This article is written by
CARA GOUBALT

Accredited psychotherapist and psychoanalyst
Specialist in eating disorders

Email: cgoubault22@gmail.com 

Website: www.caragoubault.fr

 
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Eating Problems and Expat Life, Maintaining Recovery Abroad.

When I first came to France as a young student, I thought I’d outrun and outsmarted my eating disorder. Well, whoops.

About two weeks after my arrival, the obsessional thoughts about food, eating, and my weight returned with a vengeance. I’d really thought they were gone. Gone with the charm of Paris, the new person I’d thought I’d become, and the excellent food that I thought I’d have in moderation.

It can be so disheartening to discover that your problems with food (or alcohol, depression, anxiety, etc.) have followed you to your new home. It’s all the worse when trying to get assistance means struggling in a new language and a completely different system. Moreover the stressors that come with expat life may exacerbate your eating problem.

Food and Familiarity
Many people who struggle with eating like routine, especially in their choices of food. In your home country, the food is familiar -  you know how many calories in this or that, you know where to find your favourite things, and people eat at times that make sense. In a new country, all of this will change.
I remember my shock at closed grocery stores during lunch hour, or the unavailability of sugar-substitutes (at the time). This made me anxious and irritable. It also led to binges.

The question of eating – simple for those who are “normal” with food - becomes fraught and frightening if the parameters are upended. Here in France, the meals seemed huge and endless. How was it that no one was fat? Not only that, no one seemed to be obsessed with eating low-calorie food (except me), and no one was upset about eating at crazy hours (dinner at 8PM!). How much to eat, when to eat, and what to eat was my main preoccupation; taking up so much space in my head that I was never really present, but in a worried cloud of shame and calorie-counting. In retrospect, this is obviously a sad way to live; I won’t get that time back. Many sufferers feel the same sense of imprisonment in their minds, and yet feel powerless to change.

It may seem paradoxical but thinking about food and eating may be easier than dealing with the strangeness of your surroundings. Thoughts about the ED can be more tolerable than loneliness – almost like a familiar “friend” in a foreign land, a way to recognize yourself and get your bearings through a well-known filter.
Finally, learning what “healthy” looks like in a new country may take some time and effort, even in a country where people tend to eat better in general. This will also require tolerating the discomfort of adapting to the unfamiliar – that is to say, of allowing yourself to loosen up and lose your way, in order to find it again.

Loneliness, Depression, Anxiety
Sometimes a sufferer is aware that the issue isn’t really food, it’s something else. An eating disorder is only “kind of sort of” about food. Biologically speaking, bingeing and fasting are going to have an effect on brain function. Psychologically speaking, the eating problem is a “short circuit” for another issue. In other words, ED’s can replace the psychological by the biological, turning the initial emotional problem into a physical one about food and eating. Once this happens, it’s very hard to get at the psychological issues, because the brain can’t function optimally.

Being an expat in and of itself creates loneliness, which leads to depression and anxiety. Loneliness is also inherent in an eating disorder, where living in one’s obsessional head complicates any genuine social connection. Isolation can create a distorted view of yourself and others – you feel too “different” or “strange” to have close friends. This can be a vicious circle.

What can I do?
All of this is not to discourage someone with an eating problem from taking the plunge and living abroad. However, it’s better to come prepared for a possible relapse, and know how to take care of yourself if the need arises.

Here are some ideas:

  • Know where to find an English-speaking eating disorders specialist, or center. The Academy for Eating Disorders  https://www.aedweb.org/home  can provide you with centers around the world.
  • If you have a therapist in your home country, find a way to keep in touch through Skype or the internet. Or, try to find a therapist familiar with eating disorders in your new country.
  • Make sure that you have regular medical care. Even if the doctor doesn’t speak English well, he or she can monitor your health and make sure you stay at a healthy weight.
  • Try to enjoy your expat time and adapt as best you can. Learn the language but also join English-speaking social groups. Try to see this time as another period in your recovery, even if it’s a bumpy one. Don’t be hard on yourself and try to stay in the present moment. It’s not because you had a bad day (or week or month) that your whole trip is a failure, or that you won’t adapt to your new life. Move on and get more help if you need it.
  • I have worked with eating problems for over twenty-five years; twelve of them in France. If you would like help finding help in your area of France, or would like to consult with me, don’t hesitate to contact me.

