My expat depression article in the WSJ

Last week I had an article published in the Wall Street Journal about expat depression – and in particular about how it affects accompanying spouses. I was extremely grateful to the four women in the article, who agreed not only to be interviewed for the article about their struggle with depression but to do so openly, using their own names. Each of them did so with the hope of helping others in the same situation as there are or were in.

Ms. Pogir has lived in South Africa for eight years and due to family circumstances sees her time in the country as indefinite. This feeling of being trapped just adds to her sadness. She said she looks around and sees a wonderful house and garden, a good life—but said: “I feel my happiness is the price we have to pay for all of this.”

This is such an important subject and I am so happy that it is getting the attention it deserves by being featured on such a well-read media outlet. I have had lots of visits to this blog on the back of the article, as well as seen it shared over and over on Facebook with – so far – not a single negative comment (pretty rare these days, I have been finding!).

If you are affected by this issue then please read the article, look at my other blog posts on the subject, and get help if necessary (one of my posts gives details of some places you can start to look for this help). And if you know someone you think might be suffering from depression, consider sharing the post with them as a way to help them take the first step towards getting help.

This is too important a subject to ignore.

A series on expat depression: round-up

Over the past few months I have been publishing posts about expat depression: a serious and seriously overlooked (in my opinion) issue that affects a lot more people than most realise. I myself learnt a lot while reading and then writing about the responses to a survey I did on the subject – it gave me a wonderful opportunity to reflect not only on my own situation but also on that of many, many expat friends I have known and still know all around the world.

I have now come to the end of my series but I didn’t want to finish without a summing up: links to all the posts and a conclusion. But this doesn’t mean for a moment I have finished with the topic – it’s something I feel I will come back to, will be a backdrop to many of my posts, will always be there when I think and write about expat life. I hope that by posting on this topic I have been able to help others, even if it has just given them an opening to discussion or a pause to reflect. As always, comments and feedback are welcome.

Introduction

I started the series with an introduction to the topic, explaining the reason I had decided I needed  this series was because an older post about depression I had written last year was one of my most read blogs – getting hits on it almost every day. This proved to me that a lot of people were putting the words “expat” and “depression” together into search engines – and looking for help.

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What is expat depression?

In my second post, I tried to unpick what was actually meant by the term “expat depression” but realised in the end that although there definitely is such a thing as “situational depression” caused by the situations we find ourselves in, depression is depression however or whatever it is caused by and needs to be treated accordingly. I did conclude however thar there are definite commonalities amongst expats who fall into the “depressed” camp one way or another and it was these commonalities I wanted to focus on.

When and why does it happen?

My third post started using some of the real-life experiences told to me in the survey I used as a basis for this series. This is where commonalities really started to become apparent. From the shock of the move to isolation and lonliness, loss of identity and control to repatriation – the same causes or at least catalyst of depression came up over and over again. As I said in this post:

Hopefully by recognising possible danger points in the expat cycle, I can help you be more prepared

What does expat depression look like?

Next I asked (and hopefully answered) the question: what does expat depression actually look like, how to recognise it for what it is and thus start to seek the help you need? Again, there were a lot of commonalities in my responses – from very emotional reactions (anger, tearfulness, frustration) to listlessness and feelings of wanting to shut yourself away. Food and alcohol issues were also two themes that came through in the survey.

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Overeating or eating unhealthily – one of the possible symptoms of depression.

Could it just be culture shock?

“I definitely knew and understood the concept of culture shock. By this point we had been there almost two years so I think I had gotten over the culture shock part and was resigning myself to the fact that no matter what I did I would never be able to thrive in this environment.”

My fifth post posed the question how to distinguish between culture shock – the emotional roller coaster that many of us go through at the start of a new expat life – and depression. This is a subject I had already tackled in my book the Expat Partner’s Survival Guide as I thought it was important for people to realise that very intense emotions are likely to be a normal part of their expat experience – but then also to understand when what they are feeling is something more.

Through researching for this post, I reached the conclusion that actually the two are so tightly intertwined that it’s often hard to say when culture shock ends and depression starts. But at the same time I truely believe that a really good starting point for any expat (or expat-to-be) is to read up on and gain a proper understanding of culture shock. We all know ourselves better – hopefully – than anyone else does. So you are in the best place to understand whether what you are feeling is simply down to the stresses of living in a new and alien environment….or whether it’s moved past this and heading into depression.

Help

Having now thoroughly tackled what expat depression looks like and how to recognise that is what it is, I turned to the question of how to help yourself. I did this over the course of two separate posts – the first discussed self-help methods, and the next how to look for professional assistance.

The self-help post had lots of good ideas, from finding a routine to getting a dog. Many people though agreed that these methods should be done alongside seeking the help of a professional such as a counsellor or therapist and the second post discussed the sort of help people looked for and where they found it. I included a list of therapists who specialise in helping people who love overseas in this post.

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Helping  others

I wanted to look at what to do if it wasn’t yourself you were worried about but rather a friend, a partner or anyone else you knew in your expat life. We often get close to people very quickly when we first relocate – but still it can be very hard to know when someone needs help because depression isn’s something that gets talked openly about very often. This post talked about how important it can be simply to be there, to invite people out, to talk and to listen to them. Even if you never actually touch on the subject of depression, just being there for someone might be helping them more than you would ever realise.

What about the employers?

My penultimate post in this series (if you ignore this one) looked at the role of employers. The verdict was split as to whether they should have a role at all in this area – especially when it comes to the partners of their employees rather than the employee itself. But after reflecting on this subject, my feelings are that so much of what we experience is tied to the situation we find ourselves in so perhaps the employers should be more aware of this issue? Maybe by being more proactive in this area they could stymie some of the problems before they escalate to the point where problems are going to lead to things like relationship breakdown or even their employee leaving the post. There was certainly a lot of food for thought in this one.

Repatriation

Finally, I felt I couldn’t leave this topic altogether without talking about repatriation. Frequently overlooked as a catalyst for depression, returning to your home country is often said to be the hardest part of relocation. Maybe because people don’t expect to feel this way and are therefore underprepared, maybe because the changes that happen to someone when they become an expat can make returning to your old life very hard indeed or maybe just because it is another flash point in the expat cycle I don’t know. But what I do know from all the informal research I have undertaken in this subject area is that repatriation is something that should be ignored at your peril.

And the conclusion is?

So that in a nutshell was expat depression. Or at least, it was my take on the subject. What can I take away from my experience of writing these posts? That although there certainly is no one-size-fits all approach to an illness like depression, there are commonalities. That we can all help each other just by being aware what others may be going through. Becoming an expat – especially if it is for your first time, and even more especially if you are the non-working partner – can be a difficult and frightening thing. Knowing that you are not alone, that others have gone through and continue to go through the same feelings that you are can e a huge help. On top of that though often what you need is more – and don’t be afraid to seek help from a professional if you think you may be depressed, even if you are not 100 per cent sure. The lines between normal feelings and clinical depression are very blurred so don’t leave it to chance or hope it will go away. Get that help earlier rather than later and then, hopefully, you can start to enjoy your expat life. Most of all though, never be ashamed of what you feel.

