Psychotherapie-Blog

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)

When they hear the word ‘depression’, many people think of sad or hopeless individuals who can’t cope with a life event, who are living withdrawn and are often crying their existence.

But in fact this is only rarely the case. In a U.S. study published in 1996, for example, only a third of the patients suffering from depression could name a stressful or dramatic experience that took place before the disease kicked in. And it is by no means only negative events that can trigger depression in some people, but also such as the birth of a child or winning a business contract. That not all people who experience dramatic events develop depression also suggests that other factors such as stress or genetic factors may be involved. For patients themselves or their environment is therefore usually not even possible to identify a potential reason for a probable depression – which usually leads to long delays in search for the correct diagnosis for the malaise they feel in.

Physical symptoms are another, often misinterpreted facet of depressive disorders. Headaches, insomnia, reduced memory and concentration, but also other kinds of physical pain, digestive problems or a general lack of energy are typical physical symptoms of depression.

The lack of perspective that is typical for depression, quite often also leads to self harm. Most people who commit suicide previously suffered from an (often unrecognized or untreated) depression. But it doesn’t need to be suicide: other self-defeating forms of behavior, such as alcohol and drug abuse, self-destructive eating habits or risky driving are, as studies illustrate, linked to depression in about 60% of the cases.

Particularly in older men, depression often manifests on aggression, particularly of the verbal kind, like ranting, looking down or lashing out on others or constant cynicism. Again, these persons are only rarely aware that they actually suffer from depression, but explain their inner discontent and anger with external circumstances over which they usually can’t complain too loudly and often.

About 20-25% of women and 7-12% of men suffers with depression at least once in their life time. However, the real figures are probably higher due to the frequent misdiagnoses and years of suffering without a proper diagnosis and adequate treatment.

(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)

Bipolar Disorder: Caught between depression and excitement

John always felt that his wife was ‘changeful’ – but it took both of them years to find out that she was in fact suffering from so-called ‘bipolar disorder’. People with what was formerly called ‘manic depressive disorder’ cycle between unusually intense emotional states that occur in distinct periods: ‘manic episodes’ are defined by overly joyful or overexcited states, and ‘depressive episodes’ by extremely sad or hopeless feelings. However, sometimes symptoms of one state may also occur during the other, depending on the variation of the disorder which has been estimated to afflict about one of every 45 adults, independent of sex, culture or ethnic group.

One of the most common problems of persons dealing with this disorder is that they have serious difficulty set ting and achieving goals and maintaining stable relationships in their lives. During their manic episodes, they often experience an increase in energy, set themselves highly ambitious goals and might break up their relationships with people they consider as inferior or slowing them down. They tend to self-medicate, often through substance abuse (particularly stimulants or depressants, alcohol, cocaine or sleeping pills). Some of them tend to gambling, others might become aggressive or violent or experience a break with reality. As soon as the depressive episode kicks in, almost nothing of that remains: now, feelings of sadness, anxiety and guilt are dominating, and the person might feel isolated and hopeless. The formerly high sexual drive now almost disappears, fatigue, apathy or even suicidal thoughts may occur: The rate of bipolar patients committing suicide at certain points in their lives is very high.

Today, we still know little about the causes for bipolar disorders, but studies have indicated a substantial genetic contribution, as well as environmental influence (like an unstable or traumatic childhood). It is also likely that certain triggers are required to cause an outbreak of the disorder in some people, particularly relationship issues, cultural or job-related stress or physical illness. The basis of treatment usually consists of medication (which especially for this kind of disorder should really only be prescribed by a psychiatrist!) and complimentary psychotherapy to work on environmental triggers and efficiently learn to deal with the symptoms. The prognosis for most individuals with bipolar disorder is a good one – provided that they were diagnosed accurately and received the correct treatment.

(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)

How can we become happier in our lives, and what do we need to stay happy?

Researchers have put a lot of effort into answering these questions and came up with some interesting facts that define the scientific basis of the so-called ‘positive psychology’. Today we know that about 50% of one’s happiness depends on his or her genes. About 10-15% are a result of different measurable life circumstances variables, such as socioeconomic status, marital status, health, income, sex, age and others. Research in the US, for instance, has found that older Americans are generally happier than younger adults, or that 28% of those with an annual income of $35,000 described themselves as happy while 38% were of those bringing home $75,000 or more a year. The remaining 40% of factors influencing happiness, however, are mostly the results of actions that individuals deliberately engage in to become happier. This is also where we can also deliberately start to change something right away: physical exercise or eating chocolate, for example, are both proven to release endorphines which make us feel more energetic and happy. Proximity to other happy people was also found to be an important factor – if we have a tendency to isolate ourselves or to get stuck in negative emotions out of an inability to communicate them effectively or to resolve difficult situations, it comes as no surprise that happiness will not be a frequent visitor in our homes. Even worse: if conflicts are not resolved, we frequently end up in a downward spiral that can cause chronic distress, frustration and anger, and ultimately develop psychosomatic illness.