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DOA! (Depression On Arrival)
Along with the suitcases and the jetlag, you may discover another thing upon arrival in your new country: depression. It may not be immediately apparent. It’s not the rule. But it is very frequent in people adjusting to a tremendous change, especially when they have high expectations. Did you imagine that changing your scenery, language and culture would transform everything, from the obvious externals to (possibly) your disposition? This is pretty normal; a lot of expats make the move because they hope for something much better, even amazing.

Nothing about that is in itself problematic. Initially a lot of people feel “high” from the adrenaline and excitement of a move. I’m sorry to say that for most of us this wears off once things settle in. We find a place to live, it’s finally furnished well enough, the electricity works, and all the various administrative papers are sent out. Life becomes everyday again, and any psychological baggage from the past can (and most likely will) catch up with us from this point on.

This is not to be too pessimistic about the adjustment process, au contraire. Fluctuating moods are normal, and understanding will help you gain perspective.

If in your home country you had issues with depression, anxiety or addictions, these may reappear – subtly or obviously- after settling in. We may hope that moving will change our inner world as much as the outer one, but eventually, we catch up to ourselves. What seemed behind us is still inside, no matter how far we’ve travelled. A geographical change can work temporarily (like getting a sunny vacation in February), but moving is often a superficial coat of paint over deeper issues.

Even if you’ve never had problems with depression before, you may discover intense feelings of loss and sadness. Again, if you aren’t expecting this, it can take you by surprise. It’s important to know that this is perfectly normal. The new home isn’t really home yet, and your old home is gone. While this is true of any move, expats have the obvious added stress of a strange language and different culture. Moodiness – ups and downs, irritability, and a longing for “home” with nostalgia - can become the new normal.

The reasons for depressed feelings are related to ordinary adjustment issues…
1. Loneliness

We were used to chatting with the neighbor, the cashier, whomever… these small exchanges that broke up our day might be impossible in another language. We may have never experienced loneliness quite in this way before. If we speak, we have an accent, and it’s exhausting to make the effort. We can end up living mostly in our heads, or on a computer screen. This creates a quality of life that can feel a bit unreal or filtered – we are “here” but “not here” - with a sense of distance from the world around us.

If you feel too lonely (only you know your threshold for tolerating loneliness), treat it as an urgent matter. Find someone you can speak to, face-to-face. This doesn’t mean over a computer screen (ideally), but if there’s no one around, it’s better than nothing. Speaking to someone in your language, ASAP, can get you over the hump. Luckily in most cities there are anglophone groups that meet. Find one.

2. Disappointment, Rage…
You saw the pictures: languorous chateaux with rolling green hills and vineyards, peaceable rustic villages, weathered ocean vistas. You imagined yourself in the village market, placing ripe fruit in your straw basket, while the sun warms your back through the leafy shadows of old oak trees, accordion music in the background.

Yes, it was a cliché, and part of you knew it. But to go from that image to standing in line at a French version of Walmart (if you’re from the States) can be a shock to the system. It can still be disenchanting to realize that life is still life, even in a new country. Cultural differences might mean you find your doctor too abrupt, everyone too formal, or too cold. You may miss your mushy peas more than you enjoy escargot.

We can underestimate how losing one’s bearings linguistically and culturally feels infantilizing. That is to say, in a foreign country we can be reduced to feeling childlike in our perceptions of the world, and our ability to move in it with confidence. “Natives” are also likely to treat us with condescension; speaking slowly, seeming impatient with our misunderstandings, or speaking to our partners (or children) to get their point across. Not only is this infuriating, but it will take two hours to think of the perfect rebuttal in French!

That being said, adults can and do actually regress, just like children, in new situations.
Children confronted with new and unsettling conditions can temporarily lose the skills they had mastered. For example, they want to sleep with the lights on again, have trouble with separations (school or daycare), or even wet the bed. “Grown-up” symptoms of regression include needing comfort (with food, alcohol, or screen time), feeling more anxious, or having trouble being organized and concentrating.

