Some foreigners have problems assimilating into the Chinese society; if left unaddressed, their issues can lead to psychological disorders. Photo: Courtesy of Chang Wei

 

The first 18 months of Frenchman Pitou Monjalet's (pseudonym) new life in Wuhan, Hubei Province, were among the darkest in his life. The 33-year-old wine dealer moved to China with his Chinese wife two years ago and then his life suddenly hit rock bottom.

His business was not working out as planned; he was constantly fighting with his wife who he felt had changed ever since her return to China, and the language barrier meant that he had no friends to commiserate with.

"It felt like I couldn't do anything," he said. "I was completely powerless. It was like I was losing my manhood."

Unable to cope, Monjalet started to hole up inside the house for days at a time as feelings of sadness and anger washed over him. He even began to have choking sensations, he said, and on more than one occasion he felt like there was nothing to live for.

Then he realized something was wrong with him and his wife brought him to a local Chinese hospital where a doctor diagnosed him as suffering from depression.

"It was the first time I suffered from depression; I didn't have that problem back in France. I think it was the challenges I faced with adjusting to work and life in China that caused the depression," Monjalet said.

Expatriates in China have to go through a wide range of adjustments, including work conditions, interpersonal relationships, family life, natural and social environment, which can be very challenging for some of them. Problems with assimilation into the society could cause psychological and emotional disorders, the most common of which are anxiety, depression and bipolar disorder. However, China's lack of experience in providing psychological support means it is still far from providing adequate psychological help to foreigners.

Take Beijing for example, based on Metropolitan's interviews with psychologists, roughly 70 counselors are certified to provide the service to foreigners in the city, including those who work for international hospitals and those who work privately. There are more than 173,000 foreigners living in Beijing, based on statistics published in a Xinhua News Agency October 2010 report.

There is a limited amount of psychologists and mental support organizations that provide help to foreigners in Beijing. Photo: IC

 

Problems assimilating

Monjalet faced a lot of difficulties in adjusting to life in China, from interpersonal relationships to marriage to work.

He wanted to make friends with the local Chinese, but he spoke no Chinese, and he couldn't shake the gut feeling that they didn't like him. He just couldn't seem to fit in.

Not only did Monjalet not have any Chinese friends, but he also couldn't tell his problems to his friends in France either.

"I left my own country for something better. So, I couldn't talk to my friends in France about my pressure, the same thing Chinese people do to save face, which made me feel even more lonely," he said.

Monjalet was unemployed for the first 18 months, and when he finally set up his wine business, he found that the cultural differences made it difficult to work with local partners and often caused clashes.

Dr Chang Wei, Chair of the Psychological Health Center from Beijing United Family Hospital, a psychological help provider for foreigners in China, said it is harder for Westerners to adjust to living in China than it would be if they moved to another Asian country. She attributes this to China's thousands of years' strong cultural background which is very different from the Western culture, the dense population, and different social norms such as pushing to get into a subway train or bus, which sometimes leave new arrivals taken aback.

"The changing working environment in recent years also places a lot of pressure on foreigners," Chang said. "In the past 10 years, many international companies have sent a lot of expatriates back to their home countries because of cost issues, so foreigners have less foreign colleagues and more local co-workers. Also, the management style and office culture are different, which creates more pressure for foreigners."

Expatriates also often have a tremendous workload in China, Chang said. She had many foreign patients who work in international companies in Beijing and suffer from depression and anxiety due to overwork.

"In their home countries, the workday is usually fixed at 8 hours a day, but in China, the work hours are almost indefinite," Chang said.

One reason is that in the Chinese culture, people tend to work overtime; the other is that they have to work across time zones. Some work with their Chinese colleagues during the day and have conference calls with their headquarters in the night.

Expatriates also tend to face a lot of challenges in maintaining their marriage, which can also cause mood and psychological problems, according to Chang.

Even the environment can be a contributing factor. "Some patients with psychological problems are especially sensitive to air pollution during the foggy days. When the sky is gloomy, their symptoms tend to get worse, especially for patients with seasonal mood disorder because it is related to daylight," Chang said.

Not enough help

Chang said that her hospital has seen a huge growth in the number of staff compared with almost 20 years ago.  Despite the inroads in the number of doctors available in her hospital, Chang said many foreigners can't afford to see psychologists at international hospitals.

Jerry Bond (pseudonym), a 51-year-old Canadian, arrived in China five months ago and faced such a problem.

"I work for three different schools now, and English-teaching schools in China generally don't buy us high-level insurance that will cover the psychological session, and with my paycheck, the counseling is too expensive," Bond said.

He was diagnosed with depression eight years ago and was managing it, but when he arrived in China, missing his family and being cut off from his friends, some of whom were against his move, caused him to have a serious bout of depression.

Bond was also afraid he would lose his job if he sought help.

"The other reason I don't see a psychologist in China is because I am afraid my Chinese boss would find out and think I am not able to fulfill my job. Based on what I know, China is conservative on these topics," he said.

Stephanie Tebow, a psychologist who works for Harrow International School in Beijing, also said that there isn't enough psychological support in Beijing for foreigners.

Tebow said that if foreigners want to get counseling at a lower price, like 500 yuan ($76.05) an hour, they can go to doctors with private practices, but there are not enough of them.

There is a Beijing-based mental health group, which consists of 55 to 60 psychologists who can provide service for expats, but only around 35 of them receive patients, Tebow said. She added that people in need of counseling could also call non-governmental organizations (NGOs) like the Beijing International Christian Fellowship and China Hope Center.

"Considering the large amount of foreigners in Beijing, that's far from enough. In my hometown Carbondale in Illinois, [in the US,] where there are about 26,000 people, there are 200 to 300 psychologists available," she said.

Despite the shortage, Tebow said that the current number of psychologists and support workers is already a huge improvement compared with a decade ago.

But Chang expressed concern about the safety of going to a private practice.

She said the Beijing Health Bureau requires that foreign psychologists have a license from their home country and attain a practice permit through a test organized by the bureau to ensure the quality of their training.

"But many foreign psychologists who have a private practice don't have a work visa, so the patients don't know if they have the necessary licenses from overseas and China," Chang said.

Disrupted care

The transience of the foreign population also makes it difficult for them to get help.

"Expats come and go a lot. Right after we make some progress, the patients move away to another city or country. It's very challenging for their treatment," Chang said. She said a mental health problem is a long-term issue and patients need continuous care.

People don't have depression overnight, and they may have depression for the rest of their lives, according to Chang. "[And] because in mental care doctors and patients need to form a strong, trusting relationship for the counseling to be effective, changing doctors from time to time is bad for the treatment."

She said sometimes hospitals would use online tools to maintain the doctor-patient relationship, but added that they do not use them as the primary treatment models, because Chinese law is not clear on the parameters of online treatment. Also, mental health treatment is very private and needs to be well protected, and patient information safety can't be guaranteed online.

After being diagnosed, it took Monjalet almost two months to find a psychologist in Wuhan who speaks French. When he finally contacted one, he found the doctor had already moved back to France.

"I tried to do online sessions for two weeks through Skype and e-mail, but I gave up because the sessions were not personal enough and safety could not be guaranteed," Monjalet said.

Tebow has found a way to minimize the negative influence caused by patients' frequently moving for work.

"Normally, when my patients move away, I would try to recommend a psychologist in the places they move to and talk to the psychologist about their condition and the progress of their treatment to make sure there is a smooth transition," she said.