Something was wrong with Amanda. A few months after she moved to China to teach English at a Beijing elementary school, the 23-year-old Briton started having crying fits. A panicky feeling would overtake her when she walked along crowded streets, and she began losing her temper over trivial things.

 

"I knew something was really up when I threw a vase against a wall because I couldn't find the TV remote," she said. "I'm just so angry all the time."

 

Amanda is not alone.

 

As Dr Kirsten Hogh Thogersen, Dutch professor at Sun Yat-Sen University, Guangzhou, pointed out, while "there are no statistics" for expatriate mental health, depression and anxiety are more likely to arise in those living abroad than those who remain in their home countries.

 

 

Kristina Jarotova from Slovakia is learning a tea ceremony. Dressed in a traditional Chinese costume, Jarotova is studying at Fudan University of Shanghai. Many expats have found learning about Chinese culture helps them alleviate mental pressure.

 

"At a very basic level, mental health is about who you are and knowing who you are," said the doctor, who has worked with foreigners at clinics in China for 12 of her 20 years of treating expatriates.

 

However, she explained, this self-knowledge isn't "a fixed thing". Rather, it's something constantly created, at least in part, "by mirroring your surroundings".

 

"When you arrive in a new culture, you're shaken in self-confidence, and the more different the culture is from where you're from, the greater the challenge. And China is at the end-scale of that challenge, because it's about as different of a country as you can get," Thogersen said. "You have to prove who you are, because if you're shaken, and if you don't find a way to stabilize, you start to suffer from problems."

 

And the most common of these problems, she said, is the duality of depression and anxiety.

 

"Now, I know I'm depressed. But what can I do about it? I don't know," Amanda said. "Here, I can't even buy bananas. How am I supposed to accomplish something as huge as overcoming depression?"

 

The symptoms of depression expatriates often experience include difficulty concentrating, irritability, increased tiredness, memory problems and significant changes in eating and sleeping patterns.

 

Different demographics face different challenges.

 

"For professionals, it's a hard-nosed job, the level of stress and time zone differences," Thogersen explained. "For spouses, it's a different challenge. Many spouses work at home, and when they come here and there's no work, they have to create their day, which is in many ways very difficult".

 

But at the same time, she emphasizes in her treatments, most spouses enjoy a very privileged life.

 

"People either read that it's very difficult to be a spouse, or they read that here, you have lots of possibilities to grow, possibilities to learn the language and to explore a new culture."

 

But Lauren, who came to Beijing when her husband took an executive assignment in Beijing in January, said she's had trouble looking toward the positives.

 

"I just can't get myself to leave the house. I know I need to, but I can't, and I don't know why," the 36-year-old American said. "I just feel so bored and restless, even though there's an exciting and interesting new world outside my apartment."

 

She believes it's starting to affect her marriage and worries it will also impact their 5-year-old daughter.

 

"It has huge consequences if someone in the family has a depression," Thogersen said.

 

She explained that it's important for parents to "talk to teachers and strike a good balance between light pressure and safety".

 

And she advised that expatriate parents should not leave their children with an ayi --nanny -- who doesn't speak their mother tongue, because it "could create more insecurity".

 

Thogersen said that Western expats suffering from depression and anxiety should categorize their high and low points. On "bad days" they should seek the familiar, such as Western movies, DVDs, hangouts and people.

 

"But the healing will come from connecting with the culture," Thogersen said.

 

So, on "good days", Western expats should dive into their host culture, she said, explaining that one of the best ways to overcome the expat blues is studying the language.

 

"It's a magic device to overcome depression and anxiety, because it's a connection to your surroundings you can develop at your own pace," Thogersen said, adding that it also stimulates brain activity, which slows during depression.

 

She also suggested developing a structured routine, which alleviates the insecurity that comes with living abroad and causes depression and anxiety.

 

"Habits are safety," she said. "Observe the details of your daily schedule. It's all about how you define yourself, saying: 'I like my coffee this way; I read this newspaper in this chair'."

 

At a loss for what to do and where to seek help, Amanda said she is considering going home.

 

However, foreigners who fail to overcome their depression and anxiety often return home hoping to leave their problems in China frequently find that repatriation brings with it a new host of mental health challenges.

 

"(Repatriation) is known among professionals to be even more difficult (than first coming to the host country), because you realize it was a one-way ticket," Thogersen said.

 

Usually, people find that they have been transformed, but those they left behind have not. And that makes readjustment difficult.

 

"When you come back, you realize that life will never be the same," Thogersen said, "for better or for worse -- mostly for the better."

 

By Erik Nilsson

 

(China Daily May 28, 2007)