All of this can take a toll on physical health. Stress will augment the level of certain hormones in your system (cortisol and adrenaline). This has potential cardio-vascular effects and can set you up for other stress-related and auto-immune difficulties. http://www.apa.org/helpcenter/stress.aspx

No one is trying to scare you away from your move or be overly pessimistic about your adjustment. There are many ways to be an expat, and many ways to cope with all of the above. The more you can find specific, subjective responses to help you get through – be it with exercise, clubs and associations, language classes, etc. – the more quickly you will feel better, day by day.

If you are having a hard time, there are many psychotherapists who are also English speakers available to help you. It is not “weak” to ask for help; it is actually very brave to recognize your vulnerability.

How will your move affect your relationship with your partner? How will your children react? What if I suffer from an addiction, or an eating disorder, and I start to slip up? More to come in future articles.
 

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ANXIETY

Eliminating anxiety is extremely rewarding work. When the brain and body are no longer in “fight or flight” anxious mode, an incredible amount of energy is freed up, energy that can be used to laugh, play, create, work, love, and simply enjoy life.

Because I have developed a specialty in treating anxiety, I often get referrals from other counsellors for very severe cases. For example, a typical patient might say: “I ended up in the emergency ward last night. My wife had to drive me. I thought it was a heart attack, but was told it was just anxiety.” Or “I am on more Xanax than it would take to kill a horse. But not only is it not working, I now feel too stoned to be able to concentrate at work. You are my last hope.” “Ok now, don’t worry”, I say, “You’ve come to the right place. Would you like to try a relaxation technique which stems from hypnotherapy?” At this point the patient is seized by complete wide-eyed terror, but usually acquiesces with a mumbling “Well, I am pretty desperate so I guess there’s not much to lose.”

The setup is fairly simple: the patient, in a reclined position, closes his eyes and lets the therapist’s soothing voice and skilled manoeuvres transport him elsewhere, to a place that is anxiety-free. The neuro-scientific reasoning behind this is straightforward- in order to drive anxious thoughts out of the brain, we must saturate the synapses by filling the brain with positive suggestions. Thus the patient can allow himself to calm down and get over the immediate crisis.

This part of therapy is very relaxing and fun; and the results are incredibly quick. In my own practice I have often been astounded by the speed at which anxiety is tamed in only one or two hypnotherapy or mindfulness sessions, as opposed to traditional talk-therapy.

The therapist will not only administer these techniques (i.e. relaxation, mindfulness techniques and/or hypnosis) to the patient, but will teach him how to do these techniques on her own, at home, so he is independent and does not need the therapist, and can thus gain control over the anxiety attack if and when it may arise. In many cases, having a sword to slay the monster with, and knowing how to use the sword, metaphorically speaking, is enough to keep the monster at bay.
Once the immediate crisis is over, a more psychoanalytical, or psychodynamic approach takes place. In plain English this means= we just talk. In the safe setting of a therapist’s office that is perceived as a strong and trustworthy cocoon, we can gradually begin to explore the underlying roots of anxiety. How quickly this is done depends on the skill and experience of the therapist, but most importantly on the rapport between therapist and patient. There must be an intuitive feeling of safety, understanding and trust.

The underlying roots of anxiety may stem from an earlier traumatic experience, or from childhood. Yet this doesn’t mean that “it’s all your mother’s fault” or that we need to engage in some voodoo-like rebirth or chakra-rebalancing via past lives ritual. I firmly believe that in order to heal our deepest wounds, talk therapy is more than enough, and remains the best remedy to date. Yet, even though we may get an intellectual grasp of the causes of our anxiety in two or three sessions, getting to the point where we are truly anxiety-free emotionally and physiologically may take a little longer.
I often tell my patients: “Only children are scared. Adults don’t suffer from anxiety.” Adults assess a situation, and make choices. A child often reaches a point where he is painfully aware of the menacing world all around, and the future which is at best uncertain. An adult is tall and strong. Adults must learn to handle disappointments in life, and let go of unrealistic expectations, but an adult is in control. An adult knows that every action is a choice, and that every action has its consequence. An adult sleeps well, has a healthy appetite, and is full of lust for life, looking forward to every hour of every new day.

