Anxiety may follow you home from Bali, even if you didn’t pack it.

Hi all,

I’m continuing to write and help out where I can, because I feel quite uneasy myself, and really missing home. As a psychiatrist working in private practice I would usually have seen about 15 patients this week by now, and handled a pile of inquiries via phone as well. So having this enforced break in Bali after my flight was cancelled 5 days ago is feeling really surreal, and I am feeling for my patients who have had to move their appointments until I get back.

I have heard that some people have managed to arrive home, but have noticed that the anxiety has followed them there. As a psychiatrist I can understand why, and I know it doesn’t make a lot of sense intuitively. I’m sure these people are hearing lots of comments, which are not helping the situation at all, such as

‘what do you have to be anxious about, you’ve just come home from Bali?’

Returned travelers understandably may have expected to be relieved and grateful when they finally walked in their front door. But instead they may have experienced a range of emotions, good or bad, ranging from mild disappointment to symptoms of trauma and everything else in between.

It is really important to accept it is OK to feel anything you might be feeling when you get home. Only you know and experienced your personal journey to get back in your front door.

As I have been writing about, humans love our structure and certainty. Uncertainty is a fertile breeding ground for anxiety. This structure includes daily routines which work best when they align nicely with our own circadian rhythm, or internal ‘body clock’. When we are on holidays, structure goes out the window in a really beneficial way, and because we don’t have to wake with an alarm clock or fit in with other schedules, we sleep when we want, eat when we want and we feel better for it. However, when we travel home crossing time zones and disrupting sleep (who can sleep on planes at the best of times?) we disrupt our circadian rhythm again, but in a negative way. This has a negative impact on mood and anxiety levels.

It ain’t just post holiday blues, there are known structural connections between the sleep centres and the mood centers in our brain. The good thing is once jet lag or transient sleep disturbance rectifies itself, so should you mood.

But what happens if, on top of all of this, there has been major sadness, disappointment or even illness or loss compounding the situation? What if you have been stranded like I am, annoyed and irritable that I have really no idea what will happen, fed up with comments telling me to enjoy my extended holiday, and then you finally get home? What if, instead of feeling relief and jubilation that you are home, you are teary, on edge and just plain miserable? There may be additional factors, complicating what has already happened with circadian rhythm disturbance that may be making things more difficult for you, including;

  • Nobody at home gets what you have been through. Friends, family and work colleagues only apply what they have seen on the news or have heard from other people, and you can feel they genuinely don’t understand your predicament. This invalidation may make you question your own response, feel deficient in some way, or lead you to holding back or pretending things are fine.
  • You have more FOMO. FOMO, or fear of missing out, may apply if your delays have led to you missing significant events going on for others at home. You may feel inappropriate guilt or anger because this awful unplanned event made you miss something very special to you.
  • As a coping mechanism, and because you felt helpless and uneasy, you may have coped with your extended time in Bali by being somewhat detached from the situation. This is a normal coping mechanism but also occurs when people are anxious. When reality hits you, when you see the credit card bills, or open the mail, all the emotions you may have not experienced while away may come flooding back.
  • If you have been diagnosed with depression or anxiety, you may have inadvertently missed doses of your  prescribed medications due to protracted travel home, or you may have run out while away. These feelings may actually be symptoms of a relapse of your illness and understandable.
  • You are constantly checking FaceBook feeds or news reports as you feel a connection to this situation and you feel inappropriate guilt that you got home. This in an extreme form is akin to ‘survivor guilt’, experienced by those who survive traumatic events and feel guilty that they did. This is complicated when well meaning people remark ‘how lucky were you’ and other things that make people hide their true feelings about their experiences.
  • If your time in Bali was complicated by further adversity, such as illness, theft or violence, you may be re-experiencing the event every time you see more updates, especially if the media at home is sensationalising things. You may feel a need to keep connected to social media as a way of trying to reassure yourself, which is keeping your mind on the past, and not on the healing properties of the present.

So if any of these factors (and I’m sure there are more) sound familiar, first and foremost do NOT beat yourself up for feeling the way you do. I often tell my patients that they feel anxious, depressed, sad, angry, lonely or whatever just because they do. Acknowledging how you feel regardless of whether you feel it is inappropriate or not is your first step to accepting it, then nurturing and healing yourself.

