Case Histories

1. L. V., a 46-year-old single woman lawyer, complained of recurring pains on both sides of her neck which has persisted for about two years. She has received diathermy and tried various liniments and poultices, without obtaining lasting relief. Of late she has been under the care of an orthopedist because of episodes of torticollis, with head turning to the right, occurring with increasing frequency for the past six months. It tended to come whenever she started to read, be it at home or in the office. Psychiatric help was suggested by a good friend in the office, a man in whom she occasionally confided her problems.

She is tall for a Filipino. She has poise and she dresses with fine taste. She is dark, her facial features showing the characteristics associated with women from the northern part of the Philippines. She manifests self-confidence in the manner she speaks good English. She smiles readily but noticeable are the tired lines and a grimly set jaw such as what one observes in women who have worried and worked hard all their lives. Her eyes look sad. When I told her this, she remarked matter-of-factly, as if making a mental note of it, that her friends had said the same thing.

She spent the first half of the initial interview hour massaging the sides of her neck with the tips of her fingers, working the muscles slowly up and down as she talked in a low, well-modulated voice describing her distress at the failure of one remedy after another.

Her work, she said, has been exciting. She has never practiced law but is in a well-paid position as assistant to the head of the legal division of a large business firm. She has been with this firm for over ten years and is well-liked by everyone. Because the company has dealings with foreign offices, she has had opportunity to travel to various countries in Asia and the United States. Her boss and his wife occasionally ask her to help them entertain visiting friends and associates at their home. She has come a long way, indeed, from the barrio she grew up in, from the provincial high school she attended, and from the long years of working through law school.

The oldest of six children born to farmers, she knew from childhood that the greater part of the responsibility for looking after her siblings was hers. She was usually left in charge at home when mother had to bring vegetables to neighborhood sari-sari stores. She has always been, in the words of her siblings, a second mother.

After passing the bar she started to work at the Department of Justice as a researcher, saved all the money she could and sent, one by one, her younger siblings through school in Manila. Eventually, she was able to purchase a modest home in a government housing subdivision and sent for her parents to live with her. They were simple folk, talked very little but she knew they were very grateful to her. Very soon, the whole family was in Manila and they were all under her wing.

For a while, she was the only means of financial support. The father went to the province from time to time and brought back rice for their consumption. A younger brother finished vocational school and opened a radio and TV repair shop. He helped with the expenses until he got married and moved away. In time, each of the other siblings moved away after finishing school. She has since been living with her aging parents and two maids.

Three and a half years ago she met an American who came to fulfill a temporary assignment in Manila. They were greatly attracted to each other and, before long, were inseparable. They lived as man and wife for eight months, except that she had to go home at night so that her parents would not suspect anything.

Looking back, she said she had no illusions. She knew from the start, he was married. He was the kindest, most thoughtful man she ever knew and she admired his sophistication and intelligence.

For a long time in therapy, she talked of nothing but his devotion to her and their wonderful times together.

It was about two or three months later in therapy, when she was asked to describe in detail the separation, which this idealized image began to crumble. He told lies, saying his wife was coming to Manila. He was seen around with another Filipino girl. There were many scenes between them and she was getting physically sick. She was hospitalized for two weeks b what was thought to be Meniere’s disease. He visited her twice at the hospital, but when she was discharged. she found that he had left for the United States without a word. She began to develop the neck pains around this time.

From then on in therapy, she laughingly referred to him as “the ugly American.” Men are all alike, she said. They are such cowards and are only out to get what they can from a woman — were her remarks. She recalled one other man in her life— a classmate in law school. While reviewing for the bar, he went to his hometown and the next thing she heard was that a local girl had “tricked” him into marriage (a practice locally known as piko: wherein a man caught by the girl’s parents in a physically intimate or even simply a suspicious-looking situation with her is forced by them to marry her). After his marriage he came to see her in Manila begging for forgiveness. Finding themselves alone, he almost raped her, she said, had she not run out of the house. Lately, she heard about him from friends and with much laughter remarked that he was “under the saya” (henpecked) because his wife had the money.

Her staunch rationalization for remaining single was her observation that women give themselves to men who hardly appreciate them. When told that she was in a highly similar situation with regard to her parents and siblings, she firmly disagreed. For parents, brothers, and sisters, she maintained, one did it out of love and duty. There was no choice, no alternative but for her to do what she did for them. But with a man, one could take him or We never got much further than this in therapy. After each session her friends always came to pick her up at my office. They showed much concern, sympathy and apparently went out of their way to help her. When the neck pains went away, she announced she was going to Baguio for a month’s vacation. That was the last time I saw her.

2. P.W., an 1 8-year-old freshman commerce student in an all-men’s school run by priests, was referred by the school counselor for sudden dizziness and “blacking out” during the third day of the mid-term examinations of the second semester. Earlier that morning he had approached the counselor asking to be allowed to take the examinations in a room by himself away from the rest. When this was not allowed, he became quite upset and could not get started with the examination. The preceptor reported that he looked blank, holding the pencil in the air with an immobile hand. When questioned, the patient said he felt dizzy and that he seemed to have “blacked out.” He did not lose consciousness but actually found himself unable to even write his name. He was brought to the school clinic and told to lie down and rest.

He is a short fellow, no taller than one or two inches over five feet. When he came for the first time, he constantly pressed the top of his head with one palm. He felt, he said, as though his head were either “elongating” or “going to burst.” He said he had a similar attack of nervousness during his fourth year in high school. At that time he was very much attracted to a slightly older boy who was more active and outgoing than he was. “It was almost as if I had a crush on him and I got frightened, thinking I might be a bakla (homosexual).” The boy befriended him, tending however, to use the friendship for ulterior motives, such as to borrow money, send him on errands to his girlfriends, etc. When the boy showed interest in the patient’s sister, he was greatly disappointed and before long, gave up idolizing him.

The oldest of the siblings is a 26-year-old brother. The patient has two older sisters. After him is another brother and a sister. The youngest is the “baby” of the family. The mother has a real estate office but at the same time manages to make all decisions on how the house is run, imposing discipline on all of them. A spinster aunt staying with them sees to it that all the meals are served on time, that their baon (school lunch) is always ready, their uniforms neatly pressed and that no quarreling occurs. He is close to this aunt and remembers sleeping with her until he was nearly ten. The father holds a prestigious job in the government, but mostly it is the mother’s business which keeps the family in comfort. The father is a gentle person, “never gets angry” and loves his family very much. The patient thinks his father is happiest during family reunions, a few times each year, when his parents, brothers, and sisters all gather together with their families. As a small boy he remembers being very naughty, getting into fights and being spanked often. His mother usually gave him a few severe beatings but she was quite loving at the same time.

The patient’s mother “has very good PR,” and enjoys giving parties at home for friends and associates in the real estate business. She is very “cariñosa” and the patient feels that all the children feel close to her because she is demonstrative. She easily explodes in anger but forgives just as fast.

