Loneliness

Another long lonely week-end starting here. I wrote a paper about loneliness for the website Iamexpat.nl. It will be published there in a few days. I tried my best to find in the literature what works to avoid the pain of the loneliness feeling. Do you also experience this feeling of oppression in the chest, and falling down as if there was no grond anymore? I used to feel that way very often. Sometimes it comes back. Like yesterday night.

But, ok, shake it up Catherine, there are some things we can do to avoid to be overwhelmed by this pain. I tried to summarize them in this short article. Challenging. I hope you find it useful.

This week-end I'll do some mediation and meet some friends (was invited to two parties!), have a coffee with a former colleague, and go to the market to buy some good stuff... I know the painful feeling will go away slowly... and what about you? Don't stay alone too often. It kills.  

Ooops, I forgot to say in the paper: Don't stay on the internet for too long :-)

Here is my article for Iamexpat.nl :

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Did you notice how, when you are unhappy, seeing others being cheerful gives you the impression that they are simply… fake? The lonelier we feel, the more irritable we get, and the less we enjoy good company. If loneliness was only painful it would be hard enough. But research indicates that it also impairs our ability to actually make friends. It is a vicious circle! Loneliness is one of the top issues faced by expats according to surveys.

Here you are. You are living in a new flat, in a foreign country, you did not find a job, you have still have billions of things to get done to feel settled in, you are starting to feel worthless and spiraling down… If only you had your good old friends to talk to right here and right now. All this time spent alone is getting on your nerves, and you're starting to suffer from loneliness. What comes next? 

Cacioppo is a researcher at the University of Chicago specialist of loneliness and social isolation. He has studied extensively its consequences on health and behaviors. Chronically lonely people (those who report feeling lonely more than two days a week) are more susceptible to viruses and to cardio-vascular diseases. In 2007, Cacioppo and colleagues demonstrated that lonely people have an increased activity of genes encoding molecules that promote inflammation and a decreased activity of genes encoding molecules that slow down inflammation. In other words, they demonstrated that chronic loneliness has a direct impact on the immune system. Lonely people also recover less easily: last year, a study showed that although lonely people sleep as much as others, they feel more fatigue during the day.

Cacciopo also observed the consequences of loneliness on people's behaviors. Lonely people judge their interactions with others less satisfying than non lonely people. In a scanner, their brains show less activation of the reward centers when they see smiling faces! They also produce worse impression to the people they meet _which is easy to imagine. It creates a vicious circle and it's difficult to get out of it!

Loneliness never goes away from our lives, but it can be made less common, less painful and less overwhelming. One way is to find ways to meet new people. It's a real challenge in a new country. The best is to try to join a group, like a sport lesson, a reading club, or volunteer for school. It's harder than back home: people are different, they come from other countries, other regions, or even simply from other social classes, and it makes the encounter more worrisome at first. It will take more courage, openness and tolerance than back home. But that's what makes the whole experience so worth it!

Joining a club will not fill in the days, but it will enable you to meet, not just one, but a group of new people. It will help you to develop a sense of belonging, feeling useful again, feelings appreciated by others for your contributions, and help to avoid seeing your self-esteem fading when you feel like the entire world seems to ignore your very existence!

Another remedy is to change your representations, by bringing back positive emotions when thinking about others and about ourselves. In fact, in sedentary people, loneliness is only moderately related to the number of acquaintances and friends: To a large extend, feeling lonely depends on mental representations and expectations. Cognitive therapy has proven benefits (see references below). Relaxation associated with visualization or meditation have generated a lot of encouraging results in the last decade. Relaxation relieves stress by decreasing heart rate and muscles tensions. It has a positive impact on the immune system. Meditation will help developing mindfulness and compassion by reducing fears that often prevents us from meeting new people. Studies suggest that 10 to 20 minutes mediation a day for a few weeks is already enough to see many positive effects.

References.

All you ever wanted to know about loneliness is in Cacioppo's 2008 book: Loneliness: Human Nature and the Need for Social Connection.

A number of stress reduction techniques (including cognitive therapy) are very helpful to manage loneliness feelings or prevent them. A good self-help book is: Stress reduction workbook, M. Davis & E. R. Eshelman, M. McKay.

A new feeling to add to our international repertoire: Do you feel ibasho today?

My old professor of psychology used to tell us about the Inuit people who would have ten words to describe snow. I've never been invited to a high tea by an Inuit family so I didn't have a chance to check if he was right. His point was: there are some concepts that we are lacking because every language invents his own concepts - and this limits and shapes our ways of thinking. Something that has no name just can't be discussed, analysed, compared, and so scientists will tend to ignore it. In the best case, they discover it by chance and will go back to Latin or classic Greek to name it.

