There has been a good deal of interest worldwide in recent years over the mental health issues that can affect expatriate workers, with studies suggesting that expats are far more likely to develop stress related disorders, depression and anxiety.
The increased risk of mental health problems among expats – as much as two and a half times that of the domestic workforce – is not simply a product of homesickness or being removed from one’s familiar surroundings or normal support network. Rather it is the result of a complex chain of events that begins as soon as one steps off the boat, figuratively speaking.
None of this will come as a surprise to existing expats in Japan, where the variance to Western culture and working practices is at its most marked, or the distractions from isolation and depression so potentially destructive.
Stressors Common to Japan
In this writer’s experience, it is common for foreigners living and working in Japan to go through periods of feeling trapped, isolated or frustrated by the strictures of work, the demands of inter-personal relationships, or in assimilating into the host culture. And without the immediate support of family and friends back home, and the objective viewpoint they might offer, these understandable uncertainties can result in chronic depression and anxiety.
In truth, anything can kick-start mental health problems, such as professional demands, cultural differences, pressure to learn Japanese, the torturous humid Japanese summers, or one’s own unrealistic expectations of a particular Japanese person, or of Japanese people in general. In addition, expats need to develop far greater self-sufficiency and can feel obliged to at least appear to be dealing with what life throws at them; no wonder, then, that so many choose denial, or find it difficult to seek help, even where it is freely available.
The Symptoms of Expat Stress
The problem with spiraling anxiety is that it soon begins to feed on itself and sufferers gradually lose all interest in the things that once gave them pleasure. They may become obsessed with past mistakes or by uncertainties about the future, and stop going out unless absolutely necessary. It’s a viciously understated circle that can be hard to break and, because its sufferers are essentially hiding from the world, it can be incredibly difficult for others to discern.
For some, anxiety spirals may manifest in other kinds of obsessive-compulsive behaviour such as spending money one doesn’t have, over-eating, gambling, online gaming marathons or other couch-bound pursuits, etc. Of course, we all like to pamper ourselves from time to time, to treat ourselves to feel-good, guilty pleasures, but it isn’t healthy when these become the only alternative to one’s working life.
Similarly, many expats seek to alleviate stress and cure depression through the excesses of heavy drinking, drugs or casual sex – often all three in unison! I’ve seen a large number of foreign friends and colleagues in Tokyo implode in this way over the years, some quite spectacularly, often dragging their conditions into the workplace in very visible ways, failing in their duties, or even turning professional disagreements into all out feuds.
The development of mental health problems can be quite insidious, so that sufferers are not always aware that they have a problem, let alone that they may need help with it. Furthermore, the stress and anxiety that naturally occurs when moving to live and work in a different culture might be common, but a desire to seek help for mental health issues can actually make the situation worse if one doesn’t know how to cope with isolation and loneliness, or where to begin looking for support.
This is particularly true for expats living and working in a country like Japan where unfamiliarity with the printed language puts so many services and social benefits out of obvious and immediate reach. It is as though language, culture and one’s own mental state conspire to make suitable support services all the more difficult to find. Indeed, many expats give up looking for help before they’ve even started, believing it won’t be available to foreigners, or won’t offer treatment appropriate to their needs.
Clearly, language is a barrier, and it can be difficult to find therapists who speak fluent English, for example, in spite of its prominence in the Japanese education system. However, the Japanese medical, psychiatric and psychotherapy establishments are aware of how critical it is for health workers to have foreign language skills, both in being able to understand patents’ issues, and to give clear advice.
Of course, one ready resource open to you will be your manager/s, colleagues or other foreign friends living in Japan, all of whom can form a valuable new personal support network to replace the one you left behind in your own country.
Acquiring A Personal Support Network
Some people manage to maintain the support of family and friends very well, especially over social networks, but the folk back home will never fully understand the pressures you’re under. Indeed, there’s nothing like a stint overseas to reveal one’s fair weather friends; those who envy your opportunity, or resent your leaving.
Perhaps those best placed to appreciate the stressors of job and lifestyle will be one’s colleagues, and that very much includes Japanese coworkers, because they will have insights about dealing with the demands of job and society that might not occur so easily to foreigners. It is generally understood that the Japanese work hard, but this is rarely at the expense of common sense, and Japanese managers tend to take the health and wellbeing of their staff very seriously. Most will listen to what you have to say and cut you a little slack when you need it.
