Aug 05

Beauty surgeons and the cosmetic industry love it (critics claim that they are even doing their best to support? it): the ‘Dorian Gray Syndrome‘ describes a phenomenon where people turn into heavy users of cosmetic products and medical procedures in an attempt to preserve their youth. Oscar Wilde’s famous novel ‘The Picture of Dorian Gray’ first introduced the psychological dilemma of affected persons to the wide public: conseqently the syndrome was named after the novel’s protagonist.

While this syndrome as a whole is not scientifically acknowledged, many patients suffering from it actually show diagnosable traits of body dysmorphic disorder (having excessive concerns about perceived defects in their physical features), narcissistic character elements (like a sense of superiority or being more occupied with themselves than with others), and signs of delayed maturation in certain aspects of their psychic development. In their preoccupation with their outer appearance and difficulty to accept their aging process, DGS patients are often users or abusers of hair growth and weight-loss products, mood enhancers, medication against erectile dysfunction, they are often owners of gym membership cards and very often patients for cosmetic surgery (laser resurfacing, botox injections, aesthetic surgery etc.).

In case you happen to know someone who you think might show signs of the Dorian Gray Syndrome: this person might also have depressive tendencies which, if untreated, might trigger autodestructive symptoms if he or she tries to suppress the negative self image by using drugs or repeatedly undergoing surgeries. But who would want to define when it would be ‘justified’ to look out for help? Some might not want to live a life burdened by compulsionary thoughts of this kind, but be able to fully enjoy their lives and take life as it is – like so many others do.

But then, what can be done about it? For some of the affected persons, a personality disorder turns out as the root cause for their body dysmorphic disorder, for others it is a lack of self-esteem. While in order to improve one’s psychological balance, a personality disorder can only be managed by various means (like by medication and counseling aiming at better self management), self-esteem can be improved quite well utilizing methods of psychotherapy. This doesn’t have to be a process that requires years of ‘talking cure’ – distinctive and long-lasting improvements can usually be achieved already after a few months of regular sessions. The goal of these sessions is to work out a more confident and accepting take on what our body involves.

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2011)

Aug 05

Am I a ‘pervert’ or simply enjoying the extraordinary? The answer to this question has seen remarkable changes over the times. Many sexual practices that might have resulted in getting burned at the stake for being possessed by ‘demons’ or being locked up in a mental ward during the last centuries are considered as nothing else than normal nowadays. However, there are indeed forms of sexual behavior that are considered as psychopathological even if moral issues are left aside. Today, sexual behavior is considered a disorder (or paraphilia) if it causes distress or impairment to the individual or harm to others. This is an important distinction to avoid pejorative positions towards more uncommon sexual interests and practices like a sexual attraction to the same sex which was still part of the diagnostic manuals until 1973.

Upcoming versions of  diagnostic manuals will further make a distinction between paraphilias and paraphilic disorders. A paraphilia by itself would not automatically justify or require therapeutic intervention. A paraphilic disorder will be the aforementioned paraphilia that causes distress or impairment to the individual or harm to others. In other words, non-normative sexual behavior will not automatically be labeled as psychopathological anymore. Cross-dressing, for example, will not automatically be classified as transvestitism anymore – unless the person is unhappy about this activity or impaired by it. Only then it would be diagnosed as ‘disorder’.
While the new generation of classifications will definitely bring improvements compared to diagnoses that were given in a pejorative way before, it will also link diagnoses closer to cultural values again, so in a society with tighter cultural norms like here in Asia, we will probably see more people diagnosed with sexual disorders once the new classifications have become standard, as these person’s behavior patterns are more prone to ‘harm’ or ‘distress’ others…

The most common paraphilias that are considered as disorders are exhibitionism, fetishism (certain objects are required to gain sexual excitement), frotteurism (urges to touch or rub against a nonconsenting person), pedophilia, sexual masochism and sadism, transvestic fetishism, urophilia (sexual excitement with the sight or thought of urination) and voyeurism. These forms of sexual deviance usually become a problem if non-consenting persons are involved, local laws are violated or if sexual arousal can only be reached by acting on the urge of the paraphilia.
Can paraphilias be cured? Many experts claim they can’t, at least not with standard methods of sex therapy. However, often enough, persons suffering from the restrictions their paraphilias impose on them can learn to manage their sexual behavior more efficiently and flexibly – at least to an extent that prevents them from breaking laws or destroying their relationships.

