Feb 19

‘And meanwhile, in Thailand…’ – it feels like looking back into how mental health issues were dealt with 100+ years ago in Europe.

Thailand is very backward with respect to public information regarding mental illness and its treatment and training for mental health providers. The highest degree in psychology in Thailand is a bachelor degree, and psychotherapy in general is not been heard of, let alone being an integral part in modern health (or at least mental health) treatment.

What happens is that many people, especially in the countryside, are locked up or chained by their relatives or other people in their villages. They are called ‘baa’ (crazy) and are often considered as obsessed by ghosts or demons. Sometimes, the village head or ‘healers’ will involve some amateurish form of electro shock therapy which causes memory loss or more serious neurological damage. If mental patients are lucky and a medical doctor or even psychiatrist is in reach, treatment usually only consists of dropping pills, but there is no psychotherapy, no counseling, no social work.

And if all of that wasn’t enough, the well-hyped ’30 Baht [1 USD] healthcare scheme’ introduced by former PM Thaksin Shinawatra led to most of the better doctors leaving the (low-paid) countryside and now working in the highly paid private hospitals servicing foreigners.

Also, there is very little personnel trained in geriatric mental health care. With an aging population and growing numbers of patients afflicted with age related dementia, one may well call this a health care crisis.

Expats are in a somewhat better position, as they can afford to seek professional psychotherapeutic or counseling support from well-trained Westerners. Thai psychiatrists, even if Western-trained, are often sticking to medication as only means of treatment, and many of them also lack of understanding Western culture and mindsets.

“According to the Department of Mental Health’s survey, conducted 4 years ago, less than one percent or 400,000 Thais aged between 15-59 years are suffering from various type of psychotic disorders. The most common type of mental illness suffered by 70 percent of Thais with a mental disorder is Schizophrenia”

These numbers sound highly implausible and illustrate the very limited quality of mental health research (and consequently, treatment) in Thailand. Let us hope that the new focus of the Department of Mental Health to avoid maltreatment of mental health patients is only a first step of many necessary changes in policies and education of the public just as well as the professionals already working in the field.

More on the campaign: http://tannetwork.tv/tan/ViewData.aspx?DataID=1052726

Dec 19

“Burnout in Thailand? Impossible!”

That’s probably what most of us would think. But symptoms of ‘burnout‘ are not always linked to high workload alone, they can also have other causes. I have identified 3 groups of people that are vulnerable to symptoms of burnout, even in a sunny, tropical country like ‘mai bpen rai’ (‘everything up to you’) Thailand, but of course also other tropical countries abroad:

First, there are the foreigners who try to make a living here and who are employed by foreign or local companies. Often, they have to face high amounts of work-related pressure and stress right from the beginning of their assignments, while having arrived completely unprepared for the cultural changes they would have to face. Many are surprised and overwhelmed by how hard it can be to ‘juggle’ giving up the old life, finding and adapting to a new home, new colleagues and their work ethics, and learning how to get around and at the same time, to meet all the expectations they put on themselves.

Then, there are foreigners who try to start their own business in an Asian country like Thailand. These expat entrepreneurs are completely on their own, having thought that their experiences as tourists should have prepared them well enough. Soon, however, they face all kinds of obstacles in building up a successful business venture here as foreigners. Many things don’t work out as they would have back home with the same effort and money put into the project. Many little annoyances might gradually not only take the fun out of their dream of working in an Asian country, but lead to outright frustration and the feeling of never reaching a point where everything runs smoothly. And I haven’t even mentioned dealing with governmental institutions and paperwork.

Finally and probably surprisingly, even retiring in Thailand (but just as well in any other tropical country) can lead to ‘burnout’. I already mentioned the huge changes a migration to another country involves, and even if everything started happy and smoothly, after some time, the excitement might gradually fade away, perforated by disturbing or even annoying little experiences, social isolation or conflicts with other people. Also, many Westerners suffer from a lack of challenge and communication: they are bored out by the daily routine that kicks in after a while and feel stuck between meals, drinks and hanging around without any kind of challenge. Even finding someone to talk to at a certain nouveau level might prove difficult. But being ‘bored out’ has many physical similarities to burnout and might gradually make us just as sick and depressive. So it is important to take these signs seriously and fight them at an early stage before one gets overwhelmed by his or her own negativity.

In an followup entry of my blog, I will write a bit more about typical symptoms of burnout and boreout, and also outline strategies on how to deal with them.