 

Expat depression and repatriation

I am not going to write a hugely long post about this because I think so much has already been written on this subject (see links at the end of the post). But I couldn’t close my series on expat depression without at least mentioning this topic.

When I was reading through the survey results from which I initially gathered people’s experience of overseas life and depression, one thing that stood out was the number of people who said the hardest thing for them hadn’t been moving abroad….but moving back home again. But why is this so tough? Surely you are returning to the bosom of your friends and family, to a culture you feel familiar with, to a place where you can understand what people say and find food you like in every shop?

Well, let’s start by having a look at some of the reasons why moving home isn’t always as straightforward as you may at first think it will be:

You’ve changed. They haven’t.

Of course, this isn’t entirely true as everyone changes as they grow and age. Things do happen back home just as they happen “abroad”. People get married, have babies, get sick….but these are “normal” things experienced by all; what you have gone through is very likely something out of the usual bubble of life, something out of the ordinary and something most of your friends will quite possibly never experience. And this will have changed you in ways you perhaps don’t even yet realise yourself. You will see the world differently, things that were important to you before won’t be now and vice versa. You will probably see that there is more than “one way”, that the world is a more complicated place than you possibly realised it was. And you will bring all of this with you into back into your old life – which will probably be just as you left it…

No-one will be very interested in where you have been.

Okay at first they will be. They will want to hear your stories of paddling down the Congo in a dug-out canoe or sleeping under the desert stars. They will start by asking you questions but these questions will soon run dry as they run out of understanding about your life and what you actually did on a day-to-day basis (which probably isn’t that much more exciting than theirs, despite what they may think). Eventually they will stop asking questions, start avoiding you in the street, “forget” to call you back. Not because they don’t like you but because they can’t really relate to this new version of you. And avoiding you is their best way of dealing with this.

You will have to start again.

And yes it could be just as hard as starting again in a foreign location. So you need to find schools, dentists, possibly a home, a job….you may have a group of supportive friends or you may not but many repats find themselves looking for a new support group who has more of an understanding of what life has been like for you over the past few years. So you need to find these people, get to know them, reach the point where you feel comfortable with them…You will also almost certainly find yourself going through the same culture shock cycle as at the start of your posting and as I described in my book The Expat Partner’s Survival Guide: the honeymoon period, negotiation, adjustment, acceptance.

If you have children they may very well be grieving their old life.

Whilst we may feel like we are returning home, this may not be so easy for children who have been out of the country for a long time and don’t really know anything but living in your foreign home or maybe even several foreign homes. For them, the things that are familiar and comforting to you may be very alien to them. They will probably also be missing their friends and wondering how or if they will ever see them again.

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And that is just for starters. You will read it over and over again but you probably won’t believe it until you experience it for yourself – moving home can be just as hard as moving away. In fact, many would say that it can be a lot harder – to the extent that one great piece of advice is to treat this as another foreign posting and adjust your actions and emotions accordingly.

In fact, this is why repatriating can very often lead to depression – because you are not expecting it to be so hard. You think there is something wrong with you. You feel ungrateful or guilty….you should pull yourself together, you can’t blame living in a foreign country for your feelings anymore….

So if this is you stop. Just stop. And give yourself some time. Ask for help. Do all the things people have recommended in my earlier posts on expat depression. See a professional. Don’t blame yourself, don’t think you are being weak. Just like you hopefully did when you first moved abroad, you will eventually settle back in, life will eventually get back to normal. You will be happy again. And if you don’t? Well, there is a whole world waiting out there!

Further info/reading:

Link to a free webinar on 26 May called Eeek I’m Repatriating – all about “finishing well and preparing to go home” – http://events.wattsyourpathway.co.uk/eek-i-m-repatriating-event-registration/

http://blogs.wsj.com/expat/2015/04/15/repatriation-blues-expats-struggle-with-the-dark-side-of-coming-home/

http://www.worldwideerc.org/Resources/MOBILITYarticles/Pages/0212-Dean.aspx

https://iwasanexpatwife.com/2012/01/16/repatriation-5-mistakes-i-wish-i-hadnt-made/

 

 

A Series on Expat Depression #9: What role should our employers play?

So I am nearly at the end of my voyage through the sea of expat depression. It has certainly been an interesting exercise and actually very useful for me who has found writing these blog posts to be a very reflective process. I hope others have also found them helpful, or at least to have given them pause for thought about their own situation. Today, I look at an area that I haven’t seen much discussion on – that of the role of the employer. Do they have a responsibilty to our mental welfare? Should they? What do you think?

“I think companies who move people abroad should consider their employees’ and their families’ mental health situation and be encouraging and supportive” – “V”.

Sending someone abroad to do a job is a risky strategy. But how many employers ever think to screen their workers for mental health issues before they go, or to help them once they are there?

This was the question I posed in my survey on expat depression, curious to know whether people thought employers had a responsibility for their workers overseas – and if so, what they should be doing about it.

Anecdotally, I have heard of some companies or agencies making sure anyone they send abroad (including the partners and families of their employees) are mentally fit for the stress they are fairly likely to encounter when they get there. This could include anything from having to deal with a totally new working culture to the loneliness and isolation of a non-working partner.

But in reality, most people confirmed what I had already suspected – the majority of employers either don’t even think about depression or mental health issues as a potential problem, or they do nothing at all about it.

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First the good news

“Our organisation (a church) had been sending missionaries overseas for over 100 years by the time we went overseas with them. They tried to screen for it before agreeing to send people overseas, provided a wide variety of support while you were overseas and would spend the money to send you home if you really needed help…” Missionary Kid.

It’s not all doom and gloom though. There were sporadic reports of attempts to help both employers and partners/families. One person said their employer was very aware of depression and that they could have accessed professional help through them. Another that her partner worked at a university where they had “monthly workshops for spouses”.  And Robyn told me:

“The HR manager in one location certainly attempted to stay in contact with workers and their spouses on a regular basis and tried to help with …problems related to settling in and certainly made herself available to help if any other problems arose during our stay….”

As mentioned above, I have heard reports of employers carrying out psychological screening of not just their employer but also their family before deciding where to send them (or sending them anywhere at all). This might seem like taking things a little too far until you consider how many people probably are unsuited to certain destinations. Although I would prefer to see proper support in place for everyone rather than stop people going “just in case”.

But more realistically…

Despite the isolated reports of caring employers most said this wasn’t something they had come across. Of course there was often “awareness” of the issue – as one person put it, they “must be aware as there as so many”. But awareness doesn’t always mean anything is actually done about it.

Not everyone thought the employers necessarily had a responsibility to their employees in this area – one saying “we put out hands up for the move and we were aware of the challenges we would face”. But the vast majority believed that not only was it “nice when they did”, but that it also made business sense for them to do so.

“I do think it is in their best interest to offer resources. It’s expensive to move families overseas. A failed assignment is more costly than counselling resources”.  Mary.

Unfortunately it seems many (most?) employers still have not understood the importance of making sure not only the person who is working for them is happy but their partner and family is as well. As Alison put it:

“I don’t think the employer does much to tackle the problems a trailing spouse might have. They just throw a huge chunk of money at you hoping that’s enough to entice you to go…and then you are on your own. I guess they feel that if they’re paying you so much more (in extra benefits and stipends) that it’s up to you to seek your own help”.

