Culture Stress: Long-Term Impact On The Health Of Expats

by Zurich Expats on October 9, 2012


Culture Stress: Long-Term Impact On The Health Of Expats

What is culture-stress and how does it impact on people’s health?

John Bowlby (1907-1990) was an internationally renowned psychiatrist and the father of ‘attachment theory’. In one of his famous lectures, he stated:

A particular clinical and research problem is that disturbed individuals seem often to maintain more than one working model both of the world and of the self in it. Such multiple models, moreover, are frequently incompatible with each other and can be more or less conspicuous.

Although John Bowlby was not referring specifically to culture-stress in this lecture, his statement accurately captures what can happen to people who integrate more than one culture into their minds and their lives. Under the surface, they become confused about their values, their identity and how they should think and behave. This can create deeply-seated stress, as we will see below.Over the past twenty-five years, two different Swiss organisations have been observing the effects of stress and culture-stress on people and families, including ex-pats living in Switzerland.


    1. At the Praevmedic medical clinic in Zürich, people have their health checked, either as a routine preventive measure, or because they have some serious concerns about their health. The people who go to the clinic are of different age-groups and different cultural backgrounds. Sometimes, they are sent by their employers; others go there voluntarily. The task of the Praevmedic staff is to identify any symptoms which need particular attention and to treat the underlying causes of such symptoms.


    1. At the 5C Centre in Zug, which lies a few kilometres south of Zürich, people get help with resolving cultural conflicts and personal crises. The majority of these situations arise because of frictions between competing value-systems or ‘cultures’. The latter are related to people’s social and ethnic backgrounds, their family life and the environments in which they currently live and work. The task of the 5C staff is to identify the true sources of the problems and to help people resolve them.


Below is a list of the insights which these two organisations have gathered in helping and treating ex-pats who live in the German-speaking part of Switzerland:

Culture stress



    1. The impact of culture-stress on people’s physical and mental health is widely under-estimated.Many people find it difficult to pinpoint or explain the reasons for their lack of well-being.The reason for this is that culture-stress involves deeply-seated emotions and often quite complex dynamics of values. Neither of these phenomena lends itself easily to simple analysis or explanation.As a consequence, culture-stress often goes either misdiagnosed or completely undiagnosed for many years. This can lead to severe or even chronic health problems. In some cases, it also leads to irreversible problems in families and at work. Many of the causes of the more severe forms of culture-stress are laid out below.


    1. The ability to handle culture-stress varies strongly from one individual to another, even within the same family or working group.Consequently, those suffering from deep culture-stress can sometimes get overlooked and ignored by others. Many sufferers are classed as ‘over-reacting to their new environment’. In such cases, the sufferers then tend to regard themselves as being ‘abnormal’ and try to suppress their problems. This, of course, then intensifies the impact of the culture-stress on their behaviour and health.


    1. Proneness to culture-stress varies not only from individual to individual, but also from culture to culture. Different cultures also have different ways of handling cultural dissonance.For those people who are culturally conditioned to see the world as a ‘global village’, cultural differences tend to have a much lower significance than for those who see the world getting ‘larger’, i.e. as getting increasingly diverse. Some cultures engage with others with greater initial caution than others. Interactions between cultures which

      differ in such ways can lead to quite considerable tensions. Issues like ‘inadequate respect’ and ‘mistrust’ can sometimes arise quite quickly; sometimes they only arise only after a period of months or even years. Regardless of the time period, issues like these can, of course, damage relationships very seriously.


    1. Culture-stress can arise not only because of differences of national or religious values, but also because of differences of corporate, social, family and personal values. In fact – depending on the definitions one is using - ‘culture-stress’ can be classed either as a synonym for, or as a subcategory of, ‘value-system stress’.


    1. For those who suffer under the most intensive forms of value-system stress, the roots often lie in multiple sources of value-system dissonance (see below). This makes it all the more difficult for them to realise what the true cause of their symptoms is.Those who suffer under value-system stress from multiple sources such as their workplace, their families and their acquaintances can become extremely isolated and depressed.


    1. Value-system stress at work can also lead to the accentuation of other underlying conflicts, e.g. between husband and wife, or between children and parents. Problems which had been lying dormant for several years can suddenly come to the surface and create quite stressful dynamics.


    1. In other cases, people have value-system conflicts inside themselves, again very often without realising it. These can arise when a person internalises more than one value-system, e.g. during childhood or in later life. Such ‘intra-psychic conflicts’ are quite common and vary in intensity from one person to another. They are often the root of symptoms like low self-esteem, depression, burnout and isolation. If a person already possesses inner value-system stress, this can also make it difficult for him/her to come to terms with a move to another cultural environment. In fact, a move to a different country, a change of employer or a new private relationship can trigger the outbreak of issues which have been lying suppressed or misdiagnosed for many years.Cultural assimilation – sometimes the cure, sometimes the problem 


    1. Many people are able to assimilate into a new culture without too many problems. Such people are said to possess a high level of ‘intercultural competence’, at least in relation to the specific new cultural environment.


