Should I give up on living overseas?

December 7, 2014 10:22 PM

Is living overseas too risky for a person who has gone through a psychotic episode? Should I give up on the idea of going back to teaching overseas?

Late last year I had my first psychotic episode while overseas. I was paranoid, delusional, quit my job and started doing things like randomly wandering around the city late at night much to my boyfriends alarm. Luckily my family were able to convince me to go home for a "holiday", and I stayed in hospital for 7 weeks. I remember very little of the first week or so and was apparently so disorganized and vulnerable that they had a nurse watch over me at all times for a while. Luckily they were able to find a drug that I can tolerate well, and I have recovered almost completely. I am holding down a full time job, and have no positive symptoms except for occasionally hearing "voices". They are not hallucinations but thoughts that I experience as being not my own and they refer to themselves as "we". I experience them as cooperative and kind, and they freely admit to me that they are not real. I "hear" these voices infrequently.

Now a year on from my episode I am looking at teaching overseas again. I have found a job and will likely go over in a few months. My friends are all very supportive. My doctor is supportive too saying that I have a drug that works well for me, that I am high functioning and that there is no need to give up on my goals because I have had a psychotic episode. He also says that if I continue taking my meds a relapse is much less likely, and if I had trouble and caught it early raising the dose might be enough to avoid a bad episode. My family are mainly supportive as well, with the proviso that I go over with a cushion so I can go back home in an emergency which I have duly saved up. My boyfriend who witnessed the psychotic episode closely is rightly worried that I may have a relapse and worry about what might happen if I get sick again is not far from his mind. He worries that I wouldn't be able to find a hospital to be admitted to in the country. He also says he still loves me and wants to be with me, but has a lot of anxiety surrounding my illness. I personally don't want to give up on my goals in life, but do fear being sick again. I am confident that I would be able to pick up if I was in the prodromal phase and see my doctor ( I have one overseas) but perhaps I am too confident. I also think that teaching is much more involved than my current job providing helpdesk for a small IT company, and I could end up stressed out, although I love teaching.

Given that I had a serious psychotic episode is it too risky for me to live overseas? Any anecdotes would be appreciated.

posted by anonymous to Health & Fitness (9 answers total)

I have a loved one who had her first psychotic episode several years. She had several episodes in the first year that were managed at home with higher doses but, especially at the beginning, the doses were higher enough that she was not thinking clearly and needed to be supervised for a few days. She is very good at recognizing when she is having an episode and working with her doctors to manage it and over time, got much better at managing it with smaller doses (and less "blurring" due to side effects) However, five years after the first episode, she had one that gradually escalated to the point where she needed hospitalization and self-admitted. If you have gone a year without any episodes and your doctor feels it is reasonable, your situation is different than hers.

Anyway, based on my experience, this is what I would be thinking:

Will your boyfriend be with you overseas? Having a friend or family member who really cares about you who can support you if things get tricky (and can give you perspective on your thoughts and behavior) would make this much better.

Are you going to a country that understand mental illness and where you would feel comfortable that you would get good treatment if you needed help especially if you had to be hospitalized? Or are you relying on being able to get yourself home in that case? Is that realistic?

If you do go is there someone in your family that you could make a deal with that you will keep in regular contact and be totally honest about your mental state? Probably not your boyfriend since he will get worried which might make you want to hold back - someone who stay calm and help you think clearly.

If I were your family member I would probably want you to wait - it seems safer - but if you are honest about the risk and carefully think through the tradeoffs, going might be the right thing to do. But, if you don't go now, it doesn't mean that you can't go later when you will have had more experience with managing your voices and knowing what to do if psychosis gets out of hand. If you decide to wait, you might look into local jobs that would be more satisfying than what you are currently doing.
posted by metahawk at 11:14 PM on December 7, 2014 [3 favorites]

You may as well. It's not like they haven't seen schizophrenia wherever you're going.

The real question is are you in charge, or is your mental illness?

An expat friend of mine in Dubai is also a schizophrenic, and has episodes a lot more frequently than you. Having a good psychiatrist where he lives has helped him immensely. Having a professional where you are will be a lifeline to you. So seek one out when you arrive.

Also keep the U.S. consulate number handy in case you run afoul of the law.
posted by clarknova at 12:34 AM on December 8, 2014

I've had psychotic episodes while living overseas. Medical care can be a horrible pain to figure out in a different country - especially when you're most in need of it - but it can still be done! It took me a while, and some help from friends, but I managed to get back onto a mental health plan and I have my meds and omg thank you Medi-Cal you rock.

Moving is super stressful, so if stress makes your psychotic episodes difficult then you might need to think about your strategy more. I was in the middle of an epic depressive episode - like near-suicidal depressive - just before I moved from one country to another, but I needed to make that move because it was staying stagnant that got me depressed in the first place. The adjustment was hard logistically and emotionally, but I managed to find some good resources that got me eventually in a better spot than I was before I left.

Where are you going to? That'll probably make a huge difference.
posted by divabat at 12:35 AM on December 8, 2014

I wonder, does it have to be a question of whether you stay here working at a help desk OR you go overseas and teach? Perhaps you could get a teaching job in the US and see how that goes, rather than combining the stress of moving overseas with the stress of starting a new career.

I am not trying to talk you out of your dreams, but I am wondering if there's a middle ground between staying too grounded and taking a big risk.

