In support of an effort by the group Bring Change 2 Mind to erase the stigma faced by those dealing with mental illness, my fellow expat blogger Aisha launched an ongoing series of posts on her site Expatlogue earlier this year entitled ’Breaking the Code of Silence’.
Bravely sharing her own disturbing memories from younger days, the pain and suffering Aisha endured are heartbreaking. Yet they are all the more poignant when contrasted with her life today as a healthy, happily married, caring mother of three and talented writer making a name for herself.
I committed to writing a piece in support of this stigma-smashing effort, and began mulling over ideas. Two recent articles on seemingly unrelated groups – celebrities and expats – have provided new insights and interesting perspectives.
The first is a February article on the Psychology Today website by Deborah Serani regarding the phenomenon known as ‘Celebrity Coming Out of Mental Illness’. Cynics might see the (still meager) parade of high-profile individuals such as Catherine Zeta Jones, Russell Brand and Harrison Ford proclaiming their struggles with various forms of mental illness as simply more fodder in the public relations machine. Serani has a different take.
Such candid pronouncements help to reduce the stigma of mental illness, striking a public blow against prejudice and mistreatment on behalf of those similarly afflicted. Not all sufferers are in a position to share their stories for fear of reprisal in their personal and professional lives, so it is well appreciated when others do so.
At the same time, celebrity ’outings’ of this sort offer hope to others of the possibility of enjoying a healthy, happy, productive life if proper treatment is sought. In addition to the reassuring nature of knowing they aren’t alone in their diagnoses, there is a strong sense of ‘if he or she can accomplish all that while dealing with depression, anxiety or fill-in-the-blank, then surely I can do the same in my own life’.
The surprise in Serani’s article is the statistic that one in five in the US will suffer some form of mental illness at some point in their lives. Of course there will be those who chalk that up to the supposedly typical predilection of Americans for fixating on squishy ’emotions’ and ‘feelings’ and a preoccupation with ‘happiness’, but I suspect that many other countries are right up there with the US in terms of mental illness if they take the time and effort to measure.
Which leads us to the second article Are Expats at Risk of Developing Mental Health Problems? reported last week on the Expat Info Desk website. [This was itself based on the Michele Rubin article on PRWeb Expatriates at Higher Risk for Mental Health Issues and Substance Abuse Problems.]
A study conducted by Chestnut Global Partners and The Truman Group found American expats to be at higher risk for internalizing mental health problems such as depression and anxiety, externalizing ones (e.g., hyperactivity, attention deficit, conduct and impulse control) and substance abuse than their US-based counterparts.
The study’s co-author, David Sharar Ph.D., noted the impact of stress on assignment failure rates, often stemming from ‘cultural differences and demanding workloads’. Sharar went on to say that the findings ‘underscore the need to design programs and provide services that mitigate the challenges of living and working abroad.’
The recent 2011 Global Relocation Trends Study report from Brookfield GRS has also highlighted the role of family dynamics in making or breaking expatriate assignments with top challenges being partner resistance (47%) and family adjustment (32%).
No surprise there. These studies underscore what expats have known anecdotally for years. They are gaining attention and for good reason: expatriating and repatriating across cultures can be difficult. Working your way through the highs and lows of the transition process can leave many battling feelings of alienation, dislocation, anger, frustration, loneliness, lack of identity and rootlessness.
Certainly most expats come through on the other side just fine or without lasting damage. But there is no doubt that some struggle. Expatriate employees and family members alike can be affected deeply by relocation.
Yet the resources to help support them before, during and after transition differ greatly depending on one’s experience, running the gamut from decent to nil. I for one found far greater transition support from the international school Son and Daughter have attended than anything Husband’s organization offered.
No wonder Sharar’s co-author, Sean D. Truman Ph.D. LP, notes the ‘explicit need for programs and services that are comprehensive in scope and sensitive to the personal, interpersonal and professional dynamics that contribute to the overall wellbeing of expats and their family members’.
At first glance these articles – one about celebrities and the other about expats – have seemingly little in common beyond the issue of mental illness.
But consider this: if the first article highlights the benefits to others of outing oneself regarding mental health issues and the second demonstrates that expats are at increased risk compared to their home population for encountering stress, depression and anxiety, then it stands to reason that by shedding the light on mental illness in general and in expatriate life in particular we can go a long way in smashing the stigma while encouraging people to seek necessary support and treatment.
We need to get the word out, at home and abroad. We need to be talking about these issues, writing about these issues, reading about these issues and sharing about these issues.
The growing body of expat literature reflects as much, as do efforts by Aisha and others to share their experiences. That’s a trend we can all welcome.
[Image credit: David Castillo Dominici, portfolio 3062 Freedigitalphotos.net]
A well-written piece Linda and astute linking of the celebrity and expat experience. Although we often love to hate our celebs and mercilessly label them as victims of their own success, they, like the expat, are functioning in an environment where the compass bearings have been reset. It takes time to find your new direction. Some never do.
Celebrity and expat life strips you down to your basic form. There’s nothing to hide behind. Some learn how to be comfortable with this – others find it impossible and put up barriers or fall apart. Those who have never taken the risk find it easy to judge from the comfort of obscurity, but there’s no guarantee they could do any better.
Thanks for adding your voice to the growing throng of those campaigning for an end to judgement and stigma. I’ve added this post to the Breaking the Code of Silence series.
http://wp.me/P1J9Lk-Wz
Thank you Aisha, I’m truly humbled that you’d add this piece to your incredible series. I’ve never been one to envy celebrities; if you choose to live in the public eye, you’ve signed up for faltering or failing publicly as well. There are lots of things people would rather not share with the world, so being brave enough to stand up and admit you’ve been/are being treated for mental illness is courageous indeed. They go a long way to helping others to understand that mental illness isn’t a personal failing, it’s a disease and one that can be treated.
