How culture and migration affect the health of expats

Dr. Victor Kouratovsky is a certified clinical psychologist and director at ExpatPsy, expert psychological services for expat professionals, families, and students, who explains how moving to another country can affect the health of expats.

New insights from clinical practice and science enrich our understanding of the impact of culture and migration on the mental and physical health of expats.

On the basis of these new insights and my experience in counselling expats, migrants and refugees of all ages and cultures, I have come to the following understanding of culture and migration in relation to health. 

How to understand culture

The meaning of culture seems obvious, yet it is still rather elusive and hard to define.

› Food

The best-known examples of culture that can be found in everyday life are related to our food. Food, its preparation and consumption, are clearly culturally constructed and can be articulated in a myriad of ways in terms of what we eat, how, when and why we eat it.

› Sleep

Whilst sleep is also clearly a basic and universal need, strangely enough, much less is known about the influence of culture on our sleep and sleeping arrangements. Recently, however, research has shown how culture can affect how we sleep, when, with whom, where and why, to show how diverse sleeping habits can be across cultures.

The effects of culture on expat health

When both eating and sleeping, two of our most natural and basic needs, are so influenced by culture, how do we understand culture and migration in relation to the mental and physical health of expats?

It all starts very early on in life. We are all conceived biophysically, mentally and culturally, in what can be called an ecological niche; a unique constellation for every one of us by way of sounds, odours, tastes, skin sensations and awareness.

The way we use space, how we arrange the furniture in our homes, our experience of the sun and wind outside, the smells and people that surround us; all of these ecological conditions trigger, or thwart the expression of our genes and form the ways in which we regulate ourselves and how we allow possibilities to unfold. 

We experience life through our senses

Everything we experience through our senses helps to create connections in our brain and body with the outside world, and makes it possible for our brains to develop further. These connections form patterns and structures that build upon one another and help us feel safe and like we belong.

These feelings stay with us for as long as we live. I call this process "envelopment". Envelopment provides a buffer and protects us against stress by creating patterns and rituals that have proven effective on biological and (sub)conscious levels. 

When adequate, envelopment enables adjustment, health and growth through care of the family and of the self. A change of setting, however, can be stressful and leave one feeling unprotected. 

Swaddling, a millennia-old custom in all parts of the world, can be understood as an example of envelopment. By wrapping and holding a newborn, a mother provides support to her child after leaving the womb, and in turn, reduces new stressors that the baby might encounter in the beginning of its life.

Being born constitutes the biggest change in environment that we experience, which makes it the most significant "migration" of our lives.

In the womb, we are already influenced by culture; not only by the speech we hear from our mother and father, but also by the way our mother is treated, her experiences, and even the experiences of our grandparents.

But after being born, all kinds of cultural environments and practices help us protect ourselves against stress and overwhelming situations. 

What does this understanding mean for expats?

Like being born, change is part of human nature and being human means we are remarkably adaptable; able to change and move into different spheres, adjust to different circumstances, seek out and welcome changes as sources of positive stimulation. We are also very capable of constructing and building our preferred sphere, environment and life support system, like, for instance, expats creating their own diasporic bubbles.   

Expats are, generally speaking, strong, resilient and well "enveloped" persons, but we all have our vulnerabilities. Apart from working and living conditions, children of different developmental stages, partners and spouses, and the transnational family, can all be part of expat life.

Migrating overseas requires everyone involved to go through a transitional period of moving from one sphere to another during which one is relatively more vulnerable. During this period, a new niche is created where new connections are made on different systemic levels involving the body, mind, and family functioning in society.

So life as an expatriate means adjusting to a whole new set of circumstances, starting with different sounds, smells, tastes, and ways of being. Making such adjustments requires energy, whilst family and life events, coupled with living and work conditions, can make this difficult and create stress, bringing life out of balance.

The dangers of stress

Stress can really make one ill and can create serious health issues on all levels: mentally but also physically, and can even harm children’s development.

So what do we do when we are stressed or ill? It is hard to maintain newer connections so we tend to fall back on older ones, or find reassurance in older sustaining patterns and habits, for instance, cooking the chicken soup recipe that our grandmother used to make. In other words, we fall back and rely on what worked for us in the past to restore ourselves and keep moving on.

From a clinical psychologist's perspective, one would aim to look at restoring the following aspects in the new environment: biochemical (e.g. vitamins), physical (e.g. eating), mental (e.g. relaxation, finding meaning and direction), social (family, friends), cultural (e.g. praying), as well as address the more concrete aspects such as housing, working and human rights conditions. 

In this way, expats of all ages, genders, cultures, impaired or talented, affluent or "illegal", safe or under threat, can be helped to endure, survive and recover from difficult times.       

For example, say a boy of 8 starts to present behavioural issues at school and at home and it appears that he is having difficulty sleeping. This could be due to a combination of a disturbed biorhythm since he arrived in the country, not having enough physical exercise during the day, the arrival of a newly born sister, missing his nanny and grandmother and acquiring a negative interaction pattern with both of his parents.

A case like this would require intervention on different system levels such as adjusting sleep conditions, looking for ways to contact his nanny and grandmother, and possibly some short-term play therapy with his parents that would symbolise the migration to help him to adjust and improve in a short period of time.

While this is a relatively easy example about a child, the same principles can be applied to clients of all ages and in a lot more complex situations.

Dr. Victor Kouratovsky, director and clinician of ExpatPsy for expert psychological services for expat professionals, families and students.