The Single Women

The patients were divided into two groups: a younger group in their twenties, and an older group of less than ten women, in their forties or fifties who had never married.

The young and single female patients came in almost always with a ‘man problem” as the central issue. Breaking up with a boyfriend or the discovery that what she construed to be honest intentions on the part of the man were far from being so seemed sufficient cause for a state of severe emotional confusion which could last for months. The experience of rejection was painful enough. What added salt to the wound was guilt over the involvement and an excruciating feeling of shame before one’s friends or one’s hometown crowd, who happened to have knowledge of the event.

Depersonalizations And Other Symptoms

Depersonalizations and feelings of unreality were seen in highly anxious or depressed patients as fleeting phenomena, accompanying the stare of heightened fear or despair. The patients’ usual statements were “I thought the ceiling was coming down on me”; “The Virgin Mary’s face changed several times while I prayed”; or “As if 1 were removed from myself.”

The depersonalizations were particularly severe and frightening in two female patients. Only one dissociative phenomenon, with splitting of the self, was encountered. In the latter case the patient adopted a different name for each of the two personalities she assumed. One, Clara, was reserved, kind, patient, and a devoted wife; the other, Clarita, did completely different things, such as collecting pictures of Flash Elorde (the boxer), scratching herself in public, wanting other men. She was pregnant during this episode and was, in fact, referred by her obstetrician. After the delivery, she improved greatly, came only for two more sessions and from the obstetrician’s follow-up has since been doing rather well.

Areas Of Conflict

All patients seeking psychiatric assistance present their problems as a mixture of intra- and inter-personal difficulties. Depending on the kind of personality and type of illness, a patient may evaluate his psychological problems as largely due to one set of factors rather than the other. He may regard it as primarily his problem, a result of his own mental set of urges, impulses, thoughts, and actions. Or he may perceive the problem as resulting from the manner in which he is regarded and treated by the people around him. The Filipino patients in this study leaned heavily on the latter proposition. It was difficult, if not impossible, for him to extricate himself from an interpersonal situation and independently evaluate the extent and nature of his participation. Educating the patient to delineate which psychological events proceeded mainly from him and which from others followed a long and tortuous course. This could be a most difficult goal in therapy work with Filipino patients.

“Acting-Out” Syndromes

In the absence of a ready label, I will describe the behavior of six patients as “acting-out” syndromes. They are not to be construed as social or delinquent characters. These were patients in their twenties or thirties who reacted to a traumatic event by losing partial control over their behavior and displaying poor judgment, particularly in money matters. These patients instead of getting depressed began to do things which were nor usual for them and which proved self-destructive. They brought humiliation upon themselves and caused people to think very lowly of them. Perhaps their behavior represents part of the continuum of difficulty in mastering aggressive impulses or is a depressive equivalent. The clinical presentation was so uniquely different that a separate discussion is in order. I have encountered two patients with similar patterns at the OPD psychiatry clinic of the Philippine General Hospital.