Other practical strategies to try (once again these are general guides and not specific to all cases);

  • Limit or avoid news updates about what is happening in Bali. It doesn’t help to let your mind wander into what is still happening to others. There is a fine line with feeling connected to others who understand, and perpetuating feelings of helplessness and sadness.
  • Connect to 1-2 friends who truly understand and talk to them. But if you feel overwhelmed by sharing, retreat for a while until you feel stronger.
  • Get your circadian rhythm back on track ASAP. Do not stay up late reading updates. Re-establish your normal daily routine. As bad as you have slept the night before, get up at the same time and go for a very short walk, not for the purpose of counting steps but to get some bright sunlight on your face. This will reset your melatonin levels and ensure your sleep cycle returns to normal as soon as it can. Sneak in a coffee or tea on the walk, it may help with motivation!
  • Connect with good memories and times that did happen. Print our photos of smiles, beautiful scenery, a picture of you in a relaxed happy state. All the reasons why you went to Bali in the first place.
  • If these tips do not work in a couple of days, or if you are having worrying thoughts, see your GP as a matter of urgency. You might be going there anyway, for that often needed dose of Bali-belly remedy. Make sure you tell your GP if you are not coping. Key symptoms to report are sleep disturbance, excessive worry, disturbed concentration, and more seriously thoughts of self harm.

This is not a time to think all the feelings you are having are due to you being weak, ungrateful or any other silly idea that may try and pop into your mind. Be kind to yourself, don’t avoid your feelings or excuse them away. Stay grounded. At home.

 

Dr Helen Schultz is a consultant psychiatrist in Melbourne, Australia, generally reachable by air from Bali. Right now she is stranded in Bali, churning out blogs and missing her son like anything. 

While I wait to get home, home finds me here

I am so amazed and truly inspired by all the people who read my blog yesterday and left such thoughtful comments. Like many of you I am feeling quite helpless as the days drag on and my proposed departure date is further behind me. It is really comforting for me to share my knowledge and try an help, while I am so far away from my patients in Australia, who keep getting moved to new appointment times.

Yesterday I wrote about the importance of keeping your health and safety as key priorities. That includes your mental health. Mindfulness is key here; if ever there is a time to be extremely vigilant about remaining in the present, it is now. Constant distractions and worries about home will only hamper our efforts to stay calm and we all need to be calm.

Once again, I need to impress upon anybody working in customer service and trying to assist us;

We don’t really want to call you or make your day any more stressful than it is. In fact, we would rather leave you alone, but we need to do so as the delays drag on and we search for certainty to combat feelings of despair. So please understand from our point of view that if you continue to provide consistent, clear messages and update when you promise, we will feel reassured and take ourselves out of the queue of calls waiting for you.

If you are experiencing an exacerbation in anxiety or your mood is affected adversely, remember to do what ever you can to stay calm. That may mean avoiding busy places that you may be visiting in order to kill time, or use WiFi. Sensory overload may not be helping inner anxieties, once again check in with your own anxiety and see how much you can withstand. Consider it a finite, valuable resource.

If you have run out of medication or are experiencing symptoms of a relapse of mental illness, it may be a good idea to try and call your GP at home. Although they may not be able to assist you as comprehensively as a visit to a doctor in Bali, you may be able to get some basic advice, and they may be able to reassure you. Likewise, your pharmacist at home may be able to help out. I would imagine that the local hospitals and GP clinics in Bali will currently be overflowing with requests for repeat prescriptions and treatment of acute physical and mental symptoms. I would imagine that they cannot cope too well with the huge demand, and my heart goes out to the doctors and nurses trying to help. If you are already anxious, an extended wait in a crowded emergency department may make things worse. Having said that, if you are feeling unsafe or acutely unwell, you must attend there for care.

So, from a psychiatrist’s perspective, here are some things you can do to boost your mental health reserves. they are not a substitute for specific medical advice, but they might help;

