You’re moving or just moved to China to work. It’s a new and exciting chapter in your life. New cultures, new language, new friends and environment. What could possibly go wrong?
In a survey on mental health issues faced by expatriates worldwide, depression turned out to be most prevalent condition (with a 50% depressive symptoms increase between 2014 and 2016), followed by anxiety (28% prevalence increase).
Once the initial euphoria of arriving in a new country has worn off, emotional and mental difficulties can blight your experience of working overseas.
MSH China has decided to interview Julia Banet, clinical psychologist at Raffles Medical Clinic in Shanghai. Prior to joining Raffles, Julia worked in France for 5 years in hospital’s maternity section. She’s happy to answer our questions about depression to raise awareness among people.
WHAT CAUSES EXPATS TO BECOME
A：Actually there is no distinction between expats and other people when it comes to depression. Both might experience it with similar likelihood. I was actually surprised when I first came to Shanghai, I was expecting to find some specific problems caused by expatriation. Of course there are some, but those are definitely not substantial. Problems of any human being are about the same, be it expats or not. Most of my patients in Shanghai are suffering from personal situations from either their past (e.g. childhood trauma) or present (e.g. a divorce, loss of someone, relationship issue, anxiety or depression). It’s mostly the same as compared to what I see in France.
Some factors can explain why people can become depressed:
Lack of sleep: sleep may seems obvious for everybody but when you’re suffering from insomnia for example, you will feel restless and won’t be able to control your emotions as well as you can normally. The more tired you are, the less emotionally stable you are which can become a vicious circle.
Out of Comfort Zone/Being away of your usual surroundings: this can be family, friends, food that you are used to eat, your usual routine and environment. Human being really needs benchmarks in order to feel safe. Living in a new country that is very different from your usual setting can make you lose the sense of comfort and safeness.
Lack of emotional support: human being needs emotional support in his/her daily life. This is something that you have around yourself and may not even notice it. It can come from your friends, family, co-workers or neighbors. Sometimes it can be pretty subtle and you only notice it when you lose it.
The lack of emotional support and being away from your usual settings won’t lead to what we called, a clinical depression. Instead, mostly what we can observe in this situation is a depressive phase where you will feel a little bit down for a few weeks or months. Real clinical depression comes along with some other risks factors such as a trauma, the loss of someone or a major emotional episode that will create some sensibility and fragility.
Many people think that by moving to different countries and environment they will feel better. It may, at first, but if you have existing issues that were never treated before, these will come with you no matter where you are. On the contrary, the expatriation might create a lot of stress and anxiety that can increase the risk of depression.
ARE THERE SPECIFIC CAUSES TO CHINA THAT LEAD TO ANXIETY OR DEPRESSION?
A：As you know in China, the local language is very difficult. The fact that you cannot communicate so easily in your daily life can be a factor for causing stress and anxiety. This alone, of course will not cause depression. However, if coupled with other factors, it may.
For example, sometimes when you just want to relax and go for a walk or to a nice restaurant but then you can’t really read the signs or understand the cashier. While in your country these common situations can be handled easily, here in China it will be quite difficult for some people.
This can induce stress and anxiety because it requires extra effort from someone to deal with these basic situations than they usually do when it is under their usual settings. This can be very frustrating for some people and therefore will start to blame themselves. Human quickly and easily starts to blame himself/herself. Blaming yourself is a very unhealthy habit that can then become another factor for stress/anxiety.
Another cause might be the fact that the Chinese culture doesn’t deal with emotions and feelings the exact same way as the Western culture does it. Maybe in the expats’ own country when they are not feeling so well, surrounding people like friends, family or colleagues may perceive it and respond to it, as well as comforting and advising them. While here in China people might not be able to perceive it and even if they might, they might not know how to respond to it because of cultural differences, except for some people that you know well but that’s not always the case especially when you first arrived. Cultural difference can exacerbate the feeling of loneliness and isolation.
Last but not least, it might be harder in China to follow a new routine. For instance, you need to put in extra effort to find ways to eat well and healthy, to do sport outdoor whilst being annoyed by the pollution etc. Routine is something that is good for mental health because it gives people a sense of security and therefore stability.
HOW TO RECOGNIZE EXPAT DEPRESSION?
A: Lack of envy: Is there anything that usually brings you pleasure doesn’t anymore? If it’s only for a day, then there is no problem at all, but if it lasts for more than 2 weeks then it may be good to start talking with friends or family for some support and then a professional if needed.
Lack of desire: you don’t feel like doing anything, this can be a lack of appetite as well.
Lack of sleep: waking up in the middle night for no reason, having trouble falling asleep or waking up very early in the morning.
Anxiety can also be a sign of depression, often time anxiety and depression are linked.
