thing that got me out of bed every morning early to go and jump in a freezing-cold pool. But now, kind of starting the next chapter for me, I’ve been asking myself where I want to be and what I want to do.”
Those next steps include working on a cause close to his heart: water conservation. “I obviously grew up in water and in around water for a very long time,” Phelps, a global ambassador for Colgate’s Save Water campaign, says about the world’s most vital resource. “I think it’s little small things that we can do together — no-brainers like not leaving the faucet running when you brush your teeth [and taking] shorter showers.”
His life at home with his wife, Nicole Johnson, is also becoming more of a focus, as their son, Boomer, is now 17 months old and they are about to become parents for a second time. But Phelps says he would never force his kids into the athlete life. “For me, I had an awesome mom growing up who was just so supportive of everything that we did,” Phelps says. “If I wanted to quit swimming, she was fine with it because she wanted us to follow our hearts. The only thing I’m adamant about is that [Boomer] has to learn to swim. Other than that, he can play another sport, whatever makes him happy.”
Reposted from: https://www.livestrong.
At five years old, Shannon Nagy told her mother she wanted to die. In Grade 6, she missed almost the entire school year because more often than not, she couldn’t get out of bed.
Nagy, now 20, was diagnosed with anxiety, depression, attention deficit hyperactivity disorder and borderline personality disorder and was never able to finish high school. She spent most of her childhood immersed in a mental health care system that she said “did more harm than good.”
Her struggle to get help and the impact that struggle had on her education is a trend captured in a new survey commissioned by Children’s Mental Health Ontario, released Tuesday.
It found of the 18- to 34-year-olds surveyed across the province:
- 46 per cent had missed school due to issues related to anxiety.
- 40 per cent had sought mental health help.
- Of those, 50 per cent found the experience of getting help challenging.
- 42 per cent did not get the help they needed or are still waiting.
Parents are also impacted when their child has to wait as long as 18 months for mental health care, said Kimberly Moran, CEO of CMHO, the association that represents Ontario’s publicly funded Mental Health Centres and advocates for government policies and programs.
“Parents miss work and certainly myself as a parent, I have to take time to look after my daughter,” Moran said.
The Ministry of Health and Long-Term Care and Ministry of Children and Youth Services did not respond to requests from the Star for comment, with Monday being a holiday.
The study, conducted by research firm Ipsos, surveyed 806 people in October and suggests that a quarter of parents have had to miss work to care for their child due to issues related to anxiety.
When her 11-year-old daughter tried to die by suicide while on a year-long wait list for mental health care, Moran took a four-month leave of absence and then worked part-time. Six years later, she still takes about 10 per cent of the year off to help her daughter.
Half of the parents surveyed found getting their child mental health help was challenging because wait times are long, they don’t know where to go, or service providers don’t offer what their child needs, don’t exist in their community, are too far away or aren’t available at convenient times.
Anxiety is one of the “big front-runners” when it comes to mental illness in youth, said Lydia Sai-Chew, CEO of Skylark Children, Youth and Families, which offers free counselling and mental health services in Toronto. Wait times at Skylark for in-patient programs can be up to six months.
“The difficulty with wait times is that the youth gets more stressed, but so does the family,” Sai-Chew said. “Anxieties build up. They don’t have the strategies and it just gets worse.”
For 13 years, Michele Sparling of Oakville has juggled owning a business and taking care of her son who was diagnosed with anxiety and depression when he was 10 years old.
“If your child is home from school, you’re not leaving them alone,” Sparling said. “You’re worried when you have to step out for a moment. When a fire truck goes through your neighbourhood, you think ‘not my kid, not my kid.’
“That worry is constant.”
She said her family struggled to get her son the help he needed. In between driving him to and from appointments in Toronto, she got used to telling clients she might have to end a meeting at a moment’s notice if a crisis occurred. She watched as her son had to miss school, and continues to care for him now as he struggles with mental illness in university.
“This is not just about this one person, it’s about the bigger picture, the lost potential,” Sparling said. “I think we’re doing young people such a disservice.”
CMHO is asking the province to invest $125 million in community-based mental health centres, staffing and services for children and youth.
Reposted from: https://www.thestar.com/news/gta/2017/11/14/almost-half-of-ontario-youth-miss-school-because-of-anxiety-study-suggests.html