‘I was told to cheer up’

Mov­ing to a dif­fer­ent coun­try can be very ex­cit­ing but for some, lan­guage and so­cial dif­fer­ences can lead to anx­i­ety and de­pres­sion

The Irish Times - Tuesday - Health - - Front Page - Shaun Lavelle irish­times.com/abroad The site for and about the Ir­ish over­seas

In the late 1940s, while an­thro­pol­o­gist Dr Kalervo Oberg was re­search­ing the so­cial or­gan­i­sa­tion of the Tlin­git Na­tive Amer­i­can tribe, he be­gan to no­tice a com­mon af­flic­tion among any­one sud­denly trans­planted abroad. Oberg coined the term “cul­ture shock” to ex­plain the phe­nom­e­non: an anx­i­ety that arose when a per­son was re­moved from their own so­ci­etal sym­bols and sig­nals on which “all of us de­pend for our peace of mind”.

Symp­toms ranged from sim­ple home­sick­ness – “that ter­ri­ble long­ing to be back home, to be able to have a good cup of cof­fee and a piece of ap­ple pie” – to anx­i­ety, de­pres­sion, and feel­ings of help­less­ness.

In the decades since, a large body of re­search has emerged in psy­chol­ogy and so­ci­ol­ogy analysing the im­pact of mov­ing abroad on men­tal health. It shows that while liv­ing in an­other coun­try can of­fer count­less new pos­si­bil­i­ties, it also brings a unique set of chal­lenges.

Matthew moved from Ire­land to Amsterdam last year when his part­ner found work there. Be­fore mov­ing, he was ex­cited at the prospect of work­ing in the Nether­lands. He started learn­ing Dutch and his new life be­gan well. “The first few weeks were great,” he says. “My col­leagues were very nice and ex­tremely help­ful. Ev­ery­thing was new and ex­cit­ing.”

His cal­en­dar was packed with get-to­geth­ers and so­cial func­tions, but as sum­mer be­gan to fade into au­tumn, “life got a lot tougher”.

Even though the work­ing lan­guage of his or­gan­i­sa­tion was English, he felt iso­lated. Con­ver­sa­tions around the of­fice were in Dutch. “If they wanted to speak to me di­rectly, they would speak in English. I didn’t feel part of the team or or­gan­i­sa­tion. I got re­ally self-con­scious, con­stantly won­der­ing what peo­ple were say­ing.

“It was even worse when I heard my name in con­ver­sa­tion. I was try­ing to keep up with work, but it was dif­fi­cult. I con­stantly had to rely on my col­leagues, non-stop ques­tions . . . I felt use­less.”

So­cial dif­fer­ences

So­cial dif­fer­ences were also a strug­gle. In the Nether­lands, most peo­ple rely on an agenda for so­cial ap­point­ments. It’s not un­com­mon to sched­ule a friend for a cof­fee in a week’s time, or din­ner in three weeks. “Gone was the pos­si­bil­ity of meet­ing a col­league af­ter work for a drink without a week’s no­tice,” Matthew says.

To­wards the end of the year, “things be­came a bit of a blur”. Matthew’s part­ner was trav­el­ling a lot with work, his mother was in hos­pi­tal back in Ire­land, and Dublin, just an hour’s flight away, felt like the other end of the world. He felt alone in the Nether­lands and felt he couldn’t talk to fam­ily back home about his ex­pe­ri­ences, be­cause he didn’t want them to worry.

“There were days where I would barely speak to any­one, even though I worked nine hours a day. The days were rolling into one . . . I felt like I was los­ing my mind. Even when I did speak to peo­ple, no one un­der­stood me at all . . . I lost my charisma, my so­cial skills, my con­fi­dence – I wasn’t the per­son I thought I was.”

Matthew had never ex­pe­ri­enced men­tal-health is­sues in Ire­land. He be­lieves his dif­fi­cul­ties were brought on by his in­ter­ac­tion with Dutch cul­ture, which was so un­fa­mil­iar to him, even though he says he has met many won­der­ful peo­ple there.

“Talk­ing to some­one is key,” he says. He spoke to his man­ager, who of­fered a life coach and a men­tor. Both these peo­ple helped “with the dif­fi­cult task of in­te­grat­ing into a new cul­ture”. He con­tin­ued learn­ing Dutch, which he be­lieves has helped im­mensely.

Matthew’s ex­pe­ri­ences are fa­mil­iar to Caitríona Rush, a cross-cul­tural con­sul­tant who helps busi­nesses and in­di­vid­u­als over­come the chal­lenges of liv­ing and work­ing abroad. “At some stage, most peo­ple who move to a dif­fer­ent coun­try will go through some form of cul­ture shock,” she says. “The ex­tent to which you feel it varies.”

Prob­lems come when peo­ple start to in­ter­nalise cul­tural dif­fer­ences. “Peo­ple be­gin to read be­tween the lines and they pick up mes­sages that aren’t ac­tu­ally be­ing sent.”

In these cases, peo­ple may start to ex­pe­ri­ence mood­i­ness, sleep prob­lems, eat­ing dis­or­ders and al­co­hol mis­use. “If you’re not happy in your­self for what­ever rea­son and you have those kind of cul­tural is­sues, not deal­ing with them and re­solv­ing them, they just tend to fix and grow in your mind.”