Yet, the journey from being a child to being fully an adult is a lifelong journey, and biological age is no indication of maturity. This is excellent news, because it means we can learn new skills at any age. After successful completion of therapy, we should get to a point where we consider anxiety as our best friend- a kind of barometer or signal that tells us what to watch out for, when to slow down, and how best to trust our intuition and ultimately ourselves. The first turning point in therapy comes when the patient says: “Huh. I never saw things that way before.” Yet the real triumph comes when he says: “Wow. Had I not been so exhausted and pushed up against the wall by all this anxiety, I would’ve never asked for help, and would’ve never realised how strong I really was. I have the confidence to really go after my dreams now.” And the huge beaming smile on their faces is the therapist’s best reward.
 

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ADOPTION

Perhaps the most important thing to consider when working with adoption is attachment issues. However, even though parents and therapists must be aware of and educated about attachment styles and difficulties, it is primordial to stress that the adoptee child or adult does not suffer from “attachment disorder”. She suffers from full-blown, all-out PTSD. The war veteran “ain’t got nothin’ on her”.

“I am not good enough for Mummy to keep me. I was rejected, given away. And because it happened once, I have no guarantee it won’t happen again.” This is the core belief of an adoptee, and persists until, and if, she has children of her own.

So, if you are the parent, the partner, or even the therapist: expect and be prepared for not just anger; be prepared for rage. “You say you care about me, you talk about “love”… What the f*#k does that actually mean? Oh wait I know: my own mother loved me enough to give me away!!”

Yet this rage might be so repressed that it is difficult for the untrained eye to see. On the outside, the adoptee might appear to be prefect: a permanent smile, high-achieving, with perfectionistic and people-pleasing tendencies. One of my patients calls herself Chameleon. This little animal able to change its appearance on cue is her mascot, also because the Chameleon originates from an island off the African coast, like her. “When I came into my new family I was five years old. They asked me if I wanted to change my name. I said yes. They asked me if I wanted to straighten my curls. I said yes…I would have said yes to anything.” And then, seeing my face slightly contorted with worry, she flashes me her brightest, most beaming smile ever.

As a parent, expect the adoptee to attach too quickly, almost too easily to you, whilst at the same time quite possibly not attaching at all. Once you become aware of this inevitable distance, it might help to undergo some therapy of your own in order to come to terms that her idea of and tolerance to intimacy might not be the same as yours. It might be incredibly painful to realise that even though she will give you the maximum that she can, she cannot, at least for now, give you what you wanted so desperately. This is especially poignant in the case of mothers who adopt. You wanted a child so much, you went through horrific physical and emotional hardship trying to become a mother, you waited for so long, now she is finally here, except that- sometimes you have a feeling deep inside your gut as if she wasn’t really here. As if…she didn’t really want to be here, but is almost too afraid of upsetting you if she admitted it.

Be patient. Give it time, lots and lots of time. Be very careful of suffocating (smothering) her. This will only create more distance. The adoptee is often like a wild untamed animal; you can put a leash around her neck and pull her close, but as soon as you loosen your grip she will run. Or, to tame the wild animal, you can put a saucer of milk within a safe distance, and wait. Eventually she will draw closer. Eventually she will mirror your smile and smile back, but when this moment comes, do not assume the rift has been repaired. If you do, and reach out to pet her, you might get bitten. Let her take the initiative in everything, and let her come to you.

Intimacy is very hard for most people, but it is excruciatingly complicated for adoptees, because of the deep abandonment wound at the core of their suffering. Yet, this wound can absolutely be healed. And once it is, it opens up a whole new world of magical delight, the joy of true human connection. One of my patients, who was adopted, (into a highly dysfunctional family at that) is now happily married and a mother of two spunky adolescents, neither of which seem to need therapy. She takes enormous pride and joy in her family, the one she created and worked hard for. This patient has many times told me that had she not suffered so much as a child, teenager and young adult, she would never be able to feel the extent of the dizzying gratitude she feels for her amazing life now. And that is what makes it all worthwhile.

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