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The great number of male adolescents in this study cannot be dismissed lightly. Of the 139 male patients, 41 were young students. This number is approximately half of the combined 21-40 years age group, a relatively greater percentage than the female counterpart. The adolescents ranged from 14.20 years of age, but there were five other boys who at age 23 or 24 continued to exhibit symptoms, behavior, and fantasy patterns which were strikingly adolescent.
Parental unhappiness and anxiety over his performance in school, the adolescent’s temper outbursts arid uncontrolled activities, or the appearance of somatic illness or markedly phobic behavior were reasons which brought him, and his parents, to the psychiatrist. The mother was nearly always the parent more concerned and upset; it was she who discussed the problem first with the doctor before the boy was seen. It was not unusual, however, to see her come with the adolescent in tow and the problem stated then and there. “He can’t sleep”; “He won’t leave his room”; “He can’t control himself”; or “He’s failing in Pilipino and Math” were the usual first statements.
The clinical picture presented by the patient when first seen, is most frequently that of an acute failure, unable to function in the face of what he perceives to be an overwhelming challenge. The consequence may be a grossly disabling psychophysiological reaction or. an acute phobic state. Less dramatically, it might be manifested as increasing short-temperedness or angry outbursts or violation of parental rules. Or the patient might simply be utterly confused and stunned by the imminent failure experience; he would come in looking as if he were bereft of all defenses, not knowing what had hit him.
Generally, the earliest signs that all was not well came during the last two years of high school. This was as far back as patients’ recollections could go. Many could trace the beginnings of emotional instability as fleeting insomnia, difficulties in concentration, listlessness, obsessional bouts with sex, conflicts about masturbation, frenzied “barkada” activities, the first heterosexual difficulties, occurring during this time in third or fourth year high school, when they were 13 or 16 years of age. However, they usually managed to muddle through and graduate from high school.
The climactic breakdown occurred during college years, either at the start of the, first or second year or towards the end of the third or fourth year. The parents were taken by surprise by his failure, by his behavioral aberrations or by the illness itself. In other cases, the patient was in the first year of an initial job experience when the breakdown came. The beginning decompositions actually started during the last year of college and in particular, the months before graduation.
A few were brought in at an earlier age. There were six patients, 13.14 years old, in the first and second years of high school who were brought in by parents because of poor grades and rebelliousness towards them. One of the boys stuttered and another habitually stole money from people at home. Two young boys had alarmed their parents, not so much because they did not pass their subjects but because they were exhibiting effeminate tendencies. They had developed an overfondness for another boy, arousing parental suspicions.
The majority of young men who decompensated in college blamed various factors for their difficulties. Conflict with the peer group in the form of competitive activities outside the classroom, causing one to be deeply hurt, was a common story. Arrogance of some professors who seemed to have a knack for humiliating students, especially the meek-and-insecure-looking, was another frequently cited provocation of angry tensions. Above all, the general atmosphere of heightened challenge, enhanced by frightful warnings that college was mainly an obstacle course, and rapidly rising expectations by family and friends with pressure from them combined to produce a state of insurmountable tension. The period before or during examinations was notoriously replete with aches, pains, and various kinds of anxiety and psychophysiological reactions.
The last straw might be a seemingly inconsequential incident or one apparently unrelated to the problem—a bout with flu, a witnessed fight, fright caused by a fire, a dental extraction, too much partying, or an emotionally painful incident to which the reaction was way out of proportion, e.g. a scolding by the teacher, a reprimand by the parents, an unpleasant encounter with a girl (like being snubbed or teased by her), or a quarrel with a friend.
Somatizarion was readily utilized, the most common manifestations being stomach or epigastric pains and headache. The patient might come with an annoying sinusitis which he says prevents him from concentrating on his studies. He would likely insist that something be done to his nose. Two patients felt that the shape of their nose was the main cause of their trouble; another one blamed his lack of height.