(This short article is the blog-adapted version of an article dealing with psychological expat problems and general mental health issues that was published in various newspapers and magazines in Thailand, 2011; image credit: Shiho Fukada, NYT)

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 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)

Mar 13

Everybody knows at least one: unhappy expats. Well, some of us might just have to look at ourselves…

Frequent complaints about ‘the Thais’ and the annoyances of daily life in Thailand, ranting about other expats, worrying about sickness, feeling isolated, bored or easily upset: all of these symptoms are quite typical amongst people who are experiencing culture stress.

In the late 1960’s, American anthropologist Kalervo Oberg described stages of what he called culture shock: the honeymoon stage (idealizing the host country and being excited about moving there), crisis stage (emotional stress and rising frustration, often along with physical illness caused by turning overweight, a reduced immunity system and congestive problems), recovery stage (getting familiar with the host country, learning the language, understanding cultural differences) and adjustment stage (integrating cultural differences and adapting to the host country).

Some people have difficulties reaching the recovery and adjustment stages, or repeatedly fall back to phases of serious cultural stress, even after having spent months and years in the host culture. They are dealing with what experts call the ‘expat syndrome’. Often, the reason is a lack of resiliency and/or communication skills, a lack of information about how to deal with cultural stress, and some expats simply can’t accept that certain aspects of the different culture will probably never change. Unfortunately, this means that they have to experience constant emotional stress, putting a serious strain on their bodies that will sooner or later cause physical illness. Psychologists have also found that many symptoms of culture stress are very similar to symptoms of post-traumatic-stress disorder.

Of course, counseling can help ‘boost’ the cultural adaptation process.Expat clubs are a very valuable resource of experience, just as many books that deal with cultural differences make it easier to understand why many of us feel as we do and how to improve our situation. Treat yourself well and use these resources if you can manage it, because after all, each of us initially came here to live a happier life, didn’t we?

(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 12

When I first came to Thailand, I wondered: given the healthy Thai cuisine, why are so many people – especially expats – overweight?

Take a look on any street: at least one in three expats is obese. This is a high percentage, comparable only with the ‘fattest’ States in the USA, and¬† is responsible for many of the health problems some expats have to deal with after living just for a few years in their new home.

But how exactly is ‘overweight’ actually defined? That’s an easy one: to calculate your BMI (Body Mass Index), you simply divide your weight in kilograms by the square of your height (or multiply your weight in pounds with 703 and divide the result by the square of your inches). At a height of 1.72m and 75kg weight, the formula would be: [75 √∑ (1.72 m)¬≤ = BMI 25.4] (or at 150 lbs weight and 5’5″ (65″) height: [150 √∑ 65¬≤] x 703 = 24.96). Overweight is defined as a BMI of 25.0 or greater, obesity starts at 30.0. According to doctors, a BMI higher than 27.5 imposes major risk factors for cardiovascular disease, certain types of cancer, type 2 diabetes and joint problems.

But what makes some of us so prone to gain weight rapidly in Thailand? Alcohol is one explanation, fats another. Of course, many expats drink too much and forget (or repress) that alcoholic beverages are real calorie bombs. And, many Thai kitchens cook with too much fat, and in the past several years, the food has become too sweet and salty; while these dishes may taste good, they are no longer healthy.

But where does this tendency to eat and drink too much derive from? One explanation is that eating and drinking is a compensation option for everyday frustration and boredom. Many expats have little to fill their days, and kill time by eating and drinking, for some, a visit to the buffet can be the highlight of the week.

As a sex therapist, I have to mention the hormonal and psychological changes experienced, particularly by aging men. In their younger years it was their daily goal to have sex and workout, now that they are older the epitome of sensual delight is enjoying their lunch or dinner … unfortunately to the chagrin of their body and often enough also of their psyche. Because obesity increases the incidence¬† of depression, a vicious spiral might be triggered driving them to eat even more. One of the difficulties in finding a balanced diet, is that eating too much often has downright addictive dynamics. This is one reason why serious weight loss programs always involve counseling and psychotherapy as an integral part of the recovery plan. One can do a lot alone – but with some outside support, success usually comes much easier and faster.

(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)

Jan 26

The grass might not be greener on the other side of the border, a new study from the University of Leicester has found. According to it, economic migrants travelling to different shores for greater income could be set for disappointment, because the pursuit of wealth does not necessarily equate with happiness.

Sociologist Dr David Bartram carried out the study: “Economic Migration and Happiness: Comparing Immigrants’ and Natives’ Happiness Gains from Income.”, in which he sought to establish whether those people who were motivated by higher incomes in a wealthy country actually gain greater happiness via migration. He also examined whether these economic migrants might have exaggerated expectations about what they will achieve and experience, such that there is some significant disappointment.

