Mclean Hospital

Podcast: Expert Thoughts on Managing Holiday Stress

December 17, 2018

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Life often includes many stressful moments, but stress around the holidays can be overwhelming for many people. From feelings of fatigue and isolation to financial stress and unrealistic expectations, it can be difficult to prepare ourselves for the increased stresses the holidays can often bring.

In this episode, Trevor talks about his struggles with emotional regulation and what helps ground him. Then we are joined by McLean’s Mark Longsjo, LICSW, who helps remind us that we have more control than we believe and shares some suggestions to help each of us keep things in check.

Learn more about ways to reduce holiday stress.

Episode Transcript

Trevor: Welcome back dear listeners and a welcome to new listeners. On today’s podcast we have Mark Longsjo, who oversees McLean SouthEast. I think you’re going to like Mark a lot. He’s very chill, he’s a really fascinating person to talk to. We got along very well. It’s one of those things, I try to challenge him on points and it makes it difficult. With his demeanor, I kinda feel like a jerk when I do it. But we have a really good conversation coming up regarding stress around the holidays. I am sure some of you are feeling that. I certainly am.

Last week was one for the books. I was up in Maine for a few days, interviewing people at the Maine State Prison for men and woman, for upcoming podcasts. Those are going to be really exciting. And while I was there, I got news from my potential roommate, a person I was supposed to be moving in with this past Saturday, on the 1st. She called me and told me my apartment wasn’t available anymore, for a very fair reason.

She will remain nameless for the story. But about around the beginning of November she found a lump in one of her breasts, and she was going in to have it biopsied and tested, and instead of waiting at her apartment to get the news, she wanted to go stay with her sister, she wanted to be with family because just too much anxiety around waiting for the news.

Unfortunately, the news is not good. She did test positive for breast cancer, and she just started treatment this past week. I can’t imagine that. She was very shaken by it, as expected, and I feel awful.

But while she was gone for a week and a half, while she was not at her apartment, she was served a letter from her landlord saying that she needed to move out of the premises within 30 days, because the landlord had sold the apartment. She didn’t get the letter until she returned home last week, and then she called me, in an absolute panic, telling me, “I am so sorry, you don’t have a place to move to. I’ve got to move out. I’m going to fix this,” and it was very overwhelming for me, had a lot going on.

Those interviews at the prison were very, very hard, so compound that with the fact that this woman is going through breast cancer, I mean, I don’t lack empathy, I definitely really felt for her, but also I was going to be homeless in five days. Where was I going to put my stuff? Where was I going to put my cat?

Luckily things did work out. Some friends took me in. I put a lot of my stuff in storage, friends took my cat. I wish I had my cat. That’s been really hard. My cat’s been an emotional rock for me. those of you know that from previous podcasts, which I think it’s been difficult.

When I was doing the dialectical behavior therapy program here at McLean, the head of the group program took me inside and said, “Just so you know, you’re really struggling with emotional regulation, and that’s something you really need to work on,” and he’s absolutely right. I have a very, very, very difficult time managing my emotions.

And one of the things that you have to learn, and it’s a really silly metaphor, and yet when it works it’s great, when an extreme emotion or heavy emotion comes on to feel it, to process it, to have the emotion but make sure you process the emotion and then have it slide off of you like a non-stick pan. I read that in a book, and I just shook my head and was like, “What crap is this?”

But the doctor told me, “Yeah, just try it. When the emotions come on, and they get really strong, try and just let it slide. Don’t do this let go thing. Just try and have it slide off of you. Try and feel it sliding off.” And sometimes it works, it really does. Sometimes it does work, but most of the time, for me it doesn’t. And that’s not to say that the exercise itself doesn’t work. It just means that I need to try harder.

And with a week like last week, very emotional, very stressful, emotions hit me... I’m just overwhelmed by them. I think you can even notice it in my voice. Presently I’m just so overwhelmed, and that is a bullet train straight to a borderline episode, where I become completely wrapped up in my emotions, and I start to lack empathy and sympathy for others, and I just become a really big jerk. And this exercise of having the emotions just slide off of me, that’s what helps prevent those episodes, and it’s not easy. It’s just not easy.

I miss my cat. I come home, she comes right over to me, I pick her up, and I cradle her in my arms like a baby. Most cats trip out when you do that, but not mine. She just folds right up, and she closes her eyes, and I nuzzle the top of her head with my nose, and we do that for four, five minutes until she stretches out her back and says, “Put me down.” But it’s a nice thing.

And I understand if that seems silly to some of you. I do understand that. Before I got a cat, if somebody told me that I would’ve thought it was ridiculous, but it emotionally grounds me, and to not have that every day is tough. I do go visit her, and the people that are taking care of her are just lovely. They’re great friends, and if you guys happening to be listening to this, thank you so, so much. Thank you so much.

But I’m really looking forward to settling this apartment thing, getting my life back, getting my cat back. And of course, of course this had to happen during the holidays. Of course it did. Of course.

So yeah, for those of you that are out there who become overwhelmed, and controlled, and just completely taken over by their feelings, like me, feel them, process them, and then try to have them just slide off of you. And trust me, I get it if you’re like, “I can’t do that.” I get it. Most people are like, “Well, you got to try. You got to do it,” and sometimes I just can’t do it. Sometimes I just don’t want to do it.

