Developing brains on exchange

In the summer of 2003, roughly 75 footloose fifteen- to eighteen-year-old exchange students gathered in a small town near Bangkok for three intense days of ‘cultural orientation’ and ‘sharing-our-feelings’. There, barely six weeks into the program, I first encountered a potentially serious side effect of exchange; one that, unfortunately, I would come across on many more occasions: mental health problems.

Early morning of day two, B from the US had locked herself in the bathroom and refused to come out. Instead, she was crying, furiously pounding on the door and walls, and talking incoherently about demons and conspiracies. A small crowd had gathered around the bathroom door, unsure what to do. Staff finally intervened when we heard a frantic shriek followed by the sound of breaking glass. They sent us off to our rooms, and forced the door open. Age sixteen, I doubt I even knew the meaning of the word ‘psychosis’.

B wasn’t the only one struggling. Shortly after the meeting, there were rumours that S from Switzerland had fallen so severely anorexic that she had to be hospitalised. In the next AFS Thailand newsletter, we read that S had returned home to her parents, and that we should all eat well. Unfortunately, I didn’t take that advice to heart; for me, too, my year abroad marked the onset of my eating disorder, that would continue to haunt me for many years.

The link between school-based exchange programs and emotional distress goes beyond the level of personal experiences like mine. Several studies have shown that the average exchange student feels more depressed, anxious and paranoid during their exchange compared to before e.g.[1][2][3]. In fact, one in four exchange students reportedly suffers from frequent psychological problems. Many years after my exchange, now a research scientist in psychiatry myself, these numbers are not the least surprising to me.

Depression, psychosis, eating disorders, or any psychological problem really, can happen to anyone and in any circumstances. Nevertheless, there are certainly things you can do to up your chances. First and foremost, problems tend to surface in times of stress. Stressful life events, ranging from volcano eruptions to financial difficulties to moving houses, may make us stronger in the long run (or so you may choose to believe) but they invariably water us down first. There are many ways to describe an exchange year, but stress-free is certainly not one I’ve ever used. Second, in times of stress, the one thing that keeps us sane is our social support network. When surrounded by our family and long-time friends, we’re much more likely to make it through the storm in one piece. Of course, you may land in a host-family that instantly gives you that homely family-feeling, but let’s face it: that doesn’t really happen that often. Third, if you’re looking to contract a mental illness of any kind, adolescence is the perfect time of the year. Hormones, emotions, self-image, sexuality and social environment change at ultra high-speed, and your (sorry to say) immature brain struggles to keep up. Even at home under your mother’s wings, you’re an easy target for mental illness during adolescence. Which, indeed, is what shows in the numbers: during adolescence, the prevalence of mental health problems doubles. Or, same numbers from a different angle: most mental health problems develop before the end of adolescence.

Going on exchange during adolescence is a tricky business. Which, in my view, is not necessarily a problem. There are tons of experiences to gain and millions of things to learn by taking risks. But risk-taking comes with risk-management. Exchange organisations have a responsibility to guard their students health, including mental health. Or, perhaps, especially mental health. During the years I volunteered for my exchange organisation, I was often consulted when incoming students showed signs of distress. I was always happy to help if I could, but very often there was not much I could do; the problem had already spiralled out of control before anyone caught notion of it, and the student had to return home for treatment.

So where are we going wrong? At the risk of being unfriended by all my volunteer friends, I’ll share what I think is the answer: Ignorance and Taboo. Now that’s bad news for any organisation striving to educate open-mindedness, is it? Ignorance and taboo. They make my face go “yuck”. But then, talking about my anorexia, PTSD or depression with my open-minded volunteer-friends scares the creeps out of me too, and so I don’t. Or, well, I didn’t; I do now, but that doesn’t really count since I’m no longer volunteering. Every now and then, I think about B from the US and S from Switzerland. I hope they’re volunteers now, and I hope that, unlike me, they do have the courage share their story.

Learn more about mental health of exchange students in this comprehensive 2006 NAFSA report

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