More articles and literature:

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2011)

Aug 05

Mark Twain said, “Quitting smoking is easy. I’ve done it a thousand times.” Well, we all know: quitting smoking reduces the risk of terrible illnesses like cancer and cardiovascular disease. It increases fertility levels, breathing and overall fitness. Another benefit of quitting is enjoying the taste of food again. You will look and smell better and on top of it all, save a lot of money.  Why then is it so hard for many to stop the habit – or addiction – of smoking?

The reasons for smoking addiction can be cut down to 2 important factors: nicotine and habits.

Nicotine, for one, is a highly addictive substance that occurs naturally in tobacco, and hooks your brain by stimulating it with a shot of dopamine, the hormone that tells us that food and sex are pleasurable. It also increases activity in areas of the brain that are believed to be involved in cognitive functions, so a cigarette can make you feel sharper and more focused. As if that weren’t enough, nicotine also increases the endorphin levels, the proteins that give you feelings of euphoria. Needless to say that having a ‘tool’ that can make you feel better in these ways, is something you don’t give it up easily. Quitting may leave you feeling deprived, and you may exhibit serious withdrawal symptoms if you have to go without nicotine.

Another important factor for this specific kind of addiction is habits – the patterns that are involved in smoking. Smoking behavior usually becomes closely linked with daily activities and ‘cues’ such as: after a meal, when socializing with friends, to ‘take a break’, when under stress (to relax), when relaxing (to relax further), etc. These aspects of smoking can be just as challenging to overcome as the physical dependence.

Consequently, most people who want to quit smoking once and for all, require an approach that deals with both vulnerabilities: the addiction itself and the behavioral aspects of it. The current ‘traps’ have to be identified and after that, new patterns and routines to be developed that make it easier to ‘skip’ the impulse to look for a cigarette. Hypnotherapy can support in this aspect by allowing our mind to adapt to the new behavior, but it can’t do wonders without the patient’s strong dedication  to getting rid of their smoking addiction. The first few weeks without cigarettes are usually the hardest. After 8-12 weeks, most individuals who make it that far start to feel more comfortable without smoking. Still, only 3 in 10 people can successfully stop smoking once and for all.

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2011)

Aug 05

It can be hard to be a child or teenager in Thailand … Asia. While at first thought one might think that there couldn’t be a better environment for children to grow up freely and naturally. Many expats will confirm that their children are showing various signs of what could be called ‘adjustment problems’ if we try to avoid more negative terms. But why is that so?

The most difficult challenge for children of expats moving to Asia is to leave their previous friends and their familiar environment and to be ‘transferred’ to a completely different place in the world that often enough feels hostile and alien to them at first. They don’t understand the language, feel uncomfortable by the unknown looks of the people surrounding them, and even the unfamiliar climate and food can drag them down emotionally. It’s often the little things – things adults don’t even think about – that can be difficult for them to cope with.

Younger children are usually a bit faster to adjust. It is much easier for them to pick up on a new language and usually they will also receive a lot of positive attention from Asians which makes it easier to feel welcome and to grow comfortable in the new environment. Children older than 7-8 years and teenagers however, often fight the transition as long as they can. It is difficult for them to accept what their parents ‘were doing to them’, but then, emotional resistance makes it even more difficult to adjust. Also, the older the children or teenagers are, the higher the impact of cultural differences. If we try to imagine that it is one of the biggest challenges for children to develop confidence, not only in themselves, but also in dealing with others, we might understand better why it is comparable to a trauma if they are taken out of their familiar environment and have to decipher a completely new set of ‘social rules’ and  socialize with people they can not understand, be it in terms of the language they are speaking or the way they behave and the cultural rules that apply.

