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Symptomatology

This chapter will describe and discuss the outstanding and most common symptoms encountered in patients and other clinical features, which were observed in lesser numbers. The common diagnostic categories given in Chapter II mentioned some of these features.

More attention will be given to symptoms rather than diagnoses. As is every clinical psychiatrist’s experience, discussions revolving around diagnostic possibilities are not particularly rewarding in the search for understanding of the patient and of his illness. Diagnostic labels tend to evoke built-in or preconceived notions about the illness which often discourage further study of the patient. Diagnoses are also apt to be arrived at in different ways by different psychiatrists, causing at times a good deal of non-constructive dissonance. Symptoms are less likely to be attended by these disadvantages. However, subjective differences between different workers in the elicitation, description, and interpretation of symptoms are not, by any means, totally absent.

As mentioned in Chapter II, anxiety reactions, for which overt or free-floating anxiety is a sine qua non diagnostic criterion, were the most frequent entity. However, it would not be worthwhile to discuss anxiety as a separate symptom. It may be safely assumed that anxiety is present in all the other patients in varying degrees and forms. Except for adolescents who were subjected to a certain amount of parental pressure to seek help, all had indicated a desire to be helped, even if they had not expected to arrive at a psychiatrist’s office. The free-floating anxiety in Filipino patients with anxiety reactions conforms to the classical descriptions of this condition.

Many patients labeled their illness or state in Tagalog, “atake ng nerbiyos” or literally, an attack of nerves. In an adjectival sense, “nerbiyoso” was also used to describe the feeling of being fearful, easily frightened, ruffled or rattled. In a few depressed patients it was also used to describe the general pessimistic outlook hut perhaps pertains more accurately to anxious or apprehensive feelings which sometimes go with depression. Many psycho-physiological reactions or conversion reactions in Filipinos were striking not only in the acute and dramatic quality of onset but also in degree and rapidity of incapacitation.

In such patients, anxiety did not occur in overt form but was implicit in the fulminant process. The person, as it were, quietly went to pieces.

The following symptom categories, listed in the order of frequency, were the most outstanding:

1. Somatizations
2. Depressive phenomena
3. Difficulty in mastery of aggressive impulses
4. Phobic phenomena

Each patient in the sample had symptoms falling under one or more of the above categories. The third category, difficulty in mastery of aggressive impulses, is more subjective than the others, but it is frequently mentioned as such. These four symptoms were expressed early in the psychiatric encounter and were not, in any sense, iatrogenic or an indirect consequence of psychotherapeutic intervention. In short, these symptoms were part and parcel of the presenting illness. Each of these will now be discussed separately.

 

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