Anyways. Let’s go right into Mark’s interview. Trust me, this guy is going to... if I brought you down, Mark’s going to lift you up, trust me. He’s a great guy, and he’s a great guy to talk to. He truly is. He’s a very relaxing guy. I have a lot of admiration for him, and I am so grateful that somebody like that is here at McLean helping people. Well, I could go on and on about it, but why don’t you listen to my interview with Mark Longsjo right now? Here we go.

The kind way to say it is that she’s very passionate. What can I say.

Mark: Well, yes, we live through many things through our families, and particularly through our children, so maybe culture plays a part in that in some ways.

Trevor: Maybe. I want to talk about something that you touched on just a few minutes ago, parents living vicariously through their children. I want to point out that Mark is the Program Director of the Adult Psychiatric programs at McLean SouthEast, which is located in Middleborough, Massachusetts. You oversee the inpatient and partial hospital programs there.

What I’m wondering is, I know you work with adults, but how often do you run into kids, or even adults that are trying to live out their parents’ dreams?

Mark: Sure. That’s a great question, great topic to bring up, particularly around the holidays, so thank you for the question. I think I’ll have to speak a little bit from my own personal experiences too, you know —

Trevor: That would be great.

Mark: ... from my parents, and my children, I can speak a little bit to that, but also how it relates to what we do within our treatment setting.

Certainly generational aspects to culture and society are very important to all of us. So yes, there are these times that we feel like we’re not measuring up as much as we wanted to, these unrealistic expectations of want to do everything that my father never got to do, or wanting so much for my son to be able to do things that I didn’t get a chance to do.

I think within my son’s activities I find myself wanting to support him as much as possible so that he feels like he can maximize his potential. And what I want more than anything else is for him to know how much I support him, no matter what the outcome, as long as he’s participating and having fun. And I know that’s exactly what my parents wanted for me too.

But I think there is something in there, Trevor, that we all want to rise to that occasion, we all want to achieve for our —

Trevor: Why?

Mark: Well, I think it’s innate.

Trevor: Is it just to constantly reaffirm ourselves that our parents love us?

Mark: Yes. Yeah, I think that’s part of it. I think that our parents are such models for us, and we grow up with these expectations of seeing our parents as these models for us. Whether or not they’re perfect or not is not so much the issue when you’re six, or eight, or 10 years old. It’s more about, “I really want to please mom and dad.”

So that doesn’t go away, and as you become an adult, there’re still those relationships that still are seeded in some really special memories, and special messages that you’ve always gotten from your parents.

So hopefully most people have positive messages from their families. There are those messages though that have to be reconsidered. So when we talk about those tapes playing over and over, particularly around the holidays, we ask ourselves, do we really have to keep living as if these tapes are true? Can these tapes be corrected? Can they be amended? Are there other expectations that we can set for ourselves? Now that we know a little bit more as we’re getting older and still want to have healthy relationships with our families.

Trevor: You know, in a lot of cases, having your parents living vicariously through you means that there is, I wouldn’t say a healthy dose, but there’s a lot of maybe what they would call punishment or discipline, but physical abuse, spanking, hitting, stuff like that. It’s something in the past year I’ve heard this in both in terms of... what’s the words I’m looking for? I’ve heard it both referenced in pop culture and in a psychiatric context, and it almost sounds like they’re justifying that Michael Jackson might not have been that good if his father didn’t beat the hell out of him on a regular basis and keep pushing him, and pushing him, and pushing.

And then they named two other, not just celebrities but artists that really cornered their area, and then you find out that there is this history of dad or mom really giving it to them growing up.

Mark: Well, those are the dangerous messages. There’re so many positive attributes to all of us that have healthier ways to be able to shine through. The idea that somebody needs to be pushed, or —

Trevor: But sometimes you need to be pushed.

Mark: Well, yes, but in a supportive way, right?

Trevor: So how do you do that?

Mark: It’s definitely not about yelling, and it’s no way absolutely unacceptable to have any type of physical punishment, or physical pushing of the child.

Trevor: And I’m not justifying violence or screaming, but in a world today where there is so much noise, where you have to compete with when it comes to communicating with a child. I mean, they have their physical life and then they have their social media internet life.

Mark: That’s right.

Trevor: And you’re competing against all that noise. When I was young, my parents were competing with MTV and the telephone.

Mark: I remember.

Trevor: And in my case, comic books and movies. But today it’s those things and a hell of a lot more. And I am not agreeing with it, I am not justifying it, but I know there’s a lot of parents that are saying, “Well, a good scream or a good knock in the head is the only way that I’m going to be able to get my message through to them, because I can’t compete with all this noise.”

Mark: Sure. Well, the response that I have for that is just what we’re doing right now, Trevor. You and I are sitting here in a quiet space, making good eye contact, having a conversation about some important topics, but the focus is here. It’s undivided attention.

So when I have a conversation with my children about something very important, there are no other distractions. My wife and I will sit with them, it’s very important that they make eye contact with us, and we have a discussion.

Now, when the child is maybe too young for that, you still have to make every effort to demonstrate that conversations aren’t about yelling. You find the right time, and you say, “Hey, we’re going to be talking in about five minutes. You need to be able to calm down,” and then the conversation is so much more productive and so much more meaningful.

