Transference Phenomena

One must distinguish between transference and transference. like phenomena. Like some of my colleagues, psychiatric residents and workers in allied fields in the Philippines who are familiar with psychoanalytic theory and technique, I have often wondered if Filipino patients have a “built-in” kind of transference for any benevolent authority figure who provides them with abundant narcissistic gratification through intense individual attention. The readiness to be dependent, a propensity to eroticize almost every situation and the presence of cultural practices which sanction or promote these tendencies will conceivably foster transference. I have heard colleagues remark of a patient: ‘Transference appeared after four or five meetings.” The first two or three meetings were spent by the patient in describing his (her) problems; now he (she) is asking many personal questions about the therapist. This curiosity about the therapist is interpreted by the latter as evidence of a beginning deep attachment. Perhaps the period of training of the Filipino psychiatrist spent with American patients who manifest transference by expressing great interest in the therapist’s personal life may contribute in part to the above interpretation. Actually, in Filipino culture, curiosity about another individual’s personal life precedes entry into any relationship with him.

I am inclined to discount these actuations of the patient as true transference manifestations and would prefer to label them merely as transference-like. Some of these have been described as part of the initial perception and reaction to the role of patient in relation to somebody in the role of doctor. The seeming dependency of the patient displayed in this early interaction is a logical, non-conflictual position for him to take. This is the usual way a patient in this culture behaves towards his doctor. These events occur early; the patient has not developed them as a result of the unconscious process of gradually investing the therapist with feelings carried over from relationships with important people in his childhood. The emotional content is superficial compared to the intense, unsettling, conflictual affects of true transference.

Even early allusions to eroticization of the therapeutic relationship appears to be “natural” for this culture. I have lost track of the number of times in group discussions and seminars in the Philippines that students and learned people alike had expressed the opinion that consultation of personal problems is better (and safer) conducted with someone of the same sex. What they would do in actual practice may be quite different, but the fact that they think and talk of every man-woman relationship as potentially erotic attests to the aforementioned cultural tendency. (Priests are an exception; their image is non-sexual. However, the behavior of many young girls and young women towards them does not seem to totally ignore the fact that they are men.) I have been asked by two of my male colleagues in the medical profession if I would accept psychiatric male referrals. They wanted to make sure that I would not mind.

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.