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For members

LONELINESS

‘Being honest helps’: how expats have overcome loneliness in Germany

Removed from their language and culture, many people who first arrive in Germany experience feelings of isolation. The Local has spoken to expats who have struggled with loneliness to find out how they overcame it.

For seven years as a child, Stacy Weiss lived on a Air Force on Germany’s western border. Twenty years later, the Texas native decided to revisit, reaching out to the family her parents had rented a house from.

But her trip was more than the brief hop overseas she planned: after she reconnected with the family’s son, the two began a long-distance relationship. Within a few years, they were married, and Weiss bought a one-way ticket to the Eifel region.

Despite immediately feeling like she had an in with her husband’s family and friends in their idyllic small town, she felt alone. People seemed unfriendly and distant, and making friends beyond acquaintances was hard. She held onto connections back home through social media, crying during holidays when it seemed like life there had moved on without her.

“It was really difficult at first,” says Weiss, who found a job teaching English at the local university. “There’s that expat honeymoon phase the first couple of weeks where it’s very exciting and then the newness wears off. At first I didn’t know anyone, I wasn’t working. I was trying to fix my loneliness by looking back to the States.”

Loneliness among expats

Whether in small towns or big cities, whether moving abroad with a significant other or solo, many expats in Germany have experienced loneliness, or an often sombre sense of being cut off from others. The feeling is often magnified by struggles to learn the language, form deep connections, and generally integrate into the culture.

“The loneliness that expats experience comes generally with a sense of alienation,” says Jan Kaspers, a Berlin-based psychologist who works with expats.

Indeed, learning German to at least a conversational level and interacting with Germans themselves helps subdue these feelings, according to a survey of Spanish expats conducted last year by University of Cologne psychology master’s student Juan Serrano.  

Yet social interaction on its own isn’t always a cure for loneliness, says Kaspers.

“People start to realize after a while that they have made a lot of new acquaintances, but that deep down they are still mostly unknown by the people around them, and this can cause loneliness. Friendships can take time to develop, especially in larger cities.”

Introversion can actually be an advantage over extroversion when it comes to dealing with loneliness, he adds, as “introverted people tend to have less, but also more high quality contacts.”

Photo: DPA

In order to meet more people after moving alone to Munich, Indian expat Ashish Anand attended event after event organized through InterNations, a social activities network for expats. But after a few years he still found them quite superficial. To fix that, he adopted a “quality over quantity” approach, interacting with the smaller pool of people who reciprocated his openness beyond small talk – to his surprise even becoming friends with Germans he previously believed to be somewhat reserved. 

“I think that when people start sensing that you’re coming from this genuine place, then the vibe is completely different,” says Anand, an author who has now lived in Germany for 10 years.  “And then quickly you can get into a discussion, a common point.”

SEE ALSO: Calls grow for Germany to follow UK example and combat rising loneliness

A lonely society?

It’s not just expats who feel lonely in Germany. In 2018, Christian Democratic (CDU) families spokesman Marcus Weinberg called for “a removal of taboos” on the subject of loneliness so that “it doesn’t remain a dirty issue.” He joins other politicians and religious leaders in the country who have advocated for Germany to follow the example of the UK in combating loneliness.

“Similar to most other Western countries, many people in Germany don’t like to admit that they are lonely,” says psychologist Maike Luhmann from the Ruhr-University in Bochum, pointing out that it can affect all age groups. In a recent study of 16,000 Germans, she found that the age of 30 – a transition time for many – is when there are elevated levels of loneliness.

“Probably people tend to think that lonely people are often to blame themselves for being lonely,” she adds. “Especially among young adults, admitting to feeling lonely may be akin to admitting to being unlikeable, socially incompetent.”

British expat Rebecca Hilton was no stranger to expat life when she moved to Wiesbaden, having spent the previous three years in Bangkok. Yet she found herself feeling more alone in a society more similar – “I don’t stand out as an expat until I open my mouth” – but less outwardly friendly.

Yet she found that being honest with others about her loneliness, whether other expats or Germans, helped her overcome it by forming connections with people “who operated on the same wavelength.”

Seeking to meet more like-minded foreigners, she also created the Expat Book Club. Their first read was Eleanor Oliphant is Completely Fine about a young woman suffering from isolation and loneliness. “On some level it resonated with everyone,” says Hilton, who is originally from Bolton, near Manchester, “that on the outside it looks like you’re doing just fine but on the inside you can feel completely isolated.”

Photo: depositphotos/wavebreakmedia

Making friends amid different social norms

It was a feeling of loneliness that caused Belgian expat Marijke Hermans to co-create Supermamas, a volunteer network in Berlin for expat mothers of newborns. Moving to Berlin while pregnant, she didn’t know a soul in the city except the friend with whom she formed the support group. Despite having studied German for years, she felt overwhelmed by the bureaucracy and the lack of friendliness in comparison to what she found at home.

