For people living with mental illness, the holidays can be extra challenging

Jennifer Wilson is a novelist, a poet and a mother of 13, so the holidays have always been a busy time of year. Wilson also has bipolar disorder, which is why the season can be a challenging one, too.

“I really do love the holidays, honestly,” Wilson, 50, told ABC News. “But if you’re depressed around them, you’re trying to put on the happy face for your kids and trying to decorate when you don’t feel the least bit like it. It’s like why am I doing this? I don’t want to hang this holly and make merry, I’m miserable.”

Wilson isn’t alone. About 50 percent of Americans will be diagnosed with a mental illness or disorder in their lifetime, according to the Centers for Disease Control and Prevention (CDC), and one in 25 people lives with a serious mental illness, such as bipolar disorder, schizophrenia or major depression. A 2014 survey by the National Alliance on Mental Illness (NAMI) found that 64 percent of people with mental illness reported that the holidays make their conditions worse.

The holidays can be stressful for people from all walks of life; the pressure to spend money, drink, eat, socialize and make it all look perfect can be tough. For people who have lost family members or are estranged from their families, what is missing from the holiday can feel overwhelming as well. Even those who are not struggling with mental illness can still experience the so-called “holiday blues,” which is why prioritizing mental well-being is crucial for everyone.

“Regardless if someone is dealing with a current mental health concern or given diagnosis, we can all be subject to psychological stress around the holiday season,” Dr. Shainna Ali, a Florida-based mental health clinician, educator, and advocate, told ABC News. “If someone already has a diagnosis, it can be exacerbated or triggered more, but you don’t need a diagnosis to be dealing with what has been dubbed the ‘holiday blues.'”

So how can we best take care of ourselves and support our loved ones during the holidays? Here are some tips.

Manage expectations

For many, the holidays bring the pressure to spend money you don’t have and attend events you don’t want to. Be realistic about what you can and can’t afford and who you really want to spend time with. Prioritize taking care of yourself.

“The trick is managing our expectations. It’s okay to have a high bar but it’s not helpful to think in all-or-nothing, black-and-white terms. Terms like: ‘If I’m not perfect, I’m a loser,’ or ‘If I score only a 98 percent, I’m a failure,'” writes David Pezenik, a counselor and co-founder of Google’s therapy program.

“So when you sense yourself going down that road — pause. Evaluate your own yardstick, without using it against yourself as a weapon. This time of year, it’s easy to measure ourselves against our social media peers, or against our own highest expectations, then exact harsh judgment inward,” he added.

Pull back when you need to

The holidays can pose a particular challenge for people with bipolar disorder, who experience both periods of depression and mania, which can be triggered by big events. Alcohol and overstimulation can make symptoms worse, and the frantic pace of the holidays can make remembering to take medication or make appointments to see healthcare providers harder.

For Wilson, managing her illness means knowing when to prioritize taking care of herself, which can be tough as the mother of six boys, six girls and one agender — or gender-neutral — child. The entire group ranges in age from 8 to 31.

“If you continue to put everyone before yourself and you’re rock bottom, you’re not even on the list, you’re not even 10th, you’re just nowhere, that is a surefire way to burn out and be useless to everyone,” Wilson said. “It’s very hard to extend grace and patience with yourself and hope others will do the same. I think I have learned mostly that my children are better off seeing me take time for myself and seeing me get help.”

If you have a loved one with mental illness, make sure they know you won’t judge them for needing to duck into another room to take a break or leaving early.

“Give them a place to be and don’t expect them to stay long, and try not to take it personally,” Wilson advised.

The National Alliance on Mental Illness has more information about how to support loved ones dealing with different kinds of conditions.

Reach out

If you know someone who lives with mental illness, send them a text to let them know you’re thinking about them at the holidays.

“It can be difficult because you don’t want them to be lonely, you don’t want them to think they’re not being thought of, but you also don’t want to pressure them to attend a party or a function that they aren’t up to,” Wilson said. “But I would definitely encourage people to reach out. Just send a text, say, ‘We’re having a get-together if you want to come over, no pressure. You’re welcome.’ Or maybe set up a time for a one-on-one rather than a large party.”

“It’s hard to reach out and not feel like you’re pestering them, but just to be available to them, I think, is the most important thing,” she added.

Ali said that for some people, being together at the holidays helps mitigate feelings of isolation and loneliness. Helping those in need can be a way to reach out and feel good, too.

“There are a lot of aspects of the holiday season — people being grateful, volunteer work, charity — that can be therapeutic as well,” Ali said.

Monitor your moods

If you’re dealing with mental illness or the holiday blues, consider tracking your emotions in a journal to help you make sense of your feelings and know when it’s time to reach out for help, Wilson suggests.

“If you overload yourself and you have so much going on, it’s very easy to forget to monitor your moods, which I highly recommend anyone with a mental illness to do,” Wilson said. “Just to take a journal and every day, kind of rate from one to 10 how you’re feeling and take stock internally, and that way you can kind of have a chart, a graph, of where it’s headed. Is it slowly going up? Is it slowly going down? You have a baseline, so that if it crosses up or down, you maybe need to think about getting your medication checked or seeing someone.”

Know the warning signs

While it’s a myth that suicides increase around the holidays, according to the CDC, it’s important to know the warning signs in yourself and others. The National Suicide Prevention Lifeline has more information about risk factors and warning signs.

Because the holidays might be the only time you see some family members or friends all year, it’s important to pay attention to signs they might not be doing well.

“If someone is not showing up, first of all, and you’re worried that might be out of character for them, just do a little wellness check-in, a text or phone call reaching out to make sure they’re ok,” Ali said. “Or if a person does show up, but they’re acting really out of character, you may notice that shift in mood. If someone is normally very happy and they’re not showing that, that could be a sign as well.”

Continue the conversation after the holidays have passed.

“It shouldn’t be that we’re only checking in with our loved ones during these holidays. We should be checking in with our loved ones throughout the year,” Ali said. “It’s not just meeting someone for Christmas dinner, checking in with them, trying to convey that support and then forgetting that from Jan. 1.”

Help end the stigma

Wilson, who blogs about what it is like to have bipolar disorder on her site, Crazy Real, isn’t afraid to talk about the tough realities of mental illness. But it wasn’t always that way.

“Like so many people, there was a stigma in my mind about mental illness, and a desire to simply overcome it, to just try to get it out,” Wilson said. “I had grown up with a fairly typical attitude toward psychiatry and mental illness, that it was somehow a character flaw: you just need to work harder, you just need to read your Bible more or pray more or just do more, volunteer more, and it will cure you. I had all that coming into play. And I just really resisted the notion of any help; I thought it would signify failure in some way.”

“About seven years ago, I had a full-blown mania episode and I wound up in the hospital,” Wilson said. “When I was all burnt down and had a complete meltdown, the diagnosis was such a relief. I was able then to get the help I needed and walk that journey towards more awareness, more wholeness, more healthy attitudes about mental health.”

Ali said that being open about struggles you’ve had over the past year and how you sought help could help another family member open up, too.

“Not seeing it as something that should be kept in a closet or locked away, that is powerful,” Ali said. “If you’re in a well enough place to share that, that can be really influential to model that healthy behavior.”

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