Children and teenagers having to deal with such irritations and challenges often react with protest and aggression, retreat, a drop in school performance or develop psychosomatic disorders. Parents are often enough identified as the ‘enemy’ that caused their problems in the first place. It is usually a wise decision not to try to resolve the crisis alone under all circumstances, but to involve a counselor or a friend from back home for help and support. It might take a little while, but usually it is possible even for the most difficult teenagers to gradually open themselves up and to develop a more constructive take on the situation they are in again.

In one of the next articles I will take on the challenges of expat kids who were born in Asia (Thailand).

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2011)

May 19

One of the lesser known aspects of psychotherapy is the rule of confidentiality. This rule (which by the way is not a binding part of Thai law yet, but handled very strictly in most Western countries) basically says that everything a client tells in the context of an ongoing psychotherapy has to remain between the therapist and the client/patient. In my home country Austria, psychotherapists are not even allowed to inform married partners about the diagnosis or whether the spouse or wife has been attending a therapy session or not. Clients can release the therapist from this constraint, but only to a certain extent. In court, psychotherapists are not allowed to reveal details of the therapeutic conversations as well. Exceptions to the rule of confidentiality are usually only allowed in cases where there is imminent danger.

While this regulation might sound awkward to some, it makes perfect sense. it guarantees a safe place for patients where they can trustfully express their deepest feelings and weakest points without having to fear that anyone else will ever hear about them. In times where more and more slices of our ‘privacy’ are taken away from us by governments and electronic means, and where society has developed some very tight models of ‘politically correct’ thinking, it can be very important to be able to have at least one place where you can express your thoughts, concerns, or your most delicate problems, being sure that they will remain inside the 4 walls of the therapist’s practice. It has happened more than just a few times, for instance, where men told me about pedophile or violent fantasies or where women told about certain sex-related issues or problems trying to find a partner; only if such thoughts can be expressed and openly talked about without having to fear being looked down upon it is possible to put these very delicate issues into perspective and to develop strategies on how to deal with them better than before, or maybe even to resolve the situation by applying new ideas and approaches.

The rule of confidentiality alone is a good reason why someone seeing a psychotherapist or counselor doesn’t have to consider thenselves as ‘weak’ or ‘mental’. Having an atmosphere where one can openly talk about their problems with someone who will take a neutral position and just tries to support as effectively as possible can be reason enough. If you are not sure how your therapist or counselor handles the rule of confidentiality, just ask. It’s a sign of professionalism if you receive a straight answer on it.

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2011)

May 03

Fraud, debt, murder, suicide, love, grief, depression, psychosomatic illness, destitution, drug addiction, lack of job prospects, discord within the family, delinquency in the home, … these are just some of the reasons (or consequences) Expats face when there seems to be no way to return back home. A look at the newspaper is enough, many of the expat-related press reports basically describe people who see no escape from the tension of problems here in Asia on one hand and no option for a new start back home on the other.

Although emigration feels great at first and eliminates many of the pre-existing problems, frustrations or feelings of being ‘stuck’ – sooner or later, entirely new and unexpected problems or old burdens come back one way or another. Not only is there a cultural change to deal with that was often taken lightly when leaving, but we also take our ‘backpack of mental problems’ into the new country with us. Our ‘quirks’, weaknesses, interests and vulnerabilities are superimposed by the emotional high of migration, but gradually, most people increasingly find themselves dealing with the same old problems and difficulties again.