“Here I wouldn’t ask the person next to me at a coffee shop, “Wie geht’s dir?” I wouldn’t even know if I could say dir,” says Hermans, sipping a tea in a quiet cafe in the residential neighborhood of Steglitz.

Moving to Bad Mergentheim, a town just shy of 30,000 people in Baden-Württemberg, Jim Geren also felt a sense of isolation springing from very different social norms. Shortly after his arrival in 2013, “people would whisper at each other, point and stare,” he says with a laugh, “as though word got around that I was the new American in town.”

His biggest barrier to integration was the German language, and learning it largely through an intensive course has helped him mingle with the mostly German inhabitants.

“It takes people here a while longer to make friends,” says Geren. “People here are a bit more standoffish but when you break through that, they’re essentially friends, well, pretty much forever.”

Solitude versus loneliness

It’s important to separate solitude, or “the state of being alone with yourself” from loneliness, which can cause anxiety and depression when not addressed properly, says psychologist Kaspers.

He suggests creating a structure in one’s life in order to be more at ease with the uneasiness that being an expat often entails, be it getting up at similar times or meeting the same people.

Such predictability pushed Weiss to embrace expat life further and feel less alone. Looking to improve her German and get out of the house, she began taking an integration class five days a week.

“I just started forming connections with people,” says Weiss, who now blogs about expat life in the Eifel. “I wasn’t making best friends with anybody but I was getting to know people…who understood what I was going through.”

Yet above all, says Kaspers, “it is important to stay in touch with yourself. Be gentle and compassionate for the extraordinary situation you are in.”

READ ALSO: How I made friends during my first year in Germany

For members

HEALTH

10 key things you need to know about healthcare in Germany

From the type of insurance you should get to how to find GPs and specialists, we've put together a guide to help foreigners in Germany navigate the healthcare system.

10 key things you need to know about healthcare in Germany

If you’re living in Germany or thinking of making it your home, you’re in luck. Germany’s healthcare system is widely regarded as one of the best in the world, and ranks above the OECD average on most key indicators as of 2023.

Navigating a foreign healthcare system can be a little tricky for any foreign resident, especially new arrivals. So we’ve created a guide to some of the most important aspects of Germany’s healthcare system. 

Do I need health insurance?

Yes. Health insurance is mandatory for all German residents, so you’ll need to take out a form of insurance even if your current policy from your home country covers you whilst in Germany. 

The German health insurance system operates through two co-existing insurance types; private and public.

If you’re working in Germany, you’ll need to be covered by one of the two. Some visas allow for a special expat insurance instead, however, there are specific requirements for this. 

How does public insurance work?

Public health insurance, or Gesetzliche Krankenversicherung (GKV), is the most common form of health insurance in Germany. The German Bundesministerium für Gesundheit (Health Ministry) estimates around 90 percent of the population are signed up to GKV funds.

If you opt for public insurance, you’ll pay a monthly premium to your health insurance provider, which is calculated according to your income. Your employer will also pay mandatory contributions to your insurance. 

You have free choice of your health insurance fund, with over 100 public health insurance funds to choose from. Each will provide you with different levels of benefits and coverage, so it’s wise to take a close look at the fine print for each option. 

READ ALSO: Can you switch from private to public health insurance in Germany?

Public health insurance pays for healthcare that is „sufficient, appropriate and economic“. This includes medical treatments, prescribed medications, vaccinations, psychotherapy, and allied health care. Your health insurance will also pay the cost of hospital treatments, if the need arises. 

While most treatment providers will charge the cost of your care directly to your health insurer, some healthcare costs require a co-payment. This includes prescriptions and hospital care, however, the co-payments are generally small and scaled to your annual income.

Your public health insurance will also pay you a sickness benefit, or Krankengeld, if you’re certified unfit for work for more than six weeks. 

If you’re coming to Germany to work for a company, this is most likely going to be the best form of insurance for you. However, if you earn over a certain amount, or are self-employed, you may have to opt for private health insurance. 

When you sign up to a public health insurer, you’ll be given the all-important Gesundheitskarte (health insurance card). It’s important to always bring this with you when accessing any healthcare services. It’s also helpful to carry it around all the time in case of an emergency. 

A German health insurance card.

A German health insurance card. Photo: picture alliance/dpa | Jens Kalaene

What about private insurance?

Private health insurance, or Private Krankenversicherung (PKV), is the other form of health insurance in Germany. 

If you’re self-employed, a small business owner, a freelancer, or work in the public service, you’ll most likely have to sign up for PKV, although there are still notable exceptions to this.

If you earn over the compulsory social insurance threshold – currently set at €69,300, according to the Verband der Privaten Krankenversichrung – you become eligible for private insurance. 

Premiums for PKV are calculated based on a risk assessment done by the insurer, and generally vary based on your age and health. It’s important to note you can be rejected by a private insurer if you’re deemed too risky to cover. This isn’t the case with public health insurance. 