    1. However, although ‘cultural assimilation’ can indeed significantly reduce culture-stress in the individual, it can also create new conflicts and stress within families and groups.This occurs quite frequently and it arises when one or more members of a family or a group assimilate more than the others.Even international joint-ventures and strategic alliances can break down not only as a result of cultural dissonance between the parties, but also because of differing levels of cultural assimilation among the members of each party.


    1. In the case of individuals who are able to adapt very quickly, cultural assimilation can have the effect that they inadvertently internalise a new value-system which eventually turns out to be strongly incompatible with a previously existing value-system. This in turn creates inner stress, i.e. an intra-psychic conflict (see above). Almost paradoxically, culture-stress arises as a result of their ability to adapt. In some cases, intra-psychic conflict of this nature can require very intensive treatment to resolve it.


    1. Culture-stress is not always noticeable immediately. Some people give the impression that they are assimilating into the local culture, often even believing themselves that they have truly assimilated. However, it can turn out later that that person’s assimilation has only been partial and that, at a more fundamental level, a deep form of cultural dissonance remains.


    1. In the so-called ‘second generations’ of families who have moved to another country, it can happen that young people resist the ‘new’ cultural environments, even though theyhave grown up there. Instead of assimilating, they prefer to identify themselves with the cultural origins of their parents. The culture-stress which then arises inside themselves is very often suppressed which this can have surprising and uncontrollable effects on their emotions and behaviour.


    1. In other cases, the assimilation process can be so strong and ‘dominant’ that people experience acute forms of culture-stress when they are faced with returning to live in their original cultural environments.Cultural bereavement


    1. In some cases, people come to the subconscious realisation that circumstances are such - and their assimilation is and must be so strong - that they must depart from their original cultural identity. The process of ‘cultural bereavement’ can be just as painful and stressful as bereavement over the loss of a person whom one has dearly loved. In fact, ‘cultural bereavement’ can be even more painful and stressful, because it is to a great extent a purely internal process involving ‘departure from attachment to oneself’.


In conclusion, culture-stress, cultural assimilation and cultural bereavement can impact quite seriously on the physical and psychological health of individuals and their families. A great part of the problem lies in the fact that the true source of their problems is often not adequately understood. Once properly understood, many people can often resolve their problems quite quickly and do not need further external help. Others need more extensive treatment involving a combination of appropriately specialised psychological and physical treatment.

What can be done to recognize and overcome the effects of ‘culture-stress’ and ‘value-system stress’?

Drawing on the insights above, the following tips may be useful for ex-pats living in German-speaking Switzerland:


    1. Be attentive to the fact that, even within the same family, different people deal with new cultural environments and new value-systems in strongly differing ways. If you are a parent, for example, and you seem to be able to handle such changes quite easily, do not overlook
        • what may be going on inside your partner or your children and

        • what may be going on at a deeper level inside yourself.
    2. Be particularly sensitive to those around you who shows signs of
        • reduced energy and motivation

        • poor performance

        • sleeping problems

        • questions about their identity and purpose

        • increased feelings of anxiety, isolation or depression

        • increased reactiveness or aggressiveness

        • reduced immunity to infections

        • increasing outbreaks of allergies

        • increased suffering from pains in the back, chest, head or stomach,

        • increasing relationship difficulties and conflicts with others.

    3. Be attentive to the fact that fundamental changes which take place at an early age (up to around 14 years old) can have a particularly deep and lasting impact on a person’s health and social behaviour. This applies especially to fundamental changes concerning a person’s affectional bonds, whether these be bonds with their parents, their family or their cultural environments.


    1. Be aware of the fact that human nature tends to take matters most seriously when problems are at their most acute. Prevention, so we are told, is better than cure. However, whether a problem has already become acute or not, the most crucial aspect of any remedy is to get the problem accurately diagnosed. If addressed early enough, the solution often lies in merely pinpointing and understanding the true cause of the problem. Given the complexity of the phenomena and the effects of culture-stress, cultural assimilation and cultural bereavement, ensure that you get adequately qualified help. Be particularly wary of getting help and advice from people who are not experienced in intercultural matters. However well-meant that advice might be, it could make the problem worse rather than alleviating it.


Stuart Robinson 15th September 2012If you are interested in a talk being given by Stuart on this topic, please make contact via

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