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California/General interest/Health/Politics & Causes/USA/Women

January 7, 2010

Stupak vs. America – Health care bill has come down to this

It’s hard to figure what makes Bart Stupak tick, but my guess is: Ego. Power. Self- absorption. Conceit. For sure, it has nothing to do with concern for his fellow man, and less to do with concern for women. Representative Stupak is perfectly willing to sink a bill that would offer comfort, care and in many cases life itself to millions in his petty, petulant determination to control what we do with our bodies.

Here’s a report by New York Times reporter Jodi Kantor on the gentleman from Michigan:

Representative Bart Stupak often endures things others find unbearable. He crisscrosses a Congressional district so vast that some constituents live eight hours apart and so cold that the beer at his beloved football games sometimes freezes. Years ago, as a state trooper, he blew out his knee chasing a suspect, and he has since had so many operations that he now returns to work the same day, toting crutches and ice.

After his younger son committed suicide in 2000, using the congressman’s gun, Mr. Stupak soon resumed his predawn commute to Washington and his solid voting record with the National Rifle Association.

Now he is enduring more hatred than perhaps any other member of Congress, much of it from fellow Democrats. His name has become a slogan: “Stop Stupak!”

Scott Schloegel, his chief of staff, said wearily, “I can’t tell you how many New Yorkers have called me up and yelled at me about this Stupak guy.”

Well, sorry, I can’t work up any sympathy for Scott Schloegel or his boss. I did not elect them to ordain (along with their friends the U.S. Congress of Catholic Bishops) what American women may or may not do, by writing regressive language into a bill that could start this country toward sanity in health policy. I, along with millions of others, elected Barack Obama in part because we want our ridiculous, dysfunctional health system fixed.

With final negotiations on a health care overhaul beginning this week, complaints about “the evil Stupak amendment,” as the congressman dryly called it over dinner here recently, are likely to grow even louder. The amendment prevents women who receive federal insurance subsidies from buying abortion coverage — but critics assert it could cause women who buy their own insurance difficulty in obtaining coverage.

Mr. Stupak insists that the final bill include his terms, which he says merely reflect current law. If he prevails, he will have won an audacious, counterintuitive victory, forcing a Democratic-controlled Congress to pass a measure that will be hailed as an anti-abortion triumph. If party members do not accept his terms — and many vow they will not — Mr. Stupak is prepared to block passage of the health care overhaul.

“It’s not the end of the world if it goes down,” he said over dinner. He did not sound downbeat about the prospect of being blamed for blocking the long-sought goal of President Obama and a chain of presidents and legislators before him. “Then you get the message,” he continued. “Fix the abortion language and bring the bill back.”

Stupak’s father reportedly began study for the priesthood before changing his mind and getting married. The 10 Stupak siblings went to Catholic schools and he often cites the strength of his Catholicism. I honor him for his faith, and respect that faith. I just do not respect its assertion, via the Congress of Bishops, that one faith should dictate health policy for the nation. Admittedly, they have support from many conservatives, religious and otherwise; but “Fix the abortion language and bring the bill back?” What is he smoking with his frozen beer? It will take another 19 years to bring the bill back, if it comes back at all.

“The National Right to Life Committee and the bishops saw this as a way to vastly increase restrictions on choice,” said Representative Diana DeGette, Democrat of Colorado, who is a chief deputy House whip and co-chairwoman, with Ms. Slaughter, of the Congressional Pro-Choice Caucus.

Mr. Stupak was “not given very much negotiating room” by those organizations, Ms. DeGette said. Now “he’s gotten himself into a corner where he says it’s my amendment or it’s nothing.”

(Mr. Stupak says he urged the United States Conference of Catholic Bishops to toughen its stance on the legislation; representatives from the conference and the National Right to Life Committee did not return calls.)

It may not be the end of the world for Congressman Stupak if the bill fails to pass. But it will be exactly that for uncounted thousands who are already suffering and dying for lack of health insurance and decent care.

Congressman Wears Scorn as a Medal in Abortion Fight – NYTimes.com.

