19 SEPTEMBER 2006
i R E P O R T — S T R E S S A N D T H E F I L I P I N O
OH, BUT the Filipino is resilient, we keep hearing. I've been in urban shanties where 15 people share 15 square meters of living space and yes, on the surface, everyone seems happy. Chinese Asiaweek once had a cover story featuring Filipinos as the happiest people in the world, unfazed by the most difficult of circumstances. One photo had a group of men drinking away in the middle of knee-high floodwaters.
But the scenes of smiling and laughing Filipinos, singing and dancing (and drinking) away can be deceptive. Quite often, we deal with stress by trying to be "happy." I put that in quotes because the Filipino term is masaya, which is really more of an externalized merriment. Masaya is social camaraderie, it's making cheer and quite often we do it precisely because there have been unhappy events, stressful events. The best example is that of a death — our wakes are notorious for its merry-making, but that, precisely, is part of our stress-coping mechanism.
We have folk psychology, maybe even folk psychiatry, at work here, Filipinos aware of how dangerous it is to allow stress to consume us. We warn people about excesses as a cause of illness, and that includes the excessive emotions generated by stress. The word dalamhati is graphic, describing an inner sadness (from the Malay dalam, inside and hati, the heart or the liver, believed to be seats of our emotions) that slowly consumes the person.
But for all the talk about our communitarian orientation, of helping friends to overcome stress, social pressures in the Philippines can also be counterproductive with the way we sometimes force people to repress the stress. "Enjoy!" we urge them, not realizing there are limits to resilience.
There are power dimensions to all this, such as those found in gender. Contrary to stereotypes about women being more expressive, Filipinas are actually more prone to dealing with stressful situations through tiis (endurance) and kimkim (repression). Check out the local scenes of merriment: it's usually men having a good time, bringing out the beer and toasting their problems away, while their women look for ways to make ends meet.
Men, too, are expected to keep their feelings in check, but more out of masculine values of strength and stoicism. Men are generally not allowed to cry, much less to go into hysterics; and this probably helps to explain why more men suffer from cardiovascular disease.
Many Filipinos will express their stress by complaining about recurring headaches, or abdominal pains, accompanied by dizziness, nausea, fatigue. Doctors used to dismiss these as being all in the mind, but it has become clear the physical pain and distress may be quite real, that the pent-up stress is expressed through the body.
These vague symptoms have been labeled as "somatization syndrome," and are often hard to treat, partly because medical professionals still haven't figured out the biological processes involved. Culturally, too, people may attach labels that don't quite reflect the actual part of the body that's affected, as when they say that they're suffering from nerbyos or "nerves." Nerbyos doesn't necessarily mean being nervous; it's often hypertension or high blood pressure, for example, and a health professional or caregiver may miss the problem.
Then, too, there's the intriguing bangungot, those sudden deaths, usually at night, associated with nightmares. The term itself is derived from bangon, to rise, and ungol, to moan. Young healthy men, like the late actor Rico Yan, die mysteriously and the diagnosis is immediate: bangungot. The medical world remains stumped, attributing the deaths to everything, from pancreatitis to congenital defects in the heart, but too little has been done to explore the stress angle. Similar "culture-bound" illnesses are found also in other neighboring countries and the deaths tend to be reported in international medical journals because they often occur in people who are away from home. The first cases reported in U.S. medical literature involved Filipinos in the U.S. Navy. In recent years, medical reports have included Thai men doing construction work in Singapore, and Indochinese refugees who have just relocated to the United States.
I wouldn't be surprised if bangungot is reported as well among our 8.5 million overseas Filipinos. The Filipino is so attached to home and hearth that we even have a term namamahay, missing home, to describe a range of symptoms, from insomnia to constipation that plagues us when we are away from home. That's stress too. And with men, given the cultural imperative of suppressing their distress, we might expect nightmares, some with fatal endings.
ALL SAID, there's a political economy of stress involved, meaning power relations shape the way one experiences and expresses stress. Common sense tells us the poor suffer much more daily stress, from battling the traffic while commuting, breathing in more of the toxic fumes, dealing with tyrannical bosses and snakepit offices. Poor women are doubly burdened, having to deal with the tribulations of work, as well as of the home, running after the needs of husband and children.
Public health analysts in Western countries have produced voluminous literature on how poverty interacts with stress to cause illnesses and death. Earlier research tended to be simplistic, explaining high illness and death rates among the poor as being due to their lack of access to good health care. But more recent research has shown that the problems of poverty also relate to power and autonomy. The poor are less healthy because they suffer more stress, not just from what I described earlier, but also from the inequities in power. The poor are more prone to feeling helpless and will have less self-esteem — all that contributes to a more rapid deterioration of health when confronted with stressors.
Men may be more prone to the problem of this "political economy of stress," since they have to live up to higher expectations of gender. A jobless man, for example, may be more adversely affected by stress because of a loss of pride. Machismo also blocks him from taking up jobs that he thinks are beneath his station. So he ends up drinking with the barkada, which is then interpreted as "resilience" and an ability to be happy. His wife, meanwhile, will pick up odd jobs here and there, doing laundry, mending clothes; ironically, that again generates stress for him, as he feels his masculinity threatened.
The macho imperatives around stress are inevitably tied to alcohol and drugs. Younger male Filipinos are particularly vulnerable, given their struggles with identity, masculinity and self-esteem, unable to express their frustrations and resentment. Drugs are one way of dealing with the stress, with all its attendant problems. It's significant though that the most abused drugs are metaphetamines, which are "uppers" or stimulants. Again, the Filipino response to stress is to look for more stimulation. The nerve cells fire away until, frayed and exhausted, the user develops paranoia (borrowed into Filipino as praning) and then psychosis.
Others take out their frustrations through violent behavior. The phenomenon of the amok, favorite fare for our tabloid newspapers, used to be the subject of racialized descriptions from Western anthropologists, who thought that those belonging to the "Malay race," including Filipinos, were especially prone to going on a violent rampage, sometimes with hostage-taking.
The racial angle is total nonsense of course. Running amok has nothing to do with race. It's, quite simply, a person reaching the end of the line, or put another way, the bottom of the heap. It's the poorest, most disempowered men, who tend to run amok. A stressed rich man takes out his frustrations on those lower in a pecking order; the amok has no one, not even the dogs at home, to vent his anger, so he turns to random violence.
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