As an expat, it is a given that you leave your friends and family, your home culture and most of what is familiar behind. By definition you are forced to change the things that you do each day, the people you interact with, and the life you are accustomed to. Driving on the "wrong" side of the road, the different smells, sounds and language, the expectations and routines of a new place and culture all demand repeated, and even profound, adjustment and adaptation.
No one is immune and no matter who you are or how many times you have had your passport stamped, each new time that you move, you – and your family – will need to navigate a series of adjustments in order to make your new destination a satisfying experience.
Charting Your Own Course
Seasoned expats will offer advice on how to make the transition, but the reality is that there is no one-size-fits-all adjustment strategy that works for everyone, nor works for every move. For some expats, finding people and experiences that are familiar – expat social groups and the location of the nearest Starbucks, for example – will help smooth the transition. For others, adjustment comes by throwing themselves head first into the new geography, language and culture – trying unpronounceable fruits and local dishes, and figuring out the public transportation system. There are a myriad of ways to adjust to a new environment and each person (children included), will have to chart his or her own course.
The experience of moving and living overseas is, as all expats know, a compelling and even seductive event. For people who love the lifestyle, it can be one of the most valuable, interesting and satisfying experiences in their lives. That is why so many of us continue to do it – seeking out successive opportunities for overseas placement.
There are times, however, when our coping mechanisms break down, and it becomes difficult if not impossible to make the adjustments that are necessary to do well. Most of us who have lived overseas know families that have left posts early. One of the most common reasons for this occurrence is that someone within the family has not been able to navigate the adjustments needed for a successful transition.
When Things Go Wrong
As a rule, people who move overseas tend to be a resilient group. They understand, for the most part, what they are getting into, and know that it will take a lot for them to be successful in their new lives, so their approach is usually one of hard work and determination, especially when adversity strikes. While typically this is a very good way of dealing with challenge, there are times when the gritting one's teeth and "sticking it out" approach can be counterproductive. This is especially true when difficulty verges into hardship and hardship leads to more profound problems – problems such as anxiety, depression, substance abuse and other more serious difficulties that cannot be easily managed through sheer will and determination.
One of the realities of life overseas is that the typical way we deal with adversity and challenge is not at our disposal. For expats who have moved repeatedly, there are few long-standing friendships with people in the community that go "way back." Similarly, family is far away and it is not easy to use them for support when something comes up. As a result, the social networks that someone would draw on for support and help as well as advice and guidance are not available to them. That, in conjunction the belief that they can tough it out, can lead to problems getting worse, instead of better.
Rule of 90
How do you know when are things getting out of hand? The Rule of 90 can be a helpful guideline. If there has just been a move and the problem has lasted less than 90 days, it is likely to be related to the disruption of the move. Starting out in a new country and community is disorienting and it takes time to adjust. It will take a few months before the dust settles and you or your family begin to feel comfortable.
However, if problems arise after the first few months, throw the Rule of 90 out the window and ask a different set of questions. First, how severe is the problem? Feeling a little down is normal, especially if there has recently been a major change. On the other hand, if a person's mood is very disrupted (for example they no longer get enjoyment from things they used to enjoy, or they cannot motivate themselves to get going), then the problem is more serious.
Next, ask yourself what types of problems you or your family is having. Being lonely and feeling out of place is normal in the first months of a major adjustment. Beyond that, certain things may indicate that something more serious is underway. Is there a heightened level of anxiety or panic, prolonged depression or sadness, consistently disrupted sleep or a noticeable change in appetite? Is there an over-reliance on alcohol or other mood-altering drugs or foods? Have you or your significant other begun to confide in someone other than your partner, becoming involved with them either emotionally or sexually (or both)?
Infidelity and Substance Abuse
Some of the most common problems that expatriates experience are related to substance use and infidelity, and quite frequently both. In these cases, the Rule of 90 does not apply. In both cases, it is essential that there is quick action to deal with the problem.
For alcohol or drug problems, a good first line of action can be consulting a physician. There may be local treatment options available; in a surprising number of places there are active and supportive Alcoholics and Narcotics Anonymous groups. In some cases, it might make sense to return home for a period to deal with the problem.
Infidelity is one of the most profoundly difficult (and, unfortunately, common) emotionally disruptive experiences in the expatriate community. Travel, alcohol use, opportunity, stress and loneliness all contribute to the problem. If your relationship feels strained, distant or unsatisfying, do something about it. Ideally, find a mental health provider or a clinician who specializes in expatriate care, that you can consult in person, via video link or by telephone.
Note: If you consult online, do remember all of the usual rules about caution and the need for checking credibility. In general, you should be sure that the clinician is licensed where they live and work, and it is almost always best if they have a brick and mortar practice, as opposed to only doing work remotely.
Getting Help
If you have any doubts whether anything you or someone in your family is experiencing falls within the range of usual behavior or "normal" adjustment, then it is wise to consult a health care professional. However, who do you turn to?
One of the great challenges of living overseas is that, depending on where you are, it can be difficult to obtain quality mental health care. There may be a limited number of providers in the community that share your language and culture, or they may not have sufficient training or experience to address the issues you are experiencing.
In addition, living in a small expatriate community can often feel like living in a fishbowl and it can be hard to have privacy and confidentiality. One couple we know saw a therapist for some marital conflict, only to attend an expat social function two days later and be seated across from – you guessed it – that very same therapist. Talk about uncomfortable dinner conversation!
A good place to find help may be through your physician, especially if they are mental-health-minded. Chances are they have practitioners they refer to. International schools, embassies, and expat community organizations often have lists of mental health resources. An online site called the International Therapist Directory keeps a list of providers by country who have experience treating the expat community.
Act, Act, Act
There are many places to find help. The idea is not to suffer in silence or tough it out, but to get a referral to someone who is qualified to help you or someone in your family get better.
The single most important thing to do when you run into problems related to mental health is not to ignore them. Anxiety and depression, substance abuse, marital conflict and family tension all get worse with neglect. Early identification and treatment can be highly effective and dramatically improve the chance that problems can be successfully managed.
Sean Truman, PhD LP, is a clinical psychologist who practices in St. Paul, Minnesota. An experienced expat, he grew up in Nairobi. Together with Susan Bernstein, MBA and experienced business strategist, Sean founded The Truman Group to provide high-quality, English-speaking counseling services to Westerners living overseas. The Truman Group connects highly skilled US-based clinicians, all of whom have PhDs in their respective disciplines or decades of experience treating issues common to expats, or both, to expats via Skype. The practice treats individuals, couples and adolescents over the age of 14, anywhere in the world outside the US. For more information and to contact them, please visit http://www.truman-group.com.