California/General interest/Health/Holidays/Lifestyle

January 6, 2010

Time flies when… or does it really?

by Fran Johns

In case you’re wondering what happened to 2009 — personally, I misplaced December, and have some real doubts about several weeks in March and August — maybe you were indeed having fun. Or having too much caffeine. According to an article seductively headlined “Where Did The Time Go? Do Not Ask The Brain” in the New York Times our perception of time can be linked to good times or bad, and the nature of events we peg time’s passage to affects whether it flew like the wind or dragged like a wet mattress. Science Times writer Benedict Carey assembles enough esoteric theories, along with the down-home speculations, to make a few moments vanish while reading.

That most alarming New Year’s morning question — “Uh-oh, what did I do last night?” — can seem benign compared with those that may come later, like “Uh, what exactly did I do with the last year?”

Or, “Hold on — did a decade just go by?”

It did. Somewhere between trigonometry and colonoscopy, someone must have hit the fast-forward button. Time may march, or ebb, or sift, or creep, but in early January it feels as if it has bolted like an angry dinner guest, leaving conversations unfinished, relationships still stuck, bad habits unbroken, goals unachieved.

I think for many people, we think about our goals, and if nothing much has happened with those then suddenly it seems like it was just yesterday that we set them,” said Gal Zauberman, an associate professor of marketing at the Wharton School of Business.

Studies of what makes time fly, or seem to, come up with opposite views: too many events that you’re pegging the past 30 days to might telescope them into 20 days. Or maybe your brain does have some control over your perception of time. You didn’t get that project finished on deadline? Well, the day just zoomed by.

In earlier work, researchers found a similar dynamic at work in people’s judgment of intervals that last only moments. Relatively infrequent stimuli, like flashes or tones, tend to increase the speed of the brain’s internal pacemaker.

On an obvious level, these kinds of findings offer an explanation for why other people’s children seem to grow up so much faster than one’s own. Involved parents are all too well aware of every hiccup, split lip and first step in their own children; whereas, seeing a cousin’s child once every few years, without intervening memories, telescopes the time.

On another level, the research suggests that the brain has more control over its own perception of passing time than people may know. For example, many people have the defeated sense that it was just yesterday that they made last year’s resolutions; the year snapped shut, and they didn’t start writing that novel or attend even one Pilates class. But it is precisely because they didn’t act on their plan that the time seemed to have flown away.

By contrast, the new research suggests, focusing instead on goals or challenges that were in fact engaged during the year — whether or not they were labeled as “resolutions” — gives the brain the opportunity to fill out the past year with memories, and perceived time.

My father, who spent his entire life in academia, used to speak of time as “the element that doesn’t exist.” Maybe he was right after all. Maybe that’s what happened to December.

Mind – Research on How the Brain Perceives Time – NYTimes.com.

California/General interest/Health/Holidays/Money/Politics & Causes/seniors/USA

December 31, 2009

Goodbye to all that — & hello 2010

by Fran Johns

It’s hard to mourn the passage of 2009. Jobless friends struggled to survive while our own family income took a dive. Gay friends watched meanness triumph over decency in equality battles. Friends of many stripes lamented choices made by the president we elected with unrealistically high hopes. And my hometown paper this morning lists, among the top stories of the year, teenage gang rape, government insolvency and a bunch of senseless killings.

Other front pages aren’t much different: my second-favorite city winds up the year in the red and worried about the shadow of 9/11 (New York Times.) Murder and assault — specifically assault compounded by injustice — are among today’s concerns in Chicago. And a couple of other former hometown papers lead off the year’s last day with stories of car crashes, shootouts (Atlanta Journal Constitution) and a tragic, child-abandoning, now dead, alcoholic mom (Richmond Times-Dispatch). Plus another doozy about four or five hundred dead animals found in one house — and that happened in Philadelphia.

Optimism, these days, is a full-time job.