A man who suffered from depression in the States, will most likely also have to face it in Thailand at some point. Someone with a tendency to be aggressive can’t automatically leave it behind just by crossing the border, just as it is unlikely that someone who had difficulties in the West  finding a life partner will find the perfect ‘dream woman’ in a bar. Often, the unpleasant awakening occurs months or even years later – often at a time when a return to the old home seems harder than ever, due to financial reasons, or because relationships have ended, or because a return would raise even more problems than they already face. The result is a feeling of being running around, stuck in a dead end street from which it is difficult to escape.

Many expats facing such feelings try to drown them in alcohol or drugs, entertain themselves with superficialities, or their daily life increasingly turns into a interplay between periods of aggression and frustration.

Expat clubs, social services, or in emergency cases, the embassy can provide important support. Anyone who wants to improve his or her situation and achieve a sustainable change by clarifying the reasons for the difficulties and achieving a better quality of life might find surprising new perspectives while seeking professional support like coaching for a couple of months.

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2011)

May 03

Brain doping / drug abuseIt’s very simple now to order drugs over the Internet, and most pharmacies in Asia will sell medicines over the counter that are only available by prescription in the West. Most popular products in the online catalogs are amphetamines, potency pills and antidepressants. But self-medication is actually risky, particularly with amphetamines (such as Ritaline / methylphenidate),  which can enhance performance and concentration leading to dependency and requiring withdrawal treatment at specialized clinics or psychotherapists after months or years of abuse.

According to a study of U.S. pediatricians, the number of ‘doping’ students has increased by 75 percent over the last 8 years. Often the drugs are used incorrectly, like when the cause of poor concentration or erection problems lies somewhere else than where the drug attaches. Erectile dysfunction in men aged less than 55 years, for instance, mostly has purely psychological causes. Habitual intake often leads to overdosing and increased susceptibility to disease-causing side effects. At some point, the user might in fact just treat the withdrawal syndrome (for erectile dysfunction this is often fear of having sex without first taking the drug) – they feel no significant effect of the drug anymore but can not discontinue its use and thus enter a vicious circle. Multiple dependencies, like the use of amphetamines during the day and then in the evening intake of alcohol and / or tranquilizers or sleeping pills, makes everything even more complicated and dangerous. Abuse of prescribed medications causes more accidental deaths in the United States than anything else except automobile crashes, which kill more than 30,000 Americans every year.

The first signs of psychological dependence on drugs can be feelings of insecurity or fear if no intake is possible, or if there is an increase of the dose over time, but the effect of the drug doesn’t feel the same or is completely absent. Another alarm signal could be if over the years, more and more substances are taken in without consulting a medical doctor (this also includes food substitution drugs, injections of hormones, tranquilizers, sleeping pills, nose drops, etc.).

In most cases, drug dependence is admitted very late, after diseases of the organs have developed or accidents occured (often caused by a lack of concentration). For the psychological withdrawal, a combination of psychotherapy and support groups is very effective, but a medical checkup for possible physical damage is also essential.

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2011)

May 03

When blood pressure rises, neck veins swell – and the rational mind is suspended. Aggression ‘beams’ us back to an early stage of our development … but once the adrenaline rush is gone, we often feel repentance over the damage we’ve done in our rush of emotions (be verbally or physically).

There are basically two categories of aggression: Affective Aggression (revenge, hostility, the tendency toward impulsive and uncontrolled behavior) and Instrumental Aggression (hunting, goal-oriented, deliberate behavior,). Empirical studies show that most people who have a tendency to Affective Aggression also have a lower IQ than those who do not.

Aggression is not synonymous for violence – but it can trigger violence. And there are cultural differences in the ways aggression is expressed. Studies have shown that people from the Southern states of America turn to physical violence more often than those in the Northern states than the Japanese, which prefer verbal conflict resolution. The same applies to people living in Northern and Southern countries of Europe. The murder rate is higher in these regions as well, and there is also a link between the tendency to violence and socialization. People who grow up in families with a high potential for aggression (verbal, mental or physical abuse experiences), adjust their behavior accordingly and have a tendency to outbursts of aggression later in their lives as well.

