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Childhood mobility & mental health issues

April 12, 2013

How do you recognize Third Culture Kids (TCK’s), expat kids, and other mobile children in your practice? What issues do you think they struggle with that are directly tied to mobility?

We sent this question out to several hundred recipients among various networks…  and to date have received very few answers. What is going on here?

For years, we’ve known that those who move frequently in childhood and adolescence are at greater risk for certain emotional and behavioral problems that may manifest early or not present till later in adulthood — surely mobility should be a red flag, something therapists might screen for during intake sessions with new clients.

Yet how often are clients specifically asked about childhood moves?  With increasing international and domestic mobility, how are therapists being trained to recognize and deal with these issues?

Some weeks ago, I attended the Families in Global Transition conference where I sat in on a presentation by marriage and family therapist Lois Bushong of Indiana. Herself an adult TCK, an American missionary kid who grew up in Central America, she cited some fascinating — and troubling — facts:

  • Global mobility is on the rise:  in 1999, there were close to 4.2 million US expats living overseas. By 2015, the number is expected to exceed 9.3 million. This does not include repatriated Americans or Americans moving within US borders.
  • Presenting issues may include depression and anxiety disorders, unresolved grief, identity issues, problems with relationships and transitions, substance abuse, PTSD. But without understanding how mobility can exacerbate underlying conditions, or even initiate them, children of expats who come for counseling are often misdiagnosed. The most common misdiagnoses?  Borderline Personality Disorder, Narcissistic Personality Disorder, Schizophrenia.

Bushong has developed a new intake form for use with her clients designed to help identify childhood mobility, which includes places to list the number of moves and countries lived in. Her soon-to-be-released book, “Belonging Everywhere and Nowhere:  Insights into Counseling the Globally Mobile,” is sure to help those who work  with TCKs to better understand their challenges.

Dr. Doug Ota, whose own book on setting up effective school programs to meet the needs of internationally mobile children is due out later this year, counsels many TCKs in The Hague, and finds that issues of mobility “usually arise naturally when taking a person’s history … the issues that arise invariably have to do with identity: the question of ‘who I am’ is not only constructed by the ‘self’ (a very Western notion), but also reinforced and held in shape by a person’s environment (a very Eastern notion of where a person’s identity comes from). Westerners often get into trouble with mobility because they don’t see the last part of that equation changing when they move. They feel erased when they arrive, as all their reinforcement vanishes, and they can feel invisible — without even knowing why!”

“There are (and always have been) mental health issues tied to childhood mobility,” writes Bruce La Brack, cultural anthropologist and researcher, whose own childhood included nine domestic moves in eighteen years. He has published extensively on intercultural experience, cultural adjustment and reentry issues. For years he directed the University of the Pacific’s Institute for Cross-Cultural Training, working closely with TCKs and international students and preparing students for intercultural exchange. “I believe that many TCKs are either misdiagnosed (or the background causes of their anxiety or stress are either unknown or unacknowledged) if they are treated by health care professionals who are clueless about the TCK Profile or the salient factors that impact their emotional life and constitute their identity.”

These specialists understand well the challenges of frequent moves for Third Culture Kids, many of whom don’t self-identify and won’t offer up their itinerant pasts unless pressed for the information. But the patterns and characteristics that develop as a response to global mobility among TCKs can be applied to other cross-cultural children as well — to those domestic nomads who move among cultures within a nation’s borders, or the ethnic-minority or immigrant child who lives a traditional life at home but is schooled in the larger community, or the children of refugees growing up in a country not their parents’, or international adoptees, or foster kids, or even those “stationary nomads” who remain in one place but whose world continually changes around them because of others’ mobility… the list goes on. One begins to see how huge an issue mobility has become.

How might mental health practitioners be better prepared to recognize mobility as a marker, then, when people come for help? What can our training institutions do to emphasize the importance of mobility as a catalyst for some of the presenting problems? What sort of preventive measures can be taken to insure that children — and the adults they will become — can more successfully navigate their transitions? And, finally, how can we take the reality of increased mobility, with all the benefits and enrichment that are also part of a mobile lifestyle, and reframe it into something TCKs and others can use as a model and a marketable skill?

I am hoping to explore these and other questions with readers of this blog. Please feel free to begin the conversation — I look forward to your responses.

© Nina Sichel

You can read Nina’s previous post on Third Culture Kids (TCK’s) here.

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