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.

But we are already well along the path of globalisation and our psyches must catch up if we are to stay healthy.

In my experience, expatriates need to undergo a radical overhaul of their personality in order to flourish.

I believe we are beginning to learn the skills for a whole new chapter of personality development and international organisations and global business ignore this at great peril.

One German lawyer, Katherina, came to me six months after her move to Beijing.

An extraordinarily gifted young woman, she felt that she had lost her identity. Attempting to regain herself, she tried frantically to exert an excess of control over every aspect of her waking life, even her thoughts.

She would strictly map out the route she walked from her home to my practice. She had to go exactly the same way each time, making an extra circuit around the French bakery and stepping on the same stones on the sidewalks.

She was aware that her exaggerated self-control was her way of creating at least a shell of something she did not feel any longer. "Just for there to be something instead of nothing," she said.

The elements to keep in mind

Katherina's story is not unusual. Most people gain a new sense of self within the first year after an international move, but many people need help.

Those businesses that take globalisation seriously are beginning to suggest psychological coaching for the men and women they post abroad.

I take the same approach, whether I am coaching a top executive or counselling someone already in trouble like Marc with his palpitations or Katherina who always stepped on the same stones.

The following are important elements to keep in mind:

• Get in touch with 'normality'

Expatriates always have a good reason to spend long hours in the office, to travel and to forego holidays. With international business at stake, how important can it be that you go on that picnic with your family?

Well, it can be very important. Marc's palpitations ceased when he and his wife found more time to be together and give each other positive feedback, reinforcing Marc's sense of identity. Creative expatriates find ways to connect their extraordinary work life with their more ordinary, yet no less important, domestic lives.

Chris was a 42-year-old CEO and father of three, one of whom was a troubled teenage boy I saw in psychotherapy.

I acted for a day as a family-management consultant — a job description that does not yet exist, but soon will. I spent a full day with Chris' family looking at every individual's needs.

At the end of the day, we had a list of 50 important items for the family to address in the next three months, 25 of them involving Chris.

"Instead of feeling helpless and watching Chris being buried in work and seeing the children’s need to talk with him, I felt that I could do something," said Chris' wife.
Meditate

Many expatriates feel in danger of being swamped by information. Some have created a habit of taking time out of each morning or evening to contemplate what is on their mind.

"I close my door and unplug the telephone from 8am to 10am in order to have some personal time in which to plan, contemplate, create visions and strategies and just think about where I am headed," said Matthew, an expatriate who used a coaching session with me to reflect on why he has fought like a tiger to ensure that his staff respect his need for quiet time.

"I am amazed to see how much more effective I have become during the rest of the day."

Expatriates sometimes mistakenly feel as though their experiences are so intense and powerful that they must already be highly self-aware.

In fact, intensity often works against awareness by creating a sense of urgency and excitement that inhibits calm reflection. Increasingly, expatriates are seeking good meditation strategies.

• Be an extrovert

Monica, an Italian client, came to see me because she was paralysed by oversensitivity. She told me she always had been an introvert.

In fact, it may take years before you stop feeling hurt when other people disagree with your beliefs, which happens all the time in a cross-cultural environment.

However, successful expatriates learn to be markedly more open-minded than other people. For people like Katherina, that means language training to give a real sense of control in new surroundings. For most people, it means becoming almost vehemently optimistic.

One of my clients, Michael, suffered from a mood disorder. It did not help his condition that he was living in Beijing, but his driving force was a positive one.

"If I could not find splendid new ideas to live for, then why would I be here?" Michael said. "I am not sure I would take the hassle if it wasn’t for the opportunity to pursue my ideas of a better world."

By contrast, David, another one of my clients, focused on the negative to the exclusion of all else. He could not accept the corruption he witnessed around him and it fuelled his depression.

• Have many and varied friendships

Prior to relocation, your identity was structured by well-known surroundings. In the international community, it is primarily friendships that hold you together. Do not worry that you are being dependent on other people — it comes with the territory.

• Be actively compassionate

It is a sense of purpose and connectedness that makes you feel real, but those feelings are not instantly available abroad, so you have to create them. Katherina, for instance, in her spare time started to help in a handicapped child's home.

• Use that ange

In an international environment, the way you express your emotions can be a cultural minefield. If you explode when you feel angry, it works like a volcano; everything fossilises around you.

"But I feel so much better when I express my anger," said Carol, who was seeking help for anger management. "I let go of tension. How can I contain all that without becoming mad?"

But it is a Freudian myth that anger has to be expressed. Focus it instead — it creates motivation for change.

Evolving into a successful international person is painful because it involves radical change.

But as a result, people generally become stronger and more compassionate human beings.

They also gain great leadership qualities: self-awareness, an increased ability to cope with change and real motivation for learning. People change like this when they have to.

It is as simple and difficult as that.

Updated April 2008

Kirsten Hogh Thogersen, Ph.D., is a professor at Sun Yat-Sen University, Guangzhou, China. A Ph.D. in clinical psychology from Aarhus, she has worked at International Clinics in Beijing and Brussels for 20 years while running a private counselling practice. Her work often appears in European newspapers and journals in China and in educational materials. She can be reached at +86 21 6406 3369 or e-mail kirstenthoger@gmail.com.

Reprinted with permission of Worldwide ERC®, from the publication MOBILITY.
Subject: expat support, expat health