In the late 1940s, while anthropologist Dr Kalervo Oberg was researching the social organisation of the Tlingit Native American tribe, he began to notice a common affliction among anyone suddenly transplanted abroad.

Oberg coined the term “culture shock” to explain the phenomenon: an anxiety that arose when a person was removed from their own societal symbols and signals on which “all of us depend for our peace of mind”. Symptoms ranged from simple homesickness – “that terrible longing to be back home, to be able to have a good cup of coffee and a piece of apple pie” – to anxiety, depression, and feelings of helplessness.

In the decades since, a large body of research has emerged in psychology and sociology analysing the impact of moving abroad on mental health. It shows that while living in another country can offer countless new possibilities, it also brings a unique set of challenges.

Matthew moved from Ireland to Amsterdam last year when his partner found work there. He had a good job in Ireland, but didn’t want a long-distance relationship. Before moving, he was excited at the prospect of working in the Netherlands. He started learning Dutch and his new life began well. “The first few weeks were great,” he says. “My colleagues were very nice and extremely helpful. Everything was new and exciting.”

His calendar was packed with get-togethers and social functions, but as summer began to fade into autumn, “life got a lot tougher”.

Even though the working language of his organisation was English, he felt isolated. Conversations around the office were in Dutch. “If they wanted to speak to me directly, they would speak in English. I didn’t feel part of the team or organisation. I got really self-conscious, constantly wondering what people were saying. It was even worse when I heard my name in conversation. I was trying to keep up with work, but it was difficult. I constantly had to rely on my colleagues, non-stop questions . . . I felt useless.”

Social differences Social differences were also a struggle. In the Netherlands, most people rely on an agenda for social appointments. It’s not uncommon to schedule a friend for a coffee in a week’s time, or dinner in three weeks. “Gone was the possibility of meeting a colleague after work for a drink without a week’s notice,” Matthew says.

Towards the end of the year, “things became a bit of a blur”. Matthew’s partner was travelling a lot with work, his mother was in hospital back in Ireland, and Dublin, just an hour’s flight away, felt like the other end of the world. He felt alone in the Netherlands and felt he couldn’t talk to family back home about his experiences, because he didn’t want them to worry.

“There were days where I would barely speak to anyone, even though I worked nine hours a day. The days were rolling into one . . . I felt like I was losing my mind. Even when I did speak to people, no one understood me at all . . . I lost my charisma, my social skills, my confidence – I wasn’t the person I thought I was.”

Matthew had never experienced mental-health issues in Ireland. He believes his difficulties were brought on by his interaction with Dutch culture, which was so unfamiliar to him, even though he says he has met many wonderful people there.

Matthew’s experiences are familiar to Caitríona Rush, a cross-cultural consultant who helps businesses and individuals overcome the challenges of living and working abroad. “At some stage, most people who move to a different country will go through some form of culture shock,” she says. “The extent to which you feel it varies.”

Cross-cultural consultant Caitríona Rush. Problems come when people start to internalise cultural differences. “People begin to read between the lines and they pick up messages that aren’t actually being sent.”

In these cases, people may start to experience moodiness, sleep problems, eating disorders and alcohol misuse. “If you’re not happy in yourself for whatever reason and you have those kind of cultural issues, not dealing with them and resolving them, they just tend to fix and grow in your mind.”

Culture shock can be divided into four distinct phases, Rush explains. At first, everything is new and exciting. This initial honeymoon phase lasts four to six weeks. This is usually followed by the negotiation stage, in which cultural differences lead to misunderstandings and create anxiety and frustration.

Next is the adjustment phase, when “people begin to understand their own cultural values and the adopted culture a bit more”.

Adaption phase Finally, there’s the adaption phase. “Overall, you’re happy, you know how things work, you’ve settled in and made your life here.”

Though the phases are distinct, people experience them in different ways. Some may transition quickly, while others can become stuck in the negotiation phase for years. Rush advises asking questions: “What are your list of rights and wrongs? Where do they come from? Why do you believe in that? And understanding those, and understanding that when you talk to a Dutch person, you have your Irish sunglasses on. When you’re brought up, you’re taught to treat people the way you want to be treated. When it comes to culture, you treat people the way they want to be treated.”

Cultural differences and feelings of isolation become more troubling when they are compounded with existing vulnerabilities. For various reasons, emigrants are slower to seek help for their mental health. “It’s not that expats suffer more [from mental-health issues], it’s just there are more stresses in their lives, more triggers, that will make maintaining mental health more difficult,” says Anna Costello, psychologist at Kühler and Trooster, a Dutch clinic specialising in expat mental healthcare.

Psychologist Anna Costello. Costello believes expats can find it difficult to navigate an unfamiliar health service: “It’s more complicated when you’re living in another country.”

But once people seek help, they are usually “very successful” at overcoming mental-health difficulties, and many clients are “in remission, or they fully recover”.

Kate has first-hand experience with both the Irish and Dutch mental-health services. She struggled with addiction, and the deaths of both parents before leaving Ireland. She moved to the Netherlands after falling in love with a Dutch man. As an experienced traveller, she thought the transition would be relatively smooth, but she found it difficult to integrate.

“I struggled to make friends outside the family circle. I struggled to find meaningful work . . . I thought it would be easy. I had lived in Asia and Australia, where I didn’t have a culture shock, but here I really did on how you should behave in society and how things are done. I found it almost polar opposite, and I didn’t expect that it was going to be.”

Overwhelming Eventually, her new environment became overwhelming. “Moving here and feeling so isolated triggered some past emotions I hadn’t dealt with properly ... I started drinking – a lot. The drinking got worse and worse, and suicidal thoughts were creeping in. I felt extremely lonely. I hated the dark and cold weather. Eventually, I had a drinking blackout one night – this was becoming an all-too-often occurrence – and I tried to take my own life.”

Kate sought help from the health services in the Netherlands. The Dutch healthcare system is one of the best in Europe, topping the 2017 Euro Health Consumer Index (Ireland came 24th). Even so, Kate was frustrated at the waiting time to see a professional. “When you feel like you’re losing your mind, you don’t want to be on your own . . . They gave me a time of four to six weeks. I said I’m not going to be alive in four to six weeks.”

Once in the system, Kate found Dutch healthcare to be “very good”. In addition to talk therapy, she was offered art and touch therapy for a year. She also went to an addiction clinic, though the services they could offer were limited because of her expat status.

Things are going better now. “I went through therapy, I stopped drinking, which helped. I got a kitten, so I’m not lonely. I have something to look after.”

Kate also learned Dutch, and believes learning the language is key. When she reflects on her experiences, she recommends breaking the taboo and talking about it. “That’s what was blocking me at the start. And once you can talk to people, you find out that most people have the same problems.”

When Dr Oberg first wrote about culture shock, he said the traveller would always be treated as an outsider. But he also believed they could adapt and develop two patterns of behaviour, with the two existing in harmony. When it came to the possibility of overcoming culture shock, he was sanguine: “Many recover beautifully.”