At one time the oldest brother was her favorite. However, he eloped with a girl during his second year in college. The mother was livid with’ anger but later, upon the father’s persuasion, bought them a house and gave them money to start a business of their own. Since then mother has had no special favorite, although the youngest, who is eight, is everyone’s pet.

In addition to the aunt the patient also grew up under the care of one particular maid. He remembers that his sisters had one maid and he had his own, who followed him everywhere. She was a young girl in her teens, quite lively and efficient, whom his parents brought from the province. Because he was “naughty,” she was especially assigned to keep him but of trouble. She took him to school, picked him up, and even accompanied him to the barber, the dentist, and to children’s parties. He was in grade four when she got married and moved away. He remembers that she was particularly effective in making him behave but that sometimes he would go into tantrums whenever she refused to give him what he wanted.

As a child he particularly remembers being teased about the scars on his legs. “Peklat” (scar) was his nickname. An older sister had started jt. The, scars were small and far from disfiguring, but the mere fact ‘that he was teased about them made him very ashamed and self-conscious. To this day, he is still ashamed of his legs. He is also conscious of the way he walks, thinking he is bowlegged, although no such observation could be made.

His mother accompanied him during most of his visits. Many times she would take the session herself and express great concern over the welfare of her son. She blamed his barkada and especially Jun, the boy whom the- patient had been very fond of in high school. She felt it was Jun who taught him to drink beer and stay out late. She also felt the priests in school were not considerate enough. They should have allowed her son to take the examinations in a separate room since he was not feeling well. Finally, she thought that the subject load was too heavy and that this particular school was straining its students.

The father came twice, once because he said his wife had an important business appointment which she could not postpone and the second time because she wanted him to find out from me the real cause of the illness. She felt I was not putting my finger on the exact problem. I expected him to be the kind of husband dominated by his wife, far removed from his children and preoccupied with himself. Instead, I found him to be genuinely concerned, especially because his son was now taking tranquilizers everyday for his anxiety attacks. He loves his wife and children and he observes correctly that his wife has a tendency, to be nervous. When she has a problem, she sleeps only two or three hours a night. She has been much worried about the patient, and the husband says he does not want her to get sick, too. He has even suggested to his wife and son that they go to Baguio together for a month’s rest.

Both parents seemed quite sincere and eager to do the right thing for the patient. However, they both had a tendency to look for quick solutions. The patient had boasted to his friends that he had a new car. Actually the car belonged to his brother. Now the patient felt guilty because he had boasted falsely. The father wondered if he should buy him a car. Finally he said he had thought of bringing the boy to a night club with paid hostesses and perhaps teaching him a few things about life. He felt that perhaps this was what he needed. He also confided that his wife had a sister who, many years ago, received electric shock treatments. Since then, this relative has lived a secluded existence with her parents in the province, hardly talking with anyone and never leaving the house. He hoped nothing like that would happen to his boy.

Many weeks in therapy were spent with both mother and patient, as long as the acute distressing symptoms were present. She absolutely refused the suggestion that she seek therapy or counseling separately. When the acute symptoms subsided, the boy came alone but the mother regularly called to know how things were going. She made him stop schooling altogether. I asked him how he felt about this; he said it was fine with him because he needed the rest. I asked him what his plans were. He said his father wanted him to transfer to another school which did not have such a reputation for driving its students. His mother suggested that he start next semester with a light load. His father said he should not think of anything at all this time and should completely rest his mind. In short, both parents were telling him exactly what he should do and even what he should think.

He is not a dumb boy. As a matter of fact, except for that rime in fourth year high school when his grades plummeted down, he has always had above-average grades. He chose commerce because his father is an accountant and his mother is in business.

He has many complaints about school. Many of the boys were snobbish. Although he took his high school course in the same institution, somehow the boys had changed. His old gang hardly paid him any attention any more. They were not as friendly as before. They were involved in many different things and most of them had started courting girls.

He started getting interested in girls himself during the past summer after graduation from high school. In -fact, he had become very attracted to a girl living in the house across the street from theirs. I
feel used to watch her each time she came in or out of their gate. This was difficult, since both their houses had high fences, hiding each from the other’s view. Once he saw her at a choral concert but she was with a big group of girls and boys. He wondered if she knew they were neighbors. Lately, he has become interested in a classmate of his sister whose parties he has had occasions to attend as his sister’s chaperone. Earlier, he had disliked doing this chore especially since he always became upset whenever his sister danced very close with the boys; quarrels would always follow between him and the sister on the way home. Lately, he has been surprised at himself. He actually has asked to go with her to these parties.

He says he knew all about sex. His father keeps a stack of Playboy magazines in their bedroom and since grade seven, the patient has been sneaking in from time to time to have a look at them. He has also seen his sister and the maids undressing. He has been very careful about masturbation, though. He refuses to handle his penis because that would be a sin. He is deathly afraid of VD. Jun once took him and two other young boys to a brothel in the outskirts of Manila. A young girl danced naked in front of them, lay on the table, and teased them. His friends became all excited but he said he felt dizzy and almost vomited. It discussing this incident, he said he felt very sorry for the girl, because she looked young. Since then, he cannot help but think that women’s genitals are quite dirty and likely to transmit disease.

After some improvement, the mother decided to send him to the province for more rest, sleep, and fresh air, in spite of my objections. She was grateful and assured me that she would keep in touch with her son. She had given instructions to her parents in the province to take good care of him. She requested for a prescription of the tranquilizer and a list of things the son could or could not eat or do.

3. P.L., a 24-year-old woman, married for a year and three months, is referred by a gynecologist for sexual phobia. The patient is so frightened of penetration that intercourse has not been consummated. Should her husband attempt to force her, she screams from fright until he gives up. She has allowed him to masturbate between her thighs, but even then she is tense and frightened. Six months after marriage, she was operated on for retroversion of the uterus and not long after that had a hymenectomy because the doctor said her hymen was thick and not sufficiently wide to permit intercourse. These have not helped abate her fears. The last gynecologist she went to told her flatly and unequivocably that she needs psychiatric help. This time the husband threatened that if she did not go to a psychiatrist, he would leave her.

They came together the first visit. She was a small, attractive woman who moved about in a rather jerky fashion. There was an air of tense apprehensiveness about her. She talked rapidly and well, assuring me that she had no qualms about coming since she was a major in psychology in college and knew all about mind-body problems. The husband, a young, good-looking man, sat quietly and said little. He seemed by nature mild-mannered and soft-spoken. When I requested him to leave and his wife objected, he firmly patted her shoulder and left the room.

The patient is the older of two sisters, a year apart in age. Her father disappeared during the war when she was four, presumably killed by the Japanese. She has no memories of him. Her mother and grandparents talk very little about him. The clearest memory of her childhood is that of being very close to her maternal grandmother and going with her everywhere. Her grandfather died when she was six. After the disappearance of her father, they all lived together. In fact, they are so close that it never occurred to her to live away from home after marriage. The only time she thought of it was when a girl friend, to whom she confided her sexual problem, suggested living away from home, thinking that this might help.