Which is a good point – even if an employer is aware of the issue, what can they actually do to help? Isn’t it better to leave things to the professionals?

How can they help?

Suggestions for what people thought their employers could do to help them ranged from the very simple – “even just asking after me a bit would have made me feel less irrelevant” (I will back her on this one!!), to the more ambitious eg “offering the benefit of some therapy sessions for their employee and/or partner”. Others said just having the employer be more open and communicative on the subject would help – I wonder how many people are briefed on this issue before they leave home? But practical help was also suggested – like this from Mary:

“Simple things that don’t cost a lot like a phone list would help, sponsoring a coffee morning every six months, info on working with the local internet and phones would be a great help. Providing several hours of translation services to spouses every 2-3 weeks after arrival to ask questions of local shopkeepers, apartment staff or tech service people would be a godsend”.

I might add to that list – wouldn’t it be great if every employer provided a copy of my book to anyone taking their partner overseas?

What do you think – is it the responsibility of a global employer to care about the mental health of their workforce? What can they – or should they – do to help? Have you got any stories, good or bad?

Picture credit: Jlhopgood

A Series on Expat Depression #8: Helping others

In previous posts on this subject I have talked about how you can help yourself – from simple self-help methods like talking to someone, exercise or finding a new focus, to seeking professional assistance. In this post I want to talk more about what to do if it is not you who is suffering, if you know others who may need your help and what you can do. This includes people close to you such as a partner or family member as well as friends and those in the wider expat community. In order to help with this post I asked people whether they had helped others, what they had done, how common they felt depression was amongst their own expat community and whether they felt it was more likely to affect the workers or the accompanying partners.

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How common is depression within the typical expat community?

I am a trained coach and decided to use the skills to help others. I did have clients who paid but I used the skills with people in the expat community…who just needed a boost, a point in the right direction. I think it is a common thing and it can hit anytime in the expat cycle and for any reason. Nicola M

Statistically there has to have been many people in my community who has depression! I think people just don’t talk about it. Catherine.

Although this is a difficult question to answer as one of the problems with depression or depressive feelings is that people don’t talk openly about it, most of those who responded to this question said they believed depression to be anything from “quite common” to “very common” amongst expats – with quite a few leaning more towards the “very” than the “quite”. Of course it is hard to know exactly what this means as most people don’t walk around with a badge on saying “I am depressed” or even necessarily ever get a proper diagnosis; but without a doubt according to many experienced expats this is an issue that an awful lot of people have had to deal with – probably a lot more than most of us realise.

To be fair though not everyone thought it was common – or at least, any more common amongst expats than non-expats. However even if this is so, what is an issue isn’t just how many people become depressed but how easy (or hard) it is to deal with your feelings when you are a long way from home, your usual support networks and an accessible professional service.

Who is most likely to be affected?

I think it can occur when people stay too isolated, don’t really connect to their community and locals. I would say working people are pretty safe from depression due to their involvement in tasks and social connections. Non-working mothers with small infants would be at risk…if they have no chance to connect to others. Sarah.

Non-workers for sure. Workers have at least 8 hours when they are distracted from their feelings. My only friends in my location are girls in the same situation as me. We often band together. Susanna.

Of those who answered this question almost everyone said they believed non-working partners were more likely to be affected than their working spouses (with the possible exception of people working in very stressful industries or environments like NGO’s/charity workers/health professionals in very challenging circumstances). This was put down to isolation and loneliness, lack of things to occupy themselves with, loss of careers, loss of identity. One described it as a “helpless feeling not to be financially contributing”; another said “I think the trailing spouse gets it more because we suddenly have nothing to do”.

I think it is more common among non-working spouses. Many of us are professionals in our own right and have lost a big part of our identities. Maybe we had “leaned out” of the workforce for what we thought was a short time to care for our family and the expat lifestyle has extended that beyond the timeframe we had envisioned. Rose.

But a note of caution from one respondent, who thought it was probably more common than is realised amongst the working partners too. Probably the majority of people who answered my survey were non-working partners and thus were speaking from personal experience. Most were also women and I believe we are more likely to speak up about this issues. I suspect it is harder for the partner who has moved overseas for a job, possibly uprooting their spouse and family in the process, to admit that things haven’t worked out the way they had expected. This isn’t something I can back up here with facts and figures but I wouldn’t be at all surprised if there wasn’t as much hidden or masked depression amongst the working partners as those who are not.

How can we help others?

I listen, go to newcomers coffees, share advice on where to find Western goods, how to cope with local Chinese, how to work within the censorship issue…. Mary

In Mongolia I tried to help a young wife who found herself in a situation…that threw her into a deep depression. We spent many hours talking and crying and I think my experience of depression, knowing the signs as well as knowing the experience of it, was helpful to her. Robyn.

So plenty of people seem to be aware that expat depression is a common thing, how many people have done something about it? This is such an interesting topic as I truly believe the more people there are that are aware, the more who talk about it openly and without shame, then the more people will already be getting help than otherwise. Even in the course of writing these posts I feel I have been able to talk to so many more people than I usually would about this subject – both through the blog and Facebook page and in real life – because I have been able to open up the discussion.

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Sometimes something as simple as a coffee with a friend can make the world of difference

So talking – and just listening – is definitely a thing we can all do and a lot of people have done. This doesn’t have to necessarily be an “open discussion about expat depression” – it could just as well be a conversation which starts with “how are you finding things here?” However, when I think about reaching out to some of my friends (not necessarily the ones here with me in Pretoria but other expats I know in other places) I can’t even imagine how to get them to admit there is a problem. If there is one of course. And that is one of the issues – how do you know if someone needs your help? Are you going to insult them by even a gentle probe?

Nevertheless people did tell me that “listening” was one of the most common ways they have helped others – listening, emphasising, even, as one person described, “giving them space to vent” seems to go a long way. Otherwise, sharing information to help make transition easier, making lunch and coffee dates to ease loneliness and isolation, comparing experiences good and bad are all ways people have found to help other expats. My favourite of all though was the respondent who said she had recommended my book the Expat Partner’s Survival Guide J

Who else should be listening?

We have talked about helping ourselves, we have discussed helping others within our community but there is another party in this who some believe should be involved and that is your employer (or the employer of your partner). I was interested to hear whether people thought their bosses should be involved in this issue – and if so, what they should be doing. Watch out for my next post on expat depression to find out more.

Photo credits: Lonely – Pascal Maramis; Coffee shop – J Brew

If you have found this post helpful then please read the other posts in my series on expat depression. And let me know in the comments below whether you have helped others in your expat community and if so how. 

 

 

 

A Series on Expat Depression #7 – Seeking professional help

“I found a counsellor who wasn’t particularly helpful and struggled for a year with her. I’ve found another counsellor and my husband and I are doing couples counselling, which has been very helpful for both of us to face the feelings about the move and our separate unhappiness about being here. It’s a long road from here, but it’s improving” – “V”.

