The Challenge of Expat Life

Mental health issues and substance abuse are common among expat communities. What are the reasons behind this? And how can counselling help?

An expatriate is someone who lives in another country, predominantly for work reasons, but has the intention to return to their country of origin. The OECD estimates 36 million expats globally.

Differences between the known home-environment and the unknown new place of abode can be minor or significant including cultural, religious, language, social and climate. Other common factors can be separation from family and friends; exposure to poverty, violence, suffering and death; risk of diseases; the need to develop a high level of self-sufficiency.

Often the issues of identity and loss become key, especially if expats frequently relocate to different countries and settings: Who am I? Where is home? How do others perceive me? Do I want to fit in, and how can I do that without losing aspects of my identity, which are important to me?

Frequent disruptions or endings of relationships cause human grief, which is sometimes left unattended and unprocessed. Moving frequently can also impact relationship patterns, with close friendships or relationships often being (sometimes unconsciously) avoided in order to avoid the pain of leaving.

Social and family support is often significantly reduced. Sometimes easy access to communications technology like Blackberry and Skype can be helpful as well as harmful. Keeping in touch with family, friends and work colleagues across different time zones can disrupt daily routines and sleep patterns. A permanent ‘on call’ culture leads to heightened anxiety and undermines life – work balance. The body and mind has limited time to recharge.

Finding someone to talk to when life is tough, can be hard and internalising problems is common. Rather than confronting the difficulty, ignoring it and hoping for it to ‘resolve itself’ in time or at the end of the placement abroad are more acceptable choices. While this strategy may work for some of the time, the risk is, that problems and fears start to build up and develop into anxiety and depression, which affect physical wellbeing, relationships and performance at work.

Depending on the work sector, career prospects may be lacking security or are highly competitive. Cultural norms around work may differ. The fear of failure and losing face at work and in the expat community can add a further dynamic, leading to a sense of being trapped with nowhere to turn. 

Self-medication with alcohol, drugs, food, sex and other lifestyle choices as well as extrovert acting out may offer temporary relief at the cost developing long-term addictions.

The combined effect of the unknown, differences, demanding workloads, relocation and family adjustments can lead to health and emotional problems including stress, anxiety, fatigue, insomnia, isolation, relational difficulties, muscle tension and low immune system. Soon it is hard to tell what is cause or effect, as difficulties start to multiply.

For some returning to their country of origin can cause further issues around identity and relationships. Life abroad may have had more social or economic privileges and freedoms. Depending on the length of time abroad, changes may have occurred in family, work and friendship circles. One may feel less connected and comfortable around others than before. One may be treated differently and be perceived more of an outsider than as a person that truly belongs.  Indeed, oneself may feel like no longer belonging to one country or the other.

Counselling and psychotherapy can help in several ways and at different stages of the expat experience.  Speaking with someone who is independent can provide a confidential setting where one can talk about difficulties and fears of what lies ahead (i.e. pre-placement abroad) or to process difficult experiences during or post-placement (like trauma, anxiety, addictions, relational difficulties, work stress, losses and identity). During the expat placement, therapy can become a useful addition to one’s support network abroad, as it offers a regular opportunity to take stock and review experiences before they develop into difficulties. This can also help explore techniques and self-help strategies to manage work stress and anxiety.

Overall, counselling and therapy can help release and reduce pressure, to regain emotional strength and some perspective on one’s situation, which is at the heart of exploring options and making choices for one’s life.