At the end of the manual describing mental disorders (DSM-IV) the American
Psychiatric Association has a chapter titled “Other Conditions That May Be a
Focus of Clinical Attention.” After 675 pages describing mental
disorders, this brief chapter lists conditions that are NOT mental disorders,
but they may be distressing to individuals or interfere with their functioning.
These other conditions have a “V” before their code number, and they include
the following as well as many others.
V62.2 Occupational Problem
V62.3 Academic Problem
V62.4 Acculturation Problem
V62.89 Religious or Spiritual Problem
Just as normal individuals may have a problem with work, with school, or with
grief, they may also have an “Acculturation Problem.” The DSM-IV says
only, “This category can be used when the focus of clinical attention is a
problem involving adjustment to a different culture (e.g., following
migration).” Although the DSM-IV does not elaborate on this problem
experienced by normal people, a description of what it might be like for
ordinary missionaries who reenter their passport countries is helpful. We
have written the following description.
(The Reentry Transition)
reentering their passport culture many people experience the Acculturation
Problem that some people have called “reverse culture shock.” During
the time these people were in their host culture, both they and their passport
culture have changed, so they become aliens in their own country. They
find that, rather than feeling at home where there are routine interactions,
predictable events, and few surprises, the environment is confusing and even
disgusting or “wrong.” Rather than feeling safe and secure where they
can trust their instincts and be themselves, they feel vulnerable, anxious,
fearful, and always have to think about what they do. This is often
disconcerting because if people do not feel like they belong at home, where do
people may experience great disappointment when their expectations are not met.
They may become angry and then allow the anger to become resentment or
bitterness. They may become alienated, critical, or maybe cynical.
In their frustration they may withdraw from people, even family, so that they
become isolated and lonely. They may find themselves being easily
offended, judgmental about their home culture, and even depressed. They
may become angry at their culture for the great materialism they see, especially
the great wastefulness as they see “good, useable” things discarded.
These feelings are typically greater if the people had a wonderful time in their
host culture and less if they had a difficult time.
missionaries may become disillusioned by the church in their passport country,
even by their “home church.” As one returning missionary put it,
“Our church is comatose and doesn’t even know it.” Experiencing the
different worship styles, they sense a lack of spirituality in the churches they
visit. When there is little response to their impassioned pleas for help
for people in their host culture, they may perceive a great apathy in the church
returning home, they may see familiar faces, but not familiar people. Both
they and the people they knew have changed. “Familiar” places are not
familiar any more. When returning to the same church, they find that the
people there are not really the same anymore; they have little in common, and
they cannot break into the group again. People back home seem to have such
narrow perspectives on events, and the returning ones do not know where they
fit, so they sense that they are forming temporary relationships. They
miss the closeness of the expatriate community in their host culture when
returning to a culture that places the emphasis on the individual. They
may misinterpret gestures and other “signals” so that they become marginal
people who must initiate relationships rather than being sought out.
they must remember that loneliness and unpleasantness are often the beginning of
insight and personal growth. In a sense they have become cultural hybrids
who are temporarily homeless, at home in neither their passport culture nor in
their host culture. However, when they are able to put their
cross-cultural experience in perspective and see how it relates to their whole
life story, they usually find out that they can still hold on to their new
values and attitudes and once again feel at home in their passport culture.
Associated Features and Problems
other problems may occur simultaneously with the Acculturation Problem.
Since the nature of work is likely to change following repatriation, a V62.2
Occupational Problem may occur. Returning to their passport country people
often find their work increasing in security but decreasing in significance.
Instead of being in charge, they often are expected to blend into their agency
with everyone else. Likewise schools are likely to be different for
children and adolescents. Instead of home schooling or schools with small
classes, they may find themselves in large schools with a resulting V62.3
Academic Problem. Note that these are V-codes, and not mental disorders.
Religious people may develop a V62.89 Religious or
Spiritual Problem. Religious people may experience the normal anger,
cynicism and depression and come to the conclusions that something is wrong with
their religion. Even though nothing is wrong, this can lead to a spiritual
problem. Missionaries in particular changing from “religious work” to
raising money may feel guilty about not doing what God had called them to.
Again note that this is a V-code, and not a mental disorder.
disorders such as a 300.02 Generalized Anxiety Disorder or a 296.2 Major
Depressive Disorder may develop if the normal anxiety or depression associated
with an Acculturation Problem lasts for an extended period of time. These
are mental disorders and individuals with these long-term problems should seek
help from a mental health professional.