  • Use psychological and behavioural strategies such as distraction and relaxation techniques. Believe me, they work. Anything that can bring baseline levels of anxiety or depression to a more manageable state should be your first priority.
  • Exercise is extremely therapeutic. Nature walks are much better than trying to walk along crowded roads. Walk along the shore and feel the water on your feet. Cover up, and focus on your breathing. Leave the FitBit behind (I drowned mine in the pool, oops) this is not about steps or fitness. It is about the very beneficial mental health benefits of exercise. Walk as slow as you need to and as far as you need to until you notice your thoughts calm down.
  • Try and only focus on real concerns immediately affecting you, not the ‘what if’s’. Believe me, I have a huge list of ‘what if’s’, as a mother with a son back home in Oz that I was meant to get home to 4 days ago. This is what I am doing, you may find it useful as well.
    • Pull out a piece of paper and pen. Place all of your most important concerns in a column down the left hand side.
    • On the right hand side, allocate each concern to somebody to manage. You may be able to delegate some tasks related to home to someone at home. It will seem better when you notice that a lot of the tasks, such as getting someone to water the garden, pick up the pets, check the mail, contact your employer for updates, cancel or postpone appointments waiting for you can actually done by one person at home in a short space of time.
    • Authorise someone at home to speak on your behalf and this may cut down on your need to call from Indonesia. The time you free up can then be used to work on your relaxation strategies. And seeing a list with items ticked off is extremely therapeutic.
  • For all your fears, worries, what if’s, try visualisation work. Every time an anxious irrational fear pops into your mind, rather that fight or ignore it, put it somewhere – visually. Whether it be in a suitcase or an elaborate parcel made with banana leaves and decorated with frangipanis… you get the idea. Use your imagination to take the heat or the fear out of the worry. Let the worry know you have acknowledged it, but it is not that useful right now, so you will put it away for later. If you fight it, it will get louder and scare you more. The more you feel in control of your worries, the less they can hurt you.
  • If you are looking for medication substitutes, I would strongly advise against purchasing herbal preparations, or products with ingredients you don’t recognise. Any preparation, ‘natural’ or not has the capacity to interfere with your prescribed medication, and may cause a whole new set of symptoms. Avoid health related discussions on chat rooms,  or calling on Dr Google. If you are really desperate, once again a call to your pharmacist in Australia may help, if they have a list of ALL your medications, not just psychiatry medications.
  • It may be tempting to pass the day away with a few extra cocktails, under the proviso that you ‘deserve’ them. I am not trying to be a party pooper here, but if you already feel anxious or depressed, a big night on the Bintangs will make everything a whole lot worse tomorrow. And tomorrow might be the day you get that call you can fly home, so you need to be prepared to cope with a crowded airport, different route home, different airline (breathe, visualise….). Everything in moderation. Including social media.

I’ll endeavor to write daily whilst I am stranded here, and when I get home. Notice I say ‘when’ not ‘if’. Make a conscious decision to only say things to yourself that help you feel grounded, calm, and ready for whatever tomorrow may bring.

Best wishes,

Helen

Dr Helen Schultz has found herself stranded in Bali after booking a well-needed holiday, and writing her first book, How Shrinks Think. She is now spending her time practicing what she writes about, and writing. At any other time, she would consider this her dream life. 

 

 

Grounded by an #ashcloud? How to keep yourself grounded while you wait to get home

After 8 wonderful nights relaxing in Bali, I too have joined the long list of travellers trying to make it home to Australia. It has been 7 days since flights have departed and arrived without disruption. I am witnessing and experiencing first hand how it is to deal with airlines, hotels, insurance companies and generally anybody you don’t wish to bother unless you are actually in need and trying to find a solution to a problem.

I am struggling with trying to be present in the moment and at the same time managing professional and personal issues at home, things I would be doing as part of my usual life if my plane departed on schedule on the weekend. Meanwhile, around me I notice people struggling with the same thing. We all meet again at breakfast, at the pool, share stories about what we have read or heard and try and connect to feel we aren’t alone in this. One common theme is evident,

Now, just like any other time, past or present, we can’t predict the future, and that really makes people very anxious.

In our day to days lives we are often reassured that we can control a great deal of what happens, and most of the time we do a pretty adequate job of it. That’s because humans are hard wired to work best with habit, routine, and structure. We learn how to function by recognising what has worked in the past. Such as booking a holiday, turning up at the airport, arriving at the destination, leaving the accommodation and heading home. We can often leave our comfort zones and relax on a holiday because we know what will happen when its over. When there is any disruption to this, feelings ranging from unease to panic begin to emerge. This is understandable, even in those not predisposed to anxiety. For those who are, this change in routine and dealing with uncertainty can trigger every vulnerability.

It is OK to feel uneasy. Comments like ‘just enjoy the extra few days break’ might be annoying and make you more anxious if you are experiencing financial or health concerns due to being away longer than you have budgeted for.