In last week’s blog I looked at how people had helped themselves to tackle their depression. Top of the list was the thing that I will look at this week – which is seeking the help of a professional. Which isn’t necessarily all that straightforward when you are living in a foreign location – especially one that is very remote and not necessarily an expat stronghold. So who did people turn to when they needed that help? And what was the general experience of seeking the assistance of a professional?

As always, it was a very mixed bag. The split between those who said yes they did seek professional help and those that said no was roughly about 50/50 – although if you include those who plan to do so at some point the figures go up in favour of the yes’s.

Why did people NOT seek professional help?

To start to look at why people have sought out the help of a specialist and how this has helped them, I wanted to first look at why people haven’t. This gives some idea of the problems faced by expats trying to get help in their overseas locations.

Many of course simply gave a straightforeward answer – no, they didn’t. No explanation given – they just didn’t. And others gave the same sort of reasons that anyone, anywhere might give – reasons not associated with being an expat but with just feeling vulnerable and in a difficult place: “I felt I had it handled”, “I never had the guts to call”, “I couldn’t get an appointment and gave up trying”.

However other reasons were more specific to being an expat – “the only specialist I could find was geographically unavailable”, “in our last place not a single person respects confidentiality”, and a few people mentioned the difficulty of finding someone with enough understanding of the expat experience to really be able to help.

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But for those that did – how helpful was it?

“I went to a counsellor on GP recommendation when in Dublin. First time I had been to a mental health specialist. In 2005 approached a coach in the UK (I was in the Netherlands) by phone and email to help with a decision for a future expat trip and found myself working out things I’d been holding on to for years. It began a process of self-discovery and a new career for me” – Nicola, who went on to train as an expat coach herself.

Almost everyone seemed to think that the professional assistance they did get was helpful – ranging from a simple “it did help” to “it helped immensely”. In between were some of these comments:

“I saw a therapist in the UK for several months and that, paired with being in a familiar environment with friends and family was just what I needed” – Catherine.

“In conjunction with therapy I made a lot of changes to my lifestyle….all of this helped pretty quickly” – Anne.

There were also some, to be fair, who said that seeking help from a specialist didn’t really help them. However, these were definitely outnumbered by those who said it did and it is always worth at least trying this route if you feel you need it.

Who did people seek help from?

“During my first expat experience in Indonesia I reached out for my psychologist in Australia, via email and obtained a certain amount of support that way. I was lucky enough to have a very supportive psychologist who would do that for me although I imagine it is not very common. It certainly helped knowing that she was there and would help if I asked, even if I didn’t use it. it was simply nice to know that someone who knew me very well could make decisions in an emergency that I knew I may not be able to make if my depression worsened to an extent that I was in a dangerous place”. Robyn.

So where did people find this help? What sort of professionals were they – and where or how did they find them?

Again, this was a really mixed result. Here are the words used in my survey to describe the professionals used by respondents: counsellor, therapist, psychiatrist, medical professional, OB-GYN, social worker, psychologist, family doctor, GP, life coach. So quite a range – and this is an area you may need to explore. But certainly counsellor and therapist were the words that came up most often.

Many people simply sought someone out locally, wherever they happened to be (whether in their host country or back home after repatriation). But more and more people are turning to online counselling as a great alternative to seeking face-to-face help. In particular, these therapists often have a first-hand knowledge of expat life and have almost certainly worked with many other expat clients – thus giving them an edge over those who may not have had the same sort of insight into our world. Of course local professionals can also offer an excellent service and it isn’t always necessary that they have this specialist expat knowledge – especially in cases where your depression is not a direct result of your expat experience.

Finally, as was the case of Robyn whose quote starts this section, some people were able to carry on using a therapist they were already in touch with from their home or another expat location. With the availability of the internet, Skype etc these days this is always a solution worth exploring if you do already have someone you have been working with.

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And what kind of therapy did people get?

“I wasn’t able to dig myself out of this on my own. Healing didn’t begin until I started seeing a therapist who referred me to a psychiatrist who together worked with me for about six years before they found the correct types and dosages of meds, coupled with weekly therapy.” – Anon.

Just like with any kind of counselling help, a variety of assistance was given. Some started on anti-depressant medication, others just used talking therapy. One survey respondent was given the herbal remedy St John’s Wort (“which helped for a while…but not now”), another was emailed a list of coping strategies from her online counsellor. A couple of people said they were introduced to Cognitive Behavioural Therapy (CBT) as the way to help them cope.

Importantly, almost everyone did say that they used professional counselling alongside self-help methods. It seems that it is the combination of the two that has been proved to be most successful – although often what people need is some specialist help to get them started. When you are so low that even getting out of bed is hard, it can seem like too big a mountain to climb to get out and meet people, do some exercise, find a new hobby…..

How to find help

I can’t personally endorse any counsellor as I have not used them. However I would like to mention a few  experts who I have at least been in contact with since I started this blog and can confirm them as empathetic figures and with a good knowledge of expat life. First of all is expat mental health expert Anita Columbara, who has been helping me by overseeing this series. Then there is Vivian Chinoa who featured on this blog last year and who runs the Expat Nest website and counselling service. Finally is Olivia Charlet, who has also been featured on this site and who runs a coaching business. All three offer something very different – a good example of how many different options there are out there.

In addition, here is an interesting article about Finding a Therapist while living abroad written by seasoned expat Robin Pascoe and including an interview with a Seattle-based expat counsellor.

Finally, a very helpful International Therapist Directory which is an “an online listing of professional mental health therapists familiar with the Third Culture Kid and international expatriate experiences.”

Photo credit: Counselling – Cushing Memorial Library

To read all the posts on depression in this series please visit the expat depression section of my blog here.

 

 

A Series on Expat Depression #6: Self help

“I did talk about my sadness/culture shock. It did help. I also worked hard on doing the stuff I liked to do and trying to have new friends. All these things helped” – Lola.

Up until now in this series on expat depression I have talked about what this dehabilitating illness looks like, how it affects you, why it affects you…now I want to turn towards something a bit more positive and start to explore how people have helped themselves. Later I will look more closely at professional help but before then I want to start discussing some self-help methods that you can try yourself. Of course I am not a mental health specialist so I can’t tell you whether you need to seek the help of a professional or whether tackling the illness yourself is enough. But even if you do feel the need for more help,  some of these ideas might give you something you can do alongside seeking professional assistance.

Thank you to all the brave women and men who responded to my survey asking for their experiences. I have been humbled by how willing people have been to share what has very often been very difficult times for them.

It’s good to talk

“Time, really, and being able to talk to my husband about what was wrong…and feel I was being heard. It’s still a bit tenuous but it’s improving” – “V”.

Many people told me that talking about their feelings really did help. In many cases this was to a counsellor or another professional but I will look at that in another post. After counsellors though, the most popular person to discuss feelings with was a partner.

When I wrote the Expat Partner’s Survival Guide, I suggested that it shouldn’t just be the accompanying spouse that reads the book. It is all too common for the one who isn’t working to think they shouldn’t be bothering their partner with their worries and unhappiness. There is still a misconception that the one who goes off to work every day has the harder job – that they are the ones who need the support. I know from my own personal experience as well as the extensive research I have done for the book and this blog that this certainly is not always (or even usually) the case.

