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- Category: A Study Of Psychopathology
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To a newcomer, Manila with its 15 square miles and over two and a half million people has the anonymity of any large, over-populated metropolis. To one who has lived in it for years, it has the interpersonal familiarity of a small town. To a psychiatrist practicing in Manila and residing in one of its suburbs, an encounter with a patient at the supermarket, in church, at a restaurant or night club and, in my case, at the beauty parlor or at PTA meetings is hardly surprising. The more the therapist’s social and economic class approximates that of his patients’, the greater is the likelihood of these off-hour meetings. I have had the experience of attending balls’ where the crowd included some of my patients. Being asked to dance, drink, and chat with them is only a natural part of the usual patterns of social interaction.
Outside of these chance situations, some patients will think nothing of going to the therapist’s house, for whatever reason or reasons. They may invite the therapist to their home for a birthday party, a housewarming, or a district fiesta. One may attach all kinds of psychological motivations to such gestures, but it also happens to be the cultural practice to invite friends to festivities. Otherwise, the person may feel remiss in his social obligations.
These incidents do not occur all the time, but they happen often enough to merit scrutiny as to their implications in therapy. To the Western psychiatrist, distance from the patient, enough to discourage socialization, is observed rather strictly in the interest of the therapeutic process. The therapeutic venture in the American setting is a businesslike proposition which avoids unofficial social encounters. The psychiatrist is hopeful that an aura of mystery about his personal life will promote fantasies about him in his patient, thus providing grist for the therapeutic mill. For protective reasons as well, he Likes to keep his personal life, with all its faults or defects, to himself and away from people ‘who are likely to have idealized expectations of it. If unavoidable, the therapist tries to carry off such situations with a minimum of discomfort, knowing that they will be reflected in the coming therapeutic sessions.
For the Filipino patient, such knowledge of and familiarity with his doctor is sought, not only because it is ego-fostering, but because it is part of cultural attitudes towards doctors. He likes to know his doctor’s habits, likes and dislikes and in a family- oriented society such as his, the doctor’s family life. (Many a referring doctor has mentioned to me that he was able to convince the patient to see me by telling him that I am married, have children, and will therefore understand the problem.) Encounters outside the office “humanize” the doctor, making it easier for the patient to conceptualize a real, interpersonal relationship with him. Again, for the Filipino patient, this is reassuring and if the therapist in this extramural situation greets him or acknowledges the social exchange, it allows him also further entrance into the relationship.
The Filipino psychiatrist, however, trained in the psychoanalytic approach to watch for, weigh, and interpret each interpersonal exchange, no matter how trivial, may find himself annoyed with these little extraneous events. Since every encounter with the patient is “work,” for which he is paid, it may be difficult for him to shift gears outside the office. Furthermore, not all incidents are easy to carry off and rationalize as “analyzable.” Should he lose his temper on the golf course and a patient witnesses this, his “omnipotent image” may be permanently shattered. A patient, whose child attended the same school as mine did, came to the session one morning and with mixed pleasure and embarrassment told me of how my child was brought to the school principal’s office for talking out of line.
There are other small questions a therapist may be asked at the first meeting. What province do you come from? Are you from Manila? Are you related to so-and-so who has the same surname? These are a part of cultural habits, helpful in placing the stranger in a more familiar and therefore less threatening context.