There is also extensive research data available now suggesting that religious people are happier and less stressed. It is not clear, however, whether this is because of the social contact and support that result from religious activities, the greater likelihood of behaviors related to good health (such as less substance abuse), or of a generally greater peace of mind (‘reason for being’, ‘life after death’). However, in countries where being without religion is not unusual, the happiness rates have to be found higher as well. So there is still much to be learned about the factors that influence happiness – but while we wait for the results, we can still aspire to improve the 40% we have control over.

(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)

Psychosomatic medicine is rooted in the idea of a mind-body connection, which recognizes that what a person experiences emotionally and mentally can affect his or her body. The medical community now fully recognizes the value of psychotherapy: today it is state of the art in Western clinics to offer patients complementary counseling or psychotherapy if they have to deal with severe diseases like cancer, genetic diseases, Parkinson’s disease, cardiovascular diseases and others, or if patients require surgery. Often, therapeutic counseling is also offered if someone has to deal with infertility, psychosomatic illness, allergies or other burdening physical problems where psychological factors might play a part.

Psychotherapy has been shown to improve compliance and to reduce fears and phobias related to treatment procedures. It can further help reduce anxiety and depression, and to communicate better with the physicians. Observational studies evaluating the psychosocial status of patients with severe diseases like cancer even showed that patients with low levels of social and emotional support, or that suffered from chronic depression were more likely to die from cancer. Studies by S.Levy, for example, showed that breast cancer patients that had poor adjustment and lack of social support had a lower natural killer cell activity, and that natural killer cell activity predicted disease progression and disease recurrence.

However, even if some results of similar studies have shown insignificant results and though there has still lots of research to be done to find out about the correlation of well-being and physical recovery when having to face diseases, the fact that complementary counseling during treatment and recovery can strongly improve quality of living and contribute to a more balanced emotional state calls to consider counseling or psychotherapy as an important part in a holistic treatment approach. Way too often, patients recovering from surgeries or other effects of severe diseases develop depression or anxiety – and often enough it is on us – good friends or relatives – to help them regain their mental wellbeing and strength as well.

(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)

In a global survey that was released a couple of months ago, about 10 per cent of males said that they had experienced premature ejaculation: coming too quickly is one of the commonest of all sexual problems. Not too surprisingly, especially younger men are suffering from it – as they grow older, most men will usually gain better control.

But what exactly is premature ejaculation (PE)? That’s an interesting question, as the ideas of what is ‘normal’ are differing amongst people and what doctors or therapists think is just one side of the medal after all. An American research paper stated that the average lasting time of men with PE was 1.8 minutes, while ‘normal’ men lasted an average of 7.3 minutes. However, there are men and women who are not sexually satisfied even if the man can last 5-10 minutes – and who could blame them for needing more? But according to clinical manuals, only the approximately 2.5 per cent of men who can’t last 90 seconds inside the vagina would be diagnosed with PE. Sex therapists see PE as the inability to sufficiently enjoy and play with the various levels of arousal between the start of an erection, sexual intercourse and the orgasm. Men suffering from PE are almost directly piloting towards the orgasm right from the beginning of the intercourse and have very little control over its length or intensity. In severe cases, affected men can’t have sex because they ejaculate before actually getting into the vagina.

While PE doesn’t necessarily have to be considered as a serious problem, it can make sex frustrating and even annoying for both partners. Yet, psychological pressure will often negatively affect sexual performance or even increase the problem.

Today, health professionals agree upon that PE is only caused by psychological factors, so it can usually be successfully resolved after a couple of sex therapy sessions. While there are ‘tools’ like local anesthetic gels or ‘long love condoms’, they can’t help with the roots of the problem or even further reduce sexual confidence because patients often feel increasingly dependent on the product. Also, these kinds of products often affect the sexual experience of the woman. Sex therapy will usually involve efforts to understand the psychological patterns triggering the dynamics involving PE, and the integration of techniques allowing to regain control over the sexual act. Often, ‘homework exercises’ will be prescribed in order to control the success of the therapy sessions and to achieve stable long-term effects.

(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)

The term ‘messie syndrome’ first appeared in the media when an American woman published how she had turned into a ‘messie’ during the 1980s and how difficult it was for her to change her behavior and get control over her life again.