But hey. We’re inching toward health reform. Umar’s bomb didn’t go off. Some of those bad guys (above) went to jail, and a few good guys who’d been jailed as bad guys for a very long time got out of jail thanks to the Innocence Project. And even if the best we can do for employment optimism is note that the rate of jobs lost is getting smaller — can the country’s jobless find hope in that? — the jobless recovery seems to be happening. Surely jobs will follow.

Plus: even if we don’t like all of his choices and decisions, we have an articulate president who comes across, still, as thoughtful and decent — and doesn’t make you cringe when you see him on TV. There’s hope.

And True/Slant, which you’d never heard of this time last year, is closing in on a million readers.

Happy New Year from the Boomers and Beyond page.

California/Health/seniors/USA

December 29, 2009

End-of-year look at end-of-life issues

by Fran Johns

Two end-of-year stories offer stark insights into end-of-life issues in the U.S., one from a purely financial perspective, the other purely about compassion. Between the two, the conflicted American way of dying comes into focus.

First the finance. The Wall Street Journal of December 30 features a front page story by Laura Saunders about wealthy families coming to grips with the disappearance, thanks to a quirk of Congress, of the estate tax beginning January 1, 2010. It will only disappear for a year, and in 2011 it will return at a higher rate with lower exemption. For those approximately 5,500 super-rich taxpayers to whom this tax applies, a lot of money is at stake. Presumably if a member of one of these families is now near death every possible measure will be taken to keep him or her alive into the new year and presumably that will be done for the best of reasons. But imagine the struggles involved if someone is near death this time next year, and his or her heirs stand to benefit in the millions if that death happens before January 1st rather than soon after. An altogether new meaning will have to be added to “letting go.” Not something one really wants to think through.

But the last two sentences of the WSJ article demonstrate how extensively the scenario is indeed being thought through, not from the heir’s point of view but from the soon-to-be-departed:

The situation is causing at least one person to add the prospect of euthanasia to his estate-planning mix, according to Mr. (Andrew) Katzenstein (a lawyer with) Proskauer Rose (LLP in Los Angeles.) An elderly, infirm client of his recently asked whether undergoing euthanasia next year in Holland, where it’s legal, might allow his estate to dodge the tax.

His answer: Yes.

However hard we might try to eliminate costs (and cost/benefit ratios) from considerations of end-of-life care and decision-making, they are here to stay and sure to remain complex. Another complexity — and this one should not be as difficult as it continues to be — surrounds the subject of palliative care. Palliative care is simply comfort care. It means, do everything possible to insure that a dying person might go about his or her dying with as little pain and anguish as humanly, medically possible. A long, careful look into the issue is in the New York Times most recent “Months to Live” series article, “Hard Choice for a Comfortable Death” by health writer Anemona Hartocollis.

In almost every room people were sleeping, but not like babies. This was not the carefree sleep that would restore them to rise and shine for another day. It was the sleep before — and sometimes until — death.

In some of the rooms in the hospice unit at Franklin Hospital, in Valley Stream on Long Island, the patients were sleeping because their organs were shutting down, the natural process of death by disease. But at least one patient had been rendered unconscious by strong drugs.

The patient, Leo Oltzik, an 88-year-old man with dementia, congestive heart failure and kidney problems, was brought from home by his wife and son, who were distressed to see him agitated, jumping out of bed and ripping off his clothes. Now he was sleeping soundly with his mouth wide open.

“Obviously, he’s much different than he was when he came in,” Dr. Edward Halbridge, the hospice medical director, told Mr. Oltzik’s wife. “He’s calm, he’s quiet.”

Mr. Oltzik’s life would end not with a bang, but with the drip, drip, drip of an IV drug that put him into a slumber from which he would never awaken. That drug, lorazepam, is a strong sedative. Mr. Oltzik was also receiving morphine, to kill pain. This combination can slow breathing and heart rate, and may make it impossible for the patient to eat or drink. In so doing, it can hasten death.

Mr. Oltzik received what some doctors call palliative sedation and others less euphemistically call terminal sedation. While the national health coverage debate has been roiled by questions of whether the government should be paying for end-of-life counseling, physicians like Dr. Halbridge, in consultations with patients or their families, are routinely making tough decisions about the best way to die.