The messages that children get when you’re just constantly yelling is that you don’t know when it’s most important to stop and really listen.

Trevor: That is absolutely true. That is absolutely true.

Mark: Right?

Trevor: Yeah.

Mark: They become unfortunately a little bit too used to that type of communication.

Trevor: What happens is that I became used to everything coming at me at 100%, so I didn’t know what had priority or what didn’t.

Mark: Right. Right, exactly. So if there was a different way of sending the message, then, “Oh my gosh, what’s mom really talking about here? She actually stopped and sat down on a couch with me, and this must be something really important. What is she trying to tell me?”

Trevor: Right.

Mark: Yes.

Trevor: Have you ever had an experience, sorry if I’m putting you on the spot, just in public, your child having a tantrum?

Mark: No.

Trevor: No?

Mark: No. I have not, but I’ve witnessed them, and I have tried to be helpful to others. There have been peers of mine that have had children who have had tantrums in a public setting, and my experience with that is that you need to remove yourself from the stimulation.

So that’s the best chance of being able to really have a more productive conversation, is to remove the audience, remove the whole stressful situation, and then do your best to calm down the child and talk it through.

Trevor: I don’t think I’m trying to play devil’s advocate, but I find that this is all well and good, but let’s talk about a huge demographic of single mothers who are working three jobs, they don’t have a lot of resources. I’m sorry, not even... just single parents.

Mark: Sure.

Trevor: And they’ve got 45 minutes to get the grocery shopping done before they got to go to the third job. They’ve got the kids, she or he, kids are with her, they’re running around like crazy. There’s just not the time to really take a couple minutes.

I feel that a more comfortable life allows us the time to invest into our kids like that. I’ve gone through a period, and actually recently, where I didn’t just have money, I was poor. Wasn’t even broke. I was poor. And one thing that I didn’t have, because I was trying to dig myself out of it, I did not have time. Time did not exist. It was sleep and then up and at them, and if I wasn’t working I was chasing work, and there was no time.

I’m talking just not even a small amount of time. And if you do find it, it’s five minutes to sit down and try and recapture your sanity.

Mark: Yeah. Incredibly stressful. What you’re describing is very real to so many people. What we try to do, what I try to do to be helpful is to really look for consistency with communication. I think that the more erratic the communication, particularly with a child, the more difficult it is to get any message across.

So in that flash of a moment when you’re under a lot of stress, we do try to encourage everybody to be as consistent as possible. Try to stay calm, try to send the messages that you really want to make as clear as you can, and then unfortunately back it up with some type of consequence, so that if there is that tantrum, and you’ve only got five minutes before you’ve got to get to your next job, you really have to do the best that you can to be as consistent with that message. Not add to the crisis, but try to be as consistent and solid with that message, that this is not the way that we’re going to behave, but it’s often impossible.

Trevor: And I want to clarify for the listeners that I’m not trying to justify or even advocate screaming or hitting the child, but what I am saying is that I do understand how it happens. And if you cannot fathom how it happens, for those people that can’t, you’ve led a blessed life. I understand how it happens.

Mark: Me too.

Trevor: I wasn’t beaten but I was hit, and I don’t agree with it, and it’s nothing I want to get into now, but considering the backgrounds that my parents came from, and maybe this isn’t a good way to think, but I’m surprised that it wasn’t a hell of a lot worse.

Mark: Yeah. We’ve come a long way. There’s much more awareness now, but sure, every day, Trevor, every day there are situations where parents under a lot of stress are making some very quick decisions. And we’ve worked with plenty of patients in our programs where they understand that it was wrong, it was impulsive, it was under just an incredible amount of stress. So from that point then there’s opportunity to talk about how to better handle it, maybe how to get some different resources, how to make sure that it doesn’t happen again.

So yes, over the years there’s been more awareness to this problem, but I agree with you. You can see, you can definitely see how it could happen. These are parents who are working, professionals, people who are just under an inordinate amount of stress, and you can see how it happens. It starts with yelling, but it can easily turn to something physical if not careful.

Trevor: And this is everyday stress for parents. So now add in the holidays. Let’s toss that into the mix. I’m a very cynical often negative person, I am, but I myself am surprised by how much I do enjoy the holidays. I’m not saying I love them, but I like them more than I probably sometimes should. I’ll get home and be like, “Yeah, maybe that wasn’t the best Christmas. I don’t know.”

But the thing is, is that now parents, they’re aren’t so much... well, they are. Parents are inundated, but mostly kids are inundated with the latest in technology, the latest in gaming, the latest in this, the latest in that, Black Friday sales, prices are dropping, “Mom and dad, all the other kids have it.”

So now there’s this pressure to buy something that may have a considerable dollar value, that your child understandably doesn’t consider. I mean, when I was younger, $300 meant nothing to me. Like, “Dad, $300? That’s... come on. What are you talking about?” Now, $300 is, at least in my case, that’s six weeks of gas, that’s one to three weeks of food for my cat, depending on... not food for cat, food for myself and my cat, excuse me. My cat’s appetite. My cat is skinny guys, it’s not a big blob.

Mark: It’s significant money. $300? Very significant money.

Trevor: Right. And you buy this for your child, they enjoy it, often they only enjoy it for a month, and then you see it get pushed aside. And that was $300.