Messies accumulate objects that have become worthless and useless in their apartments. Slowly, these places will become less and less habitable, in extreme cases they can just be crossed by narrow corridores between stacks of filled plastic bags, storage boxes or heaps of old magazines or books; they might even become a hygienic issue due to insect infestation or bad odor. Still, a messie can not just throw these things out, as he or she feels that they have important emotional value or that one day, they might need them again or that some of them belong to a certain collection they want to keep.

The deeper psychological problem of ‘messies’ is that they have serious difficulties to maintain or achieve order and to organize themselves. While they are often aware of the problem and develop plans on how to get rid of their ‘mess’, they fail at putting these plans into action, which leaves them even more frustrated. This also has an impact on their self-esteem and quite often results in refraining from social contacts, at times resulting in chronic isolation.

It is not a solution to force affected persons to organize themselves and get rid of what we see as ‘rubbish’, they would see that as violent, rude, and a serious intrusion into their privacy. Messies are often very intelligent and sensitive people, they easily perceive if someone doesn’t take them seriously. They just lack the automatism that old stuff has to be chucked away.

Today, a well-proven approach to help messies to slowly solve their problem, is a combination of psychotherapy and if possible, to find peer exchange in self-help groups. In severe cases, social workers might have to be involved. The affected persons will learn how to develop and apply strategies that will eventually work out better than what they themselves have tried so far. It might be something that takes some time, but at the end, the former ‘messies’ will gain personal freedom and remarkably improve their self esteem.

(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)

You have plenty of time, but can’t get things done? Busy with many little things, but way too often find yourself postponing the really important tasks?

Then you might be one of the many people suffering from procrastination. Procrastination often looks like self sabotage, since it can result in missing important business opportunities, offending others by repeatedly arriving too late at appointments or not finishing crucial steps in achieving carreer-related or educational goals.
Out of that, many develop feelings of guilt, stress and a reduction of self-esteem, which itself can leed to further procrastination, and even depression. So-called ‘Messies’ often show symptoms of procrastination as well.

Another cause for difficulties in achieving goals can be juvenile or adult ADHD (Attention-Deficit Hyperactivity Disorder). People with untreated ADHD often appear to be disorganized, have chaotic lifestyles, and tend to rely on (non-prescribed) drugs and alcohol to get by. While childhood ADHD gets lots of attention these days, psychologists and psychiatrists have found that quite many adults are suffering from the same impairments, though with slightly different symptoms.

But how to get rid of this inhibition of getting things done? My observation is that many people who are suffering from it tend to buy an abundance of guidebooks with lurid titles like ‘Everything Is Possible!‘ which usually contain at least a few dozen instructions and tips each – but at the end, this only leaves them feeling more frustrated and inapt than before. If you want to get to the roots of your problem, first check for ADHD as a potential cause by getting a diagnosis from a psychiatrist, psychotherapist or psychologist. While ADHD may require medical support in many cases, procrastination in general is a problem that can be succesfully dealt with through regular counseling and Coaching over a reasonable amount of time.

(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)

The adolescent years are a very critical period of adjustment for both teens and families. Teenagers have to adapt to many physical, mental and emotional changes during this phase of life. As parents and as community members it is important to be aware and understand how teens develop, the challenges that youth face, and the ways in which the family can help them to become and stay as physically and mentally healthy as possible. Talking to teens about issues of mental health can be difficult – but it is the best way to understand what they are going through and if they need to get help. In my experience, it is often easier for teenagers to open themselves up towards relatives, professional counselors or other non-family members.

Being a teenager is hard. Teenagers are under stress to be liked, to do well in school, get along with the family and they have to make big decisions. Most of these pressures can’t be avoided, so it is perfectly normal to worry at times. But feeling very sad, hopeless or worthless could be warning signs of a mental health problem one should seek help for. Such problems are real, sometimes painful and severe. As a teenager, look out for help if you have the signs mentioned above or if you

• Often feel very angry or worried
• Feel grief for a long time after a loss or death
• Feel very fearful at times
• Think your mind is controlled or out of control
• Primarily communicate with others over the Internet
• Spend lots of time on Online Games
• Use alcohol or drugs
• are constantly concerned about physical problems or appearance
• Exercise, diet and/or binge-eat obsessively
• Hurt other people or destroy property
• Do reckless things that could harm you or others
• Feel shy or unconfident amongst others
• Have problems in school but see no way out of it

To find help, discuss your concerns with your teacher, school counselor or others such as a family doctor, psychiatrist, psychotherapist, psychologist, social worker, religious counselor or nurse.

(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)

Relocated to my English website:

http://www.counseling-office.com/pt-blog/gambling-addiction/