What do Turks in Germany face when seeking mental health support? Read about generational experiences, barriers to seeking help and Turkish-language support.
Germany is home to one of the largest Turkish communities outside Turkey. From the first generation who came with the labour migration that began in the 1960s, to the second and third generations who were born and raised in Germany, to the newer migrants who have gone in recent years as engineers, doctors, academics or students, Turks in Germany carry very different experiences. Despite this diversity, one theme stands out in common: when mental health difficulties arise, asking for help is not always easy. Language, cultural concepts, fear of stigma and uncertainty about the healthcare system can cause many people to put off support. In this article I try to describe the experiences relating to mental health that are commonly encountered in the Turkish community living in Germany, the barriers to seeking help and the concrete steps that can be taken. I offer a general framework here; every individual's and family's experience is unique.
Turks in Germany: Different Experiences From Generation to Generation
The Turkish community in Germany is not uniform. Different generations and waves of migration may have different needs when it comes to mental health.
The first generation: Those who came
The first-generation migrants often set out thinking "we'll work for a few years and go back." They worked for many years in heavy physical jobs, were sometimes forced to leave their children with relatives in Turkey, and did not find enough time and opportunity to learn the language. Today many of this generation are of retirement age. Chronic pain, loneliness, losing a spouse, the dilemma of "Should I live in Turkey or in Germany?" and a life of going back and forth between two countries are common themes. In this generation, emotional distress is often expressed through physical complaints: "I feel dizzy", "I feel tight inside", "I ache all over."
The second and third generations: Those born here
The young people and adults who were born and raised in Germany experience the complexity of building an identity between two cultures. Turkish at home, German at school; one system of values at home, another outside. Many grow up with questions of belonging, created by being seen as "Turkish" in Germany and as "Almancı" (a Turk from Germany) in Turkey. They carry their parents' burden of migration, their expectations and sometimes their unspoken pain.
Imagine a twenty-eight-year-old woman who was born and raised in Cologne, works in a good job and speaks German like a native. Even so, she has difficulty explaining why she feels so guilty when she tells her German friends about something to do with her family. When talking to her mother, she cannot find the right Turkish words to defend her own choices. A feeling of being stuck between two languages and two cultures is an experience this generation often describes. I cover this subject in more detail in the article on second-generation Turks.
New migrants: Those who have gone in recent years
White-collar workers, healthcare workers, academics and students who have gone to Germany in recent years have a different experience. Although they are generally educated, independent and career-focused, diploma recognition procedures, language exams, bureaucracy, loneliness and worries about the family left behind in Turkey can create a serious burden. This group may sometimes not fully identify with the long-established Turkish community in Germany either, and may experience the feeling of "neither from there nor from here."
Common Mental Health Difficulties Among Turks in Germany
What is listed here is not seen in every individual; these are simply themes that may be commonly encountered.
- Migration and adjustment stress: Uncertainties relating to bureaucracy, language, work and residence
- Loneliness and isolation: Particularly among the elderly first generation and newcomers
- Depression and anxiety: May be connected with long-term stress, losses and lack of support
- Physical symptoms: Emotional burden experienced as headaches, stomach problems or chronic pain
- Questions of identity and belonging: Common in the second and third generations
- Conflicts within the family: Differences in values between generations, marriage expectations, young people's search for autonomy
- Experiences of discrimination: The effect on self-confidence and belonging of exclusion because of name, appearance or accent
- Grief from a distance and worry about caring for parents: The illness or loss of relatives in Turkey
Each of these themes carries different meanings within a person's own life story. None of them alone means a diagnosis; but if they have continued for a long time and affect daily life, they deserve to be addressed.
Barriers to Seeking Help and the Cultural Context
In Germany, mental health services are provided within a widespread system. However, many Turks may meet various barriers in reaching these services.
Stigma and the worry about "what others will say"
Beliefs such as "Whoever goes to a psychologist goes mad" or "It's shameful to tell your troubles to a stranger" can make it harder to seek help, especially in older generations. In small communities where people know one another, the worry "What will they say if it gets out?" is also an important barrier. Yet receiving psychological support is as natural as going to a doctor for a physical problem.
Language and expression
Even for someone who handles their daily affairs comfortably in German, it can be hard to describe feelings, childhood memories or embarrassing experiences in a second language. Some feelings and concepts, for example "gönül koymak" (to take offence quietly), "içine atmak" (to bottle things up) or "hakkını helal etmek" (to waive a claim in good conscience), can lose part of their meaning when translated into another language. For this reason some people look for a specialist they can talk to in their mother tongue. For details on this subject you can look at the article on why therapy in your mother tongue matters.
The fatigue of explaining the cultural context
Having to explain topics such as family structure, hospitality culture, the relationship with a mother-in-law, religious holidays and marriage expectations from scratch each time can be tiring for some clients. This does not mean specialists in Germany are inadequate; there are many professionals with experience of intercultural work. It is simply that for some people, talking to someone who shares their own cultural framework can be more reassuring.
Uncertainty about the system
There can be uncertainty about how to reach mental health services, how the referral process works and what insurance covers. It is recommended that you get the most accurate information on this from your health insurer and your family doctor; conditions can vary from person to person and change over time.
The role of the family
In Turkish families, problems are often first tried to be solved within the family. This can be a strong source of support, but it can also sometimes delay professional help. Young people in particular may find it hard to tell their families "I want to see a psychologist."
