 And joining us now to talk about your health is Dr. Jill Rockbizel, Chief of Psychiatry at the University of Maryland Medical Center and Chair of the Psychiatry Department at the University of Maryland School of Medicine. Dr, it's great to see you again. Happy holidays. Thank you. So let's talk about the holiday season. A lot of cross currents, what do you see in your practice at this time of the year? Well, what we see either in my practice or just in the community is that not everyone finds the holidays joyful. People struggle sometimes at this time of year for lots of different reasons, including suffering with memories of loss of people they used to celebrate with, reminders perhaps of negative memories from their childhood. Not everybody has a wonderful childhood. You know, holidays are about often traditions. And if you if you weren't raised with traditions, you don't have them to recall. There's also, you know, people now, the holidays are a reminder of what people don't have. Homes, families, friends, jobs. So it's not always a fun time. I think the other thing that really kind of gets in people's way is unrealistic expectations and the stress of thinking everything has to be a particular way. And all those tensions can worsen or create various kinds of mental health issues. Right. People often find themselves so stressed out, they start to feel sad. They start to feel anxious. And it gets in their way of enjoying what they can do. It's important, though, to note that feeling sad or anxious or depressed around the holidays doesn't mean you have a mental illness. It's not a mental illness condition, but it is a reaction to stress and grief and disappointment. Although people with mental illness symptoms sometimes find their symptoms worse than around this time for the very same reasons. You know, the one problem that many people have, seasonal affective disorder, if for no other reason the end of December ought to be a holiday for that, just because the winter solstice is the time of the year when the days stop getting shorter and we start seeing more daylight and spring is just around the corner. You know, that's a great example of looking at something a little differently. Sometimes we have expectations that are unrealistic, but you just gave a great example of how to look at something differently. We call that thought redirecting, finding a different way to think about something to help you get through a time that typically is difficult to tolerate. Well, let's talk about some of the specific concerns. It has to be the loneliest time of the year for somebody who for whatever reason doesn't have anybody and it's Christmas day and your expectations have been set a million years ago by Bing Crosby songs and you're sitting around, even if you're the most level-headed person in the world, that's a downer. Absolutely. And the first step is be in touch with how you're feeling and get a sense of why. What am I responding to here? And then clarify what's important to you. So this is a day you don't have a lot of friends around, you don't have what this wonderful fantasy should be, but what is important to you and what you want it to be? Can you identify one or one person in your life you'd like to talk to, pick up the phone and call them? Identify ways that make yourself feel better. Watch a favorite movie. Make a favorite food. Maybe go to a favorite restaurant on Christmas day. Exercise. Make sure you get some exercise. Go for a walk. Enjoy the beautiful outdoors. You have to make it different. If you sit around and think, gee, I don't have what everyone else has, that doesn't really help. Let's talk about the family dynamics a little bit. If there are tensions within a family and everybody is going to be cramped up, cooped up inside, have a long dinner, sitting around watching football, a lot of opportunities for maybe some historic disagreements to resurface. How do you deal with that situation short of storming out to go take a walk or something? That's also another great phenomenon that happens. Families, the children are raised and fly the coop and become independent people. But when they get back to holidays, everyone assumes their old roles and there can be a lot of conflict. I think what's again really important, be in touch with how you are feeling and what is important to you. Don't feel pressured to get involved in things that aren't important to you or that make you feel bad. Maybe you have dinner but stay for a very brief period of time and have other things planned for you to do. You don't have to stay in the middle of something that feels really bad. Don't over commit yourself. Don't commit to doing things that you don't want to do. It's okay. Other people might be a little disappointed that you don't show up everywhere that they expect you to be or participate in everything you want them to participate in. But that doesn't matter. You have to really put yourself first and call the shots yourself. A lot of drinking goes on. I wanted to ask you about the holidays from a substance abuse standpoint. There's going to be beer. There's going to be wine at dinner maybe. For somebody who's struggling with that, is it an especially difficult period? Absolutely. There's a lot of expectations that people are going to have holiday parties. There's going to be open bars and food. You forgot the spiked eggnog, by the way. There's all kinds of imbibing that goes on. There's lots of drug use as well. People that have addiction problem or substance use disorder, they know around the holidays that they are vulnerable. An individual has to understand their triggers. Being around other people that are heavily using is a bad place to be and you just don't go there. You have to say no