Thailand

I work with expatriates in Bangkok and across Thailand online, by secure video, in English or French.

The arrangement, and why it works so well

A great many men arrive in Thailand having decided, consciously or not, to start again.

What Thailand offers is not simply a lower cost of living. It is the removal of the audience. Nobody here knew you before. Nobody is keeping score against the person you were at forty in London, Sydney or Frankfurt. The professional identity that took thirty years to build can be set down, and with it the obligations that came attached.

So a second adolescence becomes available, and it is genuinely enjoyable. Late nights are possible again. Attention from much younger women is available in a way it was not at home. Alcohol is cheap, constant and entirely normal. Drugs are cheap. Nothing has to be explained to anyone.

This is usually described as a midlife crisis and then dismissed. That is a mistake. It is a real psychological event, and dismissing it is precisely why it goes untreated for years.

What is actually happening

A second adolescence is an attempt to answer a question that was never answered the first time.

The question is not about women, or drink, or the freedom to stay out. It is about meaning. Somewhere in the previous life the sense of purpose came out of the arrangement, and what was left was performance without content. Thailand does not create that emptiness. It offers a very effective anaesthetic for it, and the anaesthetic works well enough and long enough that the question stops being asked.

For a while this looks like happiness. Most people who eventually contact me were, for the first year or two, genuinely happier than they had been at home.

Then the arithmetic begins. The drinking that was social becomes daily. The relationships get shorter. The money moves in one direction. Old friendships thin out because there is less and less that can be said honestly. And underneath, usually, is something much older: a history that was never dealt with and that the whole arrangement has been organised around not feeling.

The trauma nobody came here to treat

A significant proportion of the expatriates I work with are carrying trauma from long before Thailand. Childhood, a marriage, a bereavement, a career that ended badly, something that happened once and was never spoken about.

Leaving the country does not process it. It removes the reminders, which is a different thing and works surprisingly well for a time.

That is why so much of this work is not really about the drinking. The drinking is the presenting problem. Underneath there is usually an untreated trauma and a lost sense of meaning, and treating the alcohol while leaving those alone is why people stop for six months and start again.

Thailand and the residential question

Thailand is one of the largest destinations in the world for residential addiction treatment. People fly in from everywhere for it, and some of it is excellent.

Which produces a particular irony for the expatriate already living here: world-class residential treatment is on his doorstep, and he will not go into it. Not because it is far, but because walking through that door is the public admission he moved eight thousand miles to avoid making.

So the choice is not really residential or therapy. It is therapy or nothing, for years.

That is the person this practice is for. One to one, weekly, confidential, without an admission, without an absence, and without anyone at home needing to be told.

Why online, and why from outside

Bangkok has good clinicians, and there are English-speaking therapists here. But expatriate communities are small and they talk. The person you would be seeing may well drink at the same bars, know your employer, or know the woman you are living with.

I do not know your GP, your employer, or anyone who drinks in your local. Nobody I know will be in the room when your name comes up. For a good number of people that is the entire reason they made contact.

What I work with

Addiction, including the combinations that are specific to this part of the world.

Alcohol, particularly the functioning drinker whose consumption looks unremarkable against everyone around him.

Trauma, including complex and childhood trauma, using EMDR delivered online.

Chemsex and sexual compulsivity, where drug use and sex have become a single behaviour.

The midlife crisis, which is the frame that makes sense of most of the above.

Online psychotherapy, how it is delivered and why it works.

Some figures, for context

Thailand consumes about 7.99 litres of pure alcohol per person a year among those aged fifteen and over, on World Bank and WHO figures. That is not extreme by European standards. What is different is not the national average but the expatriate environment: alcohol is inexpensive, permanently available, socially compulsory, and nobody is counting.

On drugs, there are two separate markets and they rarely get described separately.

The Thai drug is methamphetamine, in tablet form as yaba and crystal as ice. Prices have collapsed over two decades, from around 200 baht a tablet to roughly 20 in the provinces and 50 to 60 in Bangkok, and use rose by about thirty per cent in a single recent year. Thailand records the largest methamphetamine seizures in East and Southeast Asia, including one seizure of a billion yaba tablets.

The expatriate drug is cocaine. It is expensive here, considerably more so than in Europe, and that is part of its function: it signals that you are not using what the locals use. It travels with the drinking rather than separately from it, and in this practice the two almost always arrive together.

The two markets meet in one place, which is chemsex, where crystal methamphetamine crosses over into the expatriate scene through sex rather than through the street.

That combination, cheap stimulants and unlimited alcohol in an environment with no witnesses, is not a moral problem. It is a clinical one, and it accelerates things that would otherwise have taken a decade.

Practicalities

Sessions are fifty minutes, weekly, by secure video, from Bangkok, Chiang Mai, Phuket, Pattaya or anywhere else in Thailand. In English or French.

Clients may work with me directly or, where appropriate, with an Associate under my clinical supervision.

If in-person or residential treatment is what you actually need, I will say so at the assessment rather than six months in.

Dr Philippe Jacquet is a UKCP registered psychotherapist, a Jungian analyst and an HCPC registered art psychotherapist, with twenty-five years of clinical practice. His Doctorate of Professional Practice at the University of Essex examined male eating disorders from the perspective of analytical psychology. Registration can be checked on either public register.

In crisis in Thailand: the Samaritans of Thailand English line is 02 113 6789, press 2. It is anonymous and staffed around the clock; leave a message and someone calls back. The Department of Mental Health hotline is 1323, free and 24 hours, in Thai. In an emergency, go to the emergency department of an international hospital and ask for the psychiatrist on duty.

Alcoholics Anonymous runs English-language meetings in Bangkok, Chiang Mai, Pattaya, Phuket and Udon Thani, as well as online.

Statistics: World Bank and World Health Organization alcohol consumption estimates; United Nations Office on Drugs and Crime regional synthetic drug reporting. This page is for information and does not replace assessment or treatment.