People with anxiety disorders often fear the worst. They fear things that will probably never happen. This distortion in thinking is purely a symptom of anxiety and not a character fault. If you are prone to anxiety, or even if you aren’t but feeling anxious right now, here are some practical strategies that can help;

  • Reassure yourself that you will get through this, and no matter how inconvenient or stressful this may be, making rash decisions that could put your health or life at risk are not sensible. Remember to remain somewhere where you feel safe. When people are prone to panic or are distracted they can be impaired in decision making, and may be more prone to accidents or adversity. Remember to be safe crossing roads, entering areas you don’t know and so on.
  • Connect with as much home or certainty as you can. If that means a phone call or Skype chat to someone at home then make that a priority at a frequency that reassures you. Choose a person who will listen and help, rather than friends who may be there for the gossip and drama. Set up a small list of close friends on Facebook that you can contact rather than filter through all the noise on your feeds. Chose who you want to support you right now. Nominate a spokesperson at home who can call airlines, your employer etc on your behalf.
  • Where are your FOMO levels? ‘FOMO’, or fear of missing out, is a real phenomenon and is pretty rife right now, as we learn that social media channels, including unsolicited ones are updated faster than traditional means of communication. This is good and not so good. Certainly, as a group we can force airlines and insurance companies to respond to concerns faster than as an individual trying to call through on a landline. And we can feel falsely reassured by refreshing our social media feeds or listening out for notifications on an almost habitual basis. It is a typical conditioned response. You feel anxious, you press ‘refresh’, anxiety levels drop, there is nothing there, so you search more frequently and on wider platforms. Before you know it, you have spent hours staring at mindless information, in the fear of missing a notification from your airline or travel agency, and feel worse than before. Be very strict about checking for updates and stick to it. Checking your phone constantly, driven by a need to know something, will keep you completely focused on the problem.
  • Be specific about where you will look for information.  As the days go by there are more groups and information making it to our Google searches.  However, what is happening is many of the unsolicited groups and even the official sites are being drowned out by hearsay and personal experiences that may do no more than increase panic. Remember, Facebook pages are often set up by people who are generous with their time as moderators but really don’t sign up or are remunerated to deal with an influx of posts, filtering through for what is genuine or not.
  • Remember you are in one of the most tranquil places in the world, rife with ways to relax. Take this test to see how much you need to use what is here right now with you. Turn on you timer on your phone and set it for 5 minutes. That’s 300 seconds. Press start and lie back and close your eyes. Check how many times you had to resist checking emails or Facebook for updates. Feel how difficult it is to resist the urge. If you have not made it to 300 seconds, or have felt very uncomfortable after that time, you need to embrace some practical ways to help. Focus on the horizon, or where the waves are breaking out in the ocean. Watch the leaves on the trees sway in the wind. Pick up a handful of sand and see how long you can hold onto it before the grains fall to the beach. Come back to the present.
  • If you are a parent and have children with you think about the language you are using to describe your situation. If you are irritable or anxious, or need to have a conversation about your predicament, do it away from the children who will pick up on your anxiety.

Finally, the type of customer service large international companies can offer right now is on display. But now might not be the time to vent anger as it is most likely to make you very anxious, and the call centre operators very defensive. Don’t worry, I have had my fair share of difficult phone calls, when I am able to get through. Just think about what you will achieve right now, and what can wait till a very comprehensive letter of complaint when you get home.

Some tips for major companies when handling calls;

  • Assume everybody you talk to on the phone is calling because something has happened to them and they will be anxious and irritable. The best way to diffuse that is to provide clear directions and allow them to express their concerns.
  • If you broadcast that you will post an update at a certain time then do so. Even if you think it might change, do it anyway. If passengers need certainty, and all they have is a time for the next update then adhere to that.
  • Instead of delivering bad news all the time, educate passengers about what you will do when the ash cloud dissipates. Details such as the number of planes that will be dispatched to fetch stranded passengers, how the priority situation works if you need to get home due to medical emergency and so on. Pretty much every passenger is with you that we don’t want to fly if it is dangerous. there is no argument there. If you truly don’t know the answer, there is a lot of comfort in saying ‘we don’t know’.
  • Employ professional social media strategists to run your Twitter, Facebook and Instagram accounts. Irritated passengers can see right through comments that come across as patronising. Last week I was told “enjoy the pool, it is raining in Melbourne anyway”, which is no comfort to me when I have obligations at home. Social media is a powerful way of delivering effective communication as it happens, use it as such and the amount of negative comments should dissipate, hopefully as quick as this ash cloud does.

Remember, the ash cloud will pass. Don’t buy into fear mongering or shared anxiety of others. Home will be waiting for us. What we can do when there is not much else to do, is let go of what we cannot control. Continue to remain as resilient as you can using the resources around you. Stick together as couples and families, or if alone, remain connected to loved ones at home. We are all in the same boat.

Dr Helen Schultz, when not stuck in Bali, is working as a psychiatrist in Melbourne, Australia. She is now actively putting into place what she advises patients to do – mindfulness, relaxation and reading books. Oh, and waiting for travel updates.