And it’s not until they get older, get a job and stuff like that, but still you see the joy that this item, this material item brings them. But is it wrong to also try and explain that you should really appreciate the value of this? Because then that goes away from the whole concept of just giving unconditionally.

Mark: Right. No, that’s not wrong. That’s not wrong. If a child is old enough to enjoy a 300 gift, they’re old enough to have a conversation about what that means. A ​$300 gift is significant and he or she should know that.

And there could be a conversation that includes, “We really want you to enjoy this gift, but please understand that this gift is for you because we love you, and we know how important it is to you, but this gift does not matter as much as what the holiday is for us” —

Trevor: And that’s completely lost in translation for the most part.

Mark: To the child, right?

Trevor: To the child.

Mark: Right. “Let’s go plug it in.”

Trevor: Yeah, right.

Mark: Right. But it shouldn’t be missed.

Trevor: And by plugging it in, you weren’t referring to anything specific, let’s just clarify, by plugging it in.

Mark: Right. Yeah. I wasn’t talking about video games at all.

Trevor: As a fellow gamer myself, I’ll try not to be hurt by that. I’ll try to look at it as a conversation where we both learn.

Mark: Absolutely. Well, thank you. So I think that’s an important message that comes along with any gift. The pressures are incredible, the over-commercialization of our holidays is very intense. Just watching commercials on TV this past weekend, you know it’s all coming.

So the expectations need to be set around a budget, and if it’s something that can be afforded financially, okay, great. It’s a gift, but with that gift comes a very important message.

Trevor: My father, when I was younger, used to pull insane amounts of overtime just so that he would have money for us, for Christmas. And then Christmas morning comes, and he sees us kids just blow through presents within... and I’m not saying we had a lot, but to me as a child it seemed like an entire department store fell on your head.

I remember the first time I made Thanksgiving dinner for my friends, and I spent on and off an entire day in the kitchen cooking. And then you serve it, and then it’s wiped out in 15 minutes, and everybody’s like, “Oh man, Trevor, that was great.” And they get up, and they go into the back into my TV room, and they watch football, or they go back to having Mario Kart competitions, and then I’m looking and I’m like, “Now I have dishes to clean. Are you kidding me? What happened here?”

I’m sorry, I singled out fathers. Fathers and mothers who work. That’s just got to be tough to see in the morning, just your kids, all that work you did for your kids to have a glorious Christmas morning. That’s why my parents, to this day, I’m in my 40s, I go and I spend Christmas with my parents, my younger sister comes. And now it’s not much about presents anymore, we don’t buy each other much, but all the way since I was a kid, to this day, my mother makes us go around and open up each gift, one at a time, and it takes forever.

Mark: Well, it’s an important time for them. It’s a production. Yes, I have a similar experience myself too, where yes, it was one present at a time, and it was paying attention to the gift, and it was expressing your thanks.

Trevor: And you know what? And I do think ultimately it was good for me. I just feel like now that the youngest in the family is in her mid 30s is just like, “Can’t we just do this real quick and go have breakfast? What I really want for Christmas is coffee right now. That’s what I want, a cup of coffee.”

Mark: Well, I think in the same way, that your, I call it a message, but what you did for your friends on Thanksgiving, to prepare this meal and to give them this gift, and then to feel like, “I did that for them” is the very same thing that your father and/or your mother did because they gave that to you. And that’s what they wanted to do, that was their choice. They worked extra hard to make sure that there was a Christmas, that you and your siblings were happy with, and that was important to them.

And I think that’s where I want to make sure that we talk about the priorities of the holidays, because they’re different for different people. And sometimes the priority is, oh my gosh, Christmas morning has to be perfect, the wrapping has to be perfect —

Trevor: Right, because I want my children to have a better childhood than I had.

Mark: That’s right. So getting back to that whole living through our children vicariously, and making sure that I pass along a legacy that was there for me.

Trevor: I mean, my mother was poor. Poor. 18 brothers and sisters.

Mark: Wow.

Trevor: Two parents, they lived on a slum in California, and the slum was better than the reservation. My mother was poor. And as a kid, it was great, but now that I’m in my 40s and I see that it still continues to this day as an adult, my mom has to go all out on Christmas. My mom has to go all out on dinner.

And yes, I’m very, very grateful that my mother always provided, but my mother went to bed hungry often, and there’s always more food than there is necessary, and eating one plate isn’t enough. Even in my 40s, my mom’s like, “Have more.” She won’t even wait for me to ask. The spoon’s already going on my plate. “You’re a growing boy, Trevor.” “I’m in my 40s. I’m growing out. I’m not growing up.”

And what I’m watching really is my mother still trying to ease the pain of not just going without, but going without just the bare minimum.

Mark: Yeah. Good for you, Trevor. What an opportunity for you to be able to see that perspective from your mom’s point of view. I hear you talking, and it sounds like you’re really trying to understand where she’s coming from.

A lot of families don’t stop to try to do that. Some families don’t even stop to try to set aside differences around the holidays. But to stop and really understand the perspective of another family member, what must the holidays mean to them, particularly that older generation, what was it like for them as children and then growing up, because it plays a big part in what happens in traditions in families over the years. Really does.

