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Section II: Living in China continued

Culture Shock and Clinical Depression

This chapter examines the four stages of culture shock and how to distinguish one's adjustment reactions to them from clinical depression.

Four Stages of Culture Shock is estimated that up to 50 percent of all new expats eventually leave China earlier than planned...

A great deal has been written about the nature of the culture shock experienced, to varying degrees, by all foreigners in China. Essentially, just about everything is different: currency, food, available merchandise, mores and ethics, social customs and traditions, personal hygiene, medical care and family life, not to mention the physical and natural environment, to name but the major ones.

One's ability to adjust to life in China depends greatly on how resilient one's character is as well as how determined one is to make the myriad of psychological, emotional and physical adjustments required. Almost anyone can tolerate most anything for a limited period of time: Therefore, the ones who must make the greatest personal, emotional and mental adjustments required to live in China, with relative success, are the ones who—for one reason or another—have made a long-term commitment to remaining here for the "long haul."

Psychologists have identified four distinct, and often overlapping, stages that characterize the phenomenology of those who move to and remain in a different culture: 1) Excitement; 2) Withdrawal; 3) Adjustment, and; 4) Enthusiasm.

Excitement or Honeymoon Stage

When you first arrive in China, you will very likely experience an exhilarating sense of excitement and adventure. You will think to yourself "I can't believe I'm finally in China," and you will be fascinated and overwhelmingly impressed by all the "exotic" differences in culture you will encounter. This stage is often referred to as the "honeymoon" period.

Withdrawal or Negotiation Stage

Usually, within a month or so, that sense of excitement will eventually give way to new and unpleasant feelings of frustration and anger as you continue to have unfavorable encounters that strike you as strange, offensive, and unacceptable. These reactions, for most Westerners, are typically centered around the formidable language barrier as well as stark differences in: public hygiene; traffic safety; the type and quality of the food; the unavailability of creature comforts; poor, grossly unreliable, or nonexistent customer service; the manner in which agreements and contracts are disregarded or continuously changed and, related; the feeling that one is constantly being cheated or lied to (see unit on Mianzi and Guanxi).

You will find that you severely dislike the culture and will experience intermittent feelings of anxiety and depression characterized by a demonstration of animosity, a short-temper, a strong sense of "being stuck," and a frequent tendency to criticize and mock the people and their culture. Depending on the individual, this stage can last for up to three to six months, or it may persist considerably longer for those who lack the capacity, faculties, and social support required to properly adjust.

In fact, the psychosocial adjustment required of Westerners is so enormous, it is estimated that up to 50 percent of all new expats eventually leave China earlier than planned. Spouses of executives reportedly suffer the greatest degree of anomie with consequent acute episodes of depression, anxiety, and alcoholism (Farrar, 2009).

Adjustment Stage

For those who have managed to develop a sufficient social support system, stage 2 will eventually segue into an adjustment period during which time the individual begins to feel more settled-in and confident as life becomes considerably more routine and predictable, which often tends to coincide with the acquisition of some Chinese language skills and the ability to minimally communicate around basic needs without assistance. The individual will feel far less isolated, and will regain his or her sense of humor. I still remember the enormous sense of satisfaction and comfort I derived the very first time I was able to verbally instruct the taxi driver where I wanted to be taken in Chinese. This stage of adjustment seems to last from several months for most, to up to two years for some.

Enthusiasm or Assimilation Stage

After a period of time of living in the country, one begins to realize that he or she now feels "at home" in China. What used to drive you crazy in the beginning now seems mundane or insignificant (or will simply be unattended to), and you will actually start identifying several characteristics or features of the culture that you genuinely prefer to your own. In addition, you will notice that you have gradually incorporated (assimilated) several traits or behaviors from the new culture, such that if you were to return to your native country, you would in fact experience something of a reverse culture shock.

Distinguishing Culture Shock from Clinical Depression

Cartoon, Foreign Teacher Information in Chinese

While it is "normal" to experience intermittent feelings of frustration, anger, anxiety, and depression during the withdrawal or negotiation stage of culture shock, there is certainly a risk that these feelings could progress into more serious clinical conditions such as anxiety or mood disorders. The distinguishing features will be both quantitative and qualitative.

Although there will be intermittent periods of emotional disturbance during this stage of culture shock, these episodes should not constitute the majority of the individual's day-to-day life: that is, the individual should enjoy baseline functioning and a clear mental status for most of his or her waking hours. In contrast, if you find that you becoming irritable, anxious, or angry most of the time, are losing interest in activities that used to bring you pleasure, have either gained or lost more than 5 percent of your prior body weight, and are either sleeping considerably less or far more than you used to, you might be suffering from a diagnosable mood disorder.

Remember that even within one's own culture, both changing jobs and moving to a new location constitute severe psychosocial stressors. Individuals who are particularly susceptible to clinical depression include foreigners who: 1) are older, particularly those over the age of 60; 2) have a prior history of severe adjustment disorders, and related; 3) have a history of major mental illness, including bipolar disorder and (or) a history of alcohol and drug abuse or dependency.

If you have been in the country for more than eight months and find that you are feeling worse with time instead of better, you should definitely consider seeing a physician. It is very possible that medication will be indicated and could be very useful in getting you through the rough spots.

Coping Strategies

There are several measures you can take to facilitate an easier transition through the second stage of culture shock. For starters, it helps considerably if your expectations are realistic to begin with. The more mentally prepared you are for the myriad of differences you are going encounter in China, the more likely you will be able to cope with them over time. That is one of the main reasons this guide was written.

Second, you can increase the likelihood of adjusting more quickly and easily by trying to establish a social support system as soon as possible (preferably during the honeymoon period). Seek out other foreign teachers you have something in common with and use them as a "sounding board" during the rough periods. In addition, and this is especially important, try to establish at least one friendship with an English-speaking Chinese colleague. Having an "insider" on your side who can be there for you to interpret, explain, and even negotiate some of the more frustrating differences you are struggling with will go a very long way in easing your transition. In short, you need a support group. The very last thing you should do is withdraw and isolate yourself from other people, even though this is most likely what you will feel like doing.

The following eleven chapters were specifically written to help mentally prepare prospective foreign teachers for the various facets of life in China they will encounter that often produce the greatest degree of anxiety, depression and anger after the honeymoon period (stage 1) has waned.


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Middle Kingdom Life is the premier award-winning educational website for foreign teachers and Western expats in China. It was founded by an American professor in psychology and sociology for the purpose of disseminating valid and reliable information about living and teaching in China. The site's mission is to protect and enhance the interests and social welfare of foreign teachers and Western expats in China.

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