Unless you talk to them, your partner may not even know you are struggling. A classic symptom of this is that you bottle it up until one day they come home from another day in the office and you break down on them. They will probably then feel guilty that they didn’t realise there was a problem, but chances are they have been pretty wrapped up in their own, new life.

If you are unhappy, talk to them. If you worry that they will think this means moving was a huge mistake and you want to go home – reassure them, talk about culture shock, show them my book or my blog!

As well as partners (and of course not everyone has a partner, or perhaps their partner is part of the problem…), survey respondents talked to friends or family both in their host country and back home. Some though cautioned to be careful who you spoke to – many expat communities are small and lips can be loose. A trusted friend or family member not connected to your new life could be easier to talk to than someone you have only recently met.

Social interaction

“I’ve always exercised and certainly realised that I needed to get out and about and see people to help me and not stay in the house alone with my child. I joined an expat group and began going to the mum and kid activities” – Nicola.

“Reading the experience of others in expat articles – especially “trailing spouse” issues – made me feel more normal and less alone. Connecting with other expats was helpful”. Anon.

Different from talking to someone specifically about your problem or feelings, many felt that just interacting with people was also a great help. As I write this I have recently finished a Skype conversation with friends in England. I wasn’t feeling particularly unhappy anyway but it does give me a little glow inside knowing that there are people back home who miss me and who will be there for me waiting with a bottle of Prosecco when I get back.

But interacting with people around you, even if you have to force yourself out of the house, is even better than doing it through the internet. Finding a group of people all doing something that they love and joining them can be the best way to take your mind off those negative feelings. It is a cliché and may make you cringe a little but taking up a hobby that you can do with others is excellent advice. From photography to book clubs to golf, there were many suggestions for ways people could meet other people in a social setting and help move on from their depression.

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But beware the expat bubble

“I made a tremendous effort to integrate more with the locals – mums at the school gate, being more chatty with local shop-owners, offering to help out at school functions and giving people lifts in their cars. Leaving Greece wasn’t an option so I kind of decided to grin and bear it. The things that we would complain about as expats, I now accepted as the norm and just got on with it. I’ve made some amazing friends who were right under my nose all the time. I’d created a little expat bubble for myself which was the worst thing I could have done” – Nicky.

On the other hand, one respondent cautioned that she needed to get out of the “expat bubble” in order to improve her feelings. Whilst making friends with other expats can be a lifesaver to many (especially when you are newly arrived), it can also be very claustrophobic. It can be easy to fall in with people who feed off each other’s “negativity” – if this happens to you, find a way to move on. Even if you don’t find a way into making friends with lots of the “locals” (as this isn’t always an easy thing to do), there will always be another crowd out there.

Sport and exercise

“I am an avid golfer and in all of my postings, and especially when things are hard, I force myself to continue to get out there and play both for the beneficial effect of the exercise and fresh air as well as to interact with others” – Robyn.

If one of those things you can find to do involves sport then all the better because it is well documented that exercise improves our mood. Whether you run, jump, throw or swing, getting your heart pumping a bit and those endorphins going will trigger positive feelings in you similar to the drug morphine (which I can speak of from experience, having been heavily drugged up after the birth of my daughters by caesarean).

Not only that but you can also feel saintly after that weekly work-out and indulge in a nice slice of cake. Yes okay I said in another post that over-eating isn’t going to help your feelings but if you’ve just done an hour of bootcamp….

Other “lifestyle” changes and finding a routine

“In conjunction with therapy I made a lot of changes to my lifestyle in terms of exercise and activity monitoring. Thankfully the summer also came to an end and there were more groups (including a choir) that I could join to meet people. All of this helped pretty quickly.” – Anne

As well as meeting people and doing exercise, people spoke about other ways they had changed their lives (in small ways, not necessarily in an all-encompassing big sweep change way). One said she had started doing volunteer work and “got a schedule for my day”, another that she took up meditation, a third that she signed up for a couple of online courses. Others spoke of the importance of routine, of having something to get up for each day. It doesn’t have to be anything major but just having something in your diary or something to focus on can really help.

Getting a dog

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“I got a dog, which was a bigger help that I anticipated” – Nancy.

“I was lucky in a way to have my dogs with me. They were a great source of grounding and comfort. They also forced me to get up and do things every day,  needed to feed them, I needed to make sure they go exercise” – Robyn.

This is a favourite of mine as we have literally just acquired a nine-week old miniature schnauzer puppy. It is my first dog but already I can see what a huge comfort having a pet can be when you are new somewhere and perhaps on your own at home for much of the day. I am obviously not alone in thinking this – several of the respondents to my survey mentioned the benefit of “man’s best friend” to their mental wellbeing. As well as the company and comfort they provide, walking a dog also gets you out of the house, helps you exercise and provides a daily chance for social interaction. The flip side to this will be if you have to leave your dog (or cat) behind when you leave so make sure you research how easy it is to bring them home or to another location at the end of your posting.

Getting out of the country…moving on.

“I made an effort to see friends more often, and that helped to a degree. However the depression really took hold and the only thing that really helped was getting out of the country and seeking treatment in the UK” – Catherine.

“I have been taking longer vacactions back home every summer and that is the best cure. I don’t have any of those feelings when I am out of the country” – Sarah.

Finally, for some the only way they were able to fight their depression successfully was to get away. In some cases this just meant a vacation, or a prolonged spell back home, to others it meant leaving for good.

Although it is always worth giving a new location some time (definitely up to six months, a year is more realistic) to work out if you will be happy there or not, there will be some occasions when it just isn’t going to work out. And on those occasions is it worth battling? This doesn’t just relate to new assignments though – sometimes situations and circumstances change even if you have been happy somewhere for a long time. People mention in particular a group of close friends leaving and feeling alone and isolated all over again.

Leaving somewhere is never easy – especially if you have been building up to it for a long time and/or people back home don’t realise you are unhappy (I bet they all think you are on a three-year vacation!). But brave people do make that decision and it may be that this is the right thing for you. If you do, never regret it. You will almost certainly wonder if it was the right thing to do (just like most of us question the decision to move away from our homes in the first place). But once you have decided to go don’t look back.

Do you have any more ideas for people to help pull themselves out of depression? Has anything worked for you – or perhaps NOT worked for you? And don’t forget, if you haven’t already read my previous posts in this series they are all available right here.

Photo credit – the Bookclub, Shoreditch by orangejon

 

 

 

 

A Series on Expat Depression #5: Culture Shock or Something More?

“This was definitely more than culture shock. Though perhaps if I’d taken the culture shock more seriously and spent time dealing with it, the depression might not have occurred” Anne.

Just before I move on from understanding a bit more about what expat depression might look like and on to how people have started to help themselves, I wanted to consider what people understood about the term culture shock – and what they thought about its links with depression. As ever, thanks to expat mental health specialist Anita Colombara for looking over this post before publication.

When writing my book the Expat Partner’s Survival Guide I decided the subject of culture shock was such an important one that it deserved a whole chapter to itself. In the end, I also included a section at the end of the chapter on depression because I realised as I was writing it how closely linked the two are. And also how blurred the edges the two can be. How do you know if what you are experiencing is really just part of the normal experience of many (if not most) expats when they arrive in a new destination, and when it is something more serious?