So to stop and actually really think about what that means to your mom, why does she give you another helping of food, she didn’t have anything, and she wants so much for you to have what she didn’t have. She doesn’t have to say the words. What she does around the holidays and throughout the year really has a lot to do with how much she loves you and what she wants so much for you.

Trevor: It is strange though, because I do understand it comes from a place of love, but that place of love is rooted in a lot of pain. And to see love come from that place really hurts. And then, as a child, or thinking about my childhood, I start to ruminate, which is something that I do, about was I appreciative enough?

I called my mom one time, and I know I really confused her, I called her and said, “I don’t know what life you wanted, but if this wasn’t it, I’m sorry that you didn’t get to have it.” Almost kind of saying that like it was my fault, or that I got in the way.

Mark: I think the context of that phone call probably is based in something really, really important for you and your mom. So it might be best to really think about how to communicate that, how to really talk it through with her, because like you said, maybe you surprised her with this particular phone call, but there’s something there that’s really important for you and your mom to understand.

And maybe there’s an opportunity for you to stop, really think through what you are trying to say to her, which I think is part, “Thank you so much,” but also part, “What could’ve been different for us? We’re still alive, we still have this chance to be together. What could’ve been different for us that we could make better now?” I think that’s really important. We don’t want to lose sight of that.

There’re so many years that go by and that’s where the traditions come from. And most of the time there’re really beautiful memories that we all want to hold on to, and we want the perfect holidays, but maybe the perfect holidays are the ones where you stop, understand each other’s perspective, maybe even think about new traditions or at least open conversations about what were some things that we might have done differently. What could’ve been healthier? What could’ve been better? I want to communicate in a better way.

Trevor: Oh my gosh, I’m getting nervous about Thanksgiving. I was looking forward and now my anxiety... thank you.

Mark: So holidays, oh my gosh, my face lights up too. We should get excited for the holidays. It’s a fun time, it’s a happy time.

Trevor: Okay, what makes your face light up? Is it the colors? Is it the lights? Is it the music?

Mark: It’s a little bit of everything, but I suppose it’s family, it’s opportunities to be together. I think that first and foremost it’s that, it’s time to be able to dedicate to being around those that we love.

Trevor: I have to say, as a visual person, removing the context of Christmas or the holidays, it does seem really surreal when all these lights go up, and fake snow gets sprayed, and tinsel.

For people that can afford to do it or want to do it, every year our inner artist comes out and we decorate. And I know we do that for Halloween and other holidays or traditions, but there is something nice about... and I know people complain that it’s a tourist trap, but there is something nice about going to 30 Rockefeller Center just to look at a big tree.

Mark: Right. Right. I think I’ve got my own theory on some of the lights and the music, and all of what happens around this season.

Trevor: Oh no, you’re not going to hurt —

Mark: No, I’m not, but I think that there’s something that may be interesting to the conversation, that didn’t happen that long ago in terms of the calendar. And when we have daylight savings —

Trevor: Yeah, I know exactly where you’re going with this.

Mark: See? I’m telling you. Seasonal affective disorder is real, and we all feel it at some level.

Trevor: That’s why I moved to San Diego for two years. I convinced myself that I was fed up with Boston. I’m sorry I said that, Boston. I really am. I love you. I love you and all your wacky ways. I really do. But the blizzard of 2015, mentally, emotionally demolished me, and I had to go. I came back because I did not like it, but yeah, seasonal effective disorder?

Mark: Seasonal affective disorder —

Trevor: Affective.

Mark: The acronym is SAD, S-A-D.

Trevor: It’s a thing, folks. It really is.

Mark: Yeah. And even for those who are not predisposed to getting depressed, you can feel what it’s like to have it get darker earlier. In everyday conversations people are talking about, “Oh my gosh, it got dark at four o’clock. How did this happen?”

Trevor: People that go to work in the dark and come home in the dark, to me, that is a health issue.

Mark: Yes. Absolutely.

Trevor: They go to a job that doesn’t have any windows, and all the vitamin D in the world’s really not going to help this psychological effect of that.

Mark: Right. So around the corner come the holidays, and I think, as a society in some ways we say, “Okay, here come the holidays, here comes winter solstice, the days are going to get longer after that.” So I think we’re all holding on saying, “Okay, let’s move into the holidays because there’re going to be lights, there’s going to be music, there’s going to be family,” and that helps us to be able to move into that next phase of the calendar. I think that —

Trevor: Not for me.

Mark: No? —

Trevor: The second New Year’s is over —

Mark: January, February —

Trevor: ... I’m like, three months of this crap?

Mark: Right —

Trevor: I mean, I’m not making a joke. That’s where I dive.

Mark: Sometimes we make comments about making sure that there are plenty of things to plan ahead for. Sometimes the holiday get-togethers that are in January and February are much more fun, much more effective in terms of bringing as many people as you want to show up, and having a postponed holiday get-together at the end of January has been something that I’ve enjoyed doing.

Yes, we try to encourage people to look at things that are going to be after the holidays too, because you’re right, that stretch from January through March, that is a difficult time around New England.

Trevor: So what you’re saying is my regular habit during the months of January, February, March, my regular habit of just going home and getting in my pajamas, and playing video games non stop, and smoking medical marijuana is probably not the healthiest thing to do, even though it feels so good.

Mark: Right. Probably not. I don’t think you’re doing yourself any favors. You are probably making matters worse when it comes to your mood.