Fear of reciting or getting up to talk before a group was a rather frequent complaint in this group of adolescents. Clammy hands, nausea, palpitation, headache, and dizziness were mentioned as reactions to this fear. Asked to explain why, they mentioned the fear of making a mistake because then they would be laughed at.
Of the 35 adolescent boys who had problems with college work about two-thirds dropped out for the semester or the year. ”Nervous breakdown” was the usual euphemistic term parents and the patient used to label the whole experience. The somatic symptoms afforded a graceful exit. Some returned after a year; several changed college courses. Others transferred to other schools. Still others indicated no desire at all to resume the challenge, at least for the time being.
The Filipino adolescent who took time out of school or college was actually going through an “identity crisis” such as what most adolescents experience in varying degrees and with varying consequences. This can be a positive period for the young man in terms of finding himself, defining his own likes and dislikes and channeling his newly found interests and energies according to his choice. When parents and the culture rigidly decree what he should do or not do, they run counter to important psychological events within the adolescent which events are crucial to his spontaneity, creativity, originality, and the kind of personality patterns he prefers.
The Filipino adolescent in this study, forced to leave school, was reacting to the conflict between his private, psychological stresses and the demands and pressures from his environment. To label him a failure or a dropout at this stage would be inaccurate and unfair. His family and the people around him were inclined to label him as such. Both parents and professors seemed contemptuous of failure and over-stressed the glory derived from good grades. They were mainly interested, as indicated by the kind of educational experience they were prescribing, in forcing the young man to adjust and succeed according to cultural norms. It seemed to matter little to them that the adolescent needed a wider, more flexible base of emotional support to enable him to find his own identity choice, which may or may not coincide with what his parents and professors wanted.
Compared to his American counterpart, the Filipino college student in this study was usually younger by a year or two in age.
He had barely entered adolescence when the emotional and intellectual load, of college life was thrust upon him He was also much less prepared than, say, his American counterpart for challenges which required previous training on autonomy, decision-making, self-discipline, and sense of responsibility. Parental attitudes during their growing-up years had given little opportunity for these traits to develop.
The excessive protection and gratification which the boy had received from a maternal figure must be mentioned as a significant factor. Almost all of these patients had been emotionally close, until puberty, to the mother or to an unmarried aunt or grandmother to whom he was quite special. A few who were father’s pet received a similar kind of nurturing and protecting, from their father. Three boys said they slept with their father until age 10 or 11 years. One boy slept with his aunt until he was 15 and could even recall penile erections in these situations. Those raised by grandmothers enjoyed even greater gratifications. Several were free to watch grandmother do her morning ablutions or walk in when she was only half-dressed. One recalled scrubbing his grandmother’s back, during her baths. Boys “adopted” by a female relative are likely to sleep with’ her even when they are already in grade school. In large families, there may be less opportunity to do this. However, as late as grade school the mother kept close tab of his body, supervised and sometimes personally gave him his baths. It was not surprising to hear these young men say that they felt closest to their mother and most secure with her and to no other.
It would be inaccurate to use the word “spoiled” in describing the effect on the boy of this relationship. It was not “spoiling” in the sense of indiscriminate indulging. Rather, the boy received a gradual but sustained treatment of making him so dependent on cues and pressure that he never had a chance to develop a sense of autonomy. The first demand that he assume responsibility consisted of parental wishes that he bring home passing and, if possible, above average grades. In grade school and in high school, the stakes were not high, the anxiety was less and “failures” were not earth-shaking. In college where foundations for one’s lifework are being laid, where tensions run high, interpersonal relations were cold and authority figures threatening, the problem of success or failure assumed frightful importance. The biological and physiological changes at this time, exerting equally great pressure, compound the problem.
Among these young patients, the problem of detaching themselves from the maternal figure on whom they had been emotionally dependent for so long was formidable. Too often, as these cases illustrated, the “failure” experience resulted in even greater attachment to her. His lacerated self-esteem could only be mended and restored by reaffirmation of the mother’s and the family’s affection and concern for him. In this respect, physical illness is always rec ognized by Filipino parents and the culture in general as a justified cover-all for failures. Even the most avid diploma-worshipper among Filipino parents will tell the offspring: “Nothing ‘is more important to us than having you alive and well, not even finishing college or getting a good paying job.”
