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- Category: A Study Of Psychopathology
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Most of the conflicts of patients in the 20-50 years age group center around failure or success. This is probably due to the fact that this is the time in a man’s life when he makes his bid for success. Patients quickly launched into narrations of frustrations at work. Businessmen moaned about the vicissitudes brought on by ever changing political and economic conditions. Meeting bank deadlines, maneuvering loyalties of associates, chasing letters of credit, courting the politicians’ favor, etc., provided enough strain and stress for their emotional grind. Executives struggled with subordinates, often ambivalent about their authoritarian prerogatives towards the latter. Accommodating employees recommended by relatives or influential persons was a constant thorn in their side. Government employees reeled from the burdens of seniority in the service; some had conflicts involving unethical but generally accepted practices among other employees. A few had found themselves unfairly displaced by someone else with less qualifications but more impressive connections. Politicians in the sample were bitter over losing in elections or in failing to get the promised plum from their ward leaders. Skilled workers and professionals, such as doctors, lawyers, teachers were relatively more secure in their work and came with a discrete problem which did nor beat a direct relation to their job.
The irritants complained of are part and parcel of a particular profession, trade, or position chosen by the patient. There was nothing singular about these situations; they were the expected grist for the particular mill. Predictably, as the patient divulged more information about his past and provided the psychiatrist with a longitudinal view of his long pursuit of achievement, more deepseated and significant problems were revealed. These had to do largely with ambivalent attitudes towards failure and success.
It is difficult to tell which was more unsettling—failure or success. Patients presented a range of failure or success experiences, with obvious failure at one end and a clear success experience at the other. These extreme cases are easy to spot. A failure experience is one where all reasonable precautions had been taken to insure success, but the individual failed to achieve what he had set out to secure due to circumstances mostly beyond his control. Examples: a business gamble which failed; failure in a national examination where, despite adequate preparation of the candidate, the usual casualty rate was extremely high; or a highly competitive examination where there were many candidates for only one position. A clear success experience usually comes in the form of a promotion in position or an increase in salary. Somewhere in the middle of the spectrum between these extremes are instances wherein it is difficult to say whether it was failure or success which led ‘to the-emotional illness.
In this latter group of patients were individuals who had achieved some measure of success but who came for help because of later failures. When first seen by the psychiatrist for distressing symptoms, they had difficulty sorting out the events in order to pinpoint which one had really unhinged them. There were no less than ten. patients who went through this particular type of experience Here are a few capsule situations:
1. A 50.year old lawyer, occupying a prestigious government position was asked to tender a courtesy resignation when a different political party came into power. To his surprise, the resignation was accepted and he lost the job. He became depressed over this. Yet he recalled that at the time he accepted the high government position, he already had plans to quit and go into private practice. At that time everyone, including his wile, felt the plan to be ridiculous. He argued then that the position despite prestige and a high salary, did not suit him because it made him an object of envy. At present, he is in private practice, earning much less but happier.
2. A successful accountant in a reputable firm was slated to become a senior partner. Before this happened, there was some reorganization in the different departments. He asked to be assigned to a particular section which was lower in rank but which he insisted was his real field of interest. His superiors were greatly surprised as it would cost him the promotion. Nevertheless his request was granted but the scheduled promotion was consequently delayed. He lost sleep and appetite over this, later somatizing his resentment and disappointment into a gastric neurosis.
3. A 49.year.old man achieved the highest position possible for non-Americans in a certain American business firm—that of vice-president. When the president took vacations, he was in complete charge. Not long after his appointment, he ordered in good faith a very expensive machinery. An imperfection in the delivered goods threatened to be a total loss to the company, had he not called experts in time to remedy the situation. He developed a severe depression, with marked anxiety as though he had in fact caused the company to lose a big amount of money. He expressed the desire to be relieved of the high post and be reinstated in his old job.
4. One brilliant advertising man developed cold feet whenever he was about to make a financial killing. He argued with himself, wondering if he was “cutting someone else’s throat” or “prostituting his principles.” Attitudes towards money were highly ambivalent. He found it strenuous to assume a “strictly business” position with clients and employees.
5. A young ingenious businessman had made and lost fortunes which astounded others much older than him. Whenever he made good, something seemed to come along—a love affair or a deception by a business partner—to dissipate his newly acquired assets. He suffered from chronic anxiety and a fear that time was running out. After financial debacles, he would “take it easy” for several months, indulging himself with women and “good time.” Then he would slowly get started again on some business venture; his anxiety would then gather momentum to a point where it became more disruptive than helpful.