Trevor: But it’s so cold out.

Mark: Yes, you’re right. It’s dark, it’s cold, but that doesn’t mean that you have to be an absolute shut-in. Isolation is not going to be good for anybody, particularly those that may be predisposed to some mood disorder.

Trevor: What happens is that I get caught in a rut. I’m just too damn tired to do anything but this, just to sit here with my cat on my lap, and let the minutes tick away. I’m just too exhausted, probably because I’m not up and getting my blood moving, getting my heart rate going, and it’s just a vicious circle.

And people say, “Well, you just got to get up once and get out the door,” and my God they make it sound so easy. And maybe that speech works with somebody who’s going through a period where they’re not feeling very motivated, but when you suffer from depression, when you suffer from depression, and you’re stuck inside, it’s hard just to get up and go to the other room to get something.

Do you know how many times I’ve sat there holding that painful need to go and urinate? Just because I just don’t want to stand up. I’m fine right where I am. And I’m not fine. I’m sad.

Mark: What do you remember as some of the things that would help you to get up? Were there ever —

Trevor: We talked about this in previous episodes, so I won’t get into it, but getting a cat helped me because I have to get up and feed that cat, and clean the litter box, or the cat is going to get sick, or go hungry, or even worse, die. So the cat helps with that.

Mark: Absolutely.

Trevor: And then once I’m up, maybe that will motivate me to go and take my meds, and have my cup of tea, and maybe that will... it usually means I’m going over to my desk, and I’m getting sucked into my usual passive routine. But maybe I recognize the need where I’m like, “No, I really do need to go grocery shopping today because there’s nothing left,” and just getting outside might help.

Mark: Right. So you’re somebody who does respond to that external motivator. A pet has been —

Trevor: Not always, I do —

Mark: ... particularly helpful to you. But that is —

Trevor: In the last couple years yes —

Mark: ... at least one example. And perhaps, perhaps there are some other outside motivators that you have considered over the time that you’ve had these episodes of depression. We do try to encourage that. We do, we think about outside motivators that might help people provide some structure to their day so that there’s a reason to get up and get out.

The Partial Hospital Program, down at McLean SouthEast, has been a place where a lot of patients with depression and other mood disorders have found not only the content of the program, but just the idea of getting up and having someplace to go has been the beginning of a period of recovery for them.

So if you take that type of a model and think about somebody who is depressed, who may do well responding to something external, volunteering, anything outside of the home, to help make sure that there’s some type of structure to the day, someplace to go where you feel like you... where you’re needed, you have a responsibility.

Trevor: Do you find that in the inpatient program, just patients coming in to a new environment, not specifically in an environment that’s designed to help them, but just a change of scenery is enough to maybe give them more motivation to move around? Because sometimes just being in another room that is not one that I’m paying rent for is enough.

Mark: Absolutely, Trevor. In fact, sometimes we’ll even encourage people, “Move your furniture around.” If you’re just going to stay in one room, at least move some furniture around. Let’s change the pictures, let’s do something to stimulate some change.

Trevor: I found, not napping, but actually sleeping in another room.

Mark: Yes. Yes.

Trevor: Just, I’m not going to sleep in my bed tonight because if I sleep in my bed that means it’s going to be the same habit of me watching Netflix on my phone, or playing my Nintendo... now video games, you can have them in bed with you. I mean, there’s no escape. There’s no escape. And now, I have to shake that and, “Go to the couch, Trevor, go to the couch. Don’t take your phone. Bring a pillow, lay down.”

Mark: Sometimes it is that bad isn’t it, Trevor? Where the depression is so strong that you can’t even get out of the home, you can’t even get out of the room. And we will start there and feel like just what you’re saying, let do something different. If you feel like all you can do right now is sleep, well then let’s at least shake that up and sleep someplace else.

Trevor: Gosh, I’m not trying to contradict you, and I know you’ve encountered people that have felt this, but when it’s at its absolute worse, you feel dead, or what I imagine death to be. And I’m sorry I said that in kind of a dramatic voice, but it’s kind of scary to say. You just feel dead inside.

And this need for, if you’re suddenly hungry or tired, these are things that I’m so sad sometimes I don’t even pay attention to because I’m dead inside. So what is getting up and going into the kitchen and just having some rice cakes with some peanut butter or an apple? What’s that going to do?

Mark: Right. Right. And you’re right, Trevor, the symptoms that we’re talking about, that’s severe depression, and that is a severe episode of depression that really requires professional help. So you’re right, our conversation is a good one. We’re talking about even the slightest of things that could help, but we also have to consider the need for some professional assistance too.

So the level of depression that we’re talking about is so significant, is so, so intense that it’s important to know that resources are available. So a partial hospital program, a place with good mental health professionals to be able to provide structure, but also very important treatment, psychopharmacology, really intense care for a week or two, can be very helpful when we’re talking about those levels of depression, with those types of symptoms.

Trevor: As a patient here in the Partial Program at the Belmont campus, twice, and the first time I went in, I went in during Christmas. So I think I did two days, and then there was a break for the holiday, and then I had to come back, and my gosh that was weird. That was weird, two days of being on a track of digging myself out of real extreme depression, and now take a day off and spend it with your folks.