A team of researchers from Clemson University decided to explore and test the Japanese concept of Ibasho. This concept doesn't exist in English. The feeling it describes has been extensively discussed and studied in Japanese, but hardly ever discussed in the international (understand: English) scientific literature. What a pity! When I read their paper, I was immediately hooked by this concept. It sounded like a very important concept that could describe some of the stressful consequences of living abroad. As a disclaimer I must admit I don’t speak Japanese and I have never been to Japan.

According to the paper, Ibasho describes a place and the feelings associated to being in this place: it evokes the "person's feelings of comfort and security in the places that he or she normally goes". They say that more than 100 books contain this word in their title in Japan! Ibasho refers to a feeling associated to a place, but it's also about the social contacts you have there, about the sense of "security, peace, satisfaction, acceptance, belonging and coziness" (Bamba & Haight, 2006).  

It's a really useful concept to use for expats, internationals, and travellers of all species. When arriving in a new place, nothing feels peaceful. There is no sense of home yet. Not in our living room, kitchen or bedroom. Not in the neighbourhood. Not at the office. The pub at the corner of the street is full of strangers who will stare at us or royally ignore us when we come in. Nothing provides this feeling of ibasho. And we will have to soon build our ibasho: Find a place where we'll meet friends, feel comfortable, feel at home, feel a sense of belonging to the community. A place where there is no stress, no worries, just nice people we trust and have fun with. This will take a lot of time. Can this ever be reached when security is a big issue and you have to live surrounded by high walls and protected by armed guards? Is this possible for international employees working for the poorest? Some of them described to me their guilt when coming back home in a comfortable place and leaving behind those who won't eat for another 24h.

The research doesn't explain how to create this place and this feeling of well-being associated to it. But it underlines that this feeling is very important for the expats to buffer stress and feel satisfied with their life.

I wonder how many concepts like this one, describing complex feelings, have yet to be discovered and imported from other cultures. The world has about 6800 languages.

How many other feelings don't have a translation in English? Send me other examples if you think about any J

References. H.A. Herleman, T.W. Britt, & P.Y. Hashima. 2008. Ibasho and the adjustement, satisfaction, and wel-being of expatriate spouses. International journal of intercultural relations, 32, 282-299.

Free but Lonely Europe

According to the last Expat Explorer survey commissioned by the international bank HSBC, the top emotional concerns for expats moving in a new country are to re-establish a social life (41%), and feeling lonely and missing friends and family (34%). Only next come worries about career prospects, language barriers, relocation issues, healthcare, adapting to culture, and many other. Women suffer from those issues slightly more than men:  48% of women and 37% of men have concerns about re-establishing their social life in a new country. But this gender difference is not very large. There is something much more intriguing.

Surprising and massive differences are observed depending on the country where you live. It is surprising because it means that to a large extent this issue doesn't only depends on us. We all feel lonely when moving abroad and leaving family and friends behind, but some places make it even worse!

The percentages of people feeling lonely, without friends and missing their family are particularly high for expats living in many of the European countries, compared to other regions of the globe. The worst scores on the question " do you find it easy to make friends" are sadly won by Belgium, Switzerland, UK, Germany, and the NL (the lowest, with 38%)

There could be several reasons for that. There are language barriers in many European countries where locals don't see English as an international language and assume that everybody who crosses the border should learn the local language. But it's not the case everywhere: in the Netherlands, it's easy to live when you only master the English language, because most Dutch people speak English really well and will enjoy talking to you in a foreign language.

So is there another explanation? Many European countries have more individualistic values than middle East or Asian countries. According to the same survey, expats find it easier to make friends in Bahrain (80%!), Thailand (70%), South Africa, and many Asia countries (overall 80% to 60%), compared to most countries in Europe! These cultures are notoriously collectivist, as opposed to Western societies where independance, rather than interdependance, is valued. I've been a few times in India for my work, and indeed, I was never left alone for a lunch or a diner: my guests took turn to accompany me and my colleagues eventhough they lived very far away from the office. If we were left alone sometimes, it was because we insisted that we were ok to be left alone. We actually felt embarrassed to take private time from them! That's unlikely to happen in Western cultures where locals don't want to 'bother you' and assume that you will actually appreciate being left alone for diner,. They might invite you. Once. Or they may not even invite you at all. It happened to me a few times to my surprise when I visited US academics, also for work. Why? Perhaps it's about valuing freedom versus friendship? The expats in Europe and perhaps the entire Western world would trade friendship for freedom without knowing?