Her mother and grandmother would not think of her leaving. And her husband left the decision entirely up to her. Since marriage she has felt responsible for her mother and grandmother, looking after their health and happiness. They have enough property to keep them comfortable. Friends come in and play mahjong, but aside from this, they hardly go anywhere. She feels her mother is very childlike and naive. For example, she has never gone to market alone. Her sister is the most outgoing of them all. She has many boyfriends, smokes, and thinks of going abroad after finishing college.

Raised in a home where there were practically no men, she says she has no knowledge at all about sex. Her mother is so naive about sex that she once told the patient that a girl could get pregnant by sitting on a dirty toilet seat.

The patient spent four years of high school in an institution run by nuns. The girls there had many frightful stories about sex, from bleeding to death on one’s wedding night to getting pregnant from kissing. Some thought a baby came out through the anus. The nuns often lectured against impure thoughts, but the girls paid little attention. They talked a lot about sex among themselves. She remembers many girl-pairs in the school, kissing and making love and going “steady” with each other. She thought that was “icky” and avoided such relationships.

It was in college that she seemed to have become aware of her sexual feelings. She double-dated with a girl friend through whom she met her husband. Her girl friends were much impressed by him. He dressed well, spoke very good English, and was refined in his manners. They went steady for two years and he never kissed her except for a chaste peck, once or twice. She appreciated this very much, taking it as a sign of his lofty regard for her.

She was quite surprised when around graduation time, they became more sexually active and she, herself, was responsive in kissing and petting. However, she always objected to and resisted any genital play. She could not recall whether she experienced any vaginal sensations at that time.

On her honeymoon, she was so frightened at the sight of her husband’s erected penis that she cried hysterically. Since then, she tried just about everything to enable herself to have sex because she sensed that her husband was starting to lose his patience. She read sex books. She tried sedating herself prior to intercourse but she became even more alert and apprehensive. She became irritable, quarrelsome, and began to criticize and insult him quite often.

She was seen twice a week for nearly six months without much progress in her sexual problems. She was gaining some insight into her fears of growing up and breaking away from her mother and there was a lessening of her hostility towards the husband. It also became evident to her that she had been undercutting her husband in some other ways. She never went to his family’s gatherings. She thought his work in the bank was only slightly better than janitorial. She even thought, at times, that he was putting up with her because she has a house, a car at his disposal, and property to her name. When this need to be superior was interpreted to her, she said her mother felt exactly the same way she did. All other interpretations, in fact, were resisted with “no, that’s not it.”

Not long after, she discovered that her husband was seeing one of the office girls regularly. An officemate of his wrote her an anonymous letter describing details of the “affair.” She was very upset and said that she almost threw her husband out were it not for her, fear that he might walk out and never come back again. At this point, she stopped therapy with no explanation whatsoever.

About a year later, I ran into her in a hospital lobby. She was very much pregnant and was in the hospital for a pelvimetry. She told me that after she left therapy, she went into a deep depression, with nausea and vomiting. “I had to sleep with my mother; my husband had to spoon-feed me. I almost went out of my mind. I even suspected my sister of seducing my husband.” Asked why she did not contact me, she said she was afraid that I would berate her with an I-told-you-so attitude. When she got better, she had wanted to call me but felt ashamed “because [she] was a hard-headed patient.”

4. B.V., a 38-year-old refrigeration mechanic, working for a big company was referred by a surgeon for vomiting and epigastric pains, radiating up to the external area and front of the neck. He has been hospitalized twice, a month each time, for diagnosis and treatment. During the second confinement, a psychiatric consolation was made. After two interviews, the patient left the hospital and no follow-up was made. He continued to take the prescribed tranquilizers and anti-spasmodics, but finding no relief, went back to see the above-mentioned surgeon.

The patient was a pleasant, smiling man who came with his wife. They seemed to be an average Filipino couple from the working class. He was in khaki pants and a denim jacket while she, dressed simply, wore “sapatilas” (slippers with heels). When I asked to see him alone, he gently motioned her to go out.

He spent practically the entire first hour describing in detail his epigastric pains. He was very much depressed because he could not control his vomiting and he had lost twenty pounds since the illness started over a year ago. His attitude was imploring almost to the point of tears. Once in a while, his voice became whiny especially when he expressed regret over each doctor’s failure to find out what was wrong. Aside from finding it difficult to fall asleep, he would wake up in the early hours and toss about until dawn.

The next day he called, asking to come although he was supposed to come two days later. He came and reported that the pains were less, but that he still tended to vomit. He also said that although the company was going to pay for the psychiatric bill, he wanted me to know that he, too, knew how to be grateful. In a smiling, somewhat embarrassed way, he expressed hope that I would be different from other doctors who are interested primarily in money.

The day after, he was back again and with much apology for coming without an appointment, he said he wanted to report that he vomited only once and although there still were pains they were not as bothersome. He looked very much like a little boy reporting to the teacher that he was diligently doing his homework.

For many months, coming one to three times a week, depending on how he felt, he began each session with a detailed report of his entire physical condition, including bowel movements, urination, eyesight, hearing, breathing, etc. Gradually, with prodding, he gave more information about himself, his work, and family.

He has always been a worrier. Although he has progressed steadily in his income and position, he tends to be pessimistic about everything. He blames this on the grim poverty of his childhood. He recalls walking seven miles everyday to attend high school and spending ten centavos for his evening meal at the marketplace.

His father was a furniture maker and repairer in their small town. With five children, his mother had to supplement his earnings by taking in washing. His older brother did odd jobs in construction work in the next town, much bigger than theirs. Later, he married a girl there and together they ran a sari-sari store, which did well. The father wanted the patient to live with the older brother and have the latter send him through school. The patient refused and ran away to an aunt in a town in Rizal province, several miles from Manila. He was thirteen years old then. He worked for the aunt as a houseboy and went to school in the afternoon. His mother and older sister wrote letters entreating him to return home, but he never answered their letters.

After high school he worked as an apprentice in an appliance repair shop where he learned the trade. He saved money, enrolled in a vocational school and in less than a year decided to start a repair shop of his own, in the silong (like a basement) of his aunt’s house.

At 24, he met his wife who persuaded him to open a shop closer to Manila. She herself worked as a seamstress in a small shop in Pasay. He fell in love with her, he said, because she seemed “mabait” and was the first woman who ever offered advice about his work. After marriage, they moved to Manila. Instead of opening his own shop, he decided to join an appliance manufacturing company. “Being married, I wanted a sure income every month.” The wife had to give up her work because the first child came the first year.

He has been with the company for 13 years. He has worked hard, sometimes joining two shifts, missing lunch whenever a problem was at hand. He was happiest when doing overtime work because it meant his pay envelope at the end of the month would contain more. His friends at work played dice during the noon- break; he watched them once in a while but never took part. His form of relaxation was taking walks at the Luneta on Sundays with his wife and three children.

