Feelings about Christmas, as Reported by Psychiatric Emergency Patients

Article excerpt

Numerous psychodynamically oriented clinicians have suggested that various symptoms of psychopathology might be activated during Christmas holidays. For example, Eisenbud (1941) attributed the symptoms to the "relaxation on the part of the super ego of society" and clinically interpreted them, in the case of two females, as related to "an intense wish for a penis and the forlorn hope that Santa Claus would magically provide one." Boyer (1955) reported on 17 clinical cases of Christmas depression. After reviewing these clinical writings, Hillard, Holland, and Ramm's (1981) showed that statistical data from the psychiatric emergency room does not support the popular belief that psychopathology is more common at Christmas: their data showed a decrease in psychiatric emergency visits during the Christmas season. Similarly, empirical data with respect to suicides also suggest a decrease rather than increase in rates over the holiday season.

Lester's (1979) study of US suicides from 1973 to 1976 showed that the rates were actually lower in November, December, and January. With respect to major holidays (Christmas, Thanksgiving, Fourth of July, New Years, and Memorial Day), Lester found lower rates that on other weeks. Phillips and Liu (1980) reported a decline in suicide rates on major US holidays. No significant change in suicides rates on holidays was found by Jones and Jones (1977) and also by Zung and Green (1974).

Yet, it is well possible that some individuals with psychiatric deficits may report that the Christmas season generates an increased interpersonal stress, financial stress, as well as intrapsychic tension, perhaps due to the conventional expectations (gifts, participation in extended family festivities, celebration in employment settings, etc.). The present study explores the perceptions of and feelings about Christmas in patients who visited a psychiatric emergency service. These emergency patients may present a uniquely vulnerable segment of the population, during the Christmas holidays, which are usually viewed as a time to relax and enjoy. The goal was to evaluate the patients' feelings and perceptions of Christmas, with a particular focus on the potentially stressful aspects.

METHOD

Seventy-one patients who visited the emergency room for a psychiatric problem from December 1, 1994 to January 13, 1995 were interviewed. Unfortunately, data for 16 of these patients were incomplete or unusable due to factors such as poor cooperation, open refusal, or florid psychotic ideation or confusion, or mutism.

The remaining 55 patients with adequate data included 28 men and 27 women.

Their age ranged from 16 to 83 years, with the mean at 34.4 (SD = 16.8). Fourteen patients were employed, 13 were unemployed, seven lived on disability or social/ family benefits, four were retired, and the occupational status of the remaining 17 patients was not clear.

During the clinical interview, the impressions of the nonverbal and verbal behavior of the patients was recorded along the following standard categories: appearance, speech, affect, suicidal or homicidal ideation, thought form, thought content, perceptual abnormality, judgement, and insight. The dangerousness to self or others was rated on a 5 point scale from 1 (unpredictably impulsive/violent) to 5 (no suicidal/homicidal ideas or behavior and no history of such behaviour). Recorded were also information about substance abuse and also about the social stressors preceding the admission, as reported by the patient.

The patients were asked "How do you feel about Christmas?" and their response was recorded as verbatim as possible. They were also asked "What aspect of Christmas do you feel most stressed by: before, during, after?". They also were provided with a list of 14 items that may be stressful: "What specifically do you find stressful: shopping, financial cost, too many people, or too few people, being with family, being without family, loneliness, alcohol/marijuana use, stores and businesses being closed, food, expectations from others, good or bad memories,

PSYCHIATRIC EMERGENCY AT CHRISTMAS spiritual issues, or others? …