Well I would say often you don’t – and that may be the problem. Because who is to say whether what you are going through is “normal” or not? If it is bringing you low should we label it “culture shock” and tell you that you will get over it? Or should we label it “depression” and recommend you seek advice.

To help answer these questions I decided to ask people what they understood about culture shock, whether they recognised it as part of their experience of moving abroad, or whether it felt like something more. The answers, predictably, were as varied as the experiences of those giving them – and helped to show how tied up in each other culture shock and depression are.

For background information, here is the definition of culture shock I came up with for my book:

‘Culture shock could be defined as disorientation on moving somewhere new, a rollercoaster of emotions. It is said to have four phases and each phase is described differently by different people but generally they are wonder/honeymoon, negotiation, adjustment and acceptance. You can move between the four stages in order or back and forth between them; you might skip some of the phases or not experience any of them.’

An understanding of culture shock?
Most people who answered this section of the survey I used as the basis for this series said they did understand what was meant by the term culture shock – although for many this came later rather than at the time they were going through it. Although this in itself is heartening (as I think it should be part of everyone’s preparation for a move abroad to read up on culture shock), it is also worth noting that most of those who responded to my questions were already experienced expats. I wonder how many who have yet to move have ever considered a need to read up on this subject. Certainly a lack of knowledge about what is normal is one of the more common reasons people state for falling into depression – and thinking you are somehow doing something wrong by not being happy in your new home is also one of the reasons people fail to climb out of it.

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Part of their depression
For some people, their depression either started as culture shock or it was part and parcel of the same thing. Perhaps instead of moving through the cycle, they got stuck at a very negative stage. It is probably impossible to tell whether this was because the culture shock was preventing them from moving away from depression or the depression was preventing them moving through the culture shock cycle. Whichever was true, many found that the shock of moving to a new country pushed them lower than they had been before.

“The culture shock was one of the motives. Dutch people are way colder than Brazilian people. Sometimes I would feel so lonely that it was hard to make it through the day.” PKF

“Yes and no. Yes, because I’d briefly lived in the same country years earlier and my husband is native. But I discovered more things that drove me crazy and honestly, for the first three years, was desperate to move home no matter what it took. I knew it would get better but there are some things I will never like. So much of how I felt was tied up in being depressed and it was hard to separate the two”. V

Shock at the shock
Others found that they weren’t prepared for how severely they would be hit by culture shock, which in itself led to their depression. This included people moving to a new location for a second or subsequent time – not realising that culture shock doesn’t just happen the first time you leave your home country. It also includes people moving home and not realising you can get reverse culture shock.

“Having lived in Asia before I thought I understood culture shock, but China is so different that part of my problem is culture shock. Also I had never lived in a Communist, repressive, censored place before – that was a huge one we had never thought of”. Mary

“I understood the concept of culture shock. I lived right next door for five years beforehand. I just didn’t realise how different it would be here.” Sarah

“I expected to notice cultural differences and hoped to learn about different cultures and looked forward to that part of the cultural experience. I guess I was not prepared for the effect that cultural differences would have on me. In Mongolia, Indonesia and Mexico I feel that the cultural differences I saw or learned of have added to my education and enriched me. In India, the cultural differences I saw and experienced were far more extreme and made me realise that some of the core beliefs that I thought were universal were in fact not and this really unstabilised me”. Robyn.

“I did realise that part of my loneliness, isolation and frustration was the culture shock of returning home after so many years abroad” Nancy

More than culture shock
For many, especially those who understood culture shock and the effect of moving to a new environment, these feelings were definitely something more. Some recognised that they had had culture shock at some point in their expat lives and therefore knew this wasn’t that. Others worked it out when things didn’t seem to improve after a few months. As Catherine said:

“I definitely knew and understood the concept of culture shock. By this point we had been there almost two years so I think I had gotten over the culture shock part and was resigning myself to the fact that no matter what I did I would never be able to thrive in this environment.”

And from Nicky:

“This happened a long time after the initial culture shock! My friends were like family and I felt they had all abandoned ship and left me which was an irrational fear after so many years abroad”.

A good starting point: understanding culture shock
In my next post about expat depression I intend to start looking at some of the self-help methods people have used to help tackle their feelings. But a good starting point, whether you already have depression or as one of the weapons you can use against it, is to read up on culture shock.

Realising what is “normal” and what is perhaps something more can help us cope with what we may be going through. And if you believe that you have passed the stage when you should have been starting to adjust to your new life but you find yourself still struggling this could be the time to seek more help.

Further reading:

Culture Shock: What it is and How to Deal With It.

An interview I did for the podcast Tandem Nomads on Culture Shock

An article about the origins of the term Culture Shock

Photo credit: Republic of Korea

Did you suffer from culture shock? Did you understand what it was – and if so, do you think this helped? Do you wish you had known more about it before you left home?

Please don’t forget to read the other posts on this subject: Introduction to expat depression, what is expat depression, when and why does it happen and what does expat depression look like?

A Series on Expat Depression #4: What does Expat Depression look like?

“It manifested itself first in the form of breaking down every night and crying. After that, I had about an eight month gap where it seemed to be just loneliness and culture shock. Then it came back in the form of laziness and anger if someone disturbed me from my book or video game. Later came sadness, and confusion. Now I just feel numb. Like I can’t cry or even really care anymore. Just apathetic. The defining feature of my depression is that I barely touch my food”. – ‘Artemis’

“I just feel constantly tired…and grumpy and don’t really enjoy doing anything and feeling lonely even though the family (hubby, kids) are around” – anon.

Lazy….angry…..despondent….tearful…..apathetic….trapped…..

All of the above words were used to describe to me how expats felt when they were going through a bout of depression. Last week I started to look at some real life examples to break down when and why expats are affected; this week I want to focus on how the illness typically manifests itself. Hopefully this will help you recognise the condition not only in yourself, but in others around you – including your partner. By doing so, I hope you can start to find the help you (or they) need.

Like last week, I found the answers given to me from a survey I used to gather stories and experiences for this series had many commonalities. The same words and terms, the same sense of desperation, came up over and over. So, as before, I have broken the results down into the most common themes – but caution that there will be plenty of other typical signs and symptoms that I can’t cover here. So if in doubt, always seek a professional opinion.

As always, I am sending this blog post to expat mental health specialist Anita Colombara to read before it is published. I am not a medical professional so prefer to have someone with specific expertise in this field to check what I am putting out there.

Listlessness, laziness, lack of energy

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Probably the most common theme of all was one of apathy – of not wanting to get up, do anything, go anywhere. People talked about how they just didn’t want to get out of bed in the morning. Some described being “constantly tired”, others just “deflated”. One person told me they felt like they were on a treadmill, and didn’t have the energy to do anything other than the “necessary stuff just to get by”. Another said she actually experienced “chronic fatigue”. And another said she “felt overwhelmed by daily tasks”.

Spurning social interaction

This sort of listlessness is a very common symptom of depression, but when you are an expat recently arrived in a new location the feeling can be overwhelming. Getting out there and meeting people is part and parcel of this new life; for many, it’s just one step too far. Your mind may just tell you a far easier option would be to stay in bed or on the sofa, you may just find yourself switching off.

