“An unwanted carry-on bag”: Mental Health and Education Abroad

The first two weeks of my postgraduate program in England stand out more than the remaining eight months. After weeks of packing, impatiently waiting for a visa, checking and re-checking plane tickets, and reading articles about cultural adjustment, my wife and I resettled from Salem, Oregon to Durham, England. We reasoned that, on the basis of positive study abroad and travel experiences in Europe and Central Asia, we would seamlessly transition to a new academic and cultural setting. But one problem immediately presented itself: those previous trips all included American peers, professors or guides whom we could consult on cross-cultural adaptation and rely on for friendship. Faced with the prospect of making new friends in our postgraduate housing unit in England, we realized we had failed to develop the resilience necessary to adapt gracefully to a foreign setting. As a result, we failed to make friends early on who could have helped us set up our apartment, explain cultural nuances and navigate the British postgraduate system of tutors and pupils.

If it’s true that Millennials spend more on travel more than any other age demographic, why do we not give the same attention to mental health in study abroad that we do on college campuses? The American Psychological Association says college students’ mental health is a growing concern: 41 percent of students surveyed in 2013 said anxiety was concern, with depression and relationship problems coming in next. Mental health is, we contend, an aspect of education abroad that educators and students often overlook.

Mobility International finds that U.S. students with mental health conditions are studying abroad at nearly the same rate as those without mental health conditions. How can we prepare them for success? First, Planning ways to manage a mental health condition abroad before it presents problems involves having an escape plan, understanding your emotions, and sharing your whereabouts and prescription information with your program staff and embassy. Second, faculty leaders can complete training to better understand and respond to mental health crises abroad. Third, Hunley (2008) finds that journalling may diminish mental distress while abroad (while expressive writing does not). Verbal processing can also help. An ISEP study abroad student shared raw, honest reflections about mental illness in a post-trip debriefing session – and started to confront feelings of isolation through the experience. We can also acknowledge the following aspects of mental health in study abroad:

  1. Travel can be emotionally fraught.  The fact that study abroad can put a student in a sensitive, vulnerable emotional state has support in research. Experiencing a strong emotion during an event can help us remember that event later. Harvard researchers labelled memories formed in emotionally intense conditions as flashbulb memories in 1977. Given the unfamiliar sights, sounds and stimuli of a study abroad program, in which we are forming new memories, we are thus apt to experience any emotional or mental disorders with a fresh intensity.
  2. Students are not immune to travel stress despite being on study abroad. Other research suggests that the strain of travel may affect students more than other travelers. Robert Quigley of International SOS “found that students were 23 times more likely to need repatriation assistance on account of a mental health condition than their business traveler counterparts.” And that psychological distress can decrease performance: Holly Hunley (2010) discovered that stress and feelings of isolation among students at Loyola University’s Rome Center correlated with “lower levels of functioning” at several occasions during the semester overseas. In turn, stress can lower cultural intelligence, creating a downward spiral in which one loses motivation for cross-cultural living.
  3. Travel can exacerbate underlying mental health conditions. A San Diego State University student revealed struggles with depression, anxiety, and related complications such as eating disorders in an anonymous blog post. During an ISEP study abroad program in the U.K., Ireland and France, these behaviors led to withdrawal from the tour group, feelings of self-loathing, panic attacks, and an inability fully to appreciate new experiences.  The student reflected that “[t]raveling with mental illness was like having a third, unwanted and oversized carry-on bag” – a constant burden drawing unwanted attention and distracting one from learning.
  4. Reverse culture shock can affect students after their study abroad program has finished. University of Minnesota researchers assessed 613 U.S. study abroad students’ mental health at three points: before, during, and after study abroad. They found that approximately half of participants self-reported loneliness/missing people from home, homesickness, and culture shock during study abroad. These rates dropped after the global experience. Nevertheless, they did not return to the rates assessed prior to study abroad. One possible conclusion to draw is that students experience “reverse culture shock” at home (Bathke & Kim 2016).

    Making the adjustment to a study abroad location is less about arriving at perfect knowledge of a place than it is about constantly modifying and changing our behaviors and assumptions.

Yet education abroad can bolster our mental health and resilience. Those who develop coping skills can build a strong skill set abroad. After being diagnosed with anxiety and obsessive-compulsive disorder, a Stanford undergraduate chose to spend a semester in Africa. The decision paid dividends. In Kenya, “I have spare time for the first time in memory, actually, and my brain is working through all that emotional baggage” she wrote in an anonymous letter to NPR. In the University of Minnesota study already cited, self-reported stress levels declined during study abroad: while 45.02% of respondents indicated they often or almost always felt stress prior to study abroad the figure dipped to 14.85% during the experience overseas.

I have spare time for the first time in memory, actually, and my brain is working through all that emotional baggage

Post-abroad surveys indicated an 8 percent rise in stress to 23.00%, yet self-reported stress did not rise to the pre-trip level of 45.02%. The authors suggest this finding may point to the coping strategies for culture shock that students develop while abroad (Bathke & Kim 2016).

My wife and I did eventually feel at home in England thanks to relationships forged in an international Bible study.  But the adjustment showed us that, despite the ease of physical access to nearly all parts of the world in the 21st century, adaptation abroad takes time, effort and emotional commitment.


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