Mental well-being in the city
During a period of suffering brought on by family bereavements, the Irish artist, Anne Madden, took solace in the words of her friend, Samuel Beckett: “it is it trying to be said.” By it he meant the dark. “You must tackle the dark,” he said.
The dark will visit many of us in our lifetime. In 2013, the World Health Organisation stated that each year one in every 15 people suffers from major depression in the WHO European region. If anxiety and all forms of depression are included, the number increases to nearly four out of 15. How the it manifests itself and how we tackle the dark will vary greatly from person to person. However, the provision of services and a solid support network is often paramount to recovery.
In 2013, the negative meanderings and self-criticisms of my own thought processes became incessant. The world became intangible; I felt numb and disengaged. I recognised the daily merriment on Barcelona’s terraces, the flowering of human intellect and creativity in the buildings which outlined my daily journeys, but these had become so very much out of the reach of my own personal experience. This, and my guilt at feeling this way in such an alive city, compounded my state. Fortunately, friends and family noticed that my self had become lost somewhere in me. I got help; first with anti-depressants and then with mindfulness-based cognitive behavioural therapy. It is the latter which I credit with having rescued me from myself, and allowed me to live as this much calmer being, alert to life’s ordinary miracles and aware of strategies I need to negotiate its occasional miseries.
Many of you reading this will have experienced mental health issues; some more serious than others. Some will have sought help, others won’t. The circumstances which tend to affect the mental well-being of foreigners in Barcelona are many and varied, and not all suffer from the same problems, but there is a common thread of dealing with a sensitive, personal issue in a different cultural environment that may well be outside your comfort zone.
VARIABLES AFFECTING THE MENTAL WELL-BEING OF FOREIGN RESIDENTS
Vera Hilb and Claudia Ros Tusquets are both clinical psychologists and psychotherapists with NEST (Network of English Speaking Therapists) in Barcelona. Both pinpointed adaptation and integration as challenges for foreign residents. “There are a lot of adaptation issues that may be common among all expats when moving to a place with a new language, customs and culture,” Ros offered. “Adapting, however, can become more complicated when the troubles you thought you left behind, catch up with you. These issues can then manifest in more personal ways, and you may feel depressed, anxious, fearful or struggle with addictions.”
“It is a very difficult city in which to integrate,” Hilb acknowledged. "It is an easy city to come and live in for a while, but it’s difficult to establish yourself and become part of the community. From my perspective, as a psychologist, when there is a culture fighting for their own identity within a Spanish context, it is very difficult for a foreigner to integrate.”
Twelve foreigners were interviewed for this report, all of whom had experienced mental health issues whilst living in Barcelona. One interviewee said that she sometimes felt at a disadvantage for not speaking Catalan and was therefore drawn to establish relationships with other expats. “It’s as if you’re living in a separate society.” Another interviewee who had undergone therapy made reference to the transient nature of Barcelona having an effect on her well-being. She explained that after several years here, good friends began to leave and she began to question her own reasons for being here. Hilb verifies that this is indeed a trend. “It is not a question of to be or not to be,” she said. “It’s a question of to root oneself or not to root oneself.”
Both Ros and Hilb pinpoint the late twenties and early thirties as the time in which people tend to seek therapy. “It's when you start to think, 'Who am I?', 'What do I want?', 'Where do I go?'. This usually happens to people in their thirties,” said Hilb. Ros pinpoints 28 as an age at which a lot of people have a big life transition. “It is at this time that we are called to review who we thought we would be, and when you have high expectations that you think you haven’t reached, you suffer. It’s a good time to take stock of where you are.”
OTHER FACTORS THAT MAY AFFECT MENTAL WELL-BEING
The issue of expat transience, integration and adaptation is commonplace in a modern cityscape. Dr. Pilar Hurtado, a local psychiatrist based in the Mensalus clinic, Gràcia, described the city as a swarm, “with lots of people carrying out their to-do list, so often it doesn’t matter who you are. This affects our connection with others and we become isolated.”
Marcial Arredondo, a Chilean psychologist living in Barcelona, determined that the way in which we use our minds can also have an effect on us. “We are predisposed to worry about things. This allowed us to survive evolutionarily, but now this is a problem for us. We don’t distinguish between the lion and the boss.” He continued, “Our inner-voice is very critical concerning the notion of achievement and our society doesn’t value the most important things: being alive, being safe, being able to eat and establish meaningful connections. Commercialised society and city life don’t stimulate you to appreciate these things. It stimulates you to want more, be more.”