His superiors had long recognized his ability and devotion to work and as early as five years ago had asked him if he would like to be the head of a section. He smiled and said nothing but deep inside him, he said later, he felt that it seemed impossible that things could be better than they already were. He liked his co-workers. He was proud of his abilities. He was always called to tackle particularly difficult appliance problems. His own foreman took off his hat to his abilities. He still tended to worry about the future, but felt happy enough about the present.

Two years before, he was placed in charge of the freezing department. This meant more supervisory work, bigger pay, and a chance to move higher into management. Everyone felt he could fill the job quite well, since he knew the work and he was familiar with the way the men pulled tricks to delay work and prolong an assignment to their advantage. They all congratulated him on his promotion and he in turn gave a “blow-out.”

One day, after a month at the new position, while doing some inspection at the plant, ho developed chills and nausea. He went home that morning and started to vomit. He wondered if he was having a bout of indigestion from the crabs he ate the night before. He stayed home the next day, was seen by a doctor who prescribed him some pills. He returned to work but since then has been absent a good deal because of the persistence of vomiting.

The past year and a half had been marked by recurrent episodes of pain, nausea, and vomiting. The onset of pain makes him so apprehensive that he is unable to concentrate on his work. He has the nagging thought that the pain could mean cancer.

He has asked the manager to put someone else in his place, since his attendance had become unpredictable. He grew more and more pessimistic about his illness, with each failure of the doctors to discover the cause.

In therapy, he became very dependent on me and often said he thought I had “saved” his life. He wanted me to tell him everything he could do; whether he could take vitamin pills, take a full bath, resume walks in the Luneta, and whether it was all right to start going back to work since his sick leave was nearly exhausted. In an effort to extricate him from this dependency, I made many interpretations which only seemed to encourage him more to reinforce the dependency. He brought fruits and cakes. He consulted me about his children’s aches and pains. He started to work regularly but returned to his old position, explaining to friends that his physical health was not well enough for him to take on the new job.

At this time, the wife came to see me, without his knowledge. She quickly burst into tears and said that he had become unbearable at home. I pointed out to her that he seemed better and was now working. She said that he had become money-conscious and talked about money all the time. He nagged about her household budget and accused her of sending money secretly to her folks. He had also decreased the monthly amount he sends his mother. The wife felt so hurt at his attitude that she has planned to work again to earn money of her own. She wanted my opinion before she would do anything definite about it and before discussing it with him.

When I saw him again, I told him about his wife’s visit and how unhappy she was. He completely denied her allegations. He said she exaggerated everything and that all he wanted was for her to be careful about spending. His health being poor, he felt he had reached the limits of his earning capacity. He was not about to work any harder and be sick again. He said he was not like his father who was lazy half the tine and who spent money on cockfights. He felt he had a higher sense of responsibility to his children, but he was not going to kill himself working either. However, he also refused to let his wife work because it might expose her to “temptation” (flirtations with other men).

Beyond this, he refused to go farther in therapy. He comes in once in a while to tell me how he is. He called up when his son graduated with second honors from elementary school. Every Christmas, I get a kilo of grapes or a dozen oranges from him. And every once in a while, he lets me know that if anything goes wrong with my refrigerator I should not hesitate to call him right away.

5. L.C., a 22-year-old senior in business administration at an all-girls’ college run by nuns, is a chubby girl whose big brown eyes in a well-scrubbed, roundish face make her look more like ten. Sometimes she wears the fashionable long, black stockings, presumably to achieve a more grown-up look, but which only look incongruous with the rest of her. She came for help after four attacks of “uncontrollable shaking of the body” preceded by headache, choking sensations, dizziness and numbness of legs, followed by a feeling of generalized body weakness. Two of these episodes happened at home and two at school. Each rime she was revived with message and vigorous fanning. The last time at the school clinic, only an injection accomplished recovery.

The first attack happened two months ago while she was in her home province for Christmas. Her father, a doctor, bad just finished scolding her for attending parties two nights in a row. After the attack, he gave her a glycerophosphate preparation “to strengthen the nervous system.” He also asked her if she had too many extra-curricular activities in school which may have caused her to become physically weak.

She was a very active girl while at a local high school. Not only was she at the top of her class, but she also participated in dramatics, student government, religious and charity drives. Her sister preceded her to Manila by two years to enroll in college and graduated the year before her illness began. The mother used to visit them regularly each month during the first two years, but due to her business in the province she has since delegated a good friend in Manila to look after the patient. The patient stayed in the dormitory of the school and could go out only if properly chaperoned by a relative or her mother’s friend.

When talking about boys, L.C. became very embarrassed. She still felt uncomfortable in sleeveless dresses thinking they wee somewhat immodest. Her mother and sister were less bothered by this, but they did carefully emphasize modesty, decorum and above all, “avoidance of situations which will tempt men.” L.C., however, has learned a lot from her classmates who appeared to have more experience. They fixed her up a date for the junior prom and planned to go night clubbing after the dance. She felt uneasy about sneaking out. She finally agreed to the night club idea, with a male cousin to escort her instead of the “blind date.”

One summer, she had a “crush” on a town mate who returned to Manila on the same boat with her. The young man seemed much interested in her. What impressed her most was his “politeness and humbleness.” As she talked about him, she grew agitated and with legs crossed, continuously swung one of them to and fro. When I asked her what she thought about masturbation, she opened her eyes wide and asked ‘What’s that?” But from the upturned corners of her mouth and the feeble tone of her voice, one could see that she knew exactly what it was.

Again, with similar wide-eyed puzzlement and some protest, she complained that she could not understand why older men, especially the married ones, seemed to be attracted to her. She has observed this among her parents’ friends. At this point, she suddenly remembered an incident at home during her last summer vacation. A friend of her father, who was at least fifty, with children her age, had dropped in unexpectedly one afternoon. Finding her parents away, he asked her to play the piano for him. Then he sat beside her and began touching and playing with her breasts. She was so frightened that she could not move. The man then asked her to stand up and kiss him. She became dizzy and rushed out of the room. She could not recall exactly what else happened. She became ill for the next two days with nausea and vomiting, but had forgotten the incident completely and had not mentioned it to anyone, until now.

A month later, a similar incident happened in school. The graduating class was staging a play and had hired a well-known musician to take charge of the musical score. She was a stage manager in charge of props and scenery. As they went through rehearsals, she observed the man “who must be at least forty” frequently looking at her legs. She made it a point to ignore him and especially not to look at him. One evening after rehearsal, when she went back to the hall to look for her bag, the man was still there. He forcibly embraced and kissed her. This time she remembered feeling disgust “at the taste of his saliva.” She missed supper that night. The next day she had an attack of “convulsions.” Everyone told her that she was probably working too hard, but the doctor suggested a psychiatric referral.

As we talked about graduation and her future plans, it became clear that she did not want to go home to the province. Her mother who owned and managed a department store there would like her to come home and help. The older sister was now there helping their mother. Her father told her he could easily put her in a friend’s rural bank or get her a position in an accounting firm owned by his friend and golf mate, if she did not want to work in the family business. The patient felt that her mother would be very disappointed if she did not return home. Mother had plans of expanding the store to include an appliance and hardware branch and needed people, who could be trusted.

