Growing up in Thailand, the Land of Smiles, I often saw the country as a place where people are happy and enjoy all aspects of life. Thailand has always been known for its hospitality and is a top destination for travelers, who often cite the nation’s warmth and friendliness as one of the main reasons they return. With such warm and friendly locals, people may overlook the struggles the population faces on a day-to-day basis (Sriyananda, 2025).
The idea of maintaining a positive public image for yourself and your family means that admitting to challenges can be seen as losing face or disgracing the family. Thai communities also expect men to hide their emotions and be providers for their families in a traditional, patriarchal way. This was very prevalent in my family as well. The importance of maintaining a high social standing meant that if you struggled with anything, even mental health, it would reflect poorly on the family and bring shame. It’s a deep-rooted struggle that many of us in Asian families face.
The idea of always appearing to have it all together is very important. This is quite contradictory to how we grew up in Thailand, because Buddhism teaches us to be compassionate, empathetic, and to allow ourselves to express and process our emotions. However, this often contradicts our culture, and that is where the complexity lies: our religion tells us to do one thing, but our culture tells us to do another. It’s hard to maintain that balance. While Buddhism is practiced and adhered to, it still doesn’t relieve us of those mental health struggles as one might think.
Talk therapy is not common in Thailand. It is viewed through a different cultural lens, similar to making merit or going to the temple. There are even cultural superstitions that talking about one’s emotions may bring bad luck. The idea that if we were struggling with mental health, it’s due to bad karma from our past life is also another reason it brings shame upon the family to talk about mental health. The first form of treatment is usually medication, and processing emotions is very rare among mental health struggles in Thailand.
According to the WHO, over 289 million people in Southeast Asia struggle with mental health, neurological, or substance use conditions (World Health Organization: WHO, 2025). According to Thailand’s Mahidol University, there are around 320 clinical psychologists in Thailand, with only 1.3 psychiatrists per 100,000 people (Mahidol University, 2025). With a population of 70 million, Thailand faces significant challenges in addressing mental health needs. Even if Thais are brave enough to seek care, it is hard to find and even harder to afford. And it’s not just Thai people who struggle; expat groups who move to Thailand seeking a paradise and a lower cost of living still face mental health issues, even in a new therapists is very difficult and usually requires searching in Bangkok hospitals or other cities. Expats living in rural areas will struggle to find any such services, and those English-speaking services are often costly for people who have moved across the world.
With retirees, once holiday mode fades and the realities of bureaucracy set in, the joy of a new adventure may well turn into disappointment. For some, this can be an issue of destination happiness, believing that once they move to a new place, life will be ideal. As for working expats, adapting to the workplace culture is more nuanced. For instance, Thais are notorious for eating around the clock and keeping snacks in their office drawers. A Germanic hotelier was even fired for trying to ban snacking in the office! Navigating such hidden cultural norms may prove stressful.
As for karma and accepting one’s lot in life, it can make for peaceful acceptance. One CEO asked his driver if he got frustrated with the traffic and having to drive him around, or if he had bigger ambitions. The driver’s response was, “Sir, this may well be my karmic debt to you. Perhaps in my next life, provided I live a mindful and charitable one now, I may return as someone like you, being driven around.”
With this in mind, our cultural stigma around therapy continues to linger. However, the stigma is slowly changing. Many people in Thai communities are speaking out about mental health and their struggles, encouraging younger generations to be more open as well. While the stigma still exists, the tide is slowly shifting. The hope is that more Southeast Asian countries will gain access to mental health services and that more individuals will seek therapy.
Sriyananda, V. (2025, March 26). What is the State of Mental Health in Thailand? Pacific Prime Thailand’s Blog. https://www.pacificprime.co.th/blog/state-of-mental-health-in-thailand/
World Health Organization: WHO. (2025, July 24). WHO South-East Asia launches mental health dashboard to accelerate and strengthen evidence-based action. WHO. https://www.who.int/southeastasia/news/detail/24-07-2025-who-south-east-asia-launches-mental-health-dashboard-to-accelerate-and-strengthen-evidence-based-action
โครงการสุขภาพคนไทย. (2568). Thai Health Report 2025. In สุ ถานการณ์์และผลกระทบสุขภาพจิตในประเทศไทย (pp. 12–14). สถาบันวิจัยประชุมและสังคม มหาวิทยาลัยมหิดล.
Nicholas Schaub is an Associate Marriage and Family Therapist dedicated to supporting clients on their path toward healing and growth. He holds an undergraduate degree in Psychology with a minor in Entrepreneurship, as well as a master’s degree in clinical psychology with an emphasis in Marriage and Family Therapy, both from California Lutheran University. Having lived in Thailand, the Philippines, the United Kingdom, and the United States as a third-culture kid, Nicholas brings a deep appreciation for cultural diversity and adaptability to his practice. His global upbringing fosters a culturally sensitive and open approach, enabling strong connections with clients from diverse backgrounds. Aiming to break the stigma around men seeking therapy, Nicholas is committed to offering a safe, inclusive environment where clients of all genders and backgrounds can share openly and feel genuinely supported.