Writer Hartocollis covers in thoughtful detail the long, sometimes conflicted process through which the medical team and the patient’s family arrived at his eventual, peaceful death. The article looks at the multiplicity of issues that cry out for reasoned public dialogue — palliative care, physician aid in dying, end-of-life choice, family decision-making — that have been raised on this page in recent months and will be back again. It’s a story worth reading in full.

And meanwhile, the beginning of the year is a fine time to get your advance directives and other documents completed and to have those conversations with friends and loved ones that keep you from becoming another Terri Schiavo. Getting this done is one great way to put dying behind you and go about the business of living for a happy new year.

Months to Live – Hard Choice for a Comfortable Death – Sedation – Series – NYTimes.com.

California/Health/Politics & Causes/seniors/USA

December 24, 2009

The cost of trying to live forever

by Fran Johns

Why is this not an encouraging word? In a front page article, part of a Months to Live series, New York Times writer Reed Abelson leads with a glimpse into the Ronald Reagan U.C.L.A. Medical Center, a top-rated academic hospital noted for extensive, aggressive end-of-life care (and very high costs):

‘If you come into this hospital, we’re not going to let you die,’ said Dr. David T. Feinberg, the hospital system’s chief executive.

Feinberg’s commitment to “success” might be admirable, but the statement is patently false; people die at U.C.L.A. Medical Center. This is what people do: we die. Until this culture gets its act together on that subject our health care system — whatever the reform bill eventually looks like — will continue to flounder.

Difficult as it is to talk dollars when you’re talking lives, the issue of cost has to be factored in. There are only so many dollars, and there are countless lives needing care those dollars can buy: infants, children, young adults, boomers, elderly. In each of those care-needing groups, some die. Feinberg’s philosophy somewhere has to encounter reality.

…that ethos (keep testing, treating, keeping alive no matter what) has made the medical center a prime target for critics in the Obama administration and elsewhere who talk about how much money the nation wastes on needless tests and futile procedures. They like to note that U.C.L.A. is perennially near the top of widely cited data, compiled by researchers at Dartmouth, ranking medical centers that spend the most on end-of-life care but seem to have no better results than hospitals spending much less.

Listening to the critics, Dr. J. Thomas Rosenthal, the chief medical officer of the U.C.L.A. Health System, says his hospital has started re-examining its high-intensity approach to medicine. But the more U.C.L.A.’s doctors study the issue, the more they recognize a difficult truth: It can be hard, sometimes impossible, to know which critically ill patients will benefit and which will not.

That distinction tends to get lost in the Dartmouth end-of-life analysis, which considers only the costs of treating patients who have died. Remarkably, it pays no attention to the ones who survive.

No one, not the doctors, not the patients, not the best crystal ball reader around can guarantee that this patient will die or that patient will live. If there is a good chance a patient will survive — and it would be nice to add “with a reasonable quality of life” here — everything possible, and affordable, certainly should be done. Abelson’s carefully balanced article details the arguments for going to extraordinary lengths to save lives, as well as the arguments to draw the line on end-of-life expenses.

According to Dartmouth, Medicare pays about $50,000 during a patient’s last six months of care by U.C.L.A., where patients may be seen by dozens of different specialists and spend weeks in the hospital before they die.

By contrast, the figure is about $25,000 at the Mayo Clinic in Rochester, Minn., where doctors closely coordinate care, are slow to bring in specialists and aim to avoid expensive treatments that offer little or no benefit to a patient.

“One of them costs twice as much as the other, and I can tell you that we have no idea what we’re getting in exchange for the extra $25,000 a year at U.C.L.A. Medical,” Peter R. Orszag, the White House budget director and a disciple of the Dartmouth data, has noted. “We can no longer afford an overall health care system in which the thought is more is always better, because it’s not.”

By some estimates, the country could save $700 billion a year if hospitals like U.C.L.A. behaved more like Mayo. High medical bills for Medicare patients’ final year of life account for about a quarter of the program’s total spending.