The same applies for the social acceptance of violence, such as violence against specific ethnic groups: a dynamic that is probably responsible for the never-ending spiral of violence in the Middle East. Many people also react aggressively when they feel they are not understood or taken seriously, or when they can’t achieve their goals and hopes. From a psychological perspective, this is mostly rooted in low self-esteem.

Many relationships are burdened by inappropriate expressions of aggression. Studies show that men are more likely to express aggression physically and directly, while women do it more verbally and indirectly. Relationship criseses often lead to escalating patterns – starting with a verbal exchange of blows, and at some point one partner loses control of himself/herself and injures the other one either physically or psychologically. The more regularly such processes occur, the more difficult it may be to resolve the conflict patterns in couples therapy, which again proves that the earlier professional help is sought, the more promising the results!

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2011; Image

Mar 16

Within just a few days, the media reports on the earthquake in Japan are now dominated by the nuclear disaster that occurred in Fukushima. Almost everyone who saw images on TV or newspapers will have been shocked… Personally it reminded me of the disaster images displayed in the Japanese Hiroshima Museum: deserted streets, ruins, clouds of smoke. Now, street cops are dressed in white radiation suits and wearing respirators. At least half a million people must be evacuated from the blasting zone.

What is going on in the psyche of many Japanese, who now for the second time in less than 70 years experience a nuclear disaster on their islands, can hardly be imagined. Japan has turned nuclear energy into a force of peace and economic prosperity. This is one of the great postwar achievements of Japan, not only in a symbolic way but also in a very real sense. However, yet again has the ‘atom’ has turned into a scourge of the people – despite the fact that the Japanese nuclear power plants are among the ‘safest’ in the world.

To simply put away this secondary trauma will not be possible – a repeat of the shock experience breaks the last barriers even in the most stable minds. On the surface, most Japanese react as composed as usual – but one can assume that the disaster will have massive consequences. Even a move away from nuclear energy is possible in such circumstances, despite Japan now covering 20% of its energy needs by this source of energy. But in Fukushima, Man (once again) was demonstrated his limitations.
Will the catharsis of trauma ultimately lead to a massive research for alternative energy generation technologies? Japan could prove a germ cell for that as well – just as trauma patients can often finish a successful therapy stronger and more creative, than they were before the tragic event.

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2011)

Mar 13

Thomas, recovering in the hospital with a femoral neck fracture, is still a happy person. His best friend lives in the tropics and no longer needs to work – but is always grumpy.

Several good friends have suggested to Jane that she seek therapeutic help, but she says that ‘it isn’t that bad!’. Her neighbor on the other hand, takes coaching or counseling sessions whenever she has the feeling that she wants to improve her situation, but can’t get ahead.

Everybody has different tolerance levels, compensation capabilities and expectations of life. Some people seem to have an ‘elephant skin’ and are able to take a lot of hammerings. The impression of being able to take anything however, can be because the person simply has fewer expectations of life. If he or she has to deal with relationship issues or other difficulties, they are still doing okay, because they never ever expected anything better in their lives!

Other people in turn are thinner-skinned, sensitive and seriously suffer even from relatively low stresses, conflicts and obstacles in their lives. Maybe they just have higher expectations of happiness and don’t just simply put up with every difficulty and move on as if nothing had happened.

From a psychological point of view, these approaches to our lives are coined very early in our childhood. A child growing up under difficult conditions will usually expect the same during the rest of their life and be trained to rather push them aside than to face them. Children who are raised in a stable and supportive environment, however, measure their experiences in later life based on their happy childhood and will most likely be willing to work on improving their situation, because they learned that a better way of life is indeed possible.

And how would you describe your character? Are you ‘thin-skinned’ or ‘thick-skinned’? Do you hold high standards for your life and how you want to use your time, or are you satisfied if you make it through the day without too many scrapes? And last but not least: do you want to change something about your life – or is it good enough?

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2011)