The Effect on Families, Couples and Children
Intergenerational relationships: Tensions may arise between the sacrifices of the first generation and the second generation's need for autonomy. While parents say "We worked so hard for you", children may say "But I have my own life too." Both sides can be right; what is hard is holding these two truths together.
Marriages: Spouses who came to Germany by marrying from Turkey may experience serious isolation in terms of language and social circle. Living dependent on the spouse's family can lead to an imbalance of power in the relationship. In mixed marriages, the two cultures' views on family, religion and child-rearing may clash. On these matters couples therapy can be one of the support options.
Children and young people: Children growing up bilingual at school may at times struggle with language development, academic achievement and peer relationships. Questions of identity intensify in adolescence. Young people trying to fit in with both their family's values and the expectations of the society they live in can experience an inner conflict.
Concrete Steps for Turks Living in Germany
Talk to your family doctor first. In Germany the family doctor (Hausarzt) is often the gateway to the healthcare system. Describe your complaints about your mood openly; also mention that physical symptoms may have an emotional dimension.
Find out your insurance conditions. Ask your insurer directly under what conditions your health insurance covers mental health services. Because conditions on this can change, it is important to get up-to-date information.
Write down your symptoms beforehand. Before going to a doctor's or therapist's appointment, write down what you have been going through in Turkish and, if necessary, translate it into German. This reduces language anxiety and stops you from forgetting something important.
Consider physical and emotional symptoms together. If pain, fatigue or palpitations continue even though your medical tests come out normal, consider that this may be connected with stress and emotional burden.
Make use of community resources. Turkish associations, cultural centres, mosques and migrant advice services in your city can be useful for information, social connection and sometimes referral.
Open up the subject in the family. Speaking about mental health can reduce stigma in your family. Saying "I've been getting very tired lately, I'd like to talk to a specialist" can open the door for others too.
Look out for elderly parents. Pay attention to signs of loneliness, grief or listlessness in your first-generation parents. Spending regular time with them, supporting them to join social activities and, if needed, accompanying them to medical check-ups are important.
Make room for young people. If your child or a young relative wants support, see this not as a failure but as taking care of themselves.
Build daily protective habits. Regular sleep, movement, spending time in daylight and meeting regularly with people you trust are the cornerstones of protecting mental health. In the long and dark winter months in particular, planning these routines consciously can be helpful.
Asking for help is a way of protecting the life and the family you have built far from home; it is a sign not of weakness but of responsibility.
When Should You Seek Professional Support?
It can be helpful to talk to a mental health specialist in the following situations:
- If unhappiness, listlessness or hopelessness lasts longer than two weeks
- If there is intense anxiety, panic-attack-like symptoms or a constant state of being on guard
- If there are marked changes in your sleep, appetite and energy
- If you are experiencing constant conflicts in family or marital relationships
- If you observe marked changes in your child's or young person's behaviour or adjustment at school
- If you are trying to cope with alcohol or other substances
- If the effects of loss, trauma or experiences of discrimination have continued for a long time
In cases where medication may be needed, an assessment by a psychiatrist is required.
Emergencies: If you are having thoughts of harming yourself or someone else, do not wait: call 112, the emergency number in Germany, or go to the nearest emergency department. Online therapy is not an emergency intervention service; in situations of severe risk, local emergency services and local psychiatric services are necessary.
How Do We Work in Online Therapy in Your Mother Tongue?
There is more than one route to mental health support for Turks in Germany, and they do not exclude one another. Some people work with a therapist in Germany, some prefer a Turkish-speaking specialist, and some use both together. Online therapy in Turkish may suit some people for reasons such as being able to express themselves in their mother tongue, not having to explain the cultural context and the convenience of meeting from home.
In work based on Cognitive Behavioural Therapy (CBT), the following steps are generally followed:
- Assessment: The migration history, family structure, current difficulties and strengths are considered together.
- Goal setting: Concrete and measurable goals are set according to the person's priority needs.
- Working with patterns of thought and behaviour: The cycles that maintain anxiety, low mood or conflicts are noticed and worked on.
- Solutions in harmony with cultural values: Ways are sought that respect family ties but also take the person's own needs into account.
- Skill development: Skills such as emotion regulation, communication and boundary-setting are worked on.
Since the time difference between Germany and Turkey is usually one or two hours, scheduling a session is often easy. A quiet room, headphones and a secure connection are enough. Payment can be made online; it is recommended that you find out from your own insurer whether your insurance covers sessions with a specialist abroad. For details you can look at the page on Turks living abroad.
Frequently Asked Questions
Is it hard to find a Turkish-speaking psychologist in Germany?
This can vary depending on the city where you live and on waiting times. Your family doctor, your insurer and local advice centres can help with referral. Online therapy in Turkish is also one of the options.
I know German. Should I still have therapy in Turkish?
This is entirely a personal preference. Some people use German comfortably for everyday matters but find Turkish more natural when it comes to childhood, family and feelings. The language in which you feel more at ease and understood may be more suitable for you.
How can I persuade my elderly mother or father to go to therapy?
Using softer expressions instead of the word "psychologist", such as "talking things over with someone" or "getting support for your sleep and aches", can help. Instead of pushing them, listening to what they are going through and first going to the family doctor together can be a good start.
Is online therapy in Turkish covered by health insurance in Germany?
It is not possible to give definite information on this; conditions vary according to the insurer and the policy. I recommend getting the most accurate information directly from your own health insurer.
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Eda Erkan Alapala
Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.
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