Areas Of Conflict

All patients seeking psychiatric assistance present their problems as a mixture of intra- and inter-personal difficulties. Depending on the kind of personality and type of illness, a patient may evaluate his psychological problems as largely due to one set of factors rather than the other. He may regard it as primarily his problem, a result of his own mental set of urges, impulses, thoughts, and actions. Or he may perceive the problem as resulting from the manner in which he is regarded and treated by the people around him. The Filipino patients in this study leaned heavily on the latter proposition. It was difficult, if not impossible, for him to extricate himself from an interpersonal situation and independently evaluate the extent and nature of his participation. Educating the patient to delineate which psychological events proceeded mainly from him and which from others followed a long and tortuous course. This could be a most difficult goal in therapy work with Filipino patients.

Listening to the Filipino patients in this study, one was led to conclude that the patient’s interpersonal world was his primary source of emotional gratification, the main fount of his joie de vivre, superseding that of personal satisfaction from individual achievement or mastery. His successful negotiation of interpersonal affairs with family and friends brought him reassurance, recognition, and material reward. Reassurance pertained to his need for security and acceptance. Recognition assured him he could produce an impact on another person and help fulfill his own need for power and prestige. These two results were significant rewards in themselves. If his material needs were still unmet, propitious interpersonal relationships are more than half the battle towards their fulfillment. Such attitudes were evident not only in his behavior but also in his fantasies. The latter were replete with people toward whom he directed his libidinal and aggressive strivings.

Logically then, in a state of emotional distress, he automatically felt that the source of trouble was in the same interpersonal world. He quickly pointed the “others’ involved in his illness. Uppermost in his mind was the state of interpersonal relationships likely to be related to the current crises in his emotional life. His problems were apt to be expressed in the present tense or in the setting of the very recent past.

He was not at all inclined to do some retrospective analysis of upsetting events or some digging into past relationships to illuminate the problem of the present. This was due in large part to the fact the in many instances, a patient never completely leaves his past, his childhood, and significant childhood figures behind him. The significant people in his past are likely to be the same important people in his present. In a figurative, and often, literal sense, he has not traveled far in his choice of love and hate objects.

The female patient, more than the male, illustrated these tendencies prominently. She continued to be very close to her parents, even if she already has a family of her own. However, when she experienced physical, if not emotional, separation from them, she turned to her husband, to his family, as well as to her children with the expectation that her personal needs for reassurance, through their acceptance and recognition of her personal worth, will be fulfilled by them. The male patient, on the other hand, exhibited slightly more autonomy and showed more preoccupation with his individual efforts at achieving status, prestige, and security. Nevertheless, he too, fell back rather quickly on interpersonal resources in attaining these ends. To bring out more clearly the differences between the two groups, the conflicting areas among men and women patients will be discussed separately.