Expatitis: Are You Infected?

Let’s jump into Case One: Mr Indy Spensible, a mid-50′s General Manager of a large company, comes to my clinic with “funny chest pains” for a month. He’s a stocky guy with a big belly; very outgoing but obviously exhausted, wistfully eyeing his beeping Blackberry as we talk. He gets about 6 hours of sleep “if I’m lucky” and constantly travels. He has “no time” to exercise like he used to. He smokes and drinks “just enough to keep ahead” at his frequent business dinners. Lately he’s feeling “really stressed” and started having panic attacks after his second wife started threatening to move back to Europe “if I don’t slow down”. “You gotta help me, doc, I’m falling apart”…

Mr Indy Spensible (get it?), my composite über-expat, has a litany of Western medicine diagnoses, probably including obesity, tobacco and alcohol abuse, and stress, among others. But that’s not the whole picture, is it? What’s missing is what Western medicine is poor at — an overall, holistic view of what is the major underlying cause of many of his ailments. Maybe a traditional Chinese doctor would diagnose him with an underlying qi energy imbalance and prescribe medicines to slowly re-balance him. I’m not a TCM doctor, but I do realize that this man’s symptoms have important underlying factors that I struggle to define in my Western allopathic training.

So, I made up my own diagnosis, to help me better view this type of patient. And with my better, more holistic view, I can help these patients get better as well. My diagnosis is called expatitis. What is expatitis, you ask? Good question; you won’t find this on WebMD because I just made it up, to fit a syndrome of health problems I see in many expats. Here’s my definition:

Expatitis (Expat from expatriā “to leave native land” +itis “inflammation, abnormal states, excesses, tendencies, etc”) – a syndrome of multiple physical and mental illnesses brought on by maladaptive coping mechanisms to the stressors inherent to living abroad.

Let’s look at the syndrome’s main features:

1. Poor mental health (stress, insomnia, anxiety and depression)
2. Exhaustion
3. Too much alcohol use
4. A lot of smoking
5. Lack of exercise
6. Risky sex
7. Poor eating habits

Does this remind you of a friend, a loved one — or yourself?

I’m sure we all see a bit of us in some of the above, and of course everything in moderation, right? After all, the expat life in China is inherently stressful given the culture shock for most, and jobs can be stressful anywhere you live. But I think the gold-rush feeding frenzy of modern China has really pushed many workers, both local and expat, to a dangerous edge. And this Wild West anything-goes mentality also makes it harder to cling to our ethical foundations, leading to decisions we may not have made at home.

After three years at my expat clinic, I see a common pattern of health problems surfacing when normal stressors start to overwhelm people, affecting their relationships, work performance — and their health, both physical and mental. I also see a lot of expats making poor health choices — and yes, many are conscious lifestyle decisions. In other words, we create a lot of our own problems. But that’s ok — as I will discuss, we can also create our own solutions.

How Do You Define “Health”?

What does it mean to you to say “I am healthy”? The World Health Organization’s official definition of health, from the 1948 charter, is surprisingly holistic:

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

Notice how health involves a lot more than just the absence of illness; it includes self-perceptions of quality of life and your environment. There are a multitude of factors, both individual and external, that are factors to your overall health; they are called determinants of health and are pictured here:

If we look closely at this table, I think one lesson is that our environment has a huge impact on our health. And I would argue that Beijing for expats imposes a lot of potentially negative stressors on us, especially compared to our lives back home. It’s a struggle for many to find good new social networks; there are more food and environmental issues than many of us are used to; work stressors can be enormous.

Having said that, we certainly can’t blame our environment for all our ills; that’s why I included in my definition of expatitis the notion that conscious lifestyle decisions are a major factor in poor health. Yes, our surroundings often are stressful, but we all still have control over how we react and cope to these stressors.

More To Come…

Tomorrow, I will start to delve into each aspect of expatitis, starting with stress, a vastly under-appreciated malady affecting expats.

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Check Out These Related Articles:
Expatitis Spreads to China Daily, and Beyond	Chinese Office Workers Too Stressed…	Expatitis, Part Two: Stress

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