For 15 years I've been studying, training, and practicing in the fields of epidemiology, integrative nutrition, and health coaching. If there's one thing I learned in this time, it's that health is multi-dimensional. It can't be achieved by narrowly focusing on the latest fad diet or exercise plan. True health comes from nourishing body, mind, and spirit. And recognizing that nourishment is much more than the food on our plate.

Community is an essential aspect of nourishing mind and spirit. Living in Europe the last six years, and before that for shorter stints in Africa and Latin America, I've struggled at times to feel that casual sense of community. The type I took for granted when living in my home country where, due to cultural and language familiarity, I felt an instant (albeit, superficial) connection in daily life (e.g. walking the dog in the neighborhood, grocery shopping, eating in a cafe). That's why I've always made it a point to build a substantial personal and professional community.

In Madrid, I had the opportunity to work at SINEWS, a multilingual therapy institute that provides mental health services to the Madrid expat community with a specific aim to consider the holistic needs of a patient. There I offered integrative nutrition coaching to individuals and was thrilled to be part of a community of practitioners I admired. I recently sat down to speak with the Director of SINEWS, Dr. Orlanda Varela, about mental wellbeing and the importance of community.

Katie: What challenges do you notice expats and others with a multi-cultural background commonly face?

Orlanda: The main struggle for expats coming from other first world, occidental countries is realizing how different Spain is from their own culture. Expats must overcome the “tourist phase” to integrate. A tourist is excited about the differences in a culture, but those differences are challenging when you live with them day-to-day.

Expats must also decide whether they want to continue living as an expat or integrate into the local community and learn how to relate to neighbors, shop at local markets, etc. Language is everything. If you’re not willing to learn, you'll be in the expat community. This is not bad, but you’ll have to face the reality that your friends will leave. Patients tell us about the grief they experience when people they love leave.

When patients are struggling with transiting into expat life, the first thing I help them with is deciding what they want out of their expat experience. We analyze the pros and cons of both an expat and integrated lifestyle, and we consider the specific aspects of the culture, if any, they want to be exposed to (e.g. language, cuisine, meeting locals).

Katie: There's still a mental health stigma in society. Are there certain cultures that place less stigma on seeking therapy? What can we learn from those cultures?

Orlanda: We see 60 nationalities at SINEWS, including patients from Asia, North and South America, Africa, New Zealand, Australia, Iceland, and Iran.

In general, rural communities place more shame on seeking therapy than cities. But America is most open to therapy, while Asian cultures are least open.* Asia focuses on performance, but they struggle to find the words when asked how they’re feeling.

The U.S. has built a culture of emotional awareness. As a result, Americans have a larger vocabulary to describe feelings, which allows them to label what they’re feeling and process what's happening to them.

Thinking is a language process. If we don't have words, we can't analyze. And if can't analyze, we can't solve problems.

But the downside to America’s self-improvement culture is twofold.

There’s an expectation that we should always be happy. This doesn’t allow us to accept suffering as part of life. We've been sold the idea that life should be happy. But happiness is moments in life. We should instead aim for contentment. There are many times in life when we don't feel happy. So we should aim to feel satisfied with the big picture -- the choices we’ve made and the life projects we’re involved in -- even if things are not going well.
America medicalizes suffering. We make abnormal the normal painful moments of life and end up medicating breakups, grief, etc. In the end, we say antidepressants don't work. But of course they don't help with the pain of life.

*Note: I’m generalizing for the sake of comparing cultural norms. The generalizations should not be applied to individuals.

Katie: Building community is important no matter where we live. Based on your professional experience, what aspects of belonging to a community are most strongly linked to mental wellness?

Orlanda: Three things come to mind:

Feeling like you belong.
Giving back. The important part is to feel like we’re are an active part of the system. Remember, we can "belong" without being active. But if we’re active, we feel purpose in belonging.
Being yourself. Don't change or force yourself into a different role just to belong. Whether you’re into sports or the arts, figure out how you can participate in activities in your new community. It may not be the way you’re used to, so be open to seeking out opportunities and accepting they might look different. The work to find things for yourself is worth it for your own balance and sense of self. If you don’t have this, you’ll never truly belong and will be forced into a new you.

Katie: A desire to be healthy and happy is universal. If you could offer just one pearl of wisdom for reframing how we think about health and happiness, what would it be?

Orlanda: Happiness is futile and transient. Go for contentment.

The Role of Community in Mental Health: An Interview