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Expatriate Travel Health

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Anticipate the Psychologic Effects of Expatriate Life

-- Frank Gillingham, MD

While many expatriates find their overseas assignment thrilling, all of them experience some degree of disorientation, confusion and anxiety as they adjust to their host country's culture. In addition to the challenges of a foreign language and society, expatriates often find themselves on a journey of self discovery, questioning their personal goals, values and purpose, as even Sigmund Freud did:
"Italy has captured me with the magical delirium of its wonders. ...Through these feelings of amazement and wonder I have a sudden impact with parts of myself and my personality that were hidden or unknown. Thus this journey is also and above all a journey into my inner world, a discovery of myself." -- Sigmund Freud, as quoted by Dr. Mary Ann Bellini, HTH Clinical Psychologist in Florence, Italy.
The Stages of Culture Adjustment
Culture adjustment often progresses through several stages.
  • Honeymoon, in which the host country is idealized.

  • Rejection, which emerges when the expatriate encounters the inevitable problems with work, language, school and housing.

  • Regression, during which life in the home country is idealized.

  • Cultural Adjustment, when the successful expatriate becomes comfortable and happy in his or her new environment and gains a mature appreciation of cultural differences.

Expatriates should remember that culture shock can affect some family members more than others
"Usually (but not always) the partner of the international business person suffers more with symptoms of Culture Shock." HTH Clinical Psychologist, Florence, Italy.
Managing Cultural Adjustment.
There are several steps the expatriate can take to help their adjustment and prevent culture shock:
  • Study the country's language, culture and history. An HTH psychiatrist put it this way:
    "Knowledge Empowers." HTH Psychiatrist, Caracas, Venezuela.
  • Maintain your sense of humor and positive outlook.  
    "Dealing with culture shock successfully depends on your coping skills....The most important of those skills is knowing and liking yourself, having a sense of meaning in your life, having a sense of competence, having friends and continuing activities you enjoy." HTH Clinical Psychologist, Florence, Italy.

    "Remember that no place is perfect. They are only imperfect in different ways." HTH Psychiatrist, Caracas, Venezuela.

    "Criticism will not change the environment." Physician, Sao Paulo, Brazil.

    "Experiment slowly with the unknown. It's OK to want a hamburger." HTH Psychiatrist, Caracas, Venezuela.
  • Keep in touch with friends and family at home. Email has made this easier than ever. The expatriate family that signs up for web-based email (Hotmail, Yahoo mail, etc), can distribute email addresses prior to leaving home.

  • Exercise. Contributes to improved mood and better sleep.

  • Be alert of signs of mental illness. An expatriate assignment, like any significant life change, can worsen or even precipitate mental illness such as depression, anxiety or a range of adjustment disorders.  
    "If you have been treated for mood, anxiety, or other psychological disorders, including panic attacks, bipolar disorder, clinical depression, eating disorders, substance abuse, etc. be prepared for a regression with many symptoms resurfacing after about a month in your host country.... This regression is due to the extra stress of living and working abroad." HTH Clinical Psychologist, Florence, Italy.
    The expatriate who experiences deep and persistent adjustment difficulty or mood changes, or observes the same in a family member, should seek the advice of a mental health professional or primary care physician.

  • Cultivate acquaintances with fellow expatriates and local nationals. The human resources department can help by providing expatriates with a list of other individuals from their company who are currently, or have recently, been expatriated in the same or nearby posts. Expatriate associations, newcomers clubs, local chambers of commerce and other associations of US citizens abroad can be a tremendous help in adjusting.  
    "For professionals, it is often a good thing to join the relevant professional bodies in the destination country even before one leaves for the assignment." HTH General Practice Physician, Hong Kong.

    "Too often...instead of enjoying the experience of living in a different atmosphere, learning interesting cultural aspects, enjoying local food, and establishing friendly relations with local people, [expatriates] become isolated within their own small circle of co-nationals and as a result the tour of duty is not always positive." HTH General Surgeon, Mexico City.