Some of her classmates were planning to go abroad. Two others were getting married right after graduation. With a feeling of emptiness, she realized that here she was, graduating, and she did not even have the slightest idea what she wanted. She had just drifted into the course. She had thought that college, like high school, was just another phase of life leading to more of the same. She also realized how far behind she was from her girl friends with regard to dating, in spite of the fact that she was an active and popular student leader.

After graduation, she took up summer courses in a coeducational school. Her parents were reluctant to give their permission, but were amenable to the idea provided she agreed to live with the family’s good friend in Manila. The patient refused and moved instead into a boarding house a few blocks from her new school. There were many long distance phone calls and arguments between her and her parents until finally they compromised on a dormitory run by a town mate. As it turned out, she had more freedom to come and go at this place. She even learned how to ride the bus by herself, something she had never done before.

She had decided to pursue a Master of Arts course so she could stay on in Manila for two more years. It was not so much to specialize further in her course, as “to postpone decision about going home.” She also seemed ready to finally face growing up.

Most of the discussions in therapy pertained to her reactions to men and sex. For a long time she continued to be flustered by minor incidents, e.g., when a man sat too close to her on the bus, when she saw a man in the library exposing his penis, or when her professor, discussing moles, showed her one under his chin. It took her many months to see that her naivete was her way of getting involved without taking corresponding responsibility. Many times she felt a man had taken advantage of her “friendliness.” For example, a boy asked her to go alone with him to the recording room in school to listen to taped music. Finding themselves alone, he tried to kiss her. She was much surprised and hurt by his move.

Her present group of girl friends was quite different from previous ones. They made no secrets of having boyfriends, went on double dates, shared each other’s problems and gave advice and comfort to one another. Although they still regarded her as the ‘baby” of the group, she surprised them with her naive but quick way of meeting boys and somehow getting them to visit her at the dorm. She has slimmed down, now used a padded bra to enhance her appearance (“I would have never dared before”) and like her friends got a kick out of “phone pals,” who were, of course, boys.

After passing through a year of “those whom I like don’t like me and those who like me, I don’t care for,” she became serious about a fourth-year medical student who had been seeing her on-and- off for some time. As soon as they were engaged, their relationship turned stormy with many quarrels and reconciliations, usually about her guilt over kissing and petting. For some time she insisted they go to confession after each date. The boy put his foot down. She did not see the problem as a fear of losing her control. Rather, she said he was the problem since he had no self control at all. So she helped him fight his impulses, “in order to teach him self-control” In the end, he seemed resigned and even grateful that she was a truly virtuous woman.

The original symptom of “shaking” had long since disappeared. With the advent of this new relationship, especially during quarrels, she suffered from stomach cramps and nausea. They were mild and they hardly bothered her. “What could be more perfect?” she said, “he is going to be a doctor.”

6. R.R., a 44-year-old businessman, accompanied by his older brother, came because of a great fear that he may succumb to a heart attack. It was very difficult to persuade him to come for the psychiatric interview. At home, he was constantly attended to by his wife and the older two of his nine children, since he would panic whenever left alone. He also had an oxygen tank at home for emergency purposes and a special nurse at night.

The fear came a week prior to consultation after he discovered that his most trusted associate, whom he had practically “adopted” and raised to be his right-hand man in the firm, had swindled the company of huge sums of money. The patient was enraged by this, and while he was weighing possible legal measures to punish the man, he began to have chest pains, dizziness, and headache. The fear of a heart attack quickly followed.

He mentioned a similar “attack” eight years ago when he was abroad for the first time, in a hotel room in Tokyo. In bed, while trying to sleep, he had suddenly felt that the ceiling was coming down on him. He took a sedative but cut short his stay in Japan. Since then he has gradually been able to resume travelling for longer periods, except that he has to take a tranquilizer or a martini before entering the plane to the psychiatrist were made with his wife, brother, or oldest son accompanying him. It was nearly two months before he could come alone, and even for some time after that the wife continued to pick him up after each session.

This dependence on his family and seeming helplessness were in marked contrast to the impression he tried to create with me. With me he stressed his daring, his cleverness, and skills especially in negotiating business deals. Even as a child, he said, he was called “magulang” (clever, in a sneaky way) by his siblings. He would get papers at home and sell them in school. He would keep his ration of candy until everyone had eaten his; then he made all of them look on enviously while he ate his share.

His father, he said, was cruel to him for no reason other than that the oldest son happened to be his favorite. The patient, being the second, was close to this brother who was always good- natured and helpful. “My father was hateful. I don’t remember one affectionate gesture from him. He built a great business empire, but at home he was vain, insulted my mother, and had queridas.” Mother was somewhat better but she was too preoccupied with religion that not even the two younger children, both girls, were close to her.

The patient went to a Jesuit school for a course in commerce, which he regretted, he said, because the priests did not prepare him for this dog-eat-dog kind of world. He feels now that many of their teachings are incompatible in a competitive world. Right after graduation, he eloped and married his 16-year-old sweetheart. His father refused to forgive him and barred him from the house. During that time, the patient said he found out he could make money on his own and although he rode “carretelas,” sold empty bottles, and lived on “tuyo” (dried fish) he felt a fierce pride in refusing help from his mother and older brother. The only time he was allowed to return to his home was two years later when his father, who was dying, expressed a wish to see the patient’s son.

Refusing to use his inherited money for capital, he ventured out on his own. At 28 years of age the patient made and lost a fortune. For a year after that, he did nothing but lay idle, goes for long drives in the countryside, bum around with friends and women. His family, however, was comfortable from the money his father had left behind.

At 32, he made a quick killing at the stock exchange, but soon lost nearly all of it in oil prospecting which did not materialize. Four years later, through ingenuity and fortuitous political connections, he was again at the top of the heap, only to risk his position through neglect and carelessness. He saved himself from total financial loss by selling part of his ownership and yielding his top position to someone else. At this time, he had become greatly enamored with a married woman and spent most of his time with her.

At present, he is again secure financially but is involved in an ambitious expansion of his business. There is an ever-present feat that he may wake up one day and find himself, his wife, and nine children in a financial hole. He is afraid he may get a heart attack before all his plans are realized. He would like to leave them a sizeable fortune, so that they will never ever be in want.

The swindle by his trusted associate is not such a big financial catastrophe, as he analyzes it. His rage stems more “from being deceived by this boy, who was like a son [to him].” Although the man had resigned, apologized, and had asked to discuss with the patient how he hoped to gradually reimburse the money, the patient has refused to see him, much less talk to him. “The deed has been done—what is there to discuss? As far as I am concerned, he’s dead.”

Therapy brought out clearly the two sides of his character. At times he is arrogant, disdainful of therapy. He enjoys teasing the therapist (How much money do you make a year? How about joining my company?), parrying interpretations of his narcissism with a “aren’t-I-cute?” laugh. At other times, helpless, beset with fears and anxieties, he asks for constant reassurance. He gloats over reverses of his business rivals but makes novenas and prays “for everybody, even my father.” Therapy has gradually focused on his ambivalence towards money and success and the increasing anxiety now that he is “on the last mile to the top” and can no longer afford to slide down again.