Fear and start to see everything negatively. Instead of being optimistic or positive you only see things in a very negative way. Actions that usually are simple and easy become complicated. We see everythings very arduous and complex: making a mountain out of a molehill.
Experiencing these symptoms for 2 or 3 days is not alarming. Most of the time it is a reactional depression to some events or situations (break up or adapting to a new environment for example) but if it last for months then yes, you may need some professional help.
WHY IS IT HARD FOR SOME PEOPLE TO ADAPT TO THEIR NEW LIFE?
A: Human doesn’t like changes. We like stability. In fact, not only human being but also plants, for example, if you start to move it from one spot to another, it wouldn’t like it. A dog or a cat doesn’t like that either if you move to a new house. But luckily humans are much more adaptable.
However, we are naturally curious and into adventures as well. But for an expatriation, most of the time people only see the bright side like “that’s great I am going to live abroad!” without necessarily realizing or measuring the less shiny side. There are always good side and bad side in any kind of situation. Maybe being overly positive is typical amongst today’s society where we like to only share the best image and experiences, on social media for example, without letting the audience to realize that maybe things are not that easy and nice all the time.
Those people going abroad without accepting the possible difficulties they will have to overcome, are avoiding them and therefore fighting against negative thoughts. They don’t want to accept them (they think they shouldn’t exist) and by not admitting that they are present, this can create an internal tension. Instead, they should just accept the things as they are and would not be 100% good. It is definitely way better and healthier to accept them. Despite it is still hard to do so, it is not as hard as fighting against it.
Last but not least, humans are not all equal. How someone will handle a particular situation or an event really depends on their own past experiences.
WHERE PEOPLE CAN FIND SUPPORT?
A:In their home country, most of the time people suffering from psychological issues don’t really know what to do, where to go or who to talk with about it. Sometimes they are scared or think that “I am not crazy I don’t need a psychologist”. I think in China it’s even worse. You would probably think that there is no one here that can help you, which is not true because there are many foreign language-speaking psychologist.
- The Shanghai International Mental Health Association is a multidisciplinary professional association of therapists who provide mental health services to the international communities in Shanghai. They have 15 different languages available.
- You also have International hospitals and clinics where they have very good English speaking doctors as well as French, Italian and German. You can easily find something similar of what you would have in your own country.
- Here at Raffles Medical, I am present with my colleagues if people need to talk to a psychologist, they can make an appointment by contacting us by phone or email.
Julia Banet: +86 21 6197 2300
Raffles Medical Contact:
+86 21 6197 2300
- The Community Center Shanghai also proposes some kind of counselling that can help you with mental health issues. This can be a first step: reassure and evaluate your symptoms.
It is important to know that depression is not a never-ending process. There are solutions and it is definitely possible to handle and cure depression. Unfortunately, most people these days still feel shameful about being diagnosed with depression, that’s why it can sometimes take years before someone decide to finally go to see a therapist.
HOW TO BE HAPPY IN CHINA?
A: Things that can make people happy and mentally healthy are quite simple to set up:
- Sleep enough: probably the most important in order to be mentally healthy
- Eat healthy: It seems very simple but it is important. Many studies have shown the link between gut and brain (you can experience that yourself in a very simple way by observing how sometimes stress/fear/strong sadness can cause you stomach pain). Well that link is working both way, happy and balanced belly = happy brain. Plus of course a good alimentation induces a "feeling healthy and energetic" which definitely helps facing practical and emotional difficulties. That’s why eating properly is important, however might be at first challenging when you just arrived in a new country.
- Sport: it creates a lot of endorphin which is good for lifting up the mood.
- Re-create a routine: when just arrive in a new country, you need to rebuild a routine. This is very important for mental health because it creates sense of security which is good for our brain.
- Socialize: interacts with people. Even if it’s temporary, because you’re not expecting to stay here for a long time, it is very important to create social interactions to not feel depressed and isolated.
- Acceptation: Accept things the way they are rather than the way you would like them to be / or think they should be. You can only start a change from where you are. Progressively change things that you can by setting reachable goals and accept the one you cannot change.
- Don’t forget the cultural differences: try not to judge. Respect differences by thinking that they don't mean a bad thing.
- Stay active, be curious: go explore, discover, learn. Even if at first you have to force yourself when you feel down, this always have good impact on the mood and self esteem and helps recreate a positive dynamic circle.
- Patience, Indulgence and caring: By encouraging yourself, you will definitely improve your way of seeing things and feel happy about it. But if you are too harsh with yourself, you’re probably not going to feel good nor improve. Building a strong self-esteem is the key to happiness.
Julia Banet, thank you very much.
About MSH China
Founded in 2001, MSH China is a French international company specialized in high-end insurance services for corporate and individual clients. Our multicultural International department is dedicated to serve foreigners living in Asia. Leader in China, our reputation has been made from our efficient customer service and call center, a large hospital network and a cost sensitive approach.
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