Mark: This is interesting to me, Trevor. I’m always on the other side, running a partial hospital program down at the Middleborough campus. This is really interesting for me to hear you say that, because we often think about that, what is it like? What is the patient’s experience when all of a sudden there’s a break in the treatment and everybody, including the staff, are expected to just, “Okay, let’s go have a holiday and then come back.”

Trevor: I do, I have to say, the day before break... I’m not criticizing, I’m not saying that maybe they made it too obvious. I think it’s necessary to make it that obvious, but on the day before break, the partial program definitely broke away from its normal schedule, to really emphasize how are you going to handle the next two days?

Mark: Yes, good.

Trevor: And it was a lot of help. It was also kind of scary too, because it was so much of a concern of the staff, therefore their concern became my concern. It’s like I’m nervous enough about being in this hospital, now...

Mark: This whole team is dedicated the whole day to me, and me figuring out how to do the holidays. Yeah. But obviously it’s important. We try to be in the context of what’s going on with the patients, so we will do the same thing at McLean SouthEast, where there will be a lot of time dedicated to making sure that we’re talking about holiday plans, where are your supports, how would you handle a difficult conversation, or a difficult confrontation if it was to come up.

So a lot of that became very individualized for patients, but it’s always so well worth it because it’s not just about that holiday, although it’s intensified by the holiday. These are communication styles, these are coping techniques, these are things that people need to be able to practice all the time, throughout the year. They are intensified at the holidays for sure, but it’s nice to be able to take that time and really personalize it for the patients as they prepare for some potentially difficult interactions.

Trevor: Are you nervous about the holidays? I know you love them, but is there anything you’re nervous about?

Mark: No. No. I guess my honest answer is no —

Trevor: Oh my gosh, are you the spirit animal that I want to aspire to be?

Mark: Thanks for the compliment.

Trevor: And I meant it too.

Mark: I guess —

Trevor: I guess before we go on, I’m going to just take a sidebar real quick, and this is not meant as an insult. I’m just really surprised NPR hasn’t poached you yet, because you have the NPR voice. If you ever leave this place, just show up at their doorstep and just say, “I’m here,” in your soft very soothing voice, and they’ll be like, “You’re hired.”

Mark: I think it’s the new studio, Trevor.

Trevor: Yeah, is that it? Is that it? I don’t know. Terry Gross, you’d better watch out.

Mark: Well, Trevor, in my job there’re so many things that happen. I pride myself on expecting the unexpected and being able to stay steady. So my role in acute —

Trevor: But what about when you can’t stay steady, Mark? You’re a human.

Mark: I’m human for sure, but I’m the luckiest man in the world. I have a fantastic team at McLean SouthEast. I work with the best coworkers anybody could have. And then outside of work I’m blessed. I’m blessed. I’ve got family, I’ve got friends, I have my health, which is just increasingly more and more important to me.

So I’m blessed. I’m a very, very lucky man, and my job could be one of the best jobs out there because I have this chance to be able to stay steady in a place where there’re so many people that need us to be steady.

Trevor: Do you find that there’re some patients that just simply don’t like you because you’re so blessed?

Mark: Sure. Yes. They find that I —

Trevor: I’m not saying... I mean, they just simply don’t like you.

Mark: There have been times that they feel as though I can’t relate to them, but over time I think there gains a mutual respect between us.

Trevor: I mean, I still do believe that a lot of doctors, for the most part, can’t completely understand what I and a lot of us are going through. That said, what I realized in the long run is that that doesn’t matter. What does matter is, and this took me a long time to accept, is that you guys really do care.

And that ultimately, whether you understand or not, that still matters, but it doesn’t need to matter in this professional and patient relationship. Just that you care and that you want to see me get better is all that matters to me now.

Mark: Well, thank you. I think that’s very important to us as well, Trevor. And we talk about the importance of what we call person-centered care. In person-centered care you must know the person. That’s what it’s all about, is being able to take the time, listen. It’s not about coming to a quick diagnosis, it’s certainly not coming to a quick billable code. This is about getting to know someone and being able to understand the symptoms.

And what I like to do is try to find a way to use the patient’s assets to be helpful to them. For a long time, we’ve dealt with a medical model that says, “What’s your problem?” And now I think with a lot of positive psychology that has been around for 15 or 20 years now, we’re really looking at the person, the whole person, and what that individual can use to help them through difficult times.

It’s really been very fulfilling and very rewarding, and over time it’s allowed me to understand the importance of stopping and really listening, active listening, taking care of what it means to have person-centered treatment.

Trevor: This is going to be an odd question. I’m putting you on the spot, but it’s leading to something.

Mark: Sure.

Trevor: Do you drink?

Mark: I drink very occasionally.

Trevor: There are a lot of people that drink too much. I used to drink too much. It is difficult to watch during a period of time that is a celebration of family and giving, but it’s also very stressful, the amount of alcohol that is advertised, with a Christmas angle, at a time where all this stress does is create the need to imbibe more.

I mean, what is New Year’s Eve than just getting demolished for the most part? Not for everybody, but let’s be honest, for the most part. At midnight, you clink your glass, drink and kiss, and then you kiss somebody. What is this?