7. N.G., a 23-year-old housewife, left her husband and three children in Surigao province to come to Manila for a physical checkup. Her chest pains, difficulty of breathing, and body tremors, all of one year’s duration, were unrelieved by medications prescribed by doctors in the province. When she came to see me, she had just finished an extensive work-up for possible thyroid dysfunction. Yielding negative results, this was followed by psychiatric referral. The patient’s mother had insisted that she be hospitalized and get a “more thorough” going over. On her own, the patient decided to see a psychiatrist instead.

On her first visit, she explained that hospitalization would mean staying longer in Manila and she was getting homesick for her youngest, barely a year old. Told that psychiatric treatment may even take longer, she nevertheless said she would stay since she wanted to get some things off her chest. She felt a little guilty, however, since it had seemed more like a vacation, doing nothing in her parent’s home for the past two months.

She is the oldest girl of five children. Her parents had particularly doted on her. Ever since she can remember, father had always been more lenient with her than with the others. Very often, her younger brothers and sisters would course their requests to their parents through her. Her father had intended to send her abroad after college. However, during her fourth year in a course in Foreign Service, she had secretly married her husband. She was a little more than nineteen years of age then. Besides, she was not really interested in the course but had chosen it because it sounded “glamorous.” Towards her graduation she was compelled to tell her parents about the marriage since her husband, also graduating had to return right after to Mindanao to join his family’s business. Moreover, she discovered that she was pregnant and in fact was five months’ pregnant when she marched to get her diploma. She still retained her maiden name, she said, to acknowledge her debt to her parents and accord them the honor of her achievement.

Disappointed at first, the parents became resigned to losing her after a while. The mother, however, tried to talk the new son-in-law into staying in Manila by promising to find him a good job in the city. The young man refused since his own parents were expecting him to take over the management of their business.

The patient, on looking back, said she did not like her in- laws from the start. Firstly, she felt that they exploited her husband, paying him much less than what he deserved. She also found rather irritating their constant talk of money, business, and profit. She looked on them as provincial, zoveau riche, narrow-minded people who did not even know how to dress properly. She also found the slow, monotonous pace of life in the province extremely boring. They lived with her parents-in-law and three of her husband’s sisters, one of whom was married, with three children of her own.

Her husband was often away. Since they were in the rice and corn business, he had to take trips to neighboring provinces. An occasional baptismal party, going to the movies with her sister in-law or the maid, or a ride to the provincial capital to do some shopping, was the highlights of her new life. It was quite a change from the active, party-filled sorority days in college.

She turned to her babies for solace and she had two of them during the first two and a half years of marriage. She personally attended to their feeding, bathing, and diaper-changing, even though there were plenty of maids in her in-laws’ house. She worried and fussed over them and would not leave them even for a day.

One morning, a year prior to consultation, when she was near-term with her third child, she discovered that her husband was having an affair with a woman in a neighboring province. While unpacking his suitcase after one of his trips, she found an envelope with a woman’s letter addressed to him and some pictures taken of them with some friends at the beach. The contents of the letter indicated that the woman had decided to break up the affair because he was married and could offer her no future. It ended with best wishes for him, his wife, and children.

Wasting no time, the patient went to her husband’s office, cried hysterically and had to be sedated. The husband abjectly confessed to the wife that indeed there had been an affair, but that the woman was much below her in station, beauty, and breeding. In fact she was one of a group of “loose” girls whom his business friends took out on dates during their trips there. This woman had taken him seriously but he had gone with her, he said, only “to pass the time.”

The patient would not be consoled. Aside from hysterical outbursts, crying sessions, interminable questioning about what exactly the affair had consisted of, she demanded that they move out of her in-laws’ house. She was especially upset because they had not thrown themselves on her side against him. ‘Men are men,” they said. The husband, feeling guilty, acquiesced to every demand she made.

After the baby was born and they had moved to a house of their own, she insisted that they set up a business apart from his families. Then, she made him take her to the province where the other woman lived. Forcing him to give her the Woman’s name and address, she looked her up. In is show of superiority she announced to the other woman that she was the wife and that if money was the object, she would give it provided her husband would be left alone. The other woman declined the offer of money and assured the wife that she had already gotten over her infatuation with the latter’s husband.

Upon returning home, she started to berate- the husband for consorting with such a low woman. She said it made her feel dirty to have sex with him after seeing the woman he had gene to bed with. She began to complain of chest pains, body tremors, and dyspnea as her anger continued unabated. By this time, the husband was getting tired of her rantings and began to shout back at her. She countered by refusing him sex. On two occasions, she impulsively swallowed some sleeping tablets in his presence, obviously to frighten him, which it did. From that time on, he went with her to doctors to get help for her symptoms. Finally, she decided to come to Manila.

She told nothing of her problems to her parents. She was sure to get blamed for marrying him. They were alarmed, however, at her illness and insisted that she stay longer than the one month she had planned.

In therapy, which took place two or three times a week for two months, the patient had a chance to appraise her young life. She began to see that she had never really been on her own. She was one who easily lost interest in hobbies and projects and even in belongings. She was always buying bags, dresses, and shoes of which she would readily tire. Now she had her own home, she was learning for the first time how to budget and how to handle maids. She saw how ill-prepared she was for all this because throughout her high school and college days, she was more interested in books, movies, and sophisticated conversation. The prospect of returning to the province was a dreary one.

She wrote the therapist a month after her return, thanking her for the discussions. She said she felt that she had grown emotionally “about an inch” but that the rest of the growing up
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she would do by herself. With some insight she remarked that in going home to her parents, she had somehow expected that all the hurts would magically go away. It was sad to realize, she said, that her parents could no longer mold the world for her. In closing, she asked if she could communicate with the therapist should she revisit Manila.
8. M.T., a 34-year-old married woman, employed as a secretary, is six months pregnant with her fifth child. She has been “nervous” all her life, she says, but since this pregnancy began, she seems to be afraid of everything. Ten years ago she had a “nervous breakdown” when her 3 year-old son got lost for a few hours while shopping with her. She remembers receiving two electric shock treatments for her severe nervousness then and that she spent a month’s vacation with her mother. When the present illness began, her husband wanted to take her to the same psychiatrist, but she was deathly afraid of going through the treatments again and so refused. Her husband took her on a short trip to Hong Kong, but she came back more fearful than before. She is afraid “something terrible will happen,” afraid of death, of being left alone, of sharp objects, closed rooms, and crowds. She became hysterical in church one morning and started to scream. She said that while she was praying she had thought she might be forced to take the electric shock treatments again and became so frightened that she screamed.

She is the oldest of three children, with a brother next to her and the youngest, a sister, five years her junior. Her father died when she was ten. She recalls that he was a strict and reserved man. None of the children could sit on his lap because he did not want his suit messed. She was told that she rolled on the floor with grief when he died, but she recalls none of this.

