English-speaking expatriates living in Italy suffer from the same psychological symptoms and conditions found in general populations elsewhere. They seek psychotherapy for anxiety, depression, stress and substance abuse, and they struggle with relationship or health-related issues. However, there is something that sets them, and expatriates everywhere, apart from those who have not moved abroad. It colours their emotional and psychological responses, the symptoms they experience and the issues they bring to therapy. It is often referred to as silent or insidious because it frequently goes unidentified or is misdiagnosed.

Coined in 1954 by anthropologist Kalvero Berg, the term culture shock is used to describe a series of psychological responses to living in a cultural and linguistic environment significantly different from your own. Culture shock results from losing all the familiar signs and symbols of social intercourse that constitute your culture and which allow you to navigate your everyday life with a degree of predictability and ease. When you arrive in another culture most, if not all, of these signs have been replaced by others that are now unrecognisable. As a result, you are often confused, anxious and frustrated, and can suffer from a number of psychological symptoms that correspond with a four-stage process. It is important to note that individual responses to culture shock differ in many ways; stages may be experienced in a different order and may vary in duration (from weeks to months, or longer), and some stages may be omitted completely.

The honeymoon stage, as its name implies, is marked by exhilaration. You enjoy all the sights and sounds of the new culture and are often surrounded by new acquaintances. Colleagues or hosts may take you sightseeing, to restaurants or to the theatre, providing entertainment during the first weeks or months.

As you settle into a daily routine, problems of everyday living begin to arise. Activities like travelling to work, buying food, asking for directions, or making a phone call are no longer simple tasks but now require considerable effort. It is at this point that the honeymoon stage fades and the rejection stage emerges. The increasing frustration and vulnerability you feel trying to accomplish even the simplest task provokes anger and hostility towards the new culture, its people and its customs, often manifested in the form of negative stereotyping or even aggressive behaviour. One American woman hit a passing car with her umbrella as she crossed the street because the driver had failed to stop at a zebra crossing and instead had made his way through the intersection, manoeuvering around her. She admitted that the driver had in no way threatened her safety, but nonetheless remained convinced that her response was justified and appropriate.

During the rejection stage the newcomer may have a heightened sense of not belonging and of being an outsider; you may see the people of the host culture as insensitive or uncaring, and may even believe they are responsible for your unhappiness. You begin to reject the new culture. You are reluctant to learn the language or make friends among the local people, and you display a general disinterest in the new culture. Failure to work through this phase successfully leads to an escalation of the rejection, and eventually the foreigner returns home, either emotionally or physically.

If the rejection stage is not adequately resolved, those who havent physically returned home have done so mentally and emotionally, entering the regression stage. As the word regression implies, you move backwards in this phase. You may speak only your native language, and become preoccupied with thoughts of home. You may withdraw and isolate yourself from the larger culture and can become overly dependent on co-nationals. One expatriate explained that he moved to Italy with the intention of immersing himself in the Italian culture, learning the language and making Italian friends, but one year after his arrival, he spoke almost no Italian, had no Italian friends and frequented an Irish pub where he watched re-runs of The Simpsons.

The rejection and regression stages are especially stressful and it is during these phases that the symptoms of culture shock emerge (see box). Being able to identify them will allow you to maintain a balanced perspective and to take the necessary steps to ease the impact they have on your daily life.

The fourth and final phase of culture shock is the recovery stage. Arrival at this stage is facilitated by increased language competence, familiarity with customs and social cues, and the ability to move about with less effort and anxiety. You understand that your new living conditions are not better or worse but simply different from those of your own culture. One of the most obvious signs that you are in the recovery stage is that you regain your sense of humour and can laugh at some of the things that once seemed so irritating.

Coping skills, basic personality, pre-existing psychological conditions and the reasons you moved to a different country will all influence your assimilation process and the severity of the symptoms you experience. Your greatest asset is knowledge. Knowing what to expect, that you are not alone, and above all that culture shock is a normal response to your experience abroad will facilitate your adjustment.

BOX 1: Symptoms of culture shock

Withdrawal

Irritability

Alcohol/substance abuse

Crying spells

Insomnia/excessive sleeping

Depression

Anxiety

Failure to learn the language

BOX 2: Helpful tips

Ask for help

Keep a journal (record your thoughts)

Maintain a sense of humour

Learn the language

Be open-minded/flexible

Having trouble settling in? Need some advice? Send us your questions and comments, marked Ask Rose,

to editorial@wantedinrome.com.

Rose Kazma holds an MA in clinical psychology and has been in private practice for 15 years. She has taught psychology and also worked as a cross-cultural consultant to businesses. An Italian-American, she lives and practices in Rome.