The Foreign Service Journal, January 2012

J A N U A R Y 2 0 1 2 / F O R E I G N S E R V I C E J O U R N A L 41 deep. Popular culture still clings to skewed, outdated im- ages of diplomatic wives serving tea to friends while a house- keeper shushes the children and washes the dishes. Movies and TV shows show scenes of cocktail parties where junior FSOs rub elbows with prime ministers. Such exaggerations notwithstanding, any Foreign Service employee or family member can attest to the prevalence of certain patterns. The employee who copes with the stress of a demanding overseas job through drinking or other de- structive behavior. The officer at her first post who battles loneliness and the certainty that she’s made a mistake in leaving her boyfriend at home, but feels trapped. Or the diplomatic child who misses his family’s previous posting, feels himself unable to keep up at school, and sinks into de- pression. “Expatriate life,” says Truman, who himself grew up overseas, “amplifies any underlying mental health issues that may have pre- viously been latent.” But what happens then? When someone faces depression in Syracuse, N.Y., there are plenty of private counseling options, so unless the depression affects their work, an employer would never know the employee began psychotherapy or medication. But when that same family lives in Tashkent, they often find that support and services are sparse, privacy is almost nonexistent, and options are limited. Dianne Peersman, who lives in Mumbai, explains the sit- uation this way. “Once you acknowledge that there is a problem, you have to find someone to share it with. The first choice would be your husband, but do you want to make him worry? If you tell him that this overseas assign- ment is driving you crazy, what would that really mean? What are you trying to say? That he should quit his job so you can return home? “And then, once you do have that conversation, what happens next? You have to decide if it is manageable within your own family, or if you need outside help. And if you need outside help, do you do it in private, and pay all the fees yourself? If you use company insurance to pay for ther- apy or medication, then the company knows. And if they know … maybe they’ll stop your husband from getting a promotion if they see him as having a wife who can’t cope.” Rob Giallongo, a State Department medical officer, points out that help cannot be mandated by the employing agency. “If the direct-hire employee is unable to work due to behavior stemming from a mental health issue, the em- ployer can deal with it on that level. [But] if the job is not affected, then the employer is unable to get involved. It’s seen as a private issue.” Overcoming the Stigma of Seeking Help In the case of the employee’s family, support is even spot- tier. Even if a spouse keeps to the fringes of the Foreign Service community, never engages in activities, or is acting in ways that signal distress, not much can be done until the family actively pursues help. Spouses without kids and elder Members of Household are at particular risk of going with- out help. In the case of children, it is up to the parent to pursue any recommendations issued by the school, Giallongo notes. And that is where the problem potentially worsens, for within the expatriate community there remain both a solid stigma at- tached to seeking mental health support and a limited number of options for getting it. Compounding the issue is the reality that the social rules sur- rounding appropriate behavior may be drastically different than the rules at home. Expatriates, in what may be seen as both a perk of the lifestyle and a drawback, live outside the cultural norms they may have been used to at home. Nor are they expected to follow the traditions of the host country where, by virtue of their expatriate status, they have the luxury of simply leaving if things go wrong. Being “in but not of” the host-country culture allows expa- triates a certain freedom to break their own personal rules. Dianne Peersman sums it up this way: “What seems like a big issue for me may just be daily life for another expat here. Everyone in the expat community just goes by their own standards of what is OK.” The Complexity of Grief It’s important to remember that the individual response a person has to moving abroad may change over time, or even vary from post to post. This is especially true for any- one coping with a loss. “Grief, for an expatriate, is often experienced as complex, because many intense losses can occur all at one time,” says Josh Sandoz, a Seattle, Washington-based therapist who grew up overseas and who has since developed the Inter- national Therapist Directory. Dr. Sandoz notes that grief can also edge up on someone unexpectedly, or become com- pounded by subsequent moves, leaving someone who had Sec. Clinton’s memo encouraging employees to seek mental health support as needed is a welcome development.