Her mother then had to go to work. She was placed in a nuns’ schools an intern (One who lives in the school dormitory and is not allowed to go out unless the parents say so). Her younger sister and brother were made to stay with different aunts. Again, she was told that she was chosen to board in the nuns’ school because she was a very naughty girl and none of her aunts would rake her.

She does remember being very unhappy as an intern. She had been very close to her mother and as a child, despite the latter’s objections she would often sleep with her. She ran away from the nuns several times, but her mother always returned her after many tearful scenes, The threat that her mother would get married if she did not behave well always made her give in. This seemed to frighten the patient more than anything else.

In school, she was a troublemaker and was called many times to the Mother Superior’s office for disciplinary action. When she reached third year high school, she flunked and refused to resume her studies. She was 15 years old then. The mother then took the three children and rented an apartment. The patient went to secretarial school. At 18, she took her first secretarial job and since then, she has been working almost continuously.

When she was 20, her boss, a married man twice her age raped her. He invited her to dinner, gave her something to drink which made her dizzy and weak and then brought her to a hotel. Her mother took her to a gynecologist who confirmed that penetration had taken place. She neither does nor remembers whether she bled or not. Nothing more was done about this incident for fear of ‘scandal.

The next year, she met the man who is now her husband. He courted her for over a year. When he proposed marriage, she told him all about the rape incident. He said that since it was not her fault he was still willing to marry her. She has since felt very grateful to him especially because her mother had told her that a girl who has been raped has little chance to live a decent life.

Her husband is in the construction business. He works hard, makes good money, and buys everything she asks for. He cannot therefore understand her illness, although he acknowledges that she is the nervous type. He gets angry whenever she is moody or depressed because he is used to her being cheerful and talkative all the time.

In therapy, she brought out guilt feelings about the pregnancy previous to this one, which had ended in abortion. She had secretly wished for the abortion and, in fact, had willfully lifted a heavy half sack of rice to provoke it. When the abortion did come, she felt relieved but now she feels guilty and has repeatedly confessed it to a priest. Her obstetrician says it was due to a pathological ovum, but she is not convinced.

She was not happy about this pregnancy either, but her husband scolded her for not welcoming it. Their constant source of disagreement is sex and children. She cannot stand sex; he wants it several times a week. She does not want any more children; he does not cooperate. She discussed with him the advantages of taking contraceptive pills; he threatened her that should anything untoward happen he will hold her responsible. Once she asked him if he would agree to an operation ligating her Fallopian tubes. He talked to some friends, including doctors, and several told him that the woman can go crazy after such an operation. That subject never came up again.

As the date of her confinement approached, she became more apprehensive, feeling certain that death would come to her. Her mother had always told her that a woman giving birth had one foot in the grave. In subsequent sessions, the patient began to express great hostility towards the mother and started blaming her for her nervousness. She also blamed the mother for many things: for having her once with an aunt who treated her “like a dog”; for punishing her as a child, by making her kneel with arms outstretched; for leaving her in the colegia (nuns’ school); for bringing her to a gynecologist after the rape incident, when she could have kept it a secret.

I visited her a few days after the delivery. She was relaxed and cheerful as she related ho he amused everyone in the delivery room by calling my name as she went through the pains. A month later, she came back to report that she was feeling fine and could hardly wait to go back to her job. She had asked her mother to stay with her and help care for the baby until she could find a good yaya (a maid in charge of the children). The mother is also doing much of the cooking now. When I remarked that she must be enjoying all this babying from mother, she smiled and said, “Well, she might as well pay for her old debts. Besides, this is what she wants and I am only giving in to her.”

9. A 32-year-old pastor of a Protestant church in a southern province came to Manila for medical help for severe migraine. He was sent to me by a neurologist who found no organic pathology.

During the first session, he also complained of poor sleep, with particular difficulty in falling asleep. The headache had been a problem for the past year. He also had periods of depression lasting for weeks or months during which times he was surprisingly free of the headache. During the past few months, he had become more and more pessimistic about the headache and had seriously thought about the possibility of brain cancer.

There was a strong undercurrent of depression, but what was more obvious was the way he forcefully continued his tenseness and hostility. He described himself as “unable to relax, always on the go.” He took his parishioners’ problems as his own and worried often about the health and upbringing of his four children. He spent so much time “polishing and repolishing” his sermons that he dreaded the coming of each Sunday.

When I suggested that it was his work which was giving him headache, he glared and sat up as if he was ready to throw the furniture around. He however denied feeling angry. After the session, he went back to the neurologist who persuaded him to give therapy another chance. During subsequent sessions, he continued to exhibit the hostile manner of an angry man wrestling with an indefinable frustration. Soon, it was therapy that he picked on, predicting its futility and denouncing its lack of concrete guidelines. He gave me one month to remove his headache because that was all the time he could stay in Manila. He said that he had read many psychology books and had attended pastoral counseling lectures, and yet I could see he wanted magical solutions. He retained an arrogant air throughout our contacts and seemed completely devoid of humor.

He is the sixth of nine children. When he was born, his mother developed tuberculosis and he was given to his mother’s sister, a spinster, for care. The aunt resided in another town, about five kilometers away from theirs. Although his mother had recovered in a year, he stayed on with his aunt and returned to his parents only when he was nearly seven years of age, in order to start schooling. Previous to this, contacts with his parents and siblings were infrequent. The aunt who raised him lived with two other unmarried schoolteachers.

The whole family was religious, his father being a pastor. His mother with two older sisters helped his lather actively with church work. The whole family lived frugally, so as to send everyone through high school at least. The oldest, a boy, had been groomed by the father to follow his footsteps, but after two years in Manila, he switched to a course in commerce and now runs his own enterprise. The other brothers are working themselves through college while helping support the other siblings.

The patient did not want to be a minister, but his father wanted one of his Sons to be one. He had wanted to go into jaw but his mother, to whom he was close, made special efforts to convince him into entering the ministry instead. He spent four years in a seminary and two years in field work. Many times he felt discouraged, especially at the prospect of financial deprivation and the sacrifice of one’s comfort as a pastor. But, as his mother pointed out, they had sacrificed a lot, too, and that there is enough self-respect and prestige to be had in helping other people.

He recalls that while he was at the seminary he had a chronic skin rash over his arms and legs which sometimes exacerbated into acute urticarial wheals. It was so itchy “it nearly drove me out of my mind.” He would apply everything from hot towels to “katol” ashes. He avoided various foods. A dermatologist told him that it was an “emotional” problem and suggested psychiatric treatment. However, when he went into field work, it subsided.

At 27, he obtained his seminary degree. He asked for his present assignment in Mindanao which is “as far away from home as. possible,” because he warned “adventure.” He married a girl from the town where he was assigned, choosing her because she was reserved, modest, and the “silent type.”