So…. to spend that $25,000/$50,000 or not to spend? Unless we the people somehow face the reality that living forever is not a human option, the dilemma will continue.

The benefits of coming to terms with non-optional dying could be huge. We could focus on quality living. On palliative care and hospice care and end-of-life peace and comfort. Advances in palliative care now make it possible for most of us to spend final months at home (or in special hospital rooms), in comfort, surrounded by loved ones; given the choice, would you prefer a few weeks or months in a bright-lit sterile room with a lot of tubes and wires keeping you alive? U.C.L.A. now offers the choice of palliative care. Not everyone in charge, however, is convinced.

Dr. Bruce Ferrell, who helps lead the palliative care program, recalls a patient two years ago who got a liver transplant but developed serious complications afterward and remained in the hospital for a year. “He had never, ever been told that he would have to live with a ventilator and dialysis,” Dr. Ferrell said. “He was never told that this is as good as it’s going to get.”

Dr. Ferrell talked with the patient about whether he might want to leave the intensive-care unit to go home and receive hospice care. But when the surgeon overseeing the case found out, he was furious.

“We do not use the h-word” — hospice — “on my patients,” the surgeon told Dr. Ferrell. “Don’t ever come back.”

The patient chose to leave.

But lately, Dr. Ferrell says, more of the transplant surgeons appreciate the value of what he is trying to do.

“We’re not the bad guys,” he said. “We offer options.”

We the people would do well to quit being the bad guys. To quit behaving as if death were always preventable. We could learn about the options to spending all those thousands of dollars on exhaustive, often futile treatment. We could talk about what we would or would not want for ourselves, write things down, make choices.

If more of us would do that for ourselves, the House and Senate wouldn’t have such a time trying to do it for us.

California/General interest/Health/Politics & Causes/USA/Women

December 19, 2009

Should Catholic Bishops Determine U.S.Health Policy?

by Fran Johns

Why do these two sentences, in a report by New York Times health writers Robert Pear and David M. Herszenhorn which appears in today’s San Francisco Chronicle, send chills down my spine?

Nelson (Sen. Ben Nelson, D-Nebraska) and the U.S. Conference of Catholic Bishops , said Thursday that they could not accept Casey’s (Sen Bob Casey, D-Pa) initial proposal, in part because they saw money from the government and premiums as fungible.

Cardinal Daniel DiNardo, the archbishop of Galveston-Houston and chairman of the bishops’ anti-abortion committee said, ‘We continue to oppose, and urge others to oppose, the Senate bill unless and until this fundamental failure is remedied.’

A more recent report on NYTimes.com says Nelson will now support the bill, since it includes tighter restrictions on abortion coverage. I assume if it’s okay with Senator Nelson it’s okay with USCCB.

In the mid-1970s I had a friend I will call Sara, a 19-year-old single mom working hard to raise an infant daughter, who found herself pregnant with a probably defective potential baby. She saw no way to care for her existing child without a job — the pregnancy would cost her her job — let alone care for an unplanned and unwanted new child with special needs. Her church gave her no choice. She managed to have an abortion in fairly sterile circumstances, but because she was part of a small Catholic congregation she remained terrified for years afterward that she would be found out and condemned to hell. I remember thinking how sad it was that she could not seek comfort and support from her close-knit faith community.

I am fine with Sara’s beliefs and honor her for that struggle. I am not fine with having the U.S. Conference of Catholic Bishops determine health policy for all of us. And I wonder how many Saras will be denied proper care because the USCCB believes that some embryonic cells are more important than the right of a woman to control her own body. It remains to be seen if the bill passes, and what sliver of abortion coverage survives, but the tragedies of back-alley abortions, which I know from personal experiences and which the bishops cannot even begin to fathom, are quite likely to return.

What happened to that quaint notion of separation of church and state?

Health/Politics & Causes

December 17, 2009

Figuring out Joe Lieberman

by Fran Johns

New York Times columnist Gail Collins offers a few choice answers to today’s most pressing question: ‘What is it with Joe Lieberman?’

