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- Category: A Study Of Psychopathology
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However, those who come to PGH may be patients who reside north of the Pasig or who are from a remote province, but who know a doctor or a friend of a doctor who is working at the hospital. Manila itself is about fifteen square miles in area and its suburbs belong to three cities which lie adjacent to it, namely, Quezon City, Caloocan City and Pasay City.
Because the author was assigned to the PGH outpatient psychiatry clinic, she came in contact with patients from these population groups. From this experience she draws some comparisons between the PGH group and subjects from her office practice. The high quality of service at PGH as well as its reputation for adherence to principles of scientific medicine attracts many patients to it despite overcrowding and bureaucratic difficulties. To the lower economic groups, it has a particular appeal, since ninety percent of its clientele are charity patients. To them are dispensed services and medicines completely free, costing the patient not a single centavo. Perhaps this is one of very few hospitals in the world whose charity service is rendered completely free, without even a token fee.
The period during which the subjects of this study were seen, over nearly seven years, January 1961 to August 1967. The author had returned to the Philippines in December 1960, after a six- year stay in the United States - three as a psychiatric resident and the rest as a fellow and instructor in a university department of psychiatry. From her experience with American patients, she draws some comparisons between them and Filipino patients.
A word about Manila during the decade which covers the period of this study may give some glimpse into the emotional climate of the culture at this time. One is tempted to use superlatives, good and bad. This is the era of the great brain drain to the United States, to which the Philippines is a leading contributor from Asia, comparable to Great Britain and Canada. Although going abroad for studies or professional training still confers status, the relative ease with which this can now be obtained has diminished much of the awe which goes with it. In the late fifties, shingles of doctors with notations of training abroad, e.g. “Trained in Boston Lying-in Hospital” or “Post-Graduate in New York Polyclinic,” etc., commanded much awe. Now, with the number of doctors coming from and going to the United States, people find nothing extra prestigious about them.
During the period of this study, it was said that the homicide rate in Manila was eleven times the rate in New York (Bulatao 1963) and twice that in Chicago (Securest 1967). Such disturbing figures, if verified officially, would seem to indicate a high crime rate in Manila at the time. The “top ten” stories of 1967, for instance, include a rape incident, a massacre and a sensational murder. President Ferdinand E. Marcos, in his 1967 State of the Nation address, declared that although the national crime rate the previous year decreased by 4.8%, the rate in Manila increased by 23.8% for minor offenses and 18.4% for major offenses.
Elections during the period became less democratic because certain candidates resorted to violence in coercing the voters to vote in their favor while others engaged in large-scale vote-buying to win. Attracted by the “cash your ballot” enticements of moneyed candidates, “flying voters” roamed from one precinct to another, selling their precious votes. Voting became a farce and oftentimes the candidates with the most money but the leas qualifications were elected to office.
On the economic scene, mihi4naires have emerged, a number of them after an amazingly short period of time in business, some with barely a high school or college education. Construction of buildings seems to be going on everywhere. In the suburbs, sprawling subdivisions for private homes arc continuously being opened. Although there are still many poor people, the daily crowds at markets, stores, restaurants, and movie-houses attest to a lively economy. The gross national product by 1966 reached a new level of 22.3 billion, a growth of 5.6%. The population of Manila has swelled to nearly three million; the infiltration of business into old residential sections has driven residents to the nearby suburbs. Manila’s present population is a composite of all kinds of elements, such as one finds in any big metropolis. A large segment of its population is made up of people whose parents migrated from the provinces to make their fortunes or who themselves came to Manila to study and decided to establish residence there.
Private universities do a flourishing business. One such university, situated in a block in downtown Manila, has an enrollment of nearly 55,000 students. In the late fifties, 88% of the university population went to private universities. There were also approximately 175,000 university students in the total population of 21 million. With the possible exception of the United States, the Philippines have the greatest proportion of university students in the general population. (Aldaba-Lim 1959).
It has been said that the Philippines has the highest number of professionals in every field compared to other countries in Asia. The quality of training and resultant skills, however, may be something else. To complicate the situation further, the available opportunities for these graduates to practice their skills in their home country are appallingly limited. At present, every graduating class in medicine sees more than half of its members go to the United States. In one survey made during this period, of 17,000 registered lawyers in the entire country, only 5% are gainfully practicing their profession. (Aldaba-Lim 1959).
The subjects of the study reported here are patients who were seen by the writer in her private office. Excluded were all cases of psychoses, functional or organic. Also excluded were patients below thirteen years and above sixty. Only Filipinos, born and raised in the Philippines, whose parents were also Filipino, were considered many Filipinos count Chinese and Spanish forbears in their immediate or remote ancestry. Where the parents were preponderantly foreign in extraction and mode of living, the patient was excluded. Individuals who came for a psychiatric evaluation for license or compensation purposes were not included. Patients with serious physical illness in advanced state, such as cancer or decompensate heart disease, were likewise omitted.
The resulting group, 130 males and 289 females or 419, are Filipinos between the ages of 13 and 60 years whose psychiatric illnesses fall into categories of neurotic reactions, personality disorders, psycho-physiological reactions or situational adjustment difficulties.