After four children he decided to practice birth control by coitus interrupts. He says, this does not bother him and he presumes his wife is glad that pregnancy is being avoided. They both agree that money problems have become more serious with each additional child. They have been quarreling, usually over money, but also about other things, notably her housekeeping and the way she disciplines the children. He also feels she is not giving him enough help in church work and that she is too simple-minded she cannot converse intelligently. He keeps nagging her to read books and improve her English so that she can be of more help to him. Her usual reaction is to keep quiet or cry, but once in a while, she blames him for not earning more.

He stayed in Manila for two months and kept his appointments “because there is nothing else to do.” He was waiting for the next boat home. Therapy was focused mainly on feelings about his work, his perfectionistic standards, and his involvement with parishioners. Although he had been “scared of responsibility” at the start, he has found satisfaction working with people and their problems. However, he tends to get too involved with them. They exert great demands on him and, he said with a smile, he feels that he should get paid doing this kind of work, “like a psychiatrist.” That was the only time he expressed some humor.

10. C.V., a 31-year-old housewife, mother of three, was referred for epigastric pain and diarrhea. She has had these symptoms on-and-off for approximately ten years and had learned to live with them, usually by taking a little paregoric in the morning. She had intensive anti-amoebic therapy at least three times in the past with no clear improvement. The diarrhea hardly bothers her; she would have two watery stools in the morning and occasionally, another one as soon as she reached her office. The rest of the day was all right. She has frequent bouts of dizziness, weakness and difficulty in breathing but she has had them on-and-off for many years. A sniff of ammonia and a few minutes rest usually revive her. She decided to seek help, she said because she has become a nervous wreck for the last one and a half years. Severely depressed she has even thought of committing suicide.

For many months, the constant topic in therapy was her husband’s attitude towards her, his lack of sympathy, his indifference, his unwillingness to communicate with her. Six months after their youngest was born, she decided to go to work in order to afford therapy, for which he had absolutely no respect and would not pay for. Her father had predicted that she would be unhappy with him, because he was lo and like to be cold, hard, and businesslike whereas they were Visayans, lighthearted, demonstrative, and generous.

 The second girl of five siblings, she was told that she was father’s favorite although she recalls no evidence of this. The oldest girl was mother’s favorite and like the mother was inclined to be shy and sickly, while she grew up bright, clever, and spirited. She does remember taking daily walks with father, reading books with him, but he liked doing this with everybody. She recalls that she received the most spanking from him because she was inclined to be willful and to talk back when scolded.

She was ready to start high school when her father, a professor in economics, got a high position in a big university in Manila. The whole family then moved to Manila. She recalled being very happy in high school and college.

She took a course in commerce and had many lively discussions and arguments about her subjects with her father. She recalls that at breakfast time, she would come down with him and read the morning paper to him. He had encouraged her to get an M.A., preferably abroad, but she had become more interested in boys and parties.

At 22, right after college, she eloped with her present husband because she felt her father would never agree to her marrying him, having called him “mediocre” and “dull.” He was a newly graduated dentist and was about to open an office in a suburb of Manila. She cannot say what attracted her to him, but surmises, with a laugh, that perhaps it was because he was very persistent, following her “like a dog.” After the elopement, the parents gave them a grand wedding “to make things look right,” although her father was obviously displeased.

She had two babies in two years. She found that her husband talked very little. He was mainly interested in two things: good food and sex. She became very close to her mother-in-in-law, a sweet and simple woman, who was “mote of a mother to me than my own.” She visited the patient often, bringing delicacies and always offering to help her with the cooking, housekeeping, and care of the children. During this time, she saw very little of her parents.

The help situation was a constant irritation. When she had two maids, the two quarreled; when she had one, the maid complained. One maid heard of a vacancy elsewhere, closer to friends and town mates, and she left without notice. With two babies and an apartment to run, she was physically drained. Her mother-in-law, she thinks, had been the one redeeming grace of her marriage.

After the birth of her second baby, she visited her parents to attend a despedida party for her brother who had finished medical school and was leaving for abroad. A younger sister had already left for abroad. The older sister was married and living with her husband and their child in her parents’ home. At the party, her father was quite cool and hardly talked to her and her husband. Only her mother seemed unchanged.

That was June of that year. By the following January, she had applied and as accepted for a two-year scholarship in the United States. She had tried to get one in the same state where her brother or sister was, but in vain. At the time that she was making preparations to leave, she seemed dazed. “Everything happened so fast, I had no time to think.” Her husband had no particular strong reaction, one way or the other, to her leaving. Her mother-in-law promised to care for her children. Her father, still cordial but cool, wished her luck. She recalls that he did nor go to the airport to see her off.

The first year abroad was miserable. She suffered from headache, dizziness, and bad eyesight. Twice, she almost packed up to go home. Despite her daily letters to her husband and mother-in-law and regular overseas phone calls she felt lonely and homesick. Towards the end of the first year, she found herself strongly attracted to a professor who had befriended her. When things began to look serious between them, she cut short her stay and returned to the Philippines.

Not long after, she realized that the separation did not change things as she had hoped. Her husband worked hard but still talked little. He wanted his meals served just so. He wanted sex several times a week and laughed at her frantic efforts to keep him on a schedule, so as to avoid pregnancy. He also put her on a monthly allowance to run the household. She resented this very much. Her father had always given his pay envelope, intact, to her mother. She decided to start working right away. But two events forced her to postpone working.

First, she became pregnant with her third child, barely two months after her return from abroad. Then, her father died suddenly from coronary disease about the time that she delivered the baby.  She took his death without tears but they all had to take repeatedly swallowed and extruded by the patient in the start and turns staying with her mother who took it very badly.

During the first year following her return from the United States, she was a physical wreck. Aside from the pregnancy, she was in and out of hospitals for chest pains, dizziness, numbness, tremors and emergency appendectomy. She almost had a rhyroidectomy but her brother in the States had written that she go and see first an endocrinologist friend of his. This doctor, after a thorough examination of her condition, suggested psychiatric treatment. She put it off for a couple of months. It was again suggested when she consulted a gastro-enterologist. Her depression was getting obvious.

Through all of this, the husband had been rigidly unsympathetic insisting that it is her fault because she is not helping herself enough.

The course of the illness and of therapy was very uneven. Marital difficulties continued even as she went through her fourth pregnancy. She managed, however, to hang on to her job. After the first year of once-a-week therapy (she refused to come oftener), she disappeared for months at a time, then resumed for a few months, stopped and then started again. When the mother-in- law died, she was hospitalized three times. I had to see her often on emergency phone calls from her.

She talked about her frustrations with therapy. Words are like my bowel movements—watery, no substance.” She jokingly accused me of witchcraft especially when she was besieged by obsessional bouts of guilt. “Even the smallest thing I do seems to be a sin.” At other times, she had brief episodes of somatic disturbances, namely, weakness, headache, dizziness and diarrhea.

Her ambivalence towards the father and rage at his rejection of her have never been adequately discussed. For some reason, she refused to let go. She successfully evaded any serious attempt in therapy to get into this problem. She had a strong, but also ambivalent, relationship with the therapist. I often felt that I, too, was repeatedly swallowed and extruded by the patient in the start and stop patterns of the relationships.