“Acting-Out” Syndromes

In the absence of a ready label, I will describe the behavior of six patients as “acting-out” syndromes. They are not to be construed as social or delinquent characters. These were patients in their twenties or thirties who reacted to a traumatic event by losing partial control over their behavior and displaying poor judgment, particularly in money matters. These patients instead of getting depressed began to do things which were nor usual for them and which proved self-destructive. They brought humiliation upon themselves and caused people to think very lowly of them. Perhaps their behavior represents part of the continuum of difficulty in mastering aggressive impulses or is a depressive equivalent. The clinical presentation was so uniquely different that a separate discussion is in order. I have encountered two patients with similar patterns at the OPD psychiatry clinic of the Philippine General Hospital.

In these six cases, four women and two men, the precipitating event was separation from or death of a loved one, either parent or spouse. Instead of going into a depression of a psychophysiological reaction, one patient began to act injudiciously in money matters. The cases seen at the PGI-I-OPD group also exhibited similar acts showing poor handling of money. The patients began to spend money carelessly, neglected the business, borrowed from others indiscriminately and, in general, messed up themselves and their finances to an alarming degree.

One housewife sold household articles and family belongings without concern for their value. Her husband’s camera, her mother- in-law’s sewing machine, her own jewelry had already been sacrificed when the family sensed something was wrung. Another woman, engaged in a small business of lending money to low-salaried employee and collecting with interest on their paydays, became careless with her records and found herself deeply in debt. Another man who ran a used-appliance store similarly exercised poor judgment. He bought articles with no resale value and then starred to borrow money indiscriminately, from some people he knew only slightly. Three patients, one man and two women, went in for heavy gambling. One woman stayed up night after night at the mahjong table in an almost compulsive, tyrannical urge to stick it out there until she would be done in. The other woman became addicted to jai alai which surprised the husband because she had never shown a taste for gambling before. She gambled with the market money and when that was gone suggested to her husband to borrow some from his, office. The third patient, a man, went for various forms of gambling. He exhibited the interesting symptom of torrential crying spells after heavy losses, vowing never to gamble again, only to resume the habit within a short period of time. Like the others, he too began to borrow money from people he scarcely knew.

The lack of guilt was quite striking in all the six cases. There was only a superficial concern about the family’s suffering as a consequence of the abnormal behavior. The attitude towards threat of legal repercussions from the frightful financial obligations was almost nonchalant. One woman very calmly said, ‘Well, if I have to go to jail, I’ll go.” Only the family tore its collective hair in frustration, anger, and perplexity, as its members endeavored to provide the patient with emotional support, at the same time coping with the financial morass.