It is therefore important to consider what this very close relationship to a maternal figure can do to an adolescent who feels an imperative need to conceptualize in his mind what being masculine means. This factor plus the culture’s definition of maleness which emphasizes freedom from maternal domination could push him sharply in one direction (regression) or the other (precipitous sexual experience).
The clinical syndrome of the adolescent boy who folds up under the stress of college life, regressing into somatic illness, represents one end of the spectrum. Their number is greater than those who chose not to regress and instead worked out the problem without creating a permanent rupture from the parents. In addition to rebellion against parental injunctions, there were instances of running away, physical aggression towards sibling or househelp, and extremely erratic work performance. At the extreme end were three cases of undisguised hostility towards the parents, with violent tantrums such as breaking furniture, hitting the mother and, in one case, cutting up his expensive clothes with a knife.
Between these two extremes are youngsters who, like all adolescents everywhere, meet head-on the problems of separation from parents and carve for themselves an identity with varying unevenness, unpredictability, and success. Like the adolescents described in fiction and case studies, they were prone to take long lonely walks, form attachments to an over-idealized male friend, or inflict tortures of self-consciousness about body, speech, and manner. Those who felt relatively more comfortable with their aggression became involved with activities of the peer group, whether it be visiting the dark streets of Pasay, forming a combo group, crashing a party, trying alcohol, or merely engaging in frank discussions.
The youngsters who were less prone to regress also gradually detached themselves emotionally from parents at intervals long enough to air out resentments and hostilities about parentaL tendencies to over-control and undercut them. One big source of resentment was a physical beating from father, who was usually consulted only when mother has given up. It was a rare youngster who could say that he enjoyed a comfortable, open relationship with his father. To the whole group of adolescents, father was either respected or feared or admired. He was regarded as purely an authority figure. On the whole, communication between father and adolescent was dismal.
Masculinity was very much a preoccupation in the adolescent. He was openly conscious of his growing sexual powers. Circumcision was evidently a matter of great import. The older, circumcised ones recalled how the experience had instilled in them self-pride and confidence. The younger, uncircumcised boys looked forward to it with great expectation. Measuring the penis, in repose as well as in tumescence, was described by several young adolescents.
Fantasies differentiating sexual experiences with prostitutes and with “nice” girls were quite lively. Whoever was the “sexiest” TV personality at the time was the favorite subject. For a long time, one particular young female dancer on TV who seductively demonstrated dance steps on a weekly program figured prominently in a patient’s intercourse fantasies. Sadistic fantasies of making a girl suffer, through obscene insults and subjection to their sexual prowess and evoking much happiness were not at all uncommon.
There were eight adolescents, 16-20 years old, who complained of disturbing incestuous fantasies. Two of them had mother as the object; five, a sister and one, an aunt. They found it difficult to verbalize these fantasies and manifested great fear of having harbored such wicked impulses. They were always reacted to with revulsion and a forcible turning away to other heterosexual objects, e.g., peeping at a maid o reading girl or sex magazines. Only one patient took the fantasies further and actually gave in to voyeuristic impulses with his sister.
Throughout the young adolescent’s struggle, the theme of loneliness was central. Indeed, behind the disparate patterns of disturbed behavior, there were at different levels a continuous avoidance of becoming lonely. Whether he regressed hack to mother or he threw himself into the bosom of his barkada, a driving force was to avoid aloneness.
In this conflict, the closeness of family life and particularly with mother is again implicated. Since growing-up is essentially a process of separation, of which some decree of loneliness is a consequence, these youngsters found it even more difficult because of their family background. Almost all of them, and this is also true of the group of adolescent girls, said that they had never been left alone in their lives; and being alone (and lonely) was a frightful prospect.