Monday, December 23, 2013

The Holidays

Arlene is feeling better today. She’s just coming out of a bout of depression, a depression that has plagued her throughout her life and about which she has little insight. Since her father was bipolar, she sees her depression as biological, something that comes over her, an external force that descends upon her and torments her. Although I don’t dispute the biological component of her depression, I do encourage her to try and understand the trigger for any given episode which seems to me related to her feelings of anger and guilt. These interpretations make sense to her, but they fade over time, leaving her again feeling like the helpless victim of her “curse.” 

Today, though, her mood has lifted. She feels “better,” describing herself as being in a holiday mood, excited about getting ready for the holidays. Although she feels somewhat overwhelmed by last minute shopping and wrapping for her three children, as well as preparations for Christmas dinner, she feels she can “handle” the stress and is generally upbeat.

“Do lots of people get depressed during the holidays?” she asks.

I’m surprised by the question. She’s not usually interested in people outside of herself or her family. “Some,” I reply. “Why do you ask?”

She ignores my question and perseveres. “What makes them feel depressed?”

I decide to see where this will take us. “Well, some miss their families or remember childhood Christmases or past Christmases that are no longer.” My mood begins to darken, as I remember the large, festive Christmas parties my husband and I used to give. 

“You mean like people who live alone?” she continues.       

Arlene is one of my patients who read my book. She knows I’m a widow. She knows I live alone. Is she needling me? Is she concerned about me? Is she trying to hurt me?

I proceed gingerly. “Yes,” I reply, “Some people who live alone have a hard time.”

“I can see how that would be depressing,” Arlene responds.

“Arlene, are you asking me whether I’m depressed, whether I’m going to be alone for the holidays?”

She’s immediately flustered. “Oh no, I would never get so personal. I would never ask you about your life.”

“But you read my book. Which was fine. I wrote it, you certainly have every right to read it. So you do know quite a bit about me. And now you’re asking these questions about people who are alone and depressed for the holidays. Are you sure you’re not asking about me?”

Arlene squirms in the chair, her eyes shift downward, then turn to look out the window. Silence fills the room. Arlene seems to be floating away. I find myself becoming anxious, concerned that she’s again moving towards feeling depressed.  

“Arlene,” I say, “I’m not your father and you don’t have to be either. He was a disturbed man who moved between very severe depression and flights into mania. When he was depressed he put a pall over your entire household. It was as though no sunshine could get through. I’m not depressed and I’m not going to be alone for Christmas. And you don’t have to be depressed either. But I think it would be helpful if we could look at why you started to drift towards depression when I asked you to consider whether you were asking about me.”

“You know,” she says, “I didn’t even know I was getting a little depressed right then, but you’re right, I was. I guess I felt I had done something wrong, that you were mad at me for asking questions about you that I shouldn’t be asking.”

“So you’re saying that you felt guilty?” I ask.

“Yes. As always.”

“I won’t dispute that you felt guilty, Arlene, but I also wonder if you felt angry with me, angry that you were being concerned about me, and that I was cross-examining you about your motives.”

“I wouldn’t say I felt angry at you. Maybe a little annoyed.”

I smile. “Anger is a difficult emotion for you. It was hard for you to feel angry at your father, hard to feel angry with me, hard to feel angry with pretty much everyone. But I’ll accept that you felt annoyed, as long as you try to recognize that annoyance and accept it without having to turn it against yourself and end up feeling depressed.”

“I’ll try,” Arlene says.

“Good deal! And have a very happy holiday.”


Susan Miller said...

Nice piece, Linda, and I like the (open, and perceptive) way in which you worked with your patient. Have a happy New Year. Sue Miller

Linda Sherby PH.D., ABPP said...

Thanks, Sue. Good to hear from you. I appreciate your feedback. And a very happy New Year to you as well.