The patients in the examples above had similar reactions to the “two impostors”—failure and success. The conscious fear was always that of failure, yet the pursuit of success was so impeded by anxiety that failure was virtually courted.
At the other end of the spectrum are 16 patients in whom clear-cut encounter with success pulled the rug, as it were, from under their feet. A period of anxiety, with insomnia and somatizations, was followed in each instance by an inexorable downhill course, inability to function at work, ending finally in a fullblown depression or a severe psychophysiological reaction. (I have seen similar “promotional” depressive reactions at the Philippine General Hospital).
The cases were in essence identical in psychopathology with those found in the middle of the spectrum but for one difference: the patients in the extreme category had near-complete emotional foldup. In the absence of strong supportive elements in their environment or capacity to somaticize the conflict, the speculation that the depression could have gone into psychotic proportions was often entertained. These patients, in the middle of the spectrum, who waged a see-saw battle with both failure and success appeared to be undoing one with the other. The decisive actor was the difference between unconscious, neurotic wishes and rational, cognitive abilities to assess reality and define one’s goals.
In patients who were “wrecked by success,” I observed a type of background history in all, varying only in some details. As a young boy, the patient had tendencies to be serious and ambitious. He might have been playful like other children but even in play, he exhibited this tendency to be rather more purposive than the others. There was early interest in money and in ways of earning it, even if the parents were generous about allowances. At least 9 of the 16 patients recalled that at an early age, they were already earning money. One patient said that as a boy of 9, he sold “gulaman” in front of his house. Another one sold brown bags in the market. Another made profits selling sandwiches at school which he had secretly prepared at home. These patients came from homes which had no money problems. There were several, however, in whom the lack of money in the family was, according to them, a motivating factor. One patient ran away from home at age 14, because his father wanted to keep him on the farm, instead of letting him continue with his studies. He worked and supported himself through college.
They followed a well-ordered life, either rigid or deprived, as they relentlessly pursued goals and ambitions. They might cite an episode in their adolescence in which they kicked over the traces, becoming wild for a time with sex and drink, but later taking the straight and narrow path with even greater vigilance over one’s self, determined never to fall again. They became quite clever at finagling and manipulating people and situations. With subordinates, they could be reasonable facsimiles of good Joes. With authority figures, they were likely to be the ideal employees and to call them told and calculating would be inaccurate.
Much of these were unconscious character attitudes, but every move appeared calculated spurring them to a more financially secure or prestigious position. When they married, they usually chose someone who, in all likelihood, would enhance their status. Thus they advanced themselves to positions of greater prestige and higher rank. Or they might stay at one position which is already relatively important for a long period of time, lasting five, ten or more years.
Then, in their forties they received a promotion in rank or a substantial increase in salary. It might have been suggested or mentioned to them for some time before that, but they appeared to have ignored it. The new position might or might not mean greater responsibility. It might or might not entail supervision over men. The symbol of success was enough to bring down an already precarious, though outwardly stable and rigid, emotional structure. They then began to have insomnia and bodily complaints. Slowly and steadily, the whole regressive process had started.
I had two patients who, for almost two years, unconsciously avoided success. Whenever there was an in-service seminar for potential candidates to a managerial position, these patients’ names always came up but somehow, they always managed to avoid enrolling in these courses. One patient gave way twice—once, to a “compadre” because “he needed the money more” and the second time, to another man because the branch for which the position of manager was to be filled was “too far away from home.” Both patients came to therapy for phobias. One had fear of walking alone in the streets and the other of getting up and speaking in front of groups. Needless to say, they had also successfully avoided confrontation with their phobias although it had become increasingly more difficult to do so.
Long before the patient recognized his own ambivalence towards failure or success, he alleviated his depression by moving from self-castigation and inadequacy feelings to blaming people whom he felt were in some way responsible for his downfall. Most often, his father and his wife were considered most blameworthy.
I have often wondered at the omission of the mother in the distribution of blame. This must doubtlessly be significant. I wonder if, being a woman, I was primarily perceived as a maternal figure thus inhibiting expression of negative feelings towards another. But because it happened often enough, I would rather attribute the mother’s seeming exculpation to the patient’s very strong and deep identification with her. To blame her would in effect be blaming oneself and perpetuating a painful state -of guilt and self-castigation.