when it's not the right thing for you. You identify the people and the places and the things that have triggered you to overusing and you make other plans. You have to stay away from them. Your own self-awareness of what you can do and what you can't do is the most important thing in managing that. Yeah. One rule if I could offer a thought is you never drink at the office holiday party. I could tell you some stories from a previous place of employment, but you definitely want to have all of your faculties with you in those situations. So what are some strategies to avoid substance use or abuse at a time of elevated stress? In these days, we're not just talking alcohol. Even on a legal basis, marijuana is all over the place. Absolutely. And that marijuana is often very spiked with things you don't know are there. So it's dangerous. I think that the answer to something like this is to you determine what your traditions are going to be for you and you develop plans that are going to work for you. So again, you don't get pulled in to going to parties or being in places that you know are unhealthy for you or you know will often lead you to do things that are bad for you. Establish your own traditions. Establish your own ways of doing things. And you know, it's it's just like it's like kind of Thanksgiving. There's this thing friends giving where people can't be with family. So they they create their own traditions. Same thing can apply around the holidays. Here's one. How about your your spending time with either, you know, friends, coworkers, family and divisive topics come up. We were just talking with Senator Van Holland about war in the Middle East. There's a certain candidate for president of the United States who's maybe a little bit polarizing. And you know, somebody in the room is going to have a strong opinion for something. Somebody's going to have a strong opinion against it. How do you dial that down? That's a great question. And I have to tell you that my personal rule for this and my rule in my department is politics and world events don't belong as a topic of conversation because you're always going to find we're such a thankfully a diverse community population of many different kinds of people. You're going to have people on both sides or all sides of the issue and it can create horrible tension, conflict and really get in the way of having camaraderie and collegiality. It's very divisive. In my family, when I have a family dinner, we're not allowed to talk about two things religion and politics off the table. That's an old rule, isn't it? Yep. It's an old rule and it stands maybe more today than ever because there's just a lot going on in our in our world. You know, for people who are working on on mental health issues, is there another challenge this time of year because your therapist may be on vacation? I mean, does it mess up therapy schedules and other appointments? Does it mess up? You know, it's like anything in life. Things come up unexpectedly and you have to cope with it. It's sort of like you could grieve. It's sort of like a grieving process where you're used to something and all of a sudden it's not there and you have to adapt and that could be a therapy session. It could be a loved one. It could be just about anything. So being in touch again with your feelings, acknowledging what it is that you're missing and then redirecting your thoughts to what can I do instead? What can I do that's healthy? What did I would have I learned even if it's a therapy session or a lost loved one? What did they bring to me and how can I use that now, you know, to make myself feel better? How could I celebrate it this time even without that thing I'm dependent on? I know I'm speaking a little vaguely, but it really is in the individual because in the individual's head a way of rethinking how they're going to manage their time in that moment. You know I didn't bring up the loss of loved ones. It felt very strongly this time of year if somebody has passed on in the last year. Your thought is to reframe it as an opportunity to think about great times and think about that person. Yes, I mean again you have to acknowledge their loss and the pain that you're feeling, but then to try to redirect your thinking to what did they give me? What did they bring to the world? What did they value? And what is it that I'm missing and how do I recreate that? How do I celebrate their life? And so I know in my family what some of the things we do is we have favorite parts of the meal that came from my grandmother that were part of my mother's recipes and we make them in celebration of them and it is a great joy to maintain some of that sameness. So it really is, yes, redirecting your thinking and what do you hold in your heart for that person that is missing? Before we go, give me in just a paragraph or so what you would tell your patients this time of year? A little piece of advice that would work for everybody in your group. The first thing I tell my patients or my children, my family is check your expectations. Don't get carried away or dragged into things that aren't important to you and try not to get too caught up in all the commercialism. Think about what is important to you about the holidays. Is it the people that you're with or is it the things that you get? Really do some reflection on what is important and then focus on making those things happen. Don't over commit and take care of yourself. Very good Dr. Joe Rockbeisel, Chief of Psychiatry at the University of Maryland Medical Center. Dr. Happy Holidays, thank you so much for your time. Thank you so much for having me. Your health segments are a co-production of Maryland Public Television and the University of Maryland Medical System.