One anonymous respondent to my survey described

“dreading social activities, not wanting to talk to people, not leaving the apartment…”

Another respondent, Nicky, said she

“found it incredibly hard to start building new relationships. I preferred to stay home and watch TV or talk to friends back home, and I started to feel more and more isolated.”

And another, simply calling themselves PKF, told me:

“First, it started with low motivation to get out of bed in the morning. Since I don’t have an exact hour to start working, I would get up later and later every day. I also started to feel less willing to meet new people, to engage in new relationships, or even to do things that before used to bring me a sense of pleasure”.

Lack of joy, anxiety, anger, crying.

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“My husband worked long hours and I felt angry with him that he had more “freedom” than me” – Nicky.

“I yelled at my kids, snapped at my husband, and cried all the time. I was working like a maniac, running miles every week, and I couldn’t keep the demons at bay” – A trailing spouse.

One step up from a general feeling of deflation, people told me of very negative feelings they started to have – often aimed at their partner, or at their host country (which I will explore further in a post that links culture shock and depression). I know from my research for the Expat Partner’s Survival Guide (as well as personal experience!) this can be particularly true for the non-working partner in a relationship. It’s hard not to feel some bitterness when your spouse’s life carries on almost as before while yours is turned completely upside down.

Crying a lot, or just feeling tearful, was another symptom that came up many times – another sign of depression that is often unrecognised until someone looks back and realises they aren’t doing it anymore. Others reported having anxiety attacks, especially when they did get out of the house – with one respondent to the survey saying she found it particularly difficult to be anywhere where she didn’t know anyone, or around “hustle and noise, anywhere I feel my senses are being bombarded”.

Lack of interest in things that should bring you joy

“I was constantly tired and unable to do much of anything after coming home from work. I just wanted to lie down. Not even cook, although I was hungry. I knew it was depression when I was spending time with my best friends and not happy with them anymore. The stress was too much and overpowering the joy that usually comes from spending time with friends”. Anon

More specific than just a general apathy some people said they had a very definite lack of interest in things that would normally bring them pleasure. Included in this was their children, food, social activities, and sex. Some also said they couldn’t enjoy their time with their partner, had no interest in them or couldn’t think of anything to talk about with them.

Difficulty sleeping, or sleeping too much
Some felt too anxious to sleep, others were fatigued all the time. Some just found their usual sleep routines were disrupted. “Expat girl” said:

“I was sad all the time. My sleeping routine was completely shifted, I didn’t sleep at night but in the morning it was always extremely difficult to stand up from the bed to go to university. I could not listen to happy music and preferred to be in the dark lying on the floor”.

Not looking after themselves

“I stop taking care of myself and find it quite a chore to shower or to make myself look presentable” – Robyn.

Survey respondents also reported feelings of worthlessness that led to them not looking after themselves. This included both physically – not bothering to get dressed in the morning, not eating properly – and also mentally, eg not caring about their own feelings.

Food issues
Some people said they went off their food, but more commonly people reported over-eating. Food is often associated with comfort so it’s no surprise that this is often what people turned to when they were down.

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Eating too much of the wrong food can have a negative effect on your emotions at the best of time so it is inevitable that this is not going to help your mood. And when it turns into unwanted weight gain, you are probably going to feel even unhappier about yourself and less likely to want to get out there and meet people. It may be one of the less serious effects of depression but comfort eating really can become a downward spiral.

Alcohol
Sadly another bi-product of this sort of depression can be turning to alcohol. Particularly prevalent in expat communities anyway, where social life is often exaggerated compared to back home and alcohol can be cheaper, turning to drink is often first thought of as a way to cope with negative feelings. Unfortunately the short-term fix often leads to a longer-term problem – I have known several people develop an often unrecognised or diagnosed alcohol problem while living overseas.

As with all my posts I welcome all comments and contributions as this is a topic that is far wider than just these blog posts. In my next blog on this topic I want to move on to look in more detail at culture shock and whether people felt it contributed to their depression or even if they understood when culture shock ended and depression began. After that, I will begin to look at how people have helped themselves when they have been depressed and later how they have sought professional help.

(Photo credits: Man on bench – ashokboghani;  Man in water – mgstanton ; doughnut – 5th Luna)

Please don’t forget to read my other posts in this series: Introduction to expat depression, what is expat depression, when and why does it happen and the link between culture shock and expat depression

A Series on Expat Depression #3: When and Why does it happen?

In my post last week I looked at the concept of “expat” depression and whether it could be classified in a division of its own (in the same way as, for example, postnatal depression). Whilst the jury is still out on this, I did find it a useful exercise to help me reflect on why we expats are more susceptible to these feelings than many others. Certainly what I have found through my research for these posts is that sometimes the depression experienced by expats is a one-off, caused basically by the change in circumstances and the associated issues that go with the relocation; other times these changes reignite underlying problems so that those who have suffered in the past find their symptoms return when they first move abroad.

Whichever one though, my discussions on the issue with counsellor Anita Colombara has led me to conclude that depression is depression and it is always worthwhile trying to do something about it (whether by self-help methods or seeking professional help) sooner rather than later.

Today I want to move on and start to look at some real life examples of how depression has affected expats. I am going to start by looking at the when and the why. The where is in there too but it less relevant – after all, depression is something that can happen to expats wherever they are in the world.

I realised pretty quickly when I started breaking down the answers that there were a lot of common themes in responses to the survey I put together for this series. So taking each theme in turn, below is a list of some of the most common reasons given for triggering expat depression. Hopefully by recognising possible danger points in the expat cycle, I can help you be more prepared. In later posts I will look at some of the ways people have dealt with their depression in some of these situations.

Moving somewhere new

“People tend to underestimate how upsetting a move, and moreso an international move, can be. Some ex-pats chalk it up as normal culture shock. Yes, that could be so. But even seemingly small life changes can trigger  more profound depression or anxiety issues.” Anita Colombara

Of course, moving to a new place doesn’t only happen to expats. Many people have moved across town to a new house, to a neighbouring city with a new job, even to the other side of the country. But becoming an expat is something different altogether – you are not just letting go of the familiarity of your old home and neighbours, you are moving away from the cosiness of a complete culture. And very often you are stepping completely into the unknown.

Whilst the relocation is often just the start of things, many find that the early days in a new country is enough in itself to trigger their first bout of depression. Here are a couple of people talking about these changes:

“When I first moved over to the UK with my husband, it seemed like nothing was familiar. And why would it be? We were in a different country from my home country. I loved aspects of it…but then there were those certain times when I was feeling a bit vulnerable and needed something – anything – that felt familiar” Erin.

“I know….that depression can be triggered by lots of changes and their associated stressors or stresses. Moving to a foreign country, away from family and friends and any support system you might have is really exposing yourself….” Robyn.

But as difficult as it may be, the move alone isn’t usually what triggers the depression. Instead, it is usually a combination of those factors that so many of us recognise as being part and parcel of expat life – starting with that old chestnut:

Loneliness/isolation

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The expat “bubble”?