There are also sound personal as well as professional reasons for developing a network of fellow expats in Japan, both online and in the flesh. Old hands will no doubt have much wisdom to impart, but be wary of jades who can find nothing good to say about Japan; these are the worst people to be around if you’re feeling alone and vulnerable. Then again, they might offer a cautionary glimpse of that to which one ought never consciously aspire: the grumbling expat.
The Japanese Spouse – can’t live with him/her, can’t live without him/her!
Many of the mental health issues that affected some of my former colleagues and fellow expats in Japan were related to work and social isolation. But the more extreme problems with the most serious consequences seemed to concern failing relationships; specifically long-term relationships and marriages with Japanese partners.
Some would argue that young Japanese abroad, freed from the constraints of family and Japanese social norms, embrace a more gregarious western-style outlook that vanishes as soon as they return to Japan – gone are public shows of affection, for example, as that creative, carefree and self-assured person one fell in love with, is replaced by a dour stranger. But to be honest, I don’t think that Japanese affections automatically cool just because they’ve returned to their own culture, but that they may do so from simple emotional exhaustion.
We can talk about expat stress but, if you’ve gone to Japan in order to marry a Japanese person you met in your own country, try to understand how hard it must be for them as spouses of expats; being legally, socially and emotionally responsible for their partners’ integration. And they’re the ones on the front line whenever their foreign spouses react to stress with tantrums, moans, grumbles or even outright vitriol, often directed at them; a more common occurrence than you might think. Have a listen to this, as I think it expresses very well the kind of exhaustion and frustration that can occur in those who feel they’ve become a crutch for another person’s insecurities: https://www.youtube.com/watch?v=FqfQXJSvbo4
Know What You Are Getting Yourself Into
There’s no point in thinking it can’t happen to you, because it’s highly likely that it will; living and working abroad will always be stressful, often in unexpected ways, so there will be times when you’ll feel isolated, frustrated and homesick. But accepting this as a distinct possibility will at least help you to develop more realistic expectations of life in Japan and, hopefully, to consider coping strategies to avoid serious anguish if things don’t go quite as you’d planned or hoped.
As regular readers will know, the articles on this site are mainly concerned with the pros and cons of finding work in Japan, the demands of the Japanese working environment, as well as the broader social, cultural and linguistic requirements for successful integration into Japanese society. This is not simply to promote the idea of working in Japan – though I personally have no hesitation in doing just that – but to suggest there may also be caveats to consider. To have realistic expectations one needs to be well-informed, and one should never commit to life here without knowing what it might require of you personally; but only you can decide if moving to Japan is possible, desirable, or even advisable on a personal level.
Finding Professional Help
If life really starts to get you down, or your coping strategies are failing, it may be time to seek professional help. The fact is, most major urban centres offer mental health counselling, support and treatment in English, though you may have to surf around a bit to find what you need. Here are a few places to begin your search:
- TELL (Tokyo English Lifeline) offers telephone crisis counselling and flexible-fee, one-to-one counselling: http://www.telljp.com/
- Tokyo Counselling Services offers flexible-fee, one-to-one counselling and couples counselling: http://tokyocounseling.com/english/index.html
- Himawari is my go-to resource for finding English-speaking doctors in Tokyo: http://www.himawari.metro.tokyo.jp/qq/qq13enmnlt.asp
- AMDA International Medical Information Center helps people to find medical service providers in their native language in Japan: http://eng.amda-imic.com/?ml_lang=en
- Japan Healthcare Info helps to locate English-speaking medical services in Japan: http://japanhealthinfo.com/
- JSCCP (Japan Society of Certified Clinical Psychologists) offers a resource (Japanese only) to help locate therapists throughout Japan, but languages are among the search criteria. The web site may seem daunting if you don’t read Japanese, but is surprisingly easy to follow if you apply a browser translation tool: http://www.jsccp.jp/near/rinsho/indexsch
A Final Thought
Although counselling services and psychotherapy are not covered under the Japan National Insurance scheme, some psychiatrists do make use of pro-bono counsellors. Otherwise, you should always try to negotiate the fees you pay for counselling to arrive at an amicable arrangement with the counsellor. Then again, some people are content with a weekly ten minute chat with their psychiatrist and a prescription for Prozac.
However, prevention is always preferable to cure, so fully understanding as much as you can about a job in Japan and what kind of lifestyle it is likely to offer you, is paramount if you are to get the most out of your expat experience and avoid negative stress. Hopefully, our articles can help you to decide if the expat life in Japan is for you. Good luck!
By Bill Ambler
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