For Vera Hilb, the internet and online connectivity are also having an impact on our well-being. “The internet and virtual connectivity is so commonplace that one can be isolated without feeling isolated and a physical group network is difficult to establish. We still have a body and so, living abroad and not reflecting on the history of ourselves within a city makes us feel lonely. Our words need to be embodied, but it’s complicated.
GET CONNECTED
Living on foreign soil is challenging and can be a rollercoaster of emotions. Professional life coach Sam Mednick offers some tips to help you connect with the city, its people and yourself.
Language. Spanish, Catalan, or both—learning the language is key. Without it, it’s going to be difficult to feel comfortable, whether it’s ordering your groceries in the local market, or joining in the conversation with a group of friends.
Make connections. Get out there and meet people, both local and foreign. There are plenty of opportunities—meetups, evening classes, pub quiz, intercambios, 5-a-side football, networking and social events. And tap into the community of foreign residents, with whom you are likely to have something in common.
Make yourself at home. Whether it’s stocking up on a supply of English Cheddar, installing satellite TV or taking up a favourite hobby, you can still enjoy some home comforts that infuse a slice of your ‘past life’ into your daily routine here.
Take a breath. Barcelona is a densely populated, largely concrete jungle, and taking some time out from the hustle and bustle every now and then is crucial. Luckily there are plenty of more tranquil places you can escape to nearby, even if just for the afternoon, where you can enjoy some quality ‘me time’.
Keep in touch. Your past stays with you no matter where you go, and there’s no need to feel cut off from loved ones with all the wonders of modern technology. Equally, if there is something you are trying to escape, it won’t disappear just because your location has changed.
Know that you're not alone. Moving to a new city is hard. If you’re feeling a bit lost or like you don’t truly belong, take comfort in the fact that it’s completely normal! There are tons of others who are feeling the same way and it will get easier.
Help others: Not only is this a great way to give back to the community, but volunteering or helping others is the best way to get out of your head and focus on someone or something else. It’s the perfect way to meet others and connect with the community in an entirely different way.
Be patient. Rome wasn't built in a day, so give it time and don't expect everything to fall into place on day one.
SOCIAL STIGMA
Of the 12 foreigners interviewed, only three felt like they could be open about their experiences in their personal and professional life. One respondent stated, “I think there is a stigma attached to mental health. I find it difficult to open up to some people about it. There seems to be an ignorance as to how prevalent mental health issues are. It’s still somehow a ‘taboo’.”
Trevor Steward, a Barcelona-based neuroscientist, originally from California, believes that “stigma can often create an environment in which patients don’t seek treatment until their symptoms have greatly worsened and have begun to have a significant effect on their functioning.” Both Claudia Ros and Pilar Hurtado see the process of labelling as playing a part in the instigation of stigma. “I think the problem is we label people,” explained Ros. “Most people at some stage of their life have had a hardship, and would greatly benefit from doing some sort of therapy or from having some sort of treatment, and making sure they develop their consciousness and understanding of their place in the world. Labelling people holds them back.” Hurtado is of the opinion that “there is a lot of work to get rid of the impact of diagnosis, the impact of entering into a medical-psychiatric logic in which the diagnosis bears a great weight.”
Marcial Arredondo, however, acknowledged that things are changing in Barcelona. “People are becoming more and more aware that emotional regulation is very important for engaging and investing in whatever activity they are doing. Perhaps they prefer to call it well-being, rather than upkeep of mental health. People are realising that your results depend on your emotional state. If you are very angry or afraid, you can’t think clearly.”
Obertament, like Mind in the UK, is an association set up to tackle the stigma surrounding mental health in Catalunya. In 2013, they ran a campaign ‘Dóna la cara’ to find a famous person to talk, for the first time, about their mental health issues. Matthew Tree, an English writer, collaborated with them to talk about a period of mental health problems he experienced. On the stigma surrounding mental health in Catalunya, Tree said, “I believe that the change will happen when people accept that going to a psychologist is as normal as going to any other medical specialist.”
