I Think Something Is Really Wrong But I'm Not Sure

What follows is how I understand and approach this issue in my work with clients.

If you think something is wrong but aren’t sure, therapy doesn’t require a clear presenting problem. A therapist can work with the vague sense that something is off.

You've been Googling low mood signs. Maybe you've taken one of those online quizzes. You scored somewhere in the middle, not severe, not normal. Just enough to make you wonder.

And now you're stuck in the wondering. Is this low mood? Or is this just what it feels like to live abroad and miss home and not have your people around you? Is this a how you feel condition or is this a reasonable response to a hard situation? Should you be looking for a therapist or should you be looking for better friends?

I don't think that distinction matters as much as you think it does.

Here's why. Low mood isn't a thing you either have or don't have, like a broken bone. It's a word for a cluster of experiences, persistent low mood, loss of interest, fatigue, difficulty concentrating, feelings of worthlessness, changes in sleep and appetite. You don't need all of them. You don't need them to be there every day. And there's no blood test that tells you whether what you're feeling qualifies.

What matters more than the label is the pattern. Are you pulling away from things that used to interest you? Are you going through the motions without much feeling? Is the world getting smaller, fewer people, fewer activities, less energy, less motivation? Does the idea of the future feel flat?

If yes, then whether you call it low mood or adjustment difficulty or expat blues or just a really hard time doesn't change the fact that something is happening that deserves attention.

Why expat low mood is confusing

Living abroad gives you perfectly good explanations for everything that also happens to be a sign of low mood. Can't sleep? Must be the time zone adjustment. No energy? Must be the stress of settling in. Lost interest in things? Must be because you don't know where to find the things you liked. Feeling worthless? Must be the language barrier making you feel incompetent.

Every sign has a plausible alternative explanation, and every alternative explanation lets you delay taking it seriously for another week, another month, another six months. "I'm not down, I'm just adjusting."

Maybe. But at some point, adjusting that looks exactly like low mood and feels exactly like low mood and lasts as long as low mood deserves to be treated with the same seriousness, regardless of what you call it.

The question that actually matters

Instead of "am I down?" try asking: "Am I living a life that I recognize as mine?"

Not someone else's idea of a good life. Not a life that looks impressive from the outside. A life where you feel present, engaged, and like yourself. Where you have moments of genuine pleasure, not just the absence of pain.

If the answer is no, and it's been no for a while, then something needs to change. That doesn't require a label. It requires honesty.

What usually happens when people come to me with this question

They spend the first session explaining why they probably don't need therapy. They list the reasons they're fine. They describe their life in terms that sound objectively good. And then somewhere in the middle, the mask slips and they say the thing they've been trying not to say: "I'm not happy and I don't know how to get back to happy."

That's not a label. That's a starting point. And it's enough to work with.