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)

May 22

Armed conflicts are hard to process. Subconsciously they remind us of our own mortality and trigger a strong impulse to sympathize with either the aggressor’s or the victim’s side. After that, the position taken will rarely be corrected. A headwind will often amplify this, sometimes by suppressing or distorting new perceptions and information. The Swiss psychoanalyst Arno Gruen analyzed the causes for human destructiveness in a remarkable way in his publications.

This momentum explains why so many individuals as well as international media and organizations had such obvious difficulties to name the violent aspects of the political protests that took place. An openly signaled sympathy for the proponents of democratic values by individual reporters would be justifiable – but having to read and hear terms like ‘defense’ or ‘justifiable anger’ even after arson and attacks against civilians took place, many of us were stunned by the noticeable partisanship and rationalization of the damage caused.

A dynamic we saw in the camp of UDD was just as disturbing. Many people inside the camp as well as many supporters outside were so emotionalized by the passionate speeches (which constantly alleged the government of having an intent to kill them), that when their leaders finally called to immediately stop the radicalization at the time of their arrest, it did not help anymore because the train was already at full speed. Not least because revolutionary movements often attract elements who join them not from political belief but rather for the pleasure of destruction and violence – a drive just waiting for the appropriate opportunity to unleash.

(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)

Tourists walking through one of the destroyed districts of Bangkok (Image: ZEIT Online)

Arno Gruen – books dealign with
Bangkok iReport CNN
This is no peasant’s revolt (The Nation)
Put an end to this rebellion (Bangkok Post)
The Shame of the UDD (Bangkok Post)
Two “protest leaders” – two interpretations of ‘peaceful opposition’
What would your government do about this (Bangkok Post guest comment)