What is a Nervous Breakdown?

A caring wife was in a panic after the consecutive hospitalizations of her husband for tuberculosis. The husband has been experiencing a large number of stressful events. He failed his bar exam. His debt is such that his house may be taken over by the bank. He found out that his son has been addicted to cocaine. And his wife just got fired from her job. Four months ago, his father passed away. Now he is experiencing difficulty concentrating, has become very suspicious and worries a lot. He is also very irritable and jittery and has been experiencing irritable bowel syndrome. And he is having a hard time sleeping. He has been stressed out. She asked if her husband is having a nervous breakdown.

To answer her question, I would look at his life using the five aspects of his life: physical, social, emotional, mental, and spiritual. Physically he is overwhelmed with his schedule and he does have time to relax. Socially, he does not have other friends with whom he can talk to and be real about how he feels. He can act as if he is ok. He appears strong and invincible, but when he is alone he is plagued with worries, distrust and suspicions. Emotionally he is drained; he can’t talk to his wife without winding up in an argument. Mentally his work is so demanding and he has difficulty concentrating on his job. His immune system is very weak. His body is breaking down. Only the spiritual aspect of his person is sustaining him.

Is her husband having a nervous breakdown?

Her husband is experiencing high stress, which causes anxiety. People who experience a large number of stressful events are particularly vulnerable to the onset of anxiety disorders. Increases in stress have been linked to the onset of depression and other mood disorders, panic attacks, schizophrenia, sexual dysfunction, and other psychological problems. In very severe cases it can lead to a nervous breakdown, but not usually.

For professionals a nervous breakdown is called a psychotic decompensation -a state in which the client is out of touch with reality and shows symptoms such as delusions and hallucinations.

Difficulties of Seeking Counseling in the Philippines (cont.)

Another reason that counseling is difficult in the Philippines is because of a general ignorance. Families are not educated about the mental condition of someone who is in need of psychological help, nor do they know how to properly care for them. The prominent cultural reaction to someone with Bipolar I disorder is that the person is demon possessed. I remember a family insistently called different pastors to cast demons out of a family member who was clinically diagnosed with Bipolar I. I don’t negate the possibility of demonic influence on a person’s behavior. Tthe problem is when we see psychological issues as purely spiritual. Misdiagnosis and improperly prescribed treatment can prolong the suffering of the individual. I have seen neighbors whose love-ones who are suffering from a nervous breakdown, drug abuse, or schizophrenia. The family lacks the information and knowledge about the situation of the suffering person so the afflicted individual receives inhuman treatment from those who are supposed to love and care for him. Often these people are isolated and placed in an iron cage or chained, so that they cannot wander around and harm someone else or be harmed. These people are treated like a prison in a “bartolina”. Often they must sleep is an upright position because of the lack of space. They don’t have access to the bathroom. They are given a bath by having someone using a hose to sprinkle them. And maybe worst of all, they are not given time to talk and bond with their families.

Filipinos are supernaturalistic in their beliefs and convictions. They see everything that happens to them as events over which they have no control. The fatalistic tendency is to accept situations as being from God or other spirits so whatever they do will not change the situation.

The extreme poverty in the Philippines makes counseling inaccessible to many people. The minimum wage (which is a normal wage for blue collar workers) is about $6 per day. I see clients from all walks of life. In order to make the service affordable, I use a sliding scale that corresponds to the monthly wage of the family. The first instinct might be that counseling should be free, but it is important for people to take responsibility for their problems, and part of that responsibility is shouldering a cost, even if it is a very small amount. This gives the client a sense of control and ownership, as well as personal power.

Why is it hard for Filipinos to seek counseling/psychotherapy?

Though there are a lot of emotional needs and struggles with anxiety within the culture, Filipinos tend to be resistant to the idea of seeking professional help for several reasons:

First of all, seeking help from a psychotherapist is more painful than the existing emotional and psychological pain that is privately experienced by the person (or the family caring for someone who is struggling). The stigma attached to seeking professional help by those who are struggling can sometimes cause more pain. Gossip is also very influential within the culture and going to a counselor would make one the focus of that gossip. The Filipino’s cultural values of shame “Hiya” and self-protection “Amor Propio” are two of the biggest factors preventing Filipinos from seeing a counselor or psychotherapist.

Secondly, individuality and individuation are not part of the Filipino psyche. Filipinos are group oriented people. They take their identity from the group and do not want to be seen as different, nor do they want to bring a bad reputation to the group and risk being ostracized. Within the culture the diagnosis of one person might easily be assumed to other members of his or her group. If a child is suffering with schizophrenia, it is not uncommon to hear others called the family a “schizophrenic family”. The diagnosis can also affect other family members, causing discrimination and stereotypes which would mean loss of opportunity. The brother of a lady who was getting married was diagnosed with schizophrenia. When the family of the fiancé knew about it, they decided to cancel the wedding.

Third, the cultural expectation is looking for a magical touch. The vast majority of Filipinos are Roman Catholic and they seek healing through contact with religious relics and expect instantaneous healing. Many impoverished people spend all of their money to make pilgrimages to holy sites to obtain healing. Or they visit an Albularyo who mix some herbs and chant to dispense healing. In the same way, most people do not seek counseling until they are very desperate. Then they come expecting to be magically healed. A client expects to be given advice from the counselor and to come out of the counseling session with their problems solved. Psychotherapy does not really work this way.

The first meeting with a counselor is just intake and getting to know the client so they can set the goal for psychotherapy. It is not until at least the second session that they start to address the problem in a thorough way. When counseling requires more than two sessions, I notice that a number of clients will not follow through with the set appointment and may eventually drop out – unless they are still struggling with the same issue. Most of the time, when clients experience a little relief, they consider themselves healed. So instead of following through with the agreed treatment plan, they stop until problems recur. For example: I was treating a lady for panic disorder for 4 sessions. She stopped coming to counseling because she was no longer experiencing any panic attacks. But the treatment plan was based on Cognitive Behavioral Therapy and was supposed to last for 8 - 12 sessions. A year later she came back and told me that she was having panic attacks again. She asked me to see me for only two sessions, because she did not have time for counseling.