Specific Culture, Age, and Gender Features
are often quite verbal about not wanting to return to their parents’ passport
country, but they usually adjust quite rapidly. The younger they are, the
more rapidly they adjust. Within a few days or weeks younger children make
new friends and are playing happily with them.
Adolescents, likewise, may not want to return. Relationships with one’s
peers are extremely important during the teen years. Suddenly leaving
peers and trying to break into a new group in a society of teenagers can be a
very difficult task, so adolescents may want to avoid it and have great
difficulty when forced to do so. This may involve acting out and result in
getting into serious trouble.
Relationships are also very important to women. Giving up a close-knit
group of friends on the field and trying to find like-minded women in her
passport country may be difficult, especially since many may be working.
Men are more likely to experience a loss of identity
as their job changes. On the field they may be involved in anything from
church planting to construction to teaching. On home assignment they are
often on the road raising funds to go back. As one man put it he was going
through “making a difference withdrawal.” On the field he made the
difference between life and death, but back home, if he were not there, people
in need could just go to someone else.
call “reentry” for missionary kids may not be reentry at all, but really
entry to a “foreign” country. That is, they are entering the country
from which their parents came, but they have never really lived there any length
of time themselves. They may have visited grandparents and other relatives
there briefly, but real home for them is what their parents call their host
country. Thus, their Acculturation Problem is one of entry, not reentry.
Experiencing the Acculturation Problem upon reentry is very common in that about
two-thirds of the people who return to their passport country experience
significant discomfort. The other one-third reenter with little difficulty
beyond a relatively rapid adjustment to technological changes. People
usually expect an Acculturation Problem when entering their host culture because
of the widely used term “culture shock.” However, upon returning
to their passport culture many people are surprised to find that there is a
“reverse culture shock,” and that it is often even a more difficult
Acculturation Problems may occur each time one changes cultures. Some
people report each successive reentry becomes easier, probably because they
expect the problems and have learned how to adapt to them. Other people find
successive reentries more difficult, particularly if the latter ones
involve leaving children and/or grandchildren in the host country.
Each episode typically includes three stages:
leaving, “in between,” and entering. The “leaving” stage begins
several weeks or months before actual departure when the missionaries start
anticipating the return “home” and separating from the work in the host
country. This stage is marked by receiving attention and recognition from
others at receptions; saying goodbye to persons, places, and pets; withdrawing
from their work as they turn it over to others, and generally bringing closure
to their time on the field. At this time they are disengaging from their
past and turning their attention toward their future. They may be in
denial that it is already time to return and have feelings of rejection,
resentment and sadness.
between” stage begins when the missionaries leave for the airport and end when
they unpack their minds, not their suitcases. During this time they are
without status, structure, and even keys. In this time of chaos they may
feel overwhelmed and isolated, as well as exaggerating their problems. Their
self-esteem may drop and they may become anxious over the future and grieving
over their losses in the recent past.
“entering” stage begins when the missionaries have unpacked their minds and
continues until the missionaries have re-engaged with their passport culture.
During this time they realize that they are marginal persons and are in rather
superficial, tentative relationships. Reentering missionaries may
misinterpret verbal and nonverbal behaviors and make errors in responding.
They may feel vulnerable, fearful, and may be easily offended. They may
find it difficult to trust people and even experience depression. Some
experience a “honeymoon” period immediately after they reenter when
everything is seen through rose-colored glasses. Then this may be followed
by a period of disillusionment when everything is viewed through rust-colored
glasses so that they notice materialism and superficiality in their home
culture. During this time they may become angry, judgmental, bitter,
lonely, fearful and isolated.
This entering stage may take only a few months, or a year (a full annual
cycle), or never be completed. Some missionaries are unable to complete
this stage and remain disillusioned for the rest of their lives. Some return to
their host culture after retirement to spend their final days there.
that people know they have fully reentered their passport culture when they do
the following things.
They stop carrying toilet paper everywhere.
They are not afraid to swallow water while showering.
They do not get nervous when they eat lettuce.
They drink water with ice in it.
They buy cherries or grapes along the highway and eat
They use tissues to blow their noses.
Again note that an Acculturation Problem is not a mental disorder, but people
who do experience in should know that it is normal. Those who do not have
similar reactions, thoughts, or feelings need to be aware of the problems other
normal missionaries face. Also note that the above description is written
for this booklet—all the DSM-IV says about it is “This category can be used
when the focus of clinical attention is a problem involving adjustment to a
different culture (e.g., following migration).”