When Samuel L. Clemens, better known as Mark Twain, visited Florence in 1867, he dutifully visited the city’s museums, churches, and tombs. But as he stood by the Arno, he began to feel annoyed with the Italians’ insistence it was a river, not a creek. “They all call it a river, and they honestly think it is a river, do these dark and bloody Florentines,” he grumbled. “I might enter Florence under happier auspices a month hence and find it all beautiful, all attractive. But I do not care to think of it now, at all.”
Travel can make memories and broaden horizons. But it can also lead to discomfort, homesickness, and a sense of overload—a common condition known colloquially as “culture shock.” And for a few, that discomfort can tip into full-blown distress, with travel exacerbating—or even sparking—mental health problems.
Inventing ‘culture shock’
First, the good news: It’s normal to feel uncomfortable when spending time outside your home culture, even for an eagerly anticipated vacation. Feelings of discomfort, dislocation, and overload are so common among travelers that they’re referred to by many as “culture shock.” But though the term has existed since the 1950s, says Susan B. Goldstein, a psychology professor at the University of Redlands who studies acculturation, it’s an outdated way to describe these adjustment challenges. “‘Culture shock’ connotes a dramatic, unexpected, negative event,” Goldstein says. But though the vast majority of travelers will experience such challenges, “a real sense of ‘shock’ is atypical,” she adds, “so atypical that many researchers no longer use the term.”
Goldstein says that culture shock is misunderstood—even down to how the term itself originated. Though many attribute the term to Kalervo Oberg, a Canadian anthropologist who began using the term around 1960, Goldstein has tracked the term back to the 1950s, when it coined by anthropologist Ruth Benedict and first used by her colleague, Cora Dubois, in a speech about anthropologists working in unfamiliar lands.
From discomfort to cultural competence
But it was Oberg’s vivid description of culture shock—written in response to his own multicultural experiences and a growing interest in cultural exchange after World War II— that won over audiences. The anthropologist spoke of the adjustment process as “an occupational disease of people who have suddenly been transplanted abroad”—a “disease” that progressed from a honeymoon phase, through rejecting the new environment, to finally adjusting fully to it. By the 1970s many researchers adopted the idea that, like physical maladies, culture shock progressed through a remarkably consistent and universal set of stages.
Modern research, however, suggests that the experiences of acculturation are individual, not universal. “People will have their ups and downs, but for the most part, they will become increasingly comfortable and competent over time,” Goldstein says. And while many attribute the causes of culture shock to the host culture itself, an individual’s internal expectations and differences are just as important.
Travel and mental illness
Those expectations seem to play a role in some of the more dramatic forms of culture shock like Jerusalem syndrome, a condition observed in some tourists who flip from a functional psychological state into religious psychosis while visiting the Holy Land. Identified as “Jerusalem fever” in the 1930s by Heinz Hermann, a psychiatrist who ran a private women’s hospital in Jerusalem, the condition had actually been witnessed among tourists for years. Stories of mental illness and religiosity among pilgrims were common throughout the 19th and 20th century, medical historian Chris Sandal-Wilson writes, with reports of “religious mania” and “cranks” among the region’s many tourists. By 2000, Israeli psychiatrists reported they were seeing an average of 100 patients a year who, when faced with “a city that conjures up a sense of the holy, the historical, and the heavenly,” developed a “unique psychiatric phenomenon” involving delusions, magical thinking, and obsessive psychosis.
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Meanwhile, tourists in another city developed a syndrome of their own. In 2004, Japanese psychologist Hiroaki Ota and a group of French psychologists wrote about a spate of 63 psychiatric hospitalizations among Japanese tourists to Paris who experienced “acute or even violent” delusional episodes characterized by wandering, anxiety, and dissociation. This “pathological travel” was quickly dubbed Paris syndrome.
But though the terms have gained modern recognition, they’re not recognized as widespread psychiatric disorders and aren’t described in the field’s diagnostic bible, the Diagnostic and Statistical Manual of Mental Disorders. Nor is Stendahl syndrome, another travel-associated condition in which a person experiences intense physical symptoms or faints during encounters with beautiful art or architecture.
In fact, says Goldstein, the number of people who actually experience psychosis while traveling is relatively low. And it’s doubtful that the destination plays as large of a role as the patient themself. Travel is stressful, and can exacerbate pre-existing mental health conditions, while religious locations may attract individuals with mental illness who have intense religious beliefs.
Expectations and reality
Travelers’ own expectations could make matters worse, and when expectations and experiences don’t align, it can result in discomfort and even psychiatric distress. For many with Paris and Jerusalem syndromes, Goldstein says, the patient’s image of their destination “does not correspond with reality,” which can lead to more severe symptoms.
Realistic expectations can help, but so can a traveler’s attitude. People who try to avoid cultural differences fare worse than those who embrace them, Goldstein says, and research indicates that sojourners should seek out “cultural mentors” to help them get the lay of the land.
And challenging cultural experiences could actually be a good thing: In a 2015 study of 2,500 teenage exchange students, researchers found that though cultural stress was common among participants, those who faced those stresses head-on instead of turning to avoidance or support from people back home tended to thrive and were likelier to finish out their year without switching families or going home early.
The upshot: Psychological discomfort is common while traveling, but distress is not. Goldstein says travelers should seek help if their distress is long-lasting or worsens over time, or if their travel-related stress impairs their physical or day-to-day functioning.
As for Clemens, the grumpy author was able to ride out his feelings of distress and dislocation while traveling. He eventually finished out his European tour—and in his bestselling travel memoir The Innocents Abroad, famously remarked that travel is “fatal to prejudice, bigotry, and narrow-mindedness.” With the right attitude—and the willingness to seek help if you need it—it’s more than likely that you, too, can adapt and thrive in new settings, building new memories—and resilience—with each new stamp in your passport.
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