Article: Culture shock – the impact on mental health

“Life is a journey, enjoy the ride”. Certainly a short or long expatriation period can feel like a voyage in one’s life. Many feel attracted to experiencing a new country, to travelling, and to learning a new language and a new culture. There may be professional benefits, and for those who bring the family there is a possibility to experience something new and exciting together.

Although living in another country usually is an enriching experience, it also has its challenges. This paper aims to look at the impact on mental health that culture shock has on an extended stay abroad. We will review;

  1. What is good mental health?
  2. The expatriate morale curve.
  3. What does culture shock look like and why do we get it?
  4. What can be done if culture shock happens to an expatriate or family member(s).
  5. A successful and enriching stay abroad.
    1. The choices of roles to take.
    2. Tips for adjustment.

1, What is good mental health?

Good mental health is a sense of physical and mental well being, not just the absence of illness but feeling positive, satisfied, content, productive and fulfilled. For an expatriate it can include a feeling of balance and mastering their environment. One feels excitement about the surroundings and the possibilities of experiencing the country and its people. The expatriate knows that there are aspects of the culture that they do not feel comfortable with or agree with, but it does not lead to a feeling of extended distress.

2, The expatriate morale curve

Living abroad has wonderful moments as well as its challenges. Whilst it can be exciting, it can also be a difficult experience on both practical and emotional levels. As time goes by, we learn to adjust to the new environment; we start to see ways of living that appear better than where we came from, maybe we adopt some habits of our host location, we notice the beauty that surrounds us – and sometimes we still get very annoyed! And the funny thing is, when we go back to our home country, it starts all over again! We have changed as a result of living in a different country and we see things in a new light.

Before, during and after an expatriate assignment expatriates tend to go through an emotional journey.

– It starts with a “low” just prior to departure due to the stress of the move.

– The “tourist” or “honeymoon” stage is characterized by enthusiasm, still not aware of the cultural differences.

– “Culture shock”

–  and various ups and downs of “adaption”.

– “Re-entry shock”; friends, family and work relations may not be interested in your experience and acquired skills.

3, What does culture shock look like and why do we get it?

Culture shock is the experience of not knowing what is going on in the new culture and finding that normal ways to adapt don’t necessarily work in the new environment. It could lead to depression, withdrawal, fatigue and isolation. Most expatriates go through a culture shock stage, but do not necessarily feel depressed. They may feel heightened stress at work, or seeing things more negatively than before, or feeling slightly aggressive or confused. In this stage one tends to feel irritated about customs and people in the host country. One may go in and out of a culture shock state throughout an expatriate stay, but it most commonly happens within the first year.

There are usually several factors that cause a culture shock and different factors can trigger different reactions. The most common reasons are listed below.


Probably the main reason of discomfort in a new country is the lack of the ability to communicate effectively. It impacts your life from doing simple things as shopping to attending social events. Not being able to communicate can lead to a strong feeling of isolation and frustration.


Leaving friends and family to start a new job and basically a new life is a major change, and the sudden absence of family and friends can lead to a feeling of loneliness. Certain companies will handle all aspects of your move and set up on location, e.g in “expat camps” like in Nigeria. Other companies leave much of the practicalities to the expatriate, or certain locations are considered “easy” so that there is minimal company support. From my own experience in various international roles, I have seen that the ones who get maximum support and stay in “camps” tend to experience very smooth transfers. But they rarely socialize with the locals and learn about the country they are in. Expatriates that handle most of the hard work themselves, experience a high level of stress, but also tend to adapt quicker and easier into the society of the new country.


A stay abroad can strengthen the family ties because the family has more time together and experience new things. However, it can also put more stress on the family. A common situation is that the one of the spouses has left their work to follow the other and handles all the practical matters like housing (setting up telephone, internet, electricity, etc), schooling for the children, shopping, etc. Typically the spouse at home experiences less social interaction in the new country than the spouse at work. This can lead to the spouse at home experiencing that they are less able to communicate and less experienced at understanding the cultural codes. This situation puts stress on the family, as their worlds feel very different. Additionally, the accompanying spouse often leaves their job to be able to move abroad, which can give a feeling of loss of status – being “just the wife/husband” and not having a working role in society.

Research done by both Dr Scola and Berlitz Consulting confirms that it is particularly difficult for partners/spouses to adapt to the new life as expatriates.

Adaption and feeling of being effective

Learning about the new surroundings usually takes time. It is natural that after an initial introduction to the new culture, confusion sets in. It can be that the new culture feels too different to your own and that you don’t understand the customs. It is often the day to day things, or an accumulation of little things that creates a sense of not being able to be effective.

Even after years of living in another country and developing a good mastery of the language, something as seemingly simple as using the phone may feel challenging. Calling customer centres, where they talk “cultural language” (e.g business jargon) can be a challenge even in ones’ mother tongue and in another language it can feel too much to handle. On the telephone, one cannot read body language and one can feel embarrassed and stressed during those moments of silence when you try to remember the correct word.

