I'm a Psychiatrist and It's OK If You Need a Xanax to Hang Out With Your Mom Over the Holidays

I'm a Psychiatrist and It's OK If You Need a Xanax to Hang Out With Your Mom Over the Holidays

11/18/2021

If seasonal movies are to be believed, a visit home for the holidays can only go one of two ways. In one, you go home and fight with literally every member of your family the entire time. Being home is basically chaos and in returning, you enter a world of judgment and non-stop arguing about everything. You fight about food, politics, and what you are doing with your life. Your only moment of peace is taking your turkey to a separate room to eat alone. Simply thinking about that narrative fills me with dread.

On the other, instead of going home, in part for fear of encountering scenario one, you choose you and go on a beach vacation with your partner or friends — you know, like Reese Witherspoon and Vince Vaughn's characters attempted in Four Christmases. You sip Mai Tais and read trashy novels and spend the whole time relaxing and laughing. There is something magical about the idea of running away to an island for the holidays and ditching familial responsibilities and drama along the way.

The truth is though, our holiday choices and our families aren't so black and white. Sure, sometimes the right choice is to put up the boundary and to not go home at all, and there have been plenty of times as a psychiatrist that I have had that conversation with patients. Other times, you may want to be able to spend time with your family, even if they happen to be problematic, triggering, or even toxic. We can still get nostalgic for family on the holidays even if our families are…well, emotionally draining. Family is family, and particularly in the pandemic many of us have come to appreciate their importance. It is possible to have different opinions and still love them. It is also possible to hate aspects about how they interact with us and still love them.  

You can choose to spend meaningful time with relatives and still prioritize yourself in the process. That does mean, though, that to enjoy your time together and not end up wishing you were on an island or looking up the next flight out, you need to come prepared. 

You should always go home with your eyes wide open. Sure, it would be lovely if all of the sudden this year your dad wouldn't judge how much you ate or your grandmother wouldn't ask you when you were getting married, but people do not all of the sudden change. You can absolutely try to set boundaries ahead of time with family members and discuss how certain topics are off-limits. You may not want to talk to them about food or relationships, or, as my family has learned over time, maybe you don't want to have to watch particularly polarizing news channels in the background together. But you should approach the situation with realism — that these conversations can and probably will come up. You can't control the way other people behave or have behaved for years. You can only control your own reactions.

Knowing that is true, before leaving to go home, you can try to prepare how you might react to various situations. You can even make a list of a few events that are likely to occur (e.g. Uncle Jim will get drunk and say something racist, or your sister will talk about her weight loss), and role-play them or write down some responses so you feel more comfortable saying them in the heat of the moment. You will also typically revert back to old patterns in your family, like say, getting teased as the younger sibling. Knowing this will happen and preparing for it might help you stay calmer or even stop the behaviors when they start.

You also want to know what works for you when you feel triggered since anxiety can make it challenging to think clearly in the moment. For example, deep breathing. I know it feels somewhat ridiculous to think about breathing when anxiety can make it hard to breathe, but if it is something you have practiced, it can definitely help. You can also try other 'grounding techniques,' that take you out of your anxiety and back into the moment and your body. My favorite is naming five things you can see, four things you can touch, three things you can hear, two things you can smell, and one thing you can taste. Another good one for the holidays can just be listing your favorite foods or favorite holiday movies until you feel less activated. Carrying stress-putty or even calming scents like lavender or mint can also be helpful. And while yes, it is tempting to turn to alcohol to cope, keep in mind that disinhibition does you no favors with anger, triggers, and arguments. 

And remember an option that is available to you that maybe felt less accessible as a kid is ending the conversation entirely. No one can force you to talk about things that make you feel unsafe or uncomfortable. You can try to say "Let's not get into that now" and change the topic. If that doesn't work, walk away. Get up, and walk away, every time. Pre-planning where you can retreat for alone time to collect your thoughts helps so that if or when you need it, you can step back and take time for yourself. 

On the flip side, it can also be nice to feel supported and to enlist a family member to check on you and keep an eye out. Perhaps they can even help you to step away or maintain boundaries. In a house full of triggers, it is nice to know you are not alone. If that person doesn't exist, maybe you can bring a friend. If that is impossible, maybe you can at least have one on standby…on the phone.

There is also always humor. One of my favorite ways to survive the holidays was suggested to me by my therapist friend Sarah McCoy Isaacs. She works with a lot of patients who have eating disorders and really struggle going home. She makes bingo cards with her patients to make a joke out of the "classic" (but stressful) things to expect at home like "Aunt Carolyn asks if I am going to freeze my eggs" or "My mom says I look tired." They often will then enlist other family members to play, or see how fast they get to bingo. She says she often gets emails that just say "52 minutes." 

And sure, while the Xanax headline might be mostly a joke, for those who need it and are prescribed it, anxiety medication can be another legitimate tool in the toolbox. Some even pre-medicate the holiday festivities, AKA take their medication before they even arrive or are acutely triggered by something or someone. There is no harm in that either. For them, medication helps them to show up in the first place and allows them to better access their coping skills in the moment if they need them. Of course, (and unfortunately!) medication doesn't get rid of the sources of your anxiety (like your relatives), but it does make it a lot easier to tolerate them.

And, if all else fails,  protect yourself with a permanent out. Just because you make an appearance does not mean you have to move in. You should pace yourself and decide on time limits ahead of time and stick to them. Leave when you said you would leave, and if you need to leave early, that is OK, too. Less, in this case, is more.

While I can't promise you that being home will be like fleeing to an island, if you want or have to be with family this holiday season, it is possible to keep your sanity, too. It may not be easy, but it may be exactly what you were hoping it would be. In a world with a lot more loneliness and grief in it than ever before, that seems like a compromise worth making. 

Jessi Gold, M.D., M.S., is an assistant professor in the department of psychiatry at Washington University in St. Louis.

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