FWIW, I had a brush with death this year and I am facing what may, if I'm unlucky, turn out to be an abbreviated lifespan. I know very well that feeling of wanting to take a huge risk and really live vs. feeling like you are fragile as hell and maybe you should just scale way back and try to survive within the limits life has forced on you. It's a bitch.

It sounds like you should teach. That much is pretty clear. But only you know how ready you are for this move now, and nobody knows yet how it will go. If you NEED to do this, if you are ready to take that risk, do it. If you can find a similar happiness closer to home, consider it carefully.
posted by Ursula Hitler at 4:56 AM on December 8, 2014

In the abstract, I think that there's nothing wrong with your plans assuming your doctors are comfortable and on board with your plans. If you were my partner, though, I wouldn't be happy about this at all and I wouldn't be ok with participating in it. The small risk of a relapse or a weird medication issue would worry me too much if I wasn't able to be there, especially because my experience is that people often self-report ("I'm feeling fine!") incorrectly, so a problem might not get caught until it was much more severe, and then there would be all the practical difficulties of solving things from another country.

The first time I was working overseas someone I worked with had a severe psychotic episode (it was never quite clear if she stopped taking her meds or if she got a stomach virus and just puked them up for a week, but the effect was the same) that was very dangerous for her and took the full efforts of a bunch of staff members and the embassy (including putting serious political pressure on the local police to help her rather than treat her as a criminal) to get her medevaced. If she had been working on her own, without the engagement and support of the government, I'm not sure how it would have been possible to learn of her problems in time, or to find her, get her immediate in-country crisis care, and then solve the problem of forcing a non-compliant and aggressive adult back to the US for long-term care.

So I think it's possible that it's both a fine idea in terms of your health and career, and that family and/or boyfriend may have very good reasons to be opposed.
posted by Dip Flash at 6:06 AM on December 8, 2014 [1 favorite]

Here's how I would view it. If you had a physical illness of the same severity, would you be willing to go to that same country given the facilities available to you should you have an episode?

So let's say I had diabetes. If I have access to regular medical care, testing and medication. If I could have a relationship with a doctor who can monitor me and keep me healthy, then I would cautiously move forward with my plans.

But if the country I was going to had significant issues with power failures meaning that I couldn't store my insulin properly and if access to appropriate medical care was precarious, then as much as I'd WANT to teach in that country, it would be a bad idea.

You have a chronic condition that requires close medical monitoring and a predictable supply of medication. If either of these things is in question, then don't go.

If you're going to a country where the stigma for mental illness is moderate and where you'll have access to good medical care, then I think you have your bases covered. If you're going somewhere like China, I'd think twice.
posted by Ruthless Bunny at 6:30 AM on December 8, 2014 [1 favorite]

I think this depends a lot on things we don't know.

How long did you work overseas before this episode happened? How was that working out up until that time?

Did you have the psychotic episode in connection with culture shock or being away from home or anything else specific to living in an unfamiliar place?

Where do you live now, and where would you be looking to go? There's a big difference between being a Brit who wants to teach abroad in France or Italy, and being an American who wants to move to Saudi Arabia. How comfortable are you in the culture where you'd be living? How close to home are you?

What kind of support network would you have? What would your benefits or healthcare be like where you want to go? How available is mental healthcare? How stigmatized is mental illness? How available is the medication you're on? What would happen if something went wrong?

From what you've written, it sounds like you have your ducks in a row in a practical sense. Your friends, family, and doctor are all on board. You have a medication that is working for you. You've already proven that you can work and live a normal adult life following what happened. You have a way to get back home if you need to. I tentatively think you should go, though I do think you should really think through the realities of what it will be like, what could go wrong, and what would realistically happen if something did go wrong.
posted by Sara C. at 7:09 AM on December 8, 2014 [1 favorite]

My family are mainly supportive as well, with the proviso that I go over with a cushion so I can go back home in an emergency which I have duly saved up. My boyfriend who witnessed the psychotic episode closely is rightly worried that I may have a relapse and worry about what might happen if I get sick again is not far from his mind. He worries that I wouldn't be able to find a hospital to be admitted to in the country. He also says he still loves me and wants to be with me, but has a lot of anxiety surrounding my illness.

It sounds like the only person in your life who's really worried about it is your boyfriend, not you or your family. I think your boyfriend needs to do like your family did. He needs to identify something specific you can do that will reduce his anxiety to a level he can live with, and when you do it, he needs to be supportive and not burden you with his anxiety about your illness. You have enough to deal with just managing your illness. For example, maybe the thing you can do is find an acceptable hospital in country in advance, or else specifically plan out the process of getting you back to a hospital in your home country if that is needed. Beyond that, though, for the part that no one can really control (will you have another episode?), he needs to use his own coping skills to deal with that anxiety.
posted by Bentobox Humperdinck at 8:10 AM on December 8, 2014

Re partners not being supportive (bouncing off Dip Flash's comment):

My now-ex, who I broke up with soon after I moved (for reasons not entirely related to the move) but with whom I still maintain a close friendship, has remarked many times that I was doing far better mental-health wise in the new country. I didn't realise how bad I'd gotten back in our original country until he told me just how scared he was for me and made me notice just how much more functional I was elsewhere.

Of course, each case is different. Maybe the move will be good for your brain, maybe not. But it's not necessarily universal that partners need to be opposed to a move like this.
posted by divabat at 11:41 AM on December 8, 2014