Advanced Expat Psychology

Long term exposure to another culture can be enlightening. A student of language might flower in such a setting, while a career-minded anthropologist or a budding writer might lap up the all the exotic unfamiliarity; the curious customs and baffling behaviors.

Yet, years spent living abroad can also exact a heavy psychological toll. The psychic shifts that occur inside the expatriate brain are subtle, often laying dormant for years and surfacing only when triggered by the pungent smell of fish maw, the harsh sound of a moped horn, or a particularly aggressive pedicure.

This study is not concerned with neuroses that arise when emotions are suppressed in order to conform to local mores. Such a repressed state is not exclusive to any one culture, disfiguring all without regard to race, creed, color or resident alien status. An unnatural concern with ‘saving face’ is a fairly straightforward and treatable condition, whereas the enervating and long-lasting effect of, say, reading state media, has been shown to bring on severe bouts of melancholia in aging former expats.

Auditory hallucinations are not uncommon. Patient X, repatriated by his company after eight years in Shanghai, tells his analyst that he sometimes hears the voice-animated timer of a blind masseuse in the quiet comfort of his remote Maine cottage. In another celebrated case, a middle-aged man who lived in China for many years wandered the streets of Manhattan telling random citizens to “Press #2 for English!”

At issue, then, are the hidden agents of psychosis that incubate unnoticed in the deepest recesses of the expat brain.  Go for 10 years without comprehending an eavesdropped conversation. Spend a decade using Monopoly money. There are psychological consequences; the most obvious of which is a hypersensitivity to background noise and an absolute mania for hard currency.

Some veteran expats also develop phobias, the most common of which is an irrational fear of certain numbers, with 5,000 provoking intense feelings of dread. Four of anything can spark acute anxiety. Phone numbers shorter than eight digits induce feelings of abandonment. Once a mind is warped by the metric system, the sight of a square foot can result in a full-blown panic attack. 

Another patient, Mrs Y, a 39 year old former English instructor now on disability, displays classic signs of paranoia when eating abalone alone in Bayonne. Mrs Y lived and worked in China’s hinterland for eight years in the 1990s. Her symptoms began appearing three years after she returned stateside. “I get the sense that other diners are staring at me, taking pity on me for eating my abalone alone,” Mrs Y told her therapist, who surmised that her years teaching in the provinces had fostered intense feelings of dissociation. “When I use chopsticks in public,” Mrs Y continued, “I look around to see who is assessing my chopstick-using ability. I know they’re watching me. I just know it!”

Perhaps the most complicated mental health problem associated with living for long stretches in the developing world is a post-traumatic stress-like disorder, similar to the dysfunction seen in individuals who are bullied in their formative years, but rarely found in normal adult populations. The docile expat, under constant strain not to offend his passive-aggressive hosts, eventually returns to free society only to discover that he, too, has become a tormentor, forcing his children to study piano 12 hours a day (or be held responsible for his suicide) and informing dinner guests which foods are “good for health”. No pharmacological treatment or talk therapy has proven effective in treating this degenerative disorder, though a few clinicians claim progress using aversion therapy, whereby the patient is strapped to a chair and forced to watch footage of monks at prayer.