Lieberman’s apparently successful attempt to hijack health care reform and hold it hostage until it had been amended into something that liberals couldn’t stomach has mesmerized the nation’s political class. This was, after all, a guy who has been a liberal on domestic issues since he was a college student campaigning for John F. Kennedy. A guy who was in favor of the public option, of expanding Medicare eligibility, until — last week.

The theories about Why Joe Is Doing It abound. We cannot get enough of them! I have decided to start a rumor that it all goes back to the 2004 presidential race, when Lieberman not only failed to win any primaries, but was also bitten by either a rabid muskrat or a vampire disguised as a moose.

Other than that, my favorite explanation comes from Jonathan Chait of The New Republic, who theorized that Lieberman was able to go from Guy Who Wants to Expand Medicare to Guy Who Would Rather Kill Health Care Than Expand Medicare because he ‘isn’t actually all that smart.’

It’s certainly easier to leap from one position to its total opposite if you never understood your original stance in the first place, and I am thinking Chait’s theory could get some traction. ‘When I sat next to him in the State Senate, he always surprised me by how little he’d learned about the bill at the time of the vote,’ said Bill Curry, a former Connecticut comptroller and Democratic gubernatorial nominee.

Collins favors the not-that-bright theory (‘in part because it’s as good an explanation as any, and in part because it will definitely drive Lieberman nuts’), but she provides greater insight by drawing the comparison between the records of failed national candidates Al Gore and John Kerry, who moved on to useful pursuits, and those of John McCain and Joe Lieberman who are ‘work(ing) out barely suppressed rage by attacking things (they) used to be for.’

Maybe the difference comes from self-image. Lieberman and McCain both thought of themselves as ‘character’ candidates whose success was due to the love and trust of the public, and whose ultimate failure was the work of evil forces beyond their control. Kerry and Gore never believed their success was due to their innate likability. When they lost the presidency, a part of them probably shrugged and remembered that they weren’t all that popular in prep school, either.

Politicians switch direction all the time, but the Lieberman experience has been weird because he doesn’t seem to feel as though he’s changed. He bounds around happily, doing the talk shows, confident that he’s the same independent-minded independent who believes in independence as always. Observers who have known him for a long time feel as though they’re living out a scene in a science-fiction movie when the guy who’s just been bitten by the vampire-moose comes home and sits down to dinner, unaware that he’s sprouting antlers.

I used to cover Lieberman when he was the majority leader of the State Senate in Connecticut. We got along very well, except for one interview, during which he talked about working for J.F.K., and how he kept a Mass card from Robert Kennedy’s funeral to remind him of the principles to which he had dedicated his career. Showing me the card, he remarked casually that he hadn’t looked at it for some time.

I wrote an article using the neglected Kennedy card as a metaphor for Lieberman’s fall from his old ideals into the pragmatic politics of a party leader. He was outraged and wounded, and I believe I apologized.

Collins is now taking back that apology. I think it is Joe Lieberman who needs to apologize to the American people. We voted for health reform, we’ve watched the key parts get tossed for the likes of those insurance folks who so strongly support him, and now we’re feeling a little helpless as he enjoys his position of fame and glory and power.

Lieberman may not be that smart, and he’s certainly not wise. Unfortunately, he is shrewd.

Op-Ed Columnist – Sorry, Senator Kerry – NYTimes.com.

California/General interest/Health/Lifestyle/seniors/USA

December 14, 2009

Stress, sorrow and depression – – the dark side of the holidays

by Fran Johns

The photo on the front page of the Sunday New York Times tells the ultimate underside to holiday joy: a young woman, Sarah Walton, with her arms around the tombstone of her husband. The scene is in Arlington cemetery; the simple stone reads LTC James J. Walton and lists the parameters of his brief life, 1967-2008.

In households and hotel rooms everywhere, sadness and loss color the holidays gray. Most of the sadness is of a far lesser sort than that of the grieving widow, but just as real: relationships gone sour, bills that can’t be paid, health that can’t be restored — or the old, familiar pains of too many demands and too little time.