Q&A: OUR INTERVIEWEES' EXPERIENCE
Language of choice for therapy?
Half of the respondents to the survey carried out for the purpose of this report adopted Spanish as their language of choice, the other half, English.
One interviewee stated her reason for doing therapy in Spanish: “The relationship about which I had been going [to therapy] had been in Spanish, so it seemed to fit. I felt like the whole relationship, and the treatment which I subsequently sought as a result, represented a different part of my personality, one that I didn’t really equate with my English one.”
Another interviewee who chose to do her therapy in English said, “I felt that my therapist, being English, could empathise more with where I was coming from and my background. I was glad it was in English because of the cultural affinities.”
Public or private?
The majority of people interviewed sought therapy in the private sector and cited language and flexibility as being the main reasons for doing so. Some interviewees said that public sector health professionals had been compassionate, but that access to treatment depended on the determined severity of their condition, and it was often sporadic and inefficient in meeting their needs.
Effectiveness of treatment?
All respondents to the survey stated that regardless of sector (public or private), they found their treatment to be effective. One interviewee said that she was initially very apprehensive about going to therapy but she found the therapist’s method to be very practical, and the application of Cognitive Behavioural Therapy (CBT) to be beneficial. The interviewee began to practise Mindfulness alongside CBT and said that it made her feel better.
Do you think that treatment for the same problem in your native country would have been more or less effective?
All respondents said they thought the treatment would have been similar in their native countries. Three respondents emphasised the opinion that the results are very dependent on the dynamic with the therapist, on finding a ‘good fit’. One interviewee said that she thought undergoing therapy was a much more common practice here than in her native country, so she felt more comfortable seeking treatment in Barcelona.
MIND OVER MATTER
I was fortunate enough to have family and close friends with whom I could be open. Despite this, knowing that these issues carry a stigma induces moments of embarrassment, at times even shame in certain company or situations. Ros, Hilb and Hurtado all mentioned being part of a community as being instrumental in fostering good mental health. Hilb stated, “I do not believe in mental health on one’s own; I believe people have to be part of a community.”
“Being outside one’s own territory can lead to feeling down, sadness and anxiety,” explained Hurtado. Those who suffer often feel like their state of mental health has exiled them to a no man’s land, even though the territory they find themselves in has been explored many times before. It is the coming together and the sharing of these experiences which lead to more understanding, quicker and more complete recoveries and, in turn, people seeking help more readily.
As well as looking to others for connection and community, according to these professionals it is also necessary to seek to make connections with ourselves; to establish the tools to locate a peaceful place within, no matter where in the world we are. This outcome can be achieved through the practice of Mindfulness. Arredondo, who along with Hurtado runs Mindfulness courses (in Spanish) in Mensalus, details the benefits of its regular practice. “Mindfulness can help you to focus your attention. When you are more concentrated, your mind is calm and you can access your own mental activity. Then you can see your own patterns, and because of that, you can choose between the conditioned reactivity or the conscious response. Mindfulness allows you to pause between the stimulus and the answer. You have clarity if you can access the pause, you can choose your answer.”
There were, I’m sure, many reasons why we chose to come to this city. Barcelona probably shone like a beacon enticing us from dreary northern climes with its romance, its freedom, its modernity, its culture and its climate. So, coming might have been the easy part; staying and settling in might prove more problematic, as these interviews indicate. I think you will be encouraged though, as I was, by the openness of the people I surveyed, as well as by the generosity, understanding, sensitivity and professional competence of the professionals I spoke to.
When I asked Vera Hilb for her opinion on how she thought foreign residents could foster good mental health, she responded, “The question is how to become the most of oneself taking into account others.”
“How to be your best self within a community?” I replied.
“Yes,” she said, “At a conference of doctors in Perpignan, after Franco’s death, health was defined as a way of living autonomously, in solidarity and with joy.”
USEFUL LINKS
Vera Hilb. Clinical psychologist and psychotherapist. English and Spanish.
Claudia Ros Tusquets. Clinical psychologist and psychotherapist. Catalan, English and Spanish.
Marcial Arredondo. Psychologist and psychotherapist. Spanish.
Pilar Hurtado. Psychiatrist. Catalan and Spanish.
Mindfulness Course (Spanish).
Mindfulness Course (English).