But that's more complicated than that because the survey doens't show bad scores for other Western nations. Why don't we see the same numbers then for the US, Canada and Australia which are also Western cultures with high individualism? Perhaps immigration in Europe is a marginal phenomenon and there is not a strong culture (or respect?) for immigration, and therefore locals lack an awareness of the social isolation of the migrant? In the US, Canada or Australia,  immigration is part of the national history, and perhaps locals are more used to welcome foreigners and provide them with more assistance, including time and friendship? 

But to tell the truth, I don't really know. I don't think anybody has a serious set of data that replicate or explain those differences. 

And actually, when I think about it, I am not even totally sure what we can yet generalize from this survey. The authors indicate that similar results were found in previous years, so it suggests that the results seem consistent, and not just obtained by chance. But we really lack facts and statistics about expats and internationals! So there is probably something true about those results (where there is smoke there certainly is a fire) but scientists still have a lot of work to do to make sense out of those data!  

References: The HSBC surveys are on line. Thanks to the Blijberg International school in the Netherlands for sending me the link!

On individualisms and collectivism: G. Hofstede & G.J. Hofstede, Culture and organizations. A very readable book presenting Hofstede's massive amount of data on cross-cultural differences in organizaitons.   

Dear Diary, can you hold this for me?

Great! I’ve just read a paper in the Science magazine last Friday that illustrates very nicely my point: managing our emotions and thoughts (the ‘control’ I was talking about in my last post) can really improve our emotional well-being. It is so simple that I wonder everyday why psychology is not taught in primary schools! 

We are in Chicago, and a team of researchers observes 9^th grade students just before and after passing important exams. As you can expect, many are very anxious before passing their exams. Cold sweat, stomach clutch, and “OMG I’ll screw it up again I can feel it”.  For the researchers, it’s a great example of anxiety, and provides a large number of people in the very same situation the same day: ideal opportunity to study anxiety in well controlled conditions! And it's not only about students: What they will find will be of relevance for other disorders, anxiety disorders but also depression.

So how to lower anxiety and worries? They ask students to write down their worries about the coming exam, and this is done just a few minutes before the exam starts. Nothing more. These students are compared to other students who are given another writing task without emotional implications, and another set of students who aren't given any specific task at all.

The results are very clear and replicated in several experiments. Students who wrote their worries before the exam ended up less anxious and performed better (or less worse) than the other groups. This worked especially well for students who were particularly anxious. The worse the issue, the better the remedie worked.  

It certainly doesn't mean that we should on purpose think about our worries: when we evoke our worries on purpose, we don't feel better at all and we start to ruminate. This is what happens during depression for example. But putting our specific concerns regarding a situation is very different. It helps to realize for ourselves that these negative thoughts are not so big, not so terrifying, and that they may sometimes be even irrational. 

When moving in a new place, there are many good reasons to feel anxious: new place, new people, and perhaps worries about our safety, our future, our children, our marriage, our family back home, our finances, our visas, our taxes, our next move…!

Writing down systematically our fears and worries, in a diary for example, will help. It is not equivalent to procrastination; some other studies even suggest that it decrease the amount of rumination in depressed people. It help to get control over our confusions and diffuse fears.

Several mechanisms can explain this: it might be that once the worries are on paper, they aren't permanently turning in our memory (like when you make a shopping list on paper, you don't have to think about it anymore and can focus your attention on something else). It's also one way to consider our feelings with more distance, more critically, from a safer place. By the way, learning to observe our own thoughts from a distance (an emotional distance) is also something trained during relaxation or mediation. So there are other ways to manage your feelings in a gentle way… but we'll leave this topic for later, it's getting late J!

Good night!

References: Science 14 January 2011: Vol. 331 no. 6014 pp. 211-213

When controlers lost control

One important factor that increases drastically your stress level is the lack of control. Moving abroad can too easily lead to feeling helpless and having few resources to changing our situation.

For example, many spouses follow their husband or wife for a positive career move, but start to feel that they have little control over their live suddenly. They may not have the legal permission to work in the country; they may not be able to retrieve a secure job as they had back home; they may realise their diplomas won't help to find a job there in particular when their jobs involved local regulations: a lawyer can be highly skilled in her country but feel 'worthless' in the new place. They may become financially dependent for the first time in their relationship and feeling diminished and weakened by the situation. They may have a sense they are loosing their identity and feel helpless about it.   

Evidence of the terrible effects of helplessness and loss of self-confidence on physical and mental health was provided in a large scale study involving US air traffic controllers. Air traffic controllers have very difficult jobs because they have to pay attention to complex information for hours, and inattention and mistakes can cost lives.

