It is a common misconception that there are more suicides during the winter holidays than at any other time of the year, when the fact is that suicides rise significantly in the spring. But let’s back up to the winter, and think about how holiday expectations, coupled with the physiological changes with the seasons, may build up to a perfect storm we don’t always appreciate until it’s too late. And let’s also consider a solution, one that is so simple it is easily overlooked.
Many folks have at least a passing familiarity with Seasonal Affective Disorder (SAD). This is a recurrent pattern of depression that coincides with changing seasons, and is evident during winter and summer. According to the National Institute of Mental Health (NIMH), symptoms must be evident for at least two years to meet criteria for diagnosis. These may include feelings of depression, hopelessness or worthlessness, loss of energy, hypersomnia or insomnia, changes in eating and weight, anhedonia (loss of interest in things you once enjoyed), difficulty concentrating, sluggishness, anxiety, agitation, and social withdrawal. Behaviors may vary by the season, such as excessive sleepiness in winter and difficulty sleeping in summer. In addition to these symptoms, there are biological factors present in those diagnosed with SAD such as family history, lack of vitamin D, overproduction of melatonin, and difficulty regulating serotonin. SAD is also more frequently diagnosed in women and in those who live far from the equator. A history of bipolar or other major depression may also increase the likelihood of a SAD diagnosis.
Many sources, including The US Centers for Disease Control, maintain that suicide rates are highest between April and August, with the months of November, December, and January having the lowest daily rates of completed suicides. Yet, let’s look at the holidays. In 2017, the American Psychological Association released data from surveys assessing people’s feelings about “holiday blues.” They found that happy feelings were “often accompanied by feelings of fatigue, stress, irritability, bloating, and sadness.” The report published in Psychology Today noted 38% of the respondents’ “stress level increased during the holiday season” with top stressors being “lack of time, lack of money, commercialism, the pressures of gift-giving, and family gatherings.” Another poll conducted by the Principal Financial Group included in the same report indicated 53% of the respondents experienced stress due to holiday spending.
While data from these polls do not give details, we can conclude from commercialism on television (including advertisements and network holiday themed programs), on-line advertising (including Black Friday and Cyber Monday), and local markets who put up displays before Halloween that there is a certain expectation created that may be unrealistic for some people. If you are financially challenged, you feel left out. If you have sensory issues, the smells and sights and sounds can induce panic attacks or even allergic reactions. If you are depressed, the idea that you cannot afford to buy a gift for someone you love—or even that you have no one to love for whom to buy a gift—can be devastating. According to the National Alliance on Mental Illness (NAMI), about 24% of those diagnosed with mental illness find that the holidays make their condition “much” worse. 68% felt financial strained, 66% felt loneliness, 63% felt too much pressure, 57% felt unrealistic expectations, and 55% remembered happier times in the past than in the present.
In 2015, Brenda Patoine wrote a briefing paper (published by the Dana Foundation) with concern that the continued myths about suicides at the holidays might hinder education and prevention efforts. She noted that about 90% of those who complete a suicide “have clinical depression or another diagnosable mental disorder, often co-occurring with substance abuse. Adverse or traumatic life events, especially in combination with clinical depression, increase suicide risk.” Building upon the holidays, especially financial and other factors that set folks up for unrealistic expectations, she wonders if this could be a “tipping point” for someone who is already suffering, rather than a separate incident in and of itself. She quotes Eric Nestler, M.D., Ph.D., Dean for Academic and Scientific Affairs and Director of the Friedman Brain Institute at the Icahn School of Medicine at Mount Sinai in NY, who notes that “we know even less about sadness” than we do about depression, and therefore it is difficult to tease apart when someone has the “holiday blues” or when they are truly depressed. Patoine wonders if it’s possible that what we think of as the season of goodwill can actually make people sadder because heightened social interactions can be a source of more problems—meaning it can make one feel “forced” or even more lonely than before.
