Settling in to a new life

Expat wife syndrome (EWS), sometimes referred to spouse trailing syndrome, is a term often used to describe the stress-related condition that often affects the wife or partner of an expatriate who is relocated overseas.
 EWS, which comes in various intensities, represents the difficulties and/or inability to effectively adjust to important cultural, environmental, linguistic, professional and familial changes occurring in the new location.
 This lack of adjustment can lead to the spouse – in the majority of the cases the wife or female partner – to suffer psychological and health issues that can compromise the whole expatriate experience and can even lead to the break-up of the relationship.
 EWS is not clearly established in medical literature despite the fact that it is not infrequent among foreign communities living in Southeast Asia and elsewhere in the world.
 It is perfectly normal to face some emotional troubles when setting up in an exotic country. Certain assignments are obviously more complex than others: the language barrier, inappropriate healthcare or educational system, extreme climatic changes, unusual food and uncomfortable housing among are the most common and significant pressing issues. The demands of the partner’s job and travelling may cause numerous problems that the wife is left to solve and this can lead to a perceived (or true) sense of lack of spousal support and loneliness.
 Any spouse may face such a syndrome but highly educated and/or career businesswomen usually face more significant challenges because of the difficulties in finding a job – at a commensurate level – in the new location. Going almost overnight to “housewife with a doctorate degree” and handling tedious domestic tasks can be extremely frustrating.
 Schematically EWS evolves through three successive phases: First, a more serious-than-expected cultural shock a few weeks or months after arrival impacts on quality of life. Negative feelings about the “local environment” begin to outweigh any advantages linked to the relocation and generate emotional stress that might trigger withdrawal from other people. Stress-related symptoms such as continuous tension headache, irritability, insomnia and fatigue further aggravate the overall distress. Fortunately, after the initial difficulties and struggles, many spouses are able to successfully handle or cope with the unfavourable aspects of the local setting and start benefiting from its positive features.
 The second stage corresponds to the person’s inability to return to normal social interactions despite increasing boredom. Persistent isolation translates into anxiety disorders and possibly depression. A chronic existential crisis takes place with loss of self-esteem and a feeling of worthlessness that may require professional support. Sadly, serious emotional pain may be challenging to address, as finding effective psychological care from qualified professionals – in the mother tongue – is scarce in many Asian countries. However, with adequate mental support from the partner and from various sources including telemedicine, most spouses can at least partially neutralise harmful factors and evolve into a more positive state of mind momentum after several months.
 The third step happens when the psychological suffering continues to worsen and does not respond to therapy or support. With the occurrence of morbid thoughts, one of the few alternatives left is to return home Indeed, a few weeks or months stay in a familiar setting is often salutary, allowing the spouse to reflect on expatriate life and return with appropriate expectations. In very rare cases, an overwhelming conflict can lead to shattered family relationships.
 EWS needs to be first prevented through optimal preparation from all perspectives, especially for the spouse and children. The future expat and his employer have to anticipate specific challenges and put in place adequate cross-cultural understanding for both the employee and his/her spouse. Upon arrival, the need to connect without delay with other people facing similar concerns is essential. Joining a “welcome to the city” event organised by an expat women’s group is effective in acquiring valuable knowledge, building friendships, understanding and learning the new culture, and finding new opportunities. These can range from a job, helping others through joining a charitable organisation, setting up one’s own business or taking on a new educational interest. Hopefully, the spouse will become involved in many interesting projects and eventually come to enjoy a fulfilling expatriate experience.

Dr Gerard Lalande is managing director of CEO-Health, which provides medical referrals for expatriates and customised executive medical check-ups in Thailand. He can be contacted at [email protected].