In the context of a controversy opposing employers and unions, a researcher named Bob Rose was asked to explore if the working conditions of those workers could explain some high rates of health issues. With his colleagues, he observed their psychological and physical conditions at the time of the controversy and was able to find them and test them again 20 years later! In their 30s, some of them were developing blood pressure at an early age, more than in the average population. At age 50, a number of them had developed heart disease, cancer, alcoholism, or depression, again more than in the average population. A powerful finding was that the psychological factors measured when they were 30 year old had a big impact on developing diseases at 50, and more than the other body health indicator (more then for example blood pressure). In fact, the sense of alienation and of abandonment that they felt at 30 was closely related to depression and anxiety 20 years later.

This study, and others that corroborate this type of conclusion, illustrate how the lack of 'feeling in control' play a very important role in influencing the level at which people start to experience stress: when not feeling in control, the same situation feels much more stressful than the same situation when people are experienced and prepared.

In order to feel better, you need to feel (and be!) in control. There is at least one thing you can control: the way you think. It's not about lying to yourself: actually, by changing some ways of thinking, you actually put yourself in a more optimistic mode and you will have much more positive impact on your environment! Overcoming our feeling of being stuck in life is a first step in helping to actually change and get a life which is much more exciting and fun.

The lack of control over situations experienced by expats and migrants can be quite high. In most situations, we are extremely disadvantaged compared to locals, and even with lots of efforts local knowledge is still very difficult to get in full: The difficulty to master the language, accompanied by the frustration that we can't express ourselves precisely and be fully understood; the lack of understanding of some implicit rules in social encounters or at work; the lack of knowledge of institutions, administrations, education system, job market, health system… Those 'holes' in our knowledge can lead to a feeling of helplessness.

Getting your life back. Building a strong identity which will not depend upon the place you are in or the job you have at some point. I'll discuss that in the next postings.

Artic Terns. So beautiful! They are sea birds from the Swallows family. The Arctic tern is the animal that makes the longest migrations ever recorded on Earth by far: 80,000 km per year and 2 summers a year! This is equal to traveling to the moon 3 times in one life time. When I see this picture, I dream about flying over oceans, discoveries, joining north and south, freedom and feeling light. It makes me think that our migrant lives are fragile, special and precious. It's a difficult journey, sometimes, and a gift, always.

Zebras don't get ulcers.. till the day they move!

Overall, short-term stresses are quite positive for mental health: stressing ourselves with challenging goals makes life more interesting. It's a driver for our motivation to learn or do new things.

The problem arises with chronic stress, after weeks and months of emotional or physical strains! In the 30s, Hans Selye discovered that a surprising number of 'stressors' can make animals very sick. He observed that rats in his laboratory were developing symptoms where exposed to some conditions, for example injections, or staying in crowded cages.They lost weight, they became more susceptible to infections, and their autopsy showed a high proportion of stomach ulcers. He was the first scientist to make the hypothesis that many and various tensions against the organism weaken its internal balance. Tensions start to produce excessive amount of adrenal hormones which produces a number of unwelcome events in the entire body. It particularly targets the immune system, but 80 years ago, the fluids composing the immune system were not yet discovered!   

Nowadays, there is still a lot to be discovered on the relationship between stress and immune functions, but we are starting to know a bit more. When the stress is intense and repetitive, there is then a constant rush of cortisol in the blood, getting to the brain as well. And the problem is that one of the cortisol's jobs is to shut down immune response, and over time the immune system becomes desensitized to cortisol. After weeks or months of an intense stress regimen, the body and mind may reach exhaustion.

If this happens to you, you become less able to defend yourself against a common cold or flu, but more critically you can develop serious diseases, in particular heart diseases. Studies have shown that stress reduction techniques (through social support) can actually help the immune system of patients infected by HIV virus (the virus responsible for the AIDS disease in the long-term) and also augment life duration in patient suffering from cancer. It doesn't mean that stress reduction cures those diseases, but reducing stressors influence the ability of the body to cope better when it's under 'attack' by various infections.

At the psychological level, chronic stress affects mental health, and in particular long-term intense stress periods can be followed by depression and burn-out. Burn-out is a psychological and physiological reaction when the body and brain can't adapt properly to the demand anymore: the body doesn't seem to be able to respond to small stresses any longer. The cortisol is always very high. Burn-out occurs when stress has been intense, for example it's often seen in very stressful jobs (nurses and teachers have high rates of burn-outs).