If you’ve come to Germany with dependents, such as children or a spouse, they also aren’t automatically covered by your private health policy and will generally require separate premiums. 

READ ALSO: How creative freelancers can pay less for German health insurance

If you decide on private insurance, you’ll have to cover the upfront costs of seeing doctors, going to hospital and obtaining medication. You’ll be either fully or partially reimbursed afterwards by your insurer. 

PKV might not be for you if you hate being bogged down with admin tasks, as claiming the payments from the insurer means filling in forms in German, although there are some providers that offer services in English.

If you’re a member of a public health insurance fund, you can take out additional cover with a private insurer to cover you for certain benefits, such as comprehensive dental treatment. You’ll bear the cost of any additional coverage yourself. 

What about expat insurance?

Another option is expat insurance, also known as incoming insurance. It provides coverage for people newly arrived in Germany and is suitable for some visas without work contracts. 

Temporary expat insurance could act as a good stopgap if you’ve just entered the country, but it doesn’t provide as comprehensive a coverage as PKV or GKV.

Coverage varies across providers, and you’ll generally have to pre-inform them of appointments and other medical care and be reimbursed. 

However, if you’re planning on renewing or changing your visa soon, it’s worth mentioning that having expat health insurance isn’t sufficient. You’ll need to be covered by a public or private insurer for it to be approved. 

Finding a doctor 

If you don’t speak German, the prospect of finding a doctor might seem a little daunting. Fortunately, there are plenty of services to help you find a doctor who works in your native language. 

A site like doctolib.de is a fantastic resource for finding and booking appointments with a variety of different health practitioners, from GPs to cardiologists.  

READ ALSO: What you need to know about making a doctor’s appointment in Germany

How GPs work in Germany

General Practitioners, or Hausärtze, either operate by themselves as solo, practice-based physicians or within a medical centre. While registering with a local GP is encouraged, it isn’t compulsory. 

GPs in Germany can provide prescriptions, offer vaccinations, perform minor medical procedures and conduct routine check-ups. You’ll need to book an appointment in advance, but some GPs offer open hours where you can wait in the practice to be seen (and expect long waits).

E-prescription service Germany

A patient inserts their health insurance card into a card reader at a German pharmacy. Photo: picture alliance/dpa/Reuters/Pool | Annegret Hilse

Unlike many other healthcare systems around the world, GPs in Germany don’t act as a gatekeeper to more specialised care. While you won’t need to see a GP for a referral to a specialist such as a dermatologist or gynaecologist, there are a few specialities (such as radiology and laboratory services) which are exceptions to this. 

Seeing specialists

Free choice of medical practitioners is a core principle of the German healthcare system, so you’ll be able to pick and book appointments with specialists without a referral from your GP in many cases. 

When searching for specialists, you’ll likely see some specialists are only available to those who are privately insured or self-paying. Finding a specialist who works with publicly insured patients is possible, however the wait times will likely be a little longer. 

If you have any questions, your health insurer or your GP should let you know how you can access a specialist doctor. 

READ ALSO: How to get a faster appointment with a specialist doctor in Germany

What about the dentist?

Public health insurance doesn’t fully cover dental care. While basic dental is covered, such as a yearly checkup, many German residents rely on supplementary private insurance for more comprehensive dental treatments because care can be expensive.

However, you should check with your insurance to see what extra dental services are covered. For instance, some insurers contribute a one-off payment to supplement teeth cleaning, but they won’t explicitly tell you this information when you take out insurance. 

Pharmacies and medicine 

If you’ve been given a prescription by one of your physicians, your next stop should be at a pharmacy, or Apotheke to have it filled. 

You’ll typically have to present your Gesundheitskarte to the pharmacist, and depending on your health insurance you might have to make a co-payment for the medication. This will be a maximum of 10 euros and a minimum of five euros. 

If Sunday rolls around and you find yourself in need of a prescription, there are emergency pharmacies, known as Notdienst-Apotheke, which operate on a rotating schedule within one area or district. You’ll generally be able to find the schedule at your regular pharmacy or online.

If having prescriptions delivered to you works better, there’s a service called MAYD which will deliver anything you need from your local Apotheke to you.

READ ALSO: The new rules on digital prescriptions in Germany

Going to hospital  

Germany has a comprehensive hospital network, with most people able to reach an acute care hospital within 30 minutes by car. 

The quality of hospital will depend greatly on where you live. Federal states are responsible for hospital care, and some operate better hospitals than others. 

When you arrive at a hospital, you’ll need to have your Gesundheitskarte on you for the registration process. The hospital will need to know about your health insurance status for the billing process. 

It’s also important to note here that the disparity between public and private insurance is most apparent when it comes to hospital care. If you’re privately insured, you will generally have better access to more senior doctors, your own room, and be seen faster.

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