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:

Determinants of Health

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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12 thoughts on “Expatitis: Are You Infected?”

    1. He debuted yesterday with the first expatitis piece. Hopefully there will be more! I think he's a good foil for me, a fun example patient to help describe boring doctorish terms in a fun, accessible manner…

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  2. It is a fabulous post, but I'm doubting the "conscious" part of the diagnosis.

    I appreciate the pointer that the way you live are decisions people make, but I think that to most people, they are not truly conscious decisions about lifestyle.

    Hard-hitting businessmen would probably tell you that you can't do business without smoking and drinking at business dinners in China, and thus they will, for the sake of acting in culturally appropriate ways. And the decision will not be conscious, not thought-through.
    My favorite example comes from a different area:
    Teenagers who tell you that they "have to" go out and party like there's no tomorrow because you are young only once.

    The (conscious) thought behind it is not wrong, but the conclusion that seems natural, even necessary, is. You can also ruin yourself at any time in your life, and suffer the excesses of youth from then on. Or live more consciously, more healthily, and thus a better life, for longer – but thinking beyond the present situation isn't a human being's strongest suit…

    1. Gerald, you make a very good point. In fact, I was already thinking of tweaking my definition to make it more balanced. Here's the new def: "…a syndrome of multiple physical and mental illnesses brought on by maladaptive coping mechanisms to the stressors inherent to living abroad…."

      Maybe this is a more balanced outlook? I still think there's an underlying truth that these are still mostly conscious decisions. I don't buy the argument that businessmen are helpless here and have no choice but to binge drink and smoke at night. That's still a conscious decision to play the game. What does everyone think?

      1. I agree Richard.

        Business in China is changing at an astonishing pace, and I don't think it's incumbent upon a Westerner to necessarily buy into the whole "party hard" lifestyle. To me, trying to be "as Chinese as the Chinese" in business is somewhat disingenuous.

        Like most decisions in life, you can pay now or pay later. Believe me, all that drinking, smoking, and whoring around catches up with you sooner rather than later. If Westerners took a more nuanced and slow approach to the whole China scene, deals might be consummated over a longer haul and the need to be a wild man/woman mightn't serve the purpose any longer. I can tell you of many successful expat cases that I know of.

  3. Here's an email I got:

    "I wanted to send a thank you for this latest post because I think it is such a prevalent problem in the high powered ex-pat community and so little discussed.

    My husband Bob definitely had a case of expatitis, and although we are recovering, it scared the bejeesus out of both of us while it was at its worst because my normally super-man uber-capable husband was so close to a nervous breakdown. Bob is no stranger to stress or travel, and he has traveled extensively for work for years and works more hours than anyone I have ever met. Through our relationship he has managed to keep his humor and equilibrium about him, until we moved here to England, a pretty cushy move compared to China.

    Two work aquaintances of ours, both high-powered lawyers like him, committed suicide over the summer. One morning in the fall he told me he thought everyone considered suicide as a way to escape the demands of their life. But the "everyone thinks about it" made me scared and I demanded he take his health seriously and go see a doctor and get help with stress. He had been working hard and traveling non-stop for a couple of months. He was constantly jet-lagged and the time changes contributed to sleep confusion and sleep deprivation as well as a digestive system that didn't know what time it was. he argues that it was obvious he would be more irritable, have insomnia frequently, and have more stomach pains than usual. He was reluctant to talk to a doctor about stress caused mainly by work.

    Although I had been telling him for years to leave his blackberry, computer, and tv out of the bedroom, to make sure he exercised frequently (even though it is much harder here because of the rain/cold/dark), and that alcohol is a depressent, he didn't listen until he was scared by his own thoughts and a doctor said the same stuff to him. He still hasn't reduced his alcohol intake, but the other changes we have made have helped a great deal, and the fact that he consciously carves out "down time" away from work and sometimes away from family. (The last one is hard, but we also make demands of him, and although he doesn't spend enough time with us it is hard for an introvert to get recharged around children with their constant demands.)

    I also decided my role needed to be far more traditional (hear me chafing) and supportive of the whole family than it was in the states. So I volunteer instead of get paid for my work, and my secret unsupported job is to keep the kids and Bob sane. Since this happened I try to create down time and family time that re-energizes and doesn't exhaust. We cancelled a trip to Russia which we were all excited to visit because I could see that it would also exhaust and drain as well as be fascinating and fun. We also unplugged our tv and put it into a closet so that when the kids are not at school and doing homework they are interacting with each other and us (card games, board games). It promotes more laughter and also more fights, but also more sense of family togetherness in an over-scheduled and hectic life. TV took time (which is precious) but gave little back to us in terms of memories and opportunities for emotional outlets. (I'll let you know if that experiment works!)

    We are all much happier since we starting accepting that we ALL have to work as a family to fight stress and anxiety, and make (hard) choices to leave technology off whenever possible, slow down, relax more, exercise more, and support one another. Thought I'd chime in with my thanks and support for this topic/discussion. Thanks for the post…"

  4. As far as the drinking and smoking for business, my husband does not do either due to religion. He always declines and his multiple dinners a week and there has never once been a problem with any of his chinese colleagues.

  5. I was reading this post and thought .. wow, this is me! I can tell you that for many suffering this lifestyle it is hard to stop working at the levels after you have historically done this for a long while…. (and the addictive nature of work related adrenaline).

    Even in the face of logic and the very real danger of long term health related issues… to slow down , rest and take a break. For me, it made me feel weak and ‘out the game’.

    That said, I had no choice. My Dr gave me a hand full of blood pressure tablets and I started to find I was having some other physical issues – poor sleeping, poor eating, etc etc… Therefore on advice, I started to work 9am to 2pm and after this time spent time either in the gym or taking time out to read/write.

    I was fortunate to be in a position to do this but just in a few short weeks felt a pressure come off.. in fact I was able to start looking at my past behaviour in the light of someone out of control … I just hope this new timetable can help me become more productive so when I am at work/office I can achieve more. Also, I am seeing my current schedule as someone who is fortunate rather than someone not cutting it in corporate China.

    1. Thanks for your thoughtful comments. I’m glad that you’ve discovered a better way to cope with life here. I really like that idea of taking a break, or even cutting back on work hours — you’re lucky you got the chance to do this!

    2. Thanks for your thoughtful comments. I’m glad that you’ve discovered a better way to cope with life here. I really like that idea of taking a break, or even cutting back on work hours — you’re lucky you got the chance to do this!

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