Cul­ture shock can be di­vided into four dis­tinct phases, Rush ex­plains. At first, ev­ery­thing is new and ex­cit­ing. This ini­tial hon­ey­moon phase lasts four to six weeks. This is usu­ally fol­lowed by the ne­go­ti­a­tion stage, in which cul­tural dif­fer­ences lead to mis­un­der­stand­ings and cre­ate anx­i­ety and frus­tra­tion.

Next is the ad­just­ment phase, when “peo­ple be­gin to un­der­stand their own cul­tural val­ues and the adopted cul­ture a bit more”.

Adap­tion phase Fi­nally, there’s the adap­tion phase. “Over­all, you’re happy, you know how things work, you’ve set­tled in and made your life here.”

Though the phases are dis­tinct, peo­ple ex­pe­ri­ence them in dif­fer­ent ways. Some may tran­si­tion quickly, while oth­ers can be­come stuck in the ne­go­ti­a­tion phase for years. Rush ad­vises ask­ing ques­tions: “What are your list of rights and wrongs? Where do they come from? Why do you be­lieve in that? And un­der­stand­ing those, and un­der­stand­ing that when you talk to a Dutch per­son, you have your Ir­ish sun­glasses on. When you’re brought up, you’re taught to treat peo­ple the way you want to be treated. When it comes to cul­ture, you treat peo­ple the way they want to be treated.”

Cul­tural dif­fer­ences and feel­ings of iso­la­tion be­come more trou­bling when they are com­pounded with ex­ist­ing vul­ner­a­bil­i­ties. For var­i­ous rea­sons, em­i­grants are slower to seek help for their men­tal health. “It’s not that ex­pats suf­fer more [from men­tal-health is­sues], it’s just there are more stresses in their lives, more trig­gers, that will make main­tain­ing men­tal health more dif­fi­cult,” says Anna Costello, psy­chol­o­gist at Küh­ler and Trooster, a Dutch clinic spe­cial­is­ing in ex­pat men­tal health­care.

Costello be­lieves ex­pats can find it dif­fi­cult to nav­i­gate an un­fa­mil­iar health ser­vice: “It’s more com­pli­cated when you’re liv­ing in an­other coun­try.”

Kate has first-hand ex­pe­ri­ence with both the Ir­ish and Dutch men­tal-health ser­vices. She strug­gled with ad­dic­tion, and the deaths of both par­ents be­fore leav­ing Ire­land. She moved to the Nether­lands af­ter fall­ing in love with a Dutch man. As an ex­pe­ri­enced trav­eller, she thought the tran­si­tion would be rel­a­tively smooth.

“I strug­gled to make friends out­side the fam­ily cir­cle. I strug­gled to find mean­ing­ful work . . . I thought it would be easy. I had lived in Asia and Aus­tralia, where I didn’t have a cul­ture shock, but here I re­ally did on how you should be­have in so­ci­ety and how things are done. I found it al­most po­lar op­po­site, and I didn’t ex­pect that it was go­ing to be.”

Over­whelm­ing

Even­tu­ally, her new en­vi­ron­ment be­came over­whelm­ing. “Mov­ing here and feel­ing so iso­lated trig­gered some past emo­tions I hadn’t dealt with prop­erly . . . I started drink­ing – a lot. The drink­ing got worse and worse, and sui­ci­dal thoughts were creep­ing in. I felt ex­tremely lonely. I hated the dark and cold weather. Even­tu­ally, I had a drink­ing black­out one night – this was be­com­ing an all-too-of­ten oc­cur­rence – and I tried to take my own life.”

Kate sought help from the health ser­vices in the Nether­lands. The Dutch health­care sys­tem is one of the best in Europe, topping the 2017 Euro Health Con­sumer In­dex (Ire­land came 24th). Even so, Kate was frus­trated at the wait­ing time to see a pro­fes­sional. “When you feel like you’re los­ing your mind, you don’t want to be on your own . . . They gave me a time of four to six weeks. I said I’m not go­ing to be alive in four to six weeks.”

Once in the sys­tem, Kate found Dutch health­care to be very good. In ad­di­tion to talk ther­apy, she was of­fered art and touch ther­apy for a year. She also went to an ad­dic­tion clinic, though the ser­vices were lim­ited be­cause of her ex­pat sta­tus. “I went through ther­apy, I stopped drink­ing, which helped. I got a kit­ten, so I’m not lonely. I have some­thing to look af­ter.”

Kate also learned Dutch, and be­lieves learn­ing the lan­guage is key. When she re­flects on her ex­pe­ri­ences, she rec­om­mends break­ing the ta­boo and talk­ing about it. “That’s what was block­ing me at the start. And once you can talk to peo­ple, you find out that most peo­ple have the same prob­lems.”

When Dr Oberg first wrote about cul­ture shock, he said the trav­eller would al­ways be treated as an out­sider. But he also be­lieved they could adapt and de­velop two pat­terns of be­hav­iour, with the two ex­ist­ing in har­mony. When it came to the pos­si­bil­ity of over­com­ing cul­ture shock, he was san­guine: “Many re­cover beau­ti­fully.”

PHO­TO­GRAPH: IS­TOCK

Amsterdam: lan­guage and cul­tural dif­fer­ences can be a chal­lenge,

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