Ten years have gone by since my first and only suicide attempt. I was in 9th grade and spent ten days in a psychiatric hospital. After being discharged, I attended a partial program, which pulled me out of school every day at lunch to attend group therapy. My excuses were endless:

“I got special permission to work a part-time job in the afternoons”

“I’m taking a class at the community college”

Etcetera, etcetera, etcetera… Most of my peers didn’t buy it. They would prod me with further questions that I refused to answer, too embarrassed to open up about my mental illness.

Through high-school, I swallowed a handful of pills every morning. My ever-changing diagnoses began with depression, generalized anxiety disorder, ADHD, and insomnia. I was begrudgingly medicated for each and every one of them until I felt nothing.

Fourteen years old and totally numb.

I got off the medications a few years later, and after some months of instability, my coping mechanisms became more effective and productive. I felt better, for the most part. My grades were weak, but I still got into one of my top-choice universities and did remarkably well in college, unmedicated. After studying abroad in three countries over two years, I decided to move to one of them after I graduated: Japan.

To be completely transparent, my symptoms came back in Japan with a vengeance. Debilitating panic attacks, social anxiety, derealization, lack of appetite, and gut problems plagued every waking moment of my life. For months, I had been fine living in my shoebox apartment in downtown Hamamatsu, going to work, teaching English, interacting with students and friends. I got along fairly well with my Japanese colleagues and was part of a prestigious government programme. For the first time, I had achieved true financial stability and I was putting my Japanese minor to good use. I thought I was happy.

So what could go wrong?

Well, I honestly don’t know what changed, but suddenly everything went dark and I stopped functioning completely. I lost weight rapidly, cried at work, stopped seeing my friends, and starting feeling like I wasn’t an active participant in my own life. I was going through the motions, but it was as if I just watched my routine happen from outside of my body. Helplessly, I withered away.

In Japan, mental health care is abysmal. Another participant in my government program died in a psychiatric facility due to the negligence of the hospital the same year I was there. I saw a Japanese psychiatrist who barely spent five minutes with me and sent me home in the same state with no medication or resources. The mental illness taboo in Japan makes actually getting treatment difficult and shameful. This taboo exists all over the world, but there are solutions that you can access on your own without confronting judgment.

So here’s what I ultimately learned from this experience:

Don’t alienate your friends and family.

They are the driving force of your social support network. If they don’t love you when you’re depressed, anxious, manic, whatever, then they don’t deserve you at your best. Focus on the people that matter, the people that will be there for you unconditionally. Don’t push them away when they try to help and try not to blow up on them when they don’t understand what you’re going through. You need them. Period.

Don’t let anyone shame you out of taking medication for your mental health.

Medication isn’t taking the easy way out. The idea of returning to the meds that numbed me as a teen left a sour taste in my mouth, but I knew that if I didn’t take them, I couldn’t function. I had one friend tell me that “medication is for people who don’t want to try.” Some people can’t understand what you’re going through. Ignore them and do what’s best for your wellbeing. Medication is a useful tool for recovery if you are comfortable with taking it. First, you have to research providers and which medicines are available in your country. Find a healthcare provider that is non-judgemental and will get to know your condition before writing you a prescription.

Seek online therapy in your native language if you need it.

There are countless resources for online counseling and some psychologists even offer distance sessions via Skype. A few options include TalkSpace or 7 Cups. Find out what your insurance will cover. Some of these services are more affordable than others, which is particularly important if you’re on foreign insurance that doesn’t cover mental health care. Be cautious when seeking out online counseling, make sure the therapist is licensed and HIPPA-compliant. Find out the costs and payment options beforehand. Talk therapy was the most helpful part of my recovery because I was able to release the negativity that was trapped in my brain and have a professional teach me how to cope. So I highly recommend it.

Find an international doctor’s office.

Depending on where you live, this may either be a tremendous struggle or pretty simple. Regardless, international doctors may hold less cultural prejudices on mental health. For example, I was able to get an emergency medication for panic attacks from an international physician in Japan, but not from a Japanese psychiatrist. If you are unable to find an international clinic in your area online, try consulting with a local or a coworker. You don’t have to tell them why you need to go

Create a support group with other expats.

This might sound a bit cheesy, but even just a casual invitation to a group of people that you trust to sit down and talk over coffee can turn into a mutually beneficial situation. Venting is therapeutic. Lend an ear to your peers and hope they’ll lend theirs in return.

Be as productive as possible.

Mental illness can lead to reclusive, lethargic behavior if you’re anything like me. Leaving your place of residence might feel like a major accomplishment. I’d see a movie, treat myself at a bakery, meet a friend for a hike, try something new. Try staying tidy so that your home environment won’t cause additional stress. And don’t forget to feed yourself while you’re at it.

Keep a journal. Get creative.

Creating a physical representation of your feelings can help liberate you from them. Invest in a journal that begs to be filled with drawings and writing. Get those smooth pens that are oh-so-satisfying as they glide across the page. Carry it in your bag or pocket, take it out when you feel anxious or inspired. Write your thoughts, draw your surroundings, do what feels good in that moment.

Try a meditation app.

I have Calm, but I’ve also heard great reviews of HeadSpace. They both have free and paid versions. Personally, I pay for Calm because I use it every day. If it works, great! If it doesn’t, at least you tried! If you have issues with panic/anxiety, use the free breathing feature to avoid hyperventilating or just to relax. You don’t even have to think, just watch and breathe.

Find an active hobby.

Whether it’s running, martial arts, cycling, climbing, swimming, it doesn’t matter, just pick something that requires movement. Get your heart rate up. This will override your body’s response to anxiety and attribute it to the physical activity. Additionally, most sports will put you into social settings, which can counteract loneliness. Making friends in a foreign country is hard, but having a shared hobby will make the process much easier.

Quit your job if you absolutely need to.

You can’t escape your mind, but you can escape your situation. You may hold a contracted position and the choice to quit and return to your home country can seem overwhelming. It certainly was for me. “What will I do about my lease? My bills? How do I tell my boss? Can I explain the real reason why I have to leave? Will they judge me? How will this affect my future? Hiring managers will think I’m flighty. I’ll never get another job.” These are thoughts that will probably cross your mind as you make this major decision. Feeling suffocated by the pressure of staying can worsen your condition. Put your mental health first. There is nothing more important. If ultimately, you do have to go home to seek more thorough treatment in your native language, that is totally up to you and nobody else. Sometimes staying isn’t worth it.

Remember why you moved overseas in the first place.

Best case scenario: you are able to work through your issues overseas. You’re determined to stay so make the best of the situation. What brought you to this place? The culture? The language? The landscape? Use this time to reflect on your life abroad: how this experience has shaped your character, how you have grown. Explore the places you’ve been putting off and the ones that moved you in the past. Realize how strong you are for enduring this adversity in a foreign country. Mental illness is not weakness.

Everyone will experience mental illness differently and recovery varies immensely from person to person. Some things will work for you and some won’t. This article is meant to help get you started with suggestions that may alleviate anxiety.

If you or anyone you know is having suicidal thoughts or harming themselves, please seek professional help and don’t give up on them.

The Suicide Prevention Hotline in the US is available 24-hours a day. Their number is 1-800-273-8255.

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