I applaud any individual or organisation who takes mental issues amongst the expat community seriously. It’s something little talked about in international circles let alone acknowledged. If you haven’t experienced it within your own family, someone you will know will be struggling with issues whether you realise it or not.
Mental health covers so many areas and impacts more people than just the person who is suffering. It is often the spouse or a child of the international employee who struggles, with little help or support from their employer. Even if help is available, there is a reluctance to seek it out, to be seen as ‘weak’ or ‘not coping’. Finding help, even if you want it, can be a long and arduous business in a different culture, with different cultural expectations.
In a large international departmental move within my spouse’s company, little thought was given to the impact on families within this group, none of whom had lived outside the USA. Within 3 years 50% of the marriages had ended in divorce, with spouses and children returning home. It doesn’t take a rocket scientist to figure the devastation that caused in so many lives.
Like Linda, the best relocation help we have ever received was through our international school
Thank you, once again, for being fearless in raising issues which can have a devastating impact on the professional and personal lives of expat families.
You’ve brought up so many good points from perceptions of weakness or being a ‘liability’ to the challenges of finding care/treatment overseas. Your cautionary tale of the impact of a sudden, forced move is chilling. Most of us choose to experience living abroad, and most of us come through wiser, stronger and more appreciative as a result. For those who don’t have the benefit of prior knowledge or access to support, it’s important to spread the word. Thanks for doing so, too.
Thanks for addressing these issues. I’m glad to see these discussions happening online and I hope they grow and continue.
It’s interesting to hear you’ve received support from your local international school. My children are of nursery-school-age, so I’m not as plugged in to the school community as I’d like to be. I do know there are talks and various events from time to time.
Do you see any possibility that the large multinational companies may start addressing issues of mental health for expats in the future?
First, I really enjoyed your post about an ‘unbucket list’. Life’s in the journey, not the destination. Nice blog!
Good question Heather. The first step is awareness, both on the part of incoming expats and employers. The support received from our school included a 4-day orientation program for incoming students and a 2-day program for parents, plus an ‘ambassador’ of appropriate age assigned to each. A parents’ group, supported by the school, runs a weekly program discussing topics ranging from how to handle daily errands, driving rules/licenses and so on but also twice yearly discussions facilitated by a psychologist on expat transitions, culture shock, etc. School counselors keep an eye on the students, and families are welcome/encouraged to contact the school staff if problems arise. [BTW, in Bangkok you have a great resource in Julia Simens who works at an international school and wrote Emotional Resilience & the Expat Child - a great book focusing on elementary school-aged children but of value to expats of all ages.]
Knowing what to expect is a big part of preparedness; seeing the info and hearing more established expats share their own stories of working their way through the various phases, tips and suggestions, and the importance of reaching out and making connections were invaluable. In addition, the school sponsored speakers and programs. It’s never too early to start attending these events, please do. It was through such presentations that I began doing research, reading the expat literature that’s out there (and it is) and writing about it.
As for companies/employers? It would be a big step if they would focus beyond the 2-month relocation window, make available similar information and access to such programs, and provide a knowledgeable contact person to help when/if the family experiences a rough time 6-12 months in. Then if a member doesn’t work their way through the culture shock/transition phases, the family would have an ally to assist as they approach the medical community if additional assistance is needed. It won’t happen overnight, but over time that’s what I’d like to be moving toward.
Thanks, Linda. It’s good to hear what the school in your area is doing. And I agree, awareness is the first step!
I enjoyed hearing more about your thoughts on what companies can do to help. I hope that enough discussion and interest in these issues can build the momentum needed to move toward action.
BTW, I’m hoping to buy Julia Simens’ book soon!
Wonderful post about a little addressed issue. In my years as an expat, I’ve seen people struggle with mental health issues while overseas. One of the biggest challenges is finding professional help in your own language. Often people struggle along for much longer than they should because in order to obtain the right treatment they would have to repatriate which has massive consequences for the whole family. I agree 100% with what you said about schools and transition too. My experience has been that the international schools my children have attended have done more to ease transition for the children and sometimes for the adults than anything that was offered to the family by our sponsoring organization.
Thanks Evelyn. Your point about finding the right treatment, in your own language, is true. A real challenge
I have experienced bouts of depression since I was in my mid-teens – not clinical by definition but enough to disrupt life (time off school, time off work etc) – and for a long time neither myself or my family registered what ‘it’ was. After all, what did I have to be depressed about? I was a happy, successful young woman and I just needed to stop wallowing and pull myself together. It took a doctor in Melbourne that I’d never met before to identify what was going on (I cried with relief through the whole appointment) and give me the space and support to work through it.
The depression has not disappeared by any means but I can identify the symptoms and ask for help or take some practical steps much earlier. The uncertainty and challenge of moving away to create the life I wanted was scary and exhilarating and the lack of support network was one of the biggest challenges. Those I trust most have my gratitude and love for their acceptance – no, they don’t always understand but they give me the space and support I need to be all of me – not just the happy, sparkly part – unquestioningly.
In just a couple paragraphs you’ve captured the essence of why stereotypes and stigmas need to be challenged and discarded. The need for acceptance for all parts of your personality, your essence, is universal; hiding aspects that others might not understand (and so deem ‘different’) must be exhausting, and as you so beautifully point out, we all need to be all of ourselves. Thank you for sharing such a heartfelt, thoughtful comment Kym.