Depression and Third Culture Kids
The recent suicide of Robin Williams, a much-loved comedian and actor, has brought about a great deal of discussion on severe depression. With all the focus on depression, I worry about TCKs who have repeatedly gone to a therapist’s office seeking help for depression. Will they feel, like Robin Williams did, that there is no way out of their deep dark pit labeled severe depression? Will they conclude that the world of therapy and/or psychotropic medications cannot help them escape this prison? Will the therapist be a good match for them and understand their world?
Understanding Depression in the Third Culture Kid
The TCK, who is depressed, may not know why they are depressed; all they know is they are miserable. As therapists walk through the symptoms of depression with the TCK or gives them the Beck Depression Inventory, the client might certainly fit into that diagnosis. But rather than making the TCKs current situation as their only focus, such as what we do when we do Brief Therapy, here are some other areas we, as therapists, might explore.
A major problem in trying to understand what might be causing depression for those who have been globally mobile is one simple fact, the consequence of their highly mobile lifestyle. Their lives are often so rich and filled with privilege; they and those around them don’t see how they could have a reason to be depressed. Many don’t have the usual markers (family history of depression, a traumatic event, ongoing stress) that often seem to precipitate a diagnosis of depression. As a therapist, we can easily become distracted by their life of adventure that we want to just brush it aside and believe their history or globally mobile life is irrelevant to the depression and search for some “big reason” in their current world, or some past abuse, to which we can attribute their despair.
Separation and Loss in Global Nomads
We cannot ignore the fact that for those who grow up as TCKs, their lives are filled with chronic cycles of separation and loss. Obviously, such cycles are part of the experience for everyone. But for the globally mobile, the cycles are chronic and often relatively sudden and severe. They not only lose a friend here and there, they lose a whole world along with those they love. When these losses are not acknowledged it becomes unresolved grief. Grief that is not acknowledged and left to fester deep in the recesses of the soul becomes depression, anger or anxiety.
As a therapist or a friend of the TCK, the best skill you can employ with your depressed client is sitting and listening to them talk about their losses. You may need to help them in naming those losses. I many times will ask them to divide their losses into categories such as friends, pets, places, senses, relatives, homes, stores, geography, etc. If you attempt to reframe their losses into gains, the result is feelings of shame and withdrawal or anger. If you attempt to defend the system that sent their parents abroad, they will shut down and internalize that you don’t understand them. Yes, there are two sides to their experiences and it can be a challenge to embrace both the positive and negative of each of these events. But before they are willing to consider any positives, they have to experience comfort in their world of grief and loss. Ultimately, they will recognize their history is a weaving of gains and losses.
Besides the layers of unresolved grief, the TCK may be experiencing depression due to their feelings of isolation in their current situation and struggling in forming meaningful relationships in their current environment. They may not have the emotional energy to walk through the process of making friends and small talk, but yet they long for a more in-depth relationship with someone within their community. They often fear the other person will reject them or they fear they will have to once again tell another friend good bye and it just does not seem to be worth it. They may not know how to make and keep a long-term friendship with someone who has not moved or traveled beyond the borders of their state or country and is always there in real life. For many TCKs their “eyeball to eyeball” friendships have only been for two to four years, as someone always moves to another part of the world. They just do not know how to maintain a long-term friendship.
How Do We Protect and Promote Mental Health in the Globally Mobile?
How can we as therapists, help the depressed TCK? We can help the TCK by flushing out those hidden losses and celebrating those wonderful joys and experiences in their history, guide them in long-term relationships, utilize various techniques of grief therapy and Cognitive Behavioral Therapy, encourage them to engage in an exercise program and healthy eating. Some are good candidates for medication or alternative forms of treatment such as yoga, meditation and acupuncture. But the most important thing that you as a therapist or as a friend can do is LISTEN WITHOUT JUDGEMENT to your TCK as they share their world with you.
Henri Nouwen, a Catholic priest from the Netherlands and a well-respected author, once stated “When we honestly ask ourselves which person in our lives means the most to us, we often find it is those who, instead of giving advice, solutions, or cures; have chosen rather to share our pain and touch our wounds with a warm and tender hand.”