At my San Francisco church, a ‘Blue Christmas’ service was started four years ago by Associate Pastor Catherine Oliver, designed for those who struggle under the weight of everyone else’s festive spirits. Some of the faces she sees are familiar, but many belong to strangers seeking comfort or relief. This year, Oliver reports, attendance was not notably higher — “but there were more men.”

Acknowledging the stress and depression that so often accompany the Thanksgiving-to-New Year’s Day season, the Mayo Clinic recently posted a few tips to help bring a little peace and joy into the season. They are summarized here, in categories found to be common.

First, Mayo Clinic recommends, recognize holiday triggers so you can disarm them before meltdown occurs. Most common among these are:

Relationships. Relationships can cause turmoil, conflict or stress at any time, but tensions are often heightened during the holidays. Family misunderstandings and conflicts can intensify — especially if you’re thrust together for several days. On the other hand, facing the holidays without a loved one can be tough and leave you feeling lonely and sad.

Finances. With the added expenses of gifts, travel, food and entertainment, the holidays can put a strain on your budget — and your peace of mind. Not to mention that overspending now can mean financial worries for months to come.

Physical demands. Even die-hard holiday enthusiasts may find that the extra shopping and socializing can leave them wiped out. Being exhausted increases your stress, creating a vicious cycle. Exercise and sleep — good antidotes for stress and fatigue — may take a back seat to chores and errands. To top it off, burning the wick at both ends makes you more susceptible to colds and other unwelcome guests.

The good news is that even with the worst of causes, holiday blues can be lessened. Most effectively by following a few good recommendations such as these:

Acknowledge your feelings. If someone close to you has recently died or you can’t be with loved ones, realize that it’s normal to feel sadness and grief. It’s OK to take time to cry or express your feelings. You can’t force yourself to be happy just because it’s the holiday season.

Reach out. If you feel lonely or isolated, seek out community, religious or other social events. They can offer support and companionship. Volunteering your time to help others also is a good way to lift your spirits and broaden your friendships.

Be realistic. The holidays don’t have to be perfect or just like last year. As families change and grow, traditions and rituals often change as well. Choose a few to hold on to, and be open to creating new ones. For example, if your adult children can’t come to your house, find new ways to celebrate together, such as sharing pictures, emails or videotapes.

Set aside differences. Try to accept family members and friends as they are, even if they don’t live up to all your expectations. Set aside grievances until a more appropriate time for discussion. And be understanding if others get upset or distressed when something goes awry. Chances are they’re feeling the effects of holiday stress and depression too.

Stick to a budget. Before you go gift and food shopping, decide how much money you can afford to spend. Then stick to your budget. Don’t try to buy happiness with an avalanche of gifts. Try these alternatives: Donate to a charity in someone’s name, give homemade gifts or start a family gift exchange.

Plan ahead. Set aside specific days for shopping, baking, visiting friends and other activities. Plan your menus and then make your shopping list. That’ll help prevent last-minute scrambling to buy forgotten ingredients. And make sure to line up help for party prep and cleanup.

Learn to say no. Saying yes when you should say no can leave you feeling resentful and overwhelmed. Friends and colleagues will understand if you can’t participate in every project or activity. If it’s not possible to say no when your boss asks you to work overtime, try to remove something else from your agenda to make up for the lost time.

Don’t abandon healthy habits. Don’t let the holidays become a free-for-all. Overindulgence only adds to your stress and guilt. Have a healthy snack before holiday parties so that you don’t go overboard on sweets, cheese or drinks. Continue to get plenty of sleep and physical activity.

Take a breather. Make some time for yourself. Spending just 15 minutes alone, without distractions, may refresh you enough to handle everything you need to do. Take a walk at night and stargaze. Listen to soothing music. Find something that reduces stress by clearing your mind, slowing your breathing and restoring inner calm.

Seek professional help if you need it. Despite your best efforts, you may find yourself feeling persistently sad or anxious, plagued by physical complaints, unable to sleep, irritable and hopeless, and unable to face routine chores. If these feelings last for a while, talk to your doctor or a mental health professional.