So, let’s think about this. If someone has depression exacerbated by the holidays and increased by SAD, by the spring when one may become more agitated, restless and does not sleep well, perhaps the self-harm urge becomes stronger. Maybe the increase in marriages reminds those who are lonely about their loneliness at the holidays, thereby increasing their current loneliness. Maybe the financial strain does not hit until after the holidays when the credit card bills come in, hurting someone whose impulse control got the better of them when pressure to perform overcame common sense. Perhaps the holidays were a tipping point, even if after the fact.
On the other hand, I would like to suggest, in agreement with Ms. Patoine, that our over focus on the holidays and the attendant stress and strain of expectations does not help us better understand mental health issues. I would add, however, that we focus so much on “reasons” for feeling that we remove ourselves from the humanity of emotion. Sometimes, there are clinical reasons for our actions and our emotions. We know, for example, that schizophrenia and autoimmune encephalopathies cause deterioration in brain functions and impact neural connections, thereby impacting behaviors, actions, and emotions. We know that a person who is traumatized—the death of a loved one, a car accident, an assault, a war—suffers at least temporary effect caused by elevated levels of cortisol in the blood stream that impacts neural connections and the optic nerve. ADHD and Autism Spectrum Disorders disrupt impulse control and sustained attention to undesirable tasks. Persons born with Fetal Alcohol Spectrum Disorders or substance addictions may have a wide range of developmental problems that may include learning disabilities, impulse control and attention weaknesses, and other behavioral and emotional challenges. And on and on.
I say all of this not to depress the reader further, but to suggest that perhaps we are looking at this the wrong way, and therefore we are looking for the wrong answer. Maybe it is not “just” SAD. Maybe it is not “just” the holiday blues. Maybe it is not “just” a mental health diagnosis, a financial crisis, an addiction, an illness, or a life circumstance that leads to suicidal ideation and/or completion. Maybe a bigger part of the problem, and the solution, lies in how we treat each other. We are, after all, social beings. In spite of the depression, the excessive drinking, the overeating, the “bah humbug” spirit that seems to overwhelm folks during December, there is not an increase in completed suicides. Why is that? Perhaps it has something to do with our behaviors towards each other. Just when you think you’ve seen the worst of others—the crushing crowds on Black Friday, layoffs at work, old family bitterness emerging at the dinner table, no presents or even a tree in an impoverished household—one also sees some of the best of humanity as well. People open doors for each other. We hear about “Secret Santas” who pay the tab for folks at the grocery store just because they want to. People smile and say “Happy Holidays” to complete strangers, even if they do not celebrate the same holidays or celebrate no holidays at all. People donate toys or dollars or cans of food. Did you know that Americans are the most generous people in the world, donating more money than any other country to those in need? And we are generous both as a country and as individuals.
When we watch our holiday movies, many of our favorites have themes in which the protagonists declare that the feelings of Christmas can be felt year round, that we can be our “best selves” if we choose to be. In one of these films, the selfish, self-centered protagonist proclaims that one can get “greedy” for the feeling of generosity if you allow yourself to reach out to others—an ironic concept in itself! Perhaps the truth to the universal themes in these movies of love, acceptance, self-sacrifice, charity, kindness, and family (whatever the family unit looks like) is missed when researching potential links between holidays and suicidal actions because there is no apparent neurological basis or measurable variable. We know that that there will always be personality differences, relationship challenges, disagreements, wars, natural disasters, financial crises, and diseases. Some of us will suffer anomalies that only respond to or do not respond to any known medicine. And yet, knowing this—if we were to reach out to those with mental illness, with SAD, with PTSD, who are in financial crisis, who are addicted, who hear voices, who are lonely, who are awkward, who are disabled, who are not loveable but need to be loved—if we could do this all year long, could we lower the suicide rate even further? Perhaps. Could we lower addiction rates? Could we lower recidivism? And can we research this?
Just some food for thought.
And then, perhaps, we will find that the holidays are not so bad after all.