Only when the mother behaved in an unequivocally obnoxious or hateful way did she become the target of the patient’s open hostile feelings. Even then, this was a most difficult thing for the patient to do. One patient, an oldest son, who stepped into the father’s shoes after his death worked hard to keep the business intact and prosperous for his brothers and mother. The mother, somewhat jealous of her son’s wife, often told relatives and friends how the patient and his wife really pocketed much of the profit. During a heated argument with the mother denying these allegations, the patient at the height of frustration, grabbed a gun and fired it into the air. Within an hour he had made the psychiatric appointment and his first sentence on being interviewed was “It is all my fault.” Patients also described how in family conversations, any negative feeling expressed by one sibling towards the mother brought all the others to her defense.
The patient apparently felt relatively more free to bring complaints against father and wife. These were by no means given with complete ease. There was much hesitation, weighing of words, retracting or reformulating of sentences in order to be accurate and (air. But at least, the patient did of suffer from any disabling guilt after laying out the faults of his father and wife.
The case against the father brought out incidents from past or present situations wherein parents and siblings had much to do with each other. The family members were either actively involved in a business together or paid regular weekly visits to the parents during which there might be some discussions. The expressed resentments were therefore directed against past or current frustrating interactions with the father.
There were a few whose complaints were limited to mild regrets that the father seemed too distant or passive. “I hardly knew hun” was a common remark. In such a case, the patient did not have any strong feelings about father and was not quite sure whether or not he missed out on a relationship with him. However, these patients would always point out a difference between the way father was with him and his siblings and the way he is now with his children. Invariably he would say that he spends more time and does more things with his children than his own father did with him.
Philandering by the father did not cause any strong reaction, one way or the other, on the male patient’s part. It was explained simply by “He is a man.” The female patient exposed to such a father was apt to bring it up with strong negative feelings. Unless the father’s philandering brought great obvious distress to mother or disrupted family bonds, the son took it in stride.
The kinds of treatment from father which brought bitter and resentful denunciation from patients were those that caused direct, personal pain or those which were interpreted as deliberate withholding of emotional support or gratification. They may be categorized into the following:
1. Favoritism. One sibling other than the patient, was father’s per, and received nor only more time and affection but also more material favors than the others. The “pet” received more money for business capital, a choicer lot, a costlier gift at his wedding, etc. In some cases, this favored sibling was a daughter who evoked as much resentment from the others. Often, the patient was usually the son who worked harder but got less. In several cases, the patient felt a fierce sense of competition toward the favored sibling which lasted long after the father had died and material possessions were more equitably distributed. One oldest daughter, father’s favorite, who had stepped into the father’s shoes after his death to manage the family business, soon gave up, after the other siblings vented upon her all the resentments suppressed during the father’s lifetime, Many patients cited father as the one who deliberately promoted hostile competition- between siblings by exposing one’s faults or extolling another’s virtues.
2. Severe physical punishment. This was not always inflicted by the- father but when experienced was never forgotten. For some reason, harsh treatment from maternal figures were either rare or successfully repressed. Over ten patients recalled severe physical punishments from their fathers during adolescent years. Two of this group however were already in their late twenties when they received the severe beatings. One patient described how he was whipped while on his knees for smashing the family car. Of the 31 adolescents, five received severe physical blows or beatings with the belt. All of these harsh experiences were recalled with much pain and strong but controlled rage reactions. Patients talked about them only with great difficulty. Among Filipinos, despite their great love for their children, a physical beating however severe is always justified if the motive is to teach the boy a lesson. Many grown-up men in the culture will say that they recall a physical beating adm4nisrered as late as adolescence but hold no rancor over it. However, in these patients the bitter resentment was somehow kept alive and fostered by an accompanying strong feeling of rejection by the father. The physical beating was cited merely as the concrete proof of this rejection.
3. Low regard of the patient by the father. This attitude was conveyed in a hundred subtle and not so subtle ways. Teasing was one preferred way. These patients still recalled the seemingly innocent nicknames with which they were teased as children. It hurt most when it was the father who initiated, provoked, encouraged or allowed the teasing to go on. These nicknames were often unkind, directed at the person’s most obvious physical defect. Siblings might start the name-calling and it is quickly picked up by schoolmates and playmates.