The result, according to Dr. Bartram: “The study of happiness tells us that people generally do not gain greater happiness from earning higher incomes – which suggests that migrants might be mistaken in believing that they will be better off if they can move to a wealthy country. (..) I also considered whether those who choose to migrate to a wealthy country are different from most people in this regard – perhaps they do gain greater happiness from higher incomes. So, the research seeks to determine whether in general we should be pessimistic or optimistic about the consequences of migration for the migrants themselves.”

“The results suggest that economic migrants might well experience disappointment. Migrants do gain happiness from higher incomes, to a greater extent than natives – but the relationship is weak even for migrants. In fact, it also works out that migrants are less happy than natives. The probable reason is that they expect to be happier by virtue of earning the greater incomes available in a wealthy country — but they end up wanting even more after they get there: aspirations probably increase at least as much as incomes! In short, even after an increase migrants find it difficult to feel satisfied with their incomes — just like the rest of us.
Many of us are guilty of believing that money is more important for happiness than it is – and this research suggests that migrants are not terribly different in this regard. Life as an immigrant in a wealthy country can be very hard.”

The research examined responses from 1400 people in the World Values Survey (existing survey data). Dr Bartram said that his study might also serve to allay some media fears and people’s concerns about being “overrun” by immigrants: “The fact is, most people around the world do not want to move to a wealthy country like the UK: perhaps they understand that money is not the most important thing, that there would be a real price to pay in leaving one’s family and community. And perhaps the research could also help potential migrants, especially those who are attracted by wealthy-country income prospects, to develop a better understanding of what life as an immigrant in a wealthy country would really be like.”

(Sources: ScienceDaily; Bartram, D.: “Economic Migration and Happiness: Comparing Immigrants‚Äô and Natives‚Äô Happiness Gains From Income.” in: Social Indicators Research, 2010; DOI: 10.1007/s11205-010-9696-2)

Aug 10

‘Mike? I haven’t seen him for quite some time now!’

When the initial euphoria about life abroad has settled, cultural quirks, disillusionment and language barriers, coupled with a lack of a support system can create a sense of loneliness for expats. Even those who coped quite well with the challenges of transition, start to miss a close and sufficiently large circle of friends after a while. Many may have loose leisure or sports partners, but no one they would call a really good, intimate friend. So even life in Thailand can start to feel depressing after a while – out of recurring feelings of loneliness.

Younger people usually deal with this challenge more easily – it is usually easier for them to integrate into new environments, to learn the new language and to make contacts with local people. Older people, however, often develop a desire to retire from public life. Over the years, many of them even tend to reduce their contacts to the people they once enjoyed hanging out with, only leaving their apartments to buy goods or to (quietly) attend the weekly expat meetings. Eventually, even that may feel to exhausting. So it is that we have to read in our newspaper that people died isolated and lonely – whether from illness or even by their own hands. In my view, that’s the worst end of life, considering the dreams they once had in mind when deciding to move to popular retirement countries like Thailand, Gran Canaria or New Zealand.

When confronted with loneliness, feelings of depression or anxiety: stay active, keep meeting your friends and maintain your hobbies! But also keep an eye on your friends and acquaintances: how are they actually doing right now?

(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, 2010)

May 30

Can we ‘modify’ our brain structure? Until recently, the general consensus among neuroscientists was that tbe brain structure is relatively immutable after a critical period during early childhood. But new findings reveal that many aspects of the brain remain plastic even into adulthood.
Neuroplasticity is a fascinating discovery referring to the ability of the brain and nervous system in all species to change structurally and functionally as a result of input from the environment. Naturally, this concept can explain much of why psychotherapy can be very effective to improve our mental wellbeing on a long-term basis, but it also has consequences the other way round:

German neuroscientists found out that cortical brain maps are shrinking and the sense of touch is waning when brain regions are not used for some time. Of professional musicians and braille readers we know that a more frequent and intense use of the hands can result in an astounding improvement of sensorimotor abilities. The representation of the hands on the “body map” of the brain is increased by training – but the process also works in reverse, as the neuroscience research group found.

If a hand – for example due to a broken arm – is not used for a while, its representation is reduced in the brain its sense of touch as well. With the affected hand, subjects took two needle points as a single one, even though they could clearly feel that there were two peaks with their good hand. However, these effects are also reversible: a few weeks after the plaster was took off, the sense of touch and the activity in the somatosensory cortex were back at the previous level. This leads to interesting hypotheses regarding the necessity of stimulation and an extent of challenge in our lives to keep our brains functional, maybe even to keep up our mental health in general.

Source: Current Biology, “Immobilization Impairs Tactile Perception and Shrinks Somatosensory Cortical Maps” (doi: 10.1016/j.cub.2009.03.065)

Terms Cloud:
06.01.16