Mental Health Abroad

Living abroad comes with a lot of unexpected challenges, and help is available if you need it

If you’re reading this, you probably don’t belong here. Maybe that’s okay. In a foreign country, you get to choose who you belong to. You don’t belong with anyone, so you can be part of any of them. If no one belongs anywhere, then maybe we can belong everywhere.

That’s at least how International Center for Cognitive Development (ICCD, co-founder and psychologist Dr. Azreal Jeffrey believes expat social dynamics work in his observation. Expat social groups can be more porous, and it can be easier to move into and between them, he observed. “Social networks are quicker here. You know, (people) know each other for a year or two and it’s as if they’ve known each other for a long time.”

That lack of stability works both advantageously and as a liability to expat communities, DR. Jeffrey said. Absent marriages or some other extraordinary commitment, expats tend to end their stay abroad after a few years to repatriate or move elsewhere. This creates an environment where long-running, deep friendships are regularly ending. “Expats can be isolated,” he said. “There can be a lot of goodbyes.”

The depression and the isolation that can come from not talking about it is just one of the many mental health hazards that can befall expats, a community that can also fall prey to culture shock or has difficulty forming meaningful romantic relationships with those with different cultural backgrounds.

There’s no exact description for who needs therapy, and worse yet there are active stigmas still for people who decide to seek treatment. Nevertheless, Dr. Jeffrey and the team of internationally certified therapists who work with the ICCD have become known as a reliable mental health treatment for the many foreigners who use the center’s services.

A US native, Dr. Jeffrey has spent the last decade in Vietnam. When he arrived, “there was almost zero understanding of mental health.” Until he co-founded the ICCD in 2015, the nation’s mental health resources were largely served by expat clinicians who brought a traveling practice to Vietnam, then left. A dearth of mental health resources and, for children, developmental support meant that individuals with special needs—be they physical or cognitive, like a learning disorder—were simply excluded from schools.

The practice was especially disconcerting to Dr. Jeffrey given his country’s tradition, a cultural norm as well as a legal mandate, to educate all children and provide them with the resources they need to succeed. “I come from the States where special needs is law,” Jeffrey said.

The ICCD has become a resource for a group of schools in the city who rely on the center’s counseling and developmental services offered to pupils. “Many children, they don’t need much to stay in school,” he said. “A little bit of help, a little bit of support, and they don’t have to stay home” as special needs students usually do. Some of the practices and therapies that ICCD offer are somewhat new to Vietnam—the country’s first speech therapy training occurred in 2010, program ICCD cofounder Simone Maffescioni worked closely with. “It’s a very new profession,” she said adding there are around 10 trained speech pathologists in the entire country.

Dr. Jeffrey said the country has been quick to adopt and normalize developmental services as standard as they would be in Western environments. “As Vietnam opened to the world, parents just came looking (for these services). It became quite symbiotic,” he said. “The idea that there’s a stigmatization for the Vietnamese and they won’t use it is wrong, it’s just wrong.”

Ho Chi Minh City researchers convening at a conference last month told the reporting press that the country has 3 million young Vietnamese with mental and psychological health problems; of these, only a fifth were getting support by trained professionals. “It’s been the last 5, 7 years. People are much more aware, more worldly,” he said.

Dr. Jeffrey is married to a Vietnamese woman, an experience that, combined with his work at the ICCD, has given him an understanding of gender dynamics that may seem jarring to stereotypes about Asian woman. “The quiet obedient Asian woman is far from the norm,” he said. “Women here have fought in the wars, they manage businesses” as well as whatever familial responsibilities they may be accountable for. “I don’t think Vietnamese women are weak at all,”he said.

The ICCD’s portfolio of services includes marriage counseling for couples who come from different cultural backgrounds. For the men who court, date and eventually marry Vietnamese women, Dr. Jeffrey said it behooves them to fully appreciate the number of pressures the modern woman who’s grown up in this country may be experiencing: the call to realize their professional potential, to get educated, maybe also the call to marry, or to fit into someone’s definition of a “good” (insert female relational pronoun here).

Mental health issues are becoming more common in conversation, Dr. Jeffrey said, but a local tradition of privacy and saving face keeps these conversations below a whisper.

Similarly, Westerners have watched a small battery of celebrities have their mental health and addictions become public—the outbursts of Kanye West who admitted to being bipolar, the drugs involved in the deaths of Carrie Fisher and Prince—but the awareness doesn’t always translate into compassionate response.

“Go on the forums, someone says ‘I’m depressed,’ and watch all the advice, you know what I mean?” Dr. Jeffrey said. The conversation “definitely not as enlightened as we say we are. ‘Oh, you’re not depressed. Do yoga and smoke pot.’ Wow, you know? You look at Vietnamese, they may not be as loud, but I wouldn’t say they’re ‘unenlightened,’” he said.

Dr. Jeffrey’s goal has been to create a widely known yet discrete mental health services provider with a modest profile but a deep portfolio of services. He said clinicians there “run the gamut” and do everything, from teaching wellbeing courses for indigent children to suicide awareness to detecting and treating learning disabilities in corporate environments. To focus on the work itself over everything, the ICCD has never run any advertising.

The center’s practices are, where necessary, combined with drug therapies. Sometimes a lifestyle change can be a big thing. For his own wellbeing, Dr. Jeffrey said he’s tried to stay adventurous to stay out of ruts. He joined an archery team on a whim, for example. He drives like a local, according to his wife. If belonging is so malleable, it’s tantalizing to think what other features of one’s identity may also be so fluid.

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