Dr. Daniel Paulson: This is how Care Partners improve mental health this holiday season
The claims made by Christmas crooners fall flat when, instead of happiness and cheer, the season elicits anxiousness and guilt. Approximately 43% of Americans say stress hinders their holiday joy, a 2023 American Psychological Association poll shows.
“The truth is that, for many, this can actually be the most difficult time of year,” wrote National Alliance on Mental Illness (NAMI) chief executive officer Daniel H. Gillison in a 2021 blog post. “In 2014, NAMI found that 64% of people with mental illness say the holidays make their conditions worse. A 2021 survey showed that three in five Americans feel their mental health is negatively impacted by the holidays.”
Care Partnership’s unique challenges can further compound or complicate these heavier feelings.
“There’s often a tension between the obligation of family tradition and the practical concerns of getting through the day,” says Dr. Daniel Paulson, a clinical gero-psychologist and ADRC board member. “And when we start violating family traditions, or when we start neglecting family traditions, then, often people beat themselves up for that.”
But when we are intentional about how we approach this potentially emotionally-charged landscape — prioritizing connection and making space for grief — we can navigate the complexity in a way that supports our mental health and promotes happiness.
“The family traditions did not exist to make people feel badly, but rather to make people well and connected,” Paulson says.
“So if we find other ways to make people feel connected,” he adds. “That are special and different and noteworthy, but don’t make our lives impossible, then we can make the most of the season, even if it does mean accommodating the changing of others.”
That accommodation might mean softening our tight grip on tradition, and making choices that instead honor how we’d like to feel when the evening concludes.
It might mean being diligent about practicing self-care so we avoid burn-out.
“Guilt is a very common response when people start doing that,” says Paulson, who is an associate professor at the University of Central Florida. “We are not going out for fun or our own welfare (so much) as we are so that we can maintain that role.”
Ultimately, social connection is the goal – regardless of how different that might look – for both Care Partners and the people navigating dementia-related brain changes.
“In the same way that the caregiver needs to remain socially connected in order to feel well in that role, the same is true for the person with the disease,” Paulson says. “The social part of our task as caregivers is to be creative in finding ways to connect that loved one with their own social identity and make sure that the basic needs that we all have as human beings are met in whatever way they can be.”
A Care Partner might create, for instance, a scrapbook with her person. She might record stories that illustrate what is happening in a photograph, or write a biography, asking questions that promote conversation and reminiscence.
“A lot is being written about music therapy,” Paulson says. “It’s a chance to sit down and have a shared experience of listening to the songs, reliving and remembering that part of their lives. It can be very validating and feel very wholesome.”
And, while our adaptations might mean fewer visitors this year, there is one particular party-crasher who, despite dropping in without our express permission, should be tenderly tended: grief.
“Dementia caregiving often involves a dramatically-revised relationship with a loved one. Anytime our social network changes like that, we feel grief,” Paulson says. “There are two basic parts to grief. Grief is a process meaning that when grief is finished as a process, we are better adapted to our changed world, and that means crying the tears, feeling the feelings, memorializing the dead.”
“And also, there’s a restoration-oriented piece of grief that involves learning new skills, new roles in relationships, and exploring new relationships altogether,” he adds. “Through grief we become different people.”
Paulson notes that people often resist feeling difficult emotions because they think once the tears start, they will never stop, rendering them incapable of completing their other tasks.
“The ironic twist here is that… as we try to bottle those grief-stricken feelings, we become less effective,” he says.
He says that we can express our mourning in ways that feel contained.
One method he suggests is writing a letter to our person that we will never give them.
“It’s a very powerful way to organize your thoughts and your feelings and get them expressed,” Paulson says. “It’s not about the other person hearing it. It’s the process of saying it.”
This process is beneficial regardless of whether you are a current Care Partner, or you are mourning your person’s passing.
Gillison also suggested in his blog that people who are grieving a death can benefit from what he called “a personal remembrance ritual.”
“For me, every Christmas, I try to find a quiet space where I can listen to the song that was playing when my mom died,” he wrote. “And even though she is not physically present with me, I spend time talking to her.”
And, if we are experiencing overwhelm, overpowering guilt, signs of burnout — frequent crying spells, difficulty completing manageable tasks — or are otherwise struggling with our role, we may incorporate therapy into our self-care regimen.
Professional support can help families mitigate any conflict that may arise on the dementia voyage, enhancing communication and creating shared goals.
“Grief isn’t a mental health disorder and doesn’t require therapy unless you want it,” Paulson says. “About half of caregivers do not need to ever talk to somebody like me. They can learn from the internet and existing healthcare relationships, and they can take care of everything in an orderly fashion.”
Ultimately, the care that we are offering is a manifestation of love.
“And in doing that, we model that virtue for the children and the grandchildren that may one day care for us,” Paulson says.
And isn’t love what the holidays are ultimately all about?
Dr. Daniel Paulson has served on the board of the Alzheimer’s & Dementia Resource Center for approximately six years, and he has conducted program evaluations during that tenure. His research appears in The Clinical Gerontologist and elsewhere. His work with older adults and their family members also includes memory assessments and sleep-related psychotherapy.