Something was wrong with Amanda. A few months after she moved to
China to teach English at a Beijing elementary school, the
23-year-old Briton started having crying fits. A panicky feeling
would overtake her when she walked along crowded streets, and she
began losing her temper over trivial things.
"I knew something was really up when I threw a vase against a
wall because I couldn't find the TV remote," she said. "I'm just so
angry all the time."
Amanda is not alone.
As Dr Kirsten Hogh Thogersen, Dutch professor at Sun Yat-Sen
University, Guangzhou, pointed out, while "there are no statistics"
for expatriate mental health, depression and anxiety are more
likely to arise in those living abroad than those who remain in
their home countries.
Kristina Jarotova from
Slovakia is learning a tea ceremony. Dressed in a traditional
Chinese costume, Jarotova is studying at Fudan University of
Shanghai. Many expats have found learning about Chinese culture
helps them alleviate mental pressure.
"At a very basic level, mental health is about who you are and
knowing who you are," said the doctor, who has worked with
foreigners at clinics in China for 12 of her 20 years of treating
expatriates.
However, she explained, this self-knowledge isn't "a fixed
thing". Rather, it's something constantly created, at least in
part, "by mirroring your surroundings".
"When you arrive in a new culture, you're shaken in
self-confidence, and the more different the culture is from where
you're from, the greater the challenge. And China is at the
end-scale of that challenge, because it's about as different of a
country as you can get," Thogersen said. "You have to prove who you
are, because if you're shaken, and if you don't find a way to
stabilize, you start to suffer from problems."
And the most common of these problems, she said, is the duality
of depression and anxiety.
"Now, I know I'm depressed. But what can I do about it? I don't
know," Amanda said. "Here, I can't even buy bananas. How am I
supposed to accomplish something as huge as overcoming
depression?"
The symptoms of depression expatriates often experience include
difficulty concentrating, irritability, increased tiredness, memory
problems and significant changes in eating and sleeping
patterns.
Different demographics face different challenges.
"For professionals, it's a hard-nosed job, the level of stress
and time zone differences," Thogersen explained. "For spouses, it's
a different challenge. Many spouses work at home, and when they
come here and there's no work, they have to create their day, which
is in many ways very difficult".
But at the same time, she emphasizes in her treatments, most
spouses enjoy a very privileged life.
"People either read that it's very difficult to be a spouse, or
they read that here, you have lots of possibilities to grow,
possibilities to learn the language and to explore a new
culture."
But Lauren, who came to Beijing when her husband took an
executive assignment in Beijing in January, said she's had trouble
looking toward the positives.
"I just can't get myself to leave the house. I know I need to,
but I can't, and I don't know why," the 36-year-old American said.
"I just feel so bored and restless, even though there's an exciting
and interesting new world outside my apartment."
She believes it's starting to affect her marriage and worries it
will also impact their 5-year-old daughter.
"It has huge consequences if someone in the family has a
depression," Thogersen said.
She explained that it's important for parents to "talk to
teachers and strike a good balance between light pressure and
safety".
And she advised that expatriate parents should not leave their
children with an ayi --nanny -- who doesn't speak their mother
tongue, because it "could create more insecurity".
Thogersen said that Western expats suffering from depression and
anxiety should categorize their high and low points. On "bad days"
they should seek the familiar, such as Western movies, DVDs,
hangouts and people.
"But the healing will come from connecting with the culture,"
Thogersen said.
So, on "good days", Western expats should dive into their host
culture, she said, explaining that one of the best ways to overcome
the expat blues is studying the language.
"It's a magic device to overcome depression and anxiety, because
it's a connection to your surroundings you can develop at your own
pace," Thogersen said, adding that it also stimulates brain
activity, which slows during depression.
She also suggested developing a structured routine, which
alleviates the insecurity that comes with living abroad and causes
depression and anxiety.
"Habits are safety," she said. "Observe the details of your
daily schedule. It's all about how you define yourself, saying: 'I
like my coffee this way; I read this newspaper in this chair'."
At a loss for what to do and where to seek help, Amanda said she
is considering going home.
However, foreigners who fail to overcome their depression and
anxiety often return home hoping to leave their problems in China
frequently find that repatriation brings with it a new host of
mental health challenges.
"(Repatriation) is known among professionals to be even more
difficult (than first coming to the host country), because you
realize it was a one-way ticket," Thogersen said.
Usually, people find that they have been transformed, but those
they left behind have not. And that makes readjustment
difficult.
"When you come back, you realize that life will never be the
same," Thogersen said, "for better or for worse -- mostly for the
better."
By Erik Nilsson
(China Daily May 28, 2007)