Derogatory nicknames were based on a person’s defect, usually physical. The defect was one about which the patient was made to feel deep shame. Here are some examples: for a dark skin—“Negro,” “Negrito,” “Negro patente, culot sa coriente,” “dilim” (dark), “uling,” etc; for slinky eyes—”Intsik”; for being short— “pandak”; a flat nose was “nadaanan ng trak o kalabaw.” Parents and siblings sometimes teased the patient about being merely an adopted member of the family, with “We picked you up from the carabao’s dung.” A patient with a slight limp went by the name of “Si pilay” (the lame one).
Again, one must note that this making fun, in a teasing way, of another person, is a popular pastime in our culture. And the person is supposed to prove that he can take it, otherwise he earns another nickname, “pikon” (a poor sport). What seems to cause these particular patients to overact to teasing was their low state of self-esteem from lack of paternal approbation or from actual paternal derogation.
There was hardly any recollection of praise from father. As a matter of fact, there was hardly any praise from anybody. But with mother, even if she withheld praise, the patient seemed sure of how he stood with her. Incidents from childhood to adulthood of father’s negative reactions to the patient’s bids for approval are recalled. Some examples are: “1 remember bringing home my prize for winning in a carpentry contest and he did not even look at it”; “He looked at my college diploma and with sarcasm said it was nor even half the size of his high school diploma”; “When it came to me, he couldn’t afford to buy anything. I still remember how he finally gave in with great reluctance and bought me a pair of rubber shoes I had been begging for”; “He said I would either be a millionaire or a pauper but it seemed to me he didn’t care much which one I would be”; “On the day I received the medal, my father went to the cockfights—only my mother and sisters came”; “He keeps comparing me with the son of Mr. So and So, who sends money to his parents”; “He won’t give in to me, not on any point. I ask myself, why he sent me abroad for so much training when he won’t accept any suggestion I make.”
In some instances, these rejections were amplified by refusal of the father to give material help to the patient even when he could well afford to do so. In the culture, a good father gives willingly of whatever material resources he has. His children would then get a good economic start in life, especially right after marriage. A refusal to extend help was interpreted by the patient as father’s rejection of him.
In the face of a domineering and an unapproachable father, an older brother often came in to fill a more benevolent and warm fatherly role. Several patients were close to an older brother. The remark “If Kuya were here, I wouldn’t be sick this way,” was heard from several patients. By the same token, an oldest son experiencing similar conflicts with father, might find great satisfaction in being close to younger siblings and in some way actually displacing father from his role.
Hostility towards the wife was not easily expressed. The therapist was sometimes requested to talk to her because the patient seemed unable to put across to the wife his complaints about her. His hesitation to let her know is understandable from the observations made of the wife’s reactions when seen. She quickly became emotional, cried, defended herself, underscored her good intentions, recited proofs of her concern, before one could even clarify the issues with her.
A rare exception was the husband who kept his visits to the psychiatrist a secret from his wife. His reason was similar to that behind his inability to communicate with her. He was afraid to hurt her. She was sure to worry and feel guilty or inadequate if she found out he had been seeing a doctor. He found her emotional reactions too overwhelming to handle and did not want to go through them again. One husband said his wife would start going through his things again and never stop until she knew all about his problems.
The hostility towards the wife was stated in the form of complaints about her deficiencies. The, most common was “she does not help me.” By this is meant that she “does not understand enough my difficulties,” “does not appear concerned enough,” “is frivolous,” “lets maids do everything,” “plays too much mahjong,” “goes to most expensive dressmakers,” “is too attached to her family,” or “is not cordial to my family.”
The varied and diffused list of complaints tended to be petty, fault-finding and, in truth, merely served as masks for the real reasons. The deeper reasons for his hostility towards her were: (1) his feeling that she has failed to provide him with adequate gratification of his dependency needs; and (2) his own feeling that she is a burden to him.
These reasons had no rational or realistic basis. He did not really need a wife to lean on, but the burdens and, pressures of his work and his feeling that she was not doing enough often made him feel that he was doing all the work for the two of them.
Likewise, patients who complained of the wife being a millstone around their necks meant this symbolically. Many of the married male patients looked back with nostalgia to bachelor days. Some mentioned a marked change in their personality, recalling how carefree, daring, and happy they were as bachelors and how marriage turned them into worrisome, tired, or drab breadwinners. Listening to them, I could not help making a mental comparison with young married women who felt marriage had changed them from lively, outgoing college girls to cooped-in, helpless and inhibited homebodies.