Mark: Right, right. All of the pictures, all of the symbols, everything that represents the holidays, yeah, you’re always seeing some type of a wine glass, or champagne. Yes, it is —

Trevor: And folks, I’m not saying there’s anything wrong with alcohol. What I’m saying is that this is a very stressful time, there are a lot of people that struggle with alcohol, and the way that alcohol is advertised, especially during the holiday season, as a necessary element for the family table. Come on.

Mark: Right. Difficult to avoid, that’s for sure, but moderation needs to be a key. We need to remind everybody that, okay, sure, there’s going to be alcohol at most of the settings that we’re at, however moderation is so important.

Now, those that have problematic drinking, or problematic substance abuse, this is a very, very risky time. So we have —

Trevor: Especially when the thing that you’re struggling with is being advertised as something that it’s safe to welcome into your home, with your family no less.

Mark: Right. So those are difficult choices to make.

Trevor: And then to be okay, they add a little line at the end, “Drive safe.” Screw you.

Mark: Yeah, “Drink responsible.”

Trevor: Yeah, “Drink responsible.” Shut up.

Mark: Right. Those are difficult decisions to make, and those that are in recovery and making those difficult choices, sometimes that choice will be, “I’m sorry, I can’t make it to the holiday gathering this year.”

Trevor: You know, Mark, we’ve been talking for an hour, and we’re going to wrap up, but what I’m hearing from you is that this time of the year requires a lot of discipline and self-responsibility. I’m just too tired and sad for that right now. Come on, Mark, isn’t there an easier way? Come on —

Mark: Chin up, Trevor —

Trevor: Come on. There’s got to be an easier way.

Mark: What’s wrong with being disciplined and responsible?

Trevor: Nothing.

Mark: Is that another topic?

Trevor: Yes. Yes, you want to come back and talk about that? I’ll talk about that all day. How hard it is to fight through your depression, just so I can take 15 minutes to balance my finances and Quicken, so I know where I stand.

Because the other day, I hadn’t balanced my finances in maybe a week and a half, and when I need money I pull it out of savings and stick it into checking, but with my debit card it automatically comes out with checking, and because of that I had no idea what was left in my checking, and I was this close to buying groceries and getting hit with a $25 fine. And because I just don’t want to be bothered, because the effort.

And I understand viewers... listeners, I’m sorry. I understand listeners, that to some of you I may sound like a brat, but I talked to other people that are depressed, and they know exactly what I’m talking about. It just feels like a 500 pound weight is weighing you down, and the only place you can get any relief is in a bed or a chair, where you just don’t move for the next eight hours.

Mark: Yeah. I understand that, and I have not experienced it myself, Trevor, but I have worked with plenty of people who describe it that way. It’s so intense.

Trevor: It’s really intense.

Mark: The ability to get through something like that must start somewhere. So if it means that just the slightest of things that you can do differently will allow you to do the next thing, it’s worth it, because shutting down, isolating... the holidays are difficult enough, but I think we can make it better or worse by a lot of the decisions that we make.

So yes, I’m here to try to look at the side of it that allows for people to feel like this is more of an opportunity than it is a threat, and here are some of the things that you can do to make sure that you try your best to enjoy these holidays. That’s what they’re there for, it’s an opportunity to maybe do something a little different this year.

It’s an opportunity to not allow yourself to shut in, to isolate, to spend those eight hours. Maybe it’s less time on the chair, maybe it’s less time in the room, but finding those external motivators to keep yourself going, and to find a new way to communicate something to your mom that you’ve wanted to communicate to her for a long time.

Trevor: I think we’re going to wrap up here. Is there anything you want to add?

Mark: No. I appreciate the opportunity.

Trevor: There will be more. I’m bringing you back. The happy man versus the depressed man. It’s going to be Rocky Four up in here.

Mark: That sounds good. I would welcome that, Trevor. I would welcome it.

Trevor: Mark, thank you very much for coming.

Mark: You’re welcome. Thank you.

Trevor: All right. How are you feeling? Are you in your Zen place? Feeling chill? Feeling calm? I hope so. Mark’s good at that. What about the holidays? Feeling less stress? Feeling like you can take it? It’s a lot. Holidays are a lot. They are. And it’s not just for those that are suffering from mental illness. Holidays are hard for everyone.

And I’m not saying it’s there yet. I find it to still be a very emotional, very happy time to share with family and friends, but man, it seems like it’s getting crazier and crazier every year. I don’t know. Little worried.

No, now hold on. I’m not worried. I’m not worried. I don’t want to leave anyone on a worried note. Not worried. Everything’s going to be great. I’m going to take my worry, I’m going to let the emotion just slide off of me, non-stick pan, going to do it. Let it just slide away. Okay, I feel better now. Actually I do feel better, I’m not lying. I feel a little better. Hopefully you do too. We’ll be back in two weeks. Hopefully we’ll see you all then.

Thank you for listening to Mindful Things, the official podcast of McLean Hospital. If you have any suggestions for special topics or future guests, please email us at podcast@deconstructingstigma.org.

And don’t forget, mental health is everyone’s responsibility. If you or a loved one are in crisis, The Samaritans are available 24 hours a day at 877.870.4673. Again, that’s 877.870.4673.

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The McLean Hospital podcast Mindful Things is intended to provide general information and to help listeners learn about mental health, educational opportunities, and research initiatives. This podcast is not an attempt to practice medicine or to provide specific medical advice.

© 2019 McLean Hospital. All Rights Reserved.

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