If you happen to be moving from a group oriented culture to an individualist culture it can prove to be an even greater challenge to adopt and feel effective. The feeling of being alone and without a support system tends to be stronger than for those who move from an individualist culture to another individualist culture.

Seeing a doctor or therapist

Certain situations may be particularly challenging for an expatriate, like meeting with a doctor. There may be linguistic challenges and if the doctor and patient have major differences in cultural upbringing, there may be greater risks for an increased stress level for the patient. The patient may feel misunderstood, or not well understood. Also getting the diagnosis “depressed” may create even further problems as different cultures react differently to the term.

Dr Scola found in his research that some expatriates feel anxious and lack the trust in going to a doctor or dentist abroad. He found that many would wait until they returned to their home country for check-ups.

Having therapy in the host country does not always produce the wished results.

E.g western therapies are built on western values and may not always fit with the eastern values. In a therapeutic situation one should expect the therapy to be individual and consider the patient’s map of the world, with their value system and beliefs.

According to certain psychologists, mental illnesses may arise from the distress of meeting another culture. “When individuals migrate from one type of culture to another it is likely that depending upon their own personality traits (along with their biopsycho-social vulnerabilities) may develop psychiatric disorders. The cognitions and idioms of distress will be influenced by cultural factors. The clinicians must take into account cultural background when planning any interventions to enable a stronger therapeutic alliance.” D. Bhugra at the Institute of Psychiatry, London.

4, What can be done if culture shock happens to an expatriate or family member(s)

In the case that the culture shock has become a depression that lasts over a long period of time, it would be beneficial to get some help. Help can come in many ways.

Family/friends support

Share the situation and how you feel with people you trust. Make sure you talk with people who are positive and constructive and can make you feel better.

Expatriate cultural training

Many companies offer cultural training to their employees. If you are the accompanied spouse, ask to join one together.

Access to networks

There may be expatriate networks or sites where you are (e.g Petite Planet in Manosque, France) where you can meet or write with people in the same situation as you. Developing and maintaining social networks has an impact on the overall well being.

Get a coach

Life coaches or personal coaches may be the solution where you become empowered to take charge of the things you want to change.

Contact a doctor or therapist

As mentioned earlier in this paper, many people are reluctant to go to a doctor when in a foreign country, but give it a try, the doctor may just be the right person to talk to! If you do not master the language of your host country, ask for help to find someone who speaks the language you feel comfortable speaking in.

5, A successful and enriching stay abroad

It is highly likely that you will experience or have experienced some degree of culture shock. There are certain actions and attitude you can take to make the transition easier.

a. The choices of roles to take

When moving to another country, individuals have the ability to choose how much they want to integrate and to choose the attitude they will have towards the other country and its’ people. According to writer Alan Cornes, there are several types or attitudes that people tend to adopt when they live abroad. Below a short abstract from his book “Culture from Inside Out”.

The World-Weary: Laconic and unimpressed. “Been there, seen it, done it, got the t-shirt. It’s nothing new”.

The Adviser: Paternal and superior. “Let me show you how we do it back home”.

The Sardonic Old Hand: Sardonic and wise. “Let me tell you what they are really like; only last week I…” “That reminds me of a time when I traveled in the rural district, I slept on a straw pallet”.

What these three types have in common is that they feel some concern or insecurity and there is a mismatch with the inside and the outside.

According to Cornes, the type “Respectful and Curious Guest” is more likely to be effective in its new environment. This is a person who typically says “that’s interesting, thanks for inviting me”. It is a person who wants to learn, is curious, interested in understanding the host’s perspective and is aware of their own strengths and weaknesses.

b. Tips for adjustment

  • Actively look for networks through children, hobbies, work, clubs, your pet (children and dogs are people-magnets).
  • Reach out – talk with people.
  • Gather information about your host country (books, articles, talking with people).
  • Look for logical reasons for why people do as they do. Assume positive intent.
  • Recognise your own cultural heritage and the « lenses » you see through.
  • Become familiar with the cultural norms and rules.
  • Have a sense of humour about yourself . You learn from “mistakes”.
  • Explore, travel and participate in new activities.
  • Set realistic expectations; adaption takes time.
  • Smell, taste and enjoy!

References and Recommended Reading


  • Berlitz Consulting – “The Expatriation White Paper” 2010.
  • D. Bhugra, Institute of Psychiatry, London, UK – “Cultural identities and cultural congruency: a new model for evaluating mental distress in immigrants”.
  • Dr Franck Scola’s doctorate thesis – “Couverture santé des expatriés: Enquête auprés d’un échantillon de la communauté Française résidente à Rio de Janeiro“.


Alan Cornes – “Culture from the Inside Out. Travel – And Meet Yourself”.

Copyright by Sunniva Heggertveit Aoudia 2010

Enhanced by Zemanta

Tags: , ,

Reader's Comments »

  1. By Psychoanalysis London on mars 19, 2011 at 9:00

    Scores of those things make sense to me.