The feeling snuck up on Marc. First, he felt restless and uneasy outside of work hours. Then he became anxious and could not sleep.

When he started to get palpitations, he consulted his doctor who told him his heart was fine. That was when he decided to see a psychologist.

Like so many other high-achieving expatriate executives based in Beijing, China, Marc found his way to my consulting room.

"I know I probably work too much," he said, "but how can I control work when the political issues are so intense and business opportunities emerge virtually overnight. How can I rest? I feel as though if I stop working even for a moment, I'll let it all go."

After working for 15 years as a psychologist practising in international communities, I believe that the expatriate life is more than difficult. Almost every day I see people break down with depression as a result of the stress and challenges of the international lifestyle.

An expatriate may be hit by a feeling of 'emptiness' right between the eyes, and it will have very physical effects. The symptoms that I see include restlessness, fatigue, lowered physical immunity and bodily pains.

Transformation in a new environment

Anna, struggling with anxiety, described her life as "full of insecurities".

"As soon as you find a successful approach, the next minute things have changed," she said. "Your good habits break down too often. You have to be creative to twist that into being your force."

Anna understood that there was an element of transformation in learning to survive in a new environment. If you take a bird away from its environment it might die, but for better or worse, a human being has an incredible ability to change.

When my fellow countrywoman, Karen Blixen, took her first steps into Africa, she found it to be a liberating experience.

"I was dizzy," she wrote. "It was dangerous, but it was intoxicating, a superb feeling. Only one step further in that direction, I thought, and I will be face to face with God."

There are few psychologists living and working outside their native cultures, and little work has been done to understand how to thrive in an international environment.

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