Some extreme examples of stress are seen in people suffering from post-traumatic stress syndrome such as survivors, holocaust survivors, war survivors, people who have been raped or mugged. It also exists, though less intensively, in many other conditions. A work place can be stressful. The most powerful stressors are the loss of the loved one (especially the spouse), a divorce, and the loss of a job. Basically, chronic stress targets anybody who's experiencing changes or many difficult tasks to do at the same time and for a long time: working full-time while taking care of children or taking care of a parent with Alzheimer.

So moving to a new country is also of course an important source of chronic stress! It seems odd to compare the stress of moving to traumas like being a war veteran or loosing a spouse, because there doesn't seem to be a lot of distress and emotional turmoil to moving. But a move and especially a move to another country could lead to burn out, physical and mental exhaustion, diseases, because of the constant demand to adapt over many months. It's not initiated by a trauma, and we definitely made the decision to be there... but it's the result of a high number and accumulation over time of many daily 'small' and not-so-small stresses (dealing with issues in a foreign language, the unknowns, the fears of making wrong decisions, sometimes fears for our safety, loss of most of our familiar social contacts, loss of career opportunities…).

Our job is to help our bodies to avoid the chronicity of stress, the permanent state of being and feeling under constant pressure to get things done.

The respiratory system is connected to the cardio-vascular system: when you inhale, your heart accelerates slightly, and when you exhale it slows down slightly. It is also related to our ability to regulate emotions and to our immune system. This is why a basic stress reducing technique is deep breathing and relaxation!

But stress is also very easily generated by our own thoughts! As Robert Sapolsky explains in his fabulous book "zebras don't get ulcers", many of the stresses come from our worries and feelings and exacerbated by life style and things like our lack of physical activity, overwork, or social isolation. We evolved to deal with very short-term stresses like running or hiding from predators to avoid being the next course on their menu. Evolutionary, we are not prepared to being stuck in traffic jams on Monday mornings with our baby crying in the back seat and worrying we will be late at work. So another important aspect of stress reduction, besides working on relaxing the body, is to reduce the amount of negative thoughts that invade our mental life.

Body and mind, not one or the other. Both are strongly connected, and it's never as obvious as for scientists whose job is to study stress!

Sources:
Robert Sapolsky. Why zebras don't get ulcers. 2004 (everything you ever wanted to know about stress by a very entertaining author!)
Elizabeth Sternberg. The balance within, the sience of connecting health and emotions. 2001.
A good workbook to reduce stress: Martha Davis, E. Robbins Eshalman & M. McKay. The relaxation and stress reduction workbook. 2008.

Feeling depressed and stressed after arrival

Did you feel euphorical and ready for a great new adventure when you arrived in a new region or a new country to settle in? Most people don't. On average, around the first month after the entry in a new country, feelings are quite negative towards the entire experience. Many studies done in sojourners show that levels of depression are higher after the arrival than before (observations were done in international students and visiting scholars, for example Japanese arriving in New Zeeland, Chinese arriving in Canada, Singaporians arriving in New Zeeland) . Even 6 months after arrival. Things start to get better after about 4 months, 6 months or one year depending on people's expectations at start and their preparation, and depending on the differences between the culture of origin and the culture of arrival. A small portion of people, about 10% according to one study, seem to do better after the arrival, show great enthusiasm and happiness, but the overwhelming majority feels really low. In some studies, more than 50% of the sojourners interviewed in the first months after their arrival showed clinical symptoms of depression!

There are big problems, big life changes, the anxiety of the unknown, the daily hurdles that aren't easy to solve anymore... and a terrible lack of resource: poor if any language skills, little prior information and few ideas on where to find information (from getting a visa to finding a good shampoo!). And most of the times no family and no friends, sometimes no partner, to share the daily frustrations and get some comfort when it's time to melt down. So the adaptation challenge is massive, and the stress very high! After a few months of stress, mental health and physical health are at high risk.

[source: Ward et al. The Psychology of culture shock. 2001 gives an overview of the studies run in 'sojourners': international students, visiting scholars, and expats]

Day 1: Stressed or excited?

It's day 1 for this blog and the first thing that comes to my mind is: how do I feel right now at the beginning of a new adventure? Very excited! Very nerveous too! Where am I heading with this blog? What will happen next? I didn't think too much about the details yet. Oops!
Did you experience this excitement and suddenly also lots of unexpected questions and surprises the last time you started a new project? Remember the time you arrived in a new country to get settled? Isn't it confusing? What does the science tells us about this transition? That's what I'm trying to figure out. I'm looking for answers in science books and in the real life as well. How does it feel for me? How does it feel for you? What would you like science to explain to you when it comes to better understanding the challenges we're facing in our lives as expats or migrants?