I suspect many of us underestimate how isolated you can feel when you first move somewhere new. We probably think we can make it through the first few days/weeks/months (possibly even years) without close companions, but in fact as much as anything it is the daily interactions with familiar faces as much as the close friends and family that help us cope.

You often lose this interaction when you move – maybe you stop working, or you don’t go to the school gates every day, or you don’t shop in the same shops on a regular basis. It may take time to build these sort of regular meetings up, you may never be able to do it. And although social media is a godsend to many of us, it is never truly a substitute for proper, human, face-to-face contact.

People mentioned loneliness because they weren’t working, they didn’t have children, they did have children, they couldn’t find ways to meet people….loneliness affects people in so many different ways and for so many different reasons, which is why it is hard to say exactly when and why it happens. Here are a couple of examples, starting with more from Erin:

“With my husband working long and crazy shifts, I felt isolated and alone. And because we had moved two months before the twins were born, I didn’t really have a good local friend to lean on. I was able to Skype home but if anything, it just made me feel more depressed. I wanted to physically hang out with those people. I wanted those people to go out with me or look after the twins while I took a break. Skype can do many things – but it can’t do that”.

And, from Amanda:

“…my partner was working and I wasn’t so I was spending a lot of time alone. Living in a small town made it hard to meet people, as most people were working during the day. The lack of daylight in the winter didn’t help as it made it difficult to get out of the house much”.

Living in a difficult place/cultural issues
Not all expat assignments are equal – some, without a doubt, are going to be more challenging than others. Although I should add that what one person finds hard is another’s easy ride. A lot of people think a Caribbean island would be a dream posting. I would tell them otherwise!

But even so, there are some places and some situations which undoubtedly do put extra pressure on. Alyson told me about the “cultural differences” that made running a business in Kenya quite a “challenge”; Sarah described living somewhere that she couldn’t drive (by law) or walk alone (which attracted negative attention). Talking about her time in India, Robyn told me:

“I was in an overcrowded, noisy, hot, dusty, culturally shocking place, trying to find my feet without any safety net and it wasn’t long before I felt some of the symptoms of depression start to take hold”.

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India streelife – can be quite a culture shock to many.

Lack of job/role/purpose and boredom

“It started because I was a trailing spouse – I had a successful career of my own, but I gave it up to come abroad….” – Susanna

“After both my move to Africa and my move to Asia, I experienced feelings close to depression. My entire four years in Africa were an emotional roller coaster. The first three I was a stay-at-home mom with full-time staff, which left virtually “nothing” for me to do”- Mary.

“On my last island there was little to do. Seriously little to do. It’s beautiful for a holiday but to live there it’s difficult. Most of the wives ended up leaving to return back to the UK. We did two years but I felt like I was going mad from boredom” – “Princess Banana Hammock”.

Closely related to isolation, many people stated that one of their main problems was having no purpose in their new life. This is particularly common for the non-working “trailing” partner, who gets left at home when their spouse walks out the door to work. I think it is also a lot harder for those who don’t have children or whose children have left home. No job, no social life, often not even a real role in the house – domestic staff being such a common part of expat life for many.

I have often likened life abroad to that of being a 1950’s housewife – certainly, this is how it feels on the days when my main mission is to sit at home and wait for the electrician to turn up. And whilst there is nothing wrong with this type of life, you can see how demoralising it can become for those of us used to, well, a bit “more”.

While finding a job (paid or unpaid) is high on the list of many new expat partners, this can often be impossible due to lack of opportunity, visa restrictions, language difficulties…any of a number of things can impede your path to greater fulfilment and lead to a new sense of failure when you find you not only can’t find a role for yourself in yournew country, but you also can’t earn an independent income.

Loss of control
Another common reason for finding life abroad hard is a feeling that you have lost control. Again, this is probably more common to the partners of those who are working – the ones who have to call their spouse’s office if they need something done in the house or whose visa relies on their partner’s job or who can’t open a bank account in their own name. You may not get to choose your house, your furniture, even the school your children go to. Another major reason for this feeling of losing control is that their very being in that country relies on their partner’s job – and often on the plans of their partner’s employer. It’s hard to plan a life when you don’t know if you will still be living in your current location a year, even six months from now.

Life event
Of course not all depression that that develops among expats is based solely on their actual expat experience. Often it is triggered by the sort of thing that could happen to anyone, anywhere. But it is the fact that you are not in your home surroundings with familiar faces around you that can turn a distressing situation into one that plunges you very low. Anything from a major traumatic occurrence (a car crash, being robbed, an illness or death of a close relative) to something basically joyful but stressful like the birth of a new baby can set you off. This is especially true if you are already susceptible to low moods or have suffered from depression in the past. And of course, what is potentially a difficult situation is made harder by being a long way from your usual support networks.

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Even something like a minor car crash can have a traumatic effect when you are living far from your usual support networks

Mary gave an example of how a series of events can really spiral out of control. After describing how her daughter basically shut down following a move to China, she:

“developed health issues….then the vet here literally killed our beloved cat that we’d brought with us and then the company stopped paying us for three months so we were living on savings. That’s when I hit bottom….”

Whilst most of these things (bar her daughter’s reaction to their move) could have happened anywhere, it was the fact that these events were combined with their move to a new environment, and the accompanying culture shock of the move, that caused the downward spiral. Shockingly, Mary admitted in her response to the survey that she had seriously considered suicide at this point; luckily, just giving herself this control over her own destiny helped her to “refocus” and she now says she is feeling a lot “better”.

I urge anyone who feels like this to seek professional help as soon as possible.

Repatriation
Finally, I wanted to mention something that comes up over and over again in any discussion on expat depression, and that is going home again.

Many people underestimate quite how hard this can be – and I suspect that it is often this underestimation that partially at least leads to these feelings. Why would it be hard – you’re just going back to that place where you were happy and had friends and family around you, right? Well, sadly, not – what often happens is that whilst your home and those who live there hasn’t changed, you have. And this disconnect between what you think will be waiting for you when you return and the reality can often be what causes the problem.

Reasons for moving home varied, with some people having more control over it than others. But even those that chose to return often found their lives a lot harder than they realised it would be –

This from someone identifying themselves simply as “a trailing spouse”:

“When I moved back to my home country employment was difficult and, although highly skilled, I was unable to find work. My resume, which showed frequent moves, “outed” me immediately as “someone not worth investing time in”….my oldest child had a very bad mismatch with his teacher at school, my spouse’s job was long hours….I hated it. HATED it.”

So from first moving overseas to moving back home again, there are many flashpoints in the expat cycle that we need to be aware of in tackling the issue of depression. I am sure there are many, many more reasons for why someone might be affected but these are the most common ones given to me.

Next week I want to look at how depression manifests itself, the reaction people had – hopefully all things that can help you recognise these symptoms in yourself.

Can you relate to any of these? Or do you have other circumstances to share? Please add your comments below – I want this series to be a starting point for further discussion as much as anything. I am not the expert – but I am giving you the space and the place to bring your experience to share with others who might be going through the same thing.

Photo credits: The Expat Bubble – David Ingram;  India street life: David Sanchini;  Car crash – Pat Joyce