Ferrer vs.

Ferrer Answer: I graduated from Cebu

Institute of Medicine, batch
Presentation of Witness 2008.
for the Petitioner
7. Counsel: Do you have a
Direct Examination- Dr. Margie Sy license, if any?
Answer: I am a licensed physician.
I am Margie Sy, 36 years old, married,
resident of Cebu City.
8. Counsel: Were you licensed
by proper authority?
Answer: Yes, I have an PRC ID to
We offer the testimony of the witness to prove it.
prove the credibility and qualification of
the expert witness, the genuineness of the 9. Counsel: Is this the ID you
psychological report and assessment, the were referring to?
psychological incapacity of the Answer: Yes.
respondent, and for all other matters, Your Honor, we would like to have
facts and circumstances relevant and this psychological assessment
material to this case. marked as P- 10
 Qualification of the expert
witness 10. Counsel: After being licensed
 Existence of patient-doctor as a physician, did you
relationship immediately specialize in
 HPD and its seriousness psychiatry?
Answer: No.
 Severity and effect on marital
obligations
11. Counsel: What did you do
after being licensed as a
1. Counsel: What is your
physician, if any?
occupation?
Answer: I was a resident doctor of
Answer: I am a psychiatrist
Chong Hua hospital for 1 and a
half year.
2. Counsel: Where do you
work?
Answer: Spring Clinic Institute of
12. Counsel: What else, if any?
Psychiatry
Answer: After that, I was specifically
in the practice of psychiatry for
3. Counsel: Can you prove it?
3 years around 2012 to 2015,
Answer: Yes.
under the supervision and
mentorship of Dr. Alex Junia.
4. Counsel: How?
Answer: By a certification from my
13. Counsel: What else, if any?
clinic.
Answer: From the latter half of 2015,
I was already specializing in
psychiatry under my own clinic.
5. Counsel: Is this the
certification you were
14. Counsel: How long have you
referring to?
been practicing your
Answer: Yes.
profession?
Your Honor, we would like to have
Answer: I have been practicing
this psychological assessment
professionally for a total of
marked as P- 9
almost 4 years now.

6. Counsel: Where did you

graduate medical school?
 15. Counsel: In a span of four
years, how many patients did
you have?
Answer: I lost count, I have too many.
16. Counsel: Can you say around
100 patients?
Answer: Yes, around that number.
17. Counsel: What is the most
common psychological
illnesses you help your
patients with, if any?
Answer: I have helped treat patients
with schizophrenia, major
depressive disorders, panic
attacks or anxiety, sleep
disorders or post-traumatic
stress disorders.
Present the psychological report
18. Counsel: Showing this
document to you, are you
familiar with the same?
Answer: Yes
Your Honor, we would like to have
this psychological assessment
marked as P- 11
19. Counsel: How so?
Answer: I prepared this document
myself. It was my
psychological assessment of a
patient.
20. Counsel: Is the signature
appearing on the last page
above the name Dr. Margie Sy
your signature?
Answer: Yes
Your Honor, we would like to have
this signature on the same
document to be marked as P-
11.1
21. Counsel: Is the name
appearing on this document
“Cynthia Manalo- Ferrer”
your patient?
Answer: Yes
22. Counsel: How long has she
been your patient?
Answer: Around six years since she
came into my clinic for
consultation.
23. Counsel: How did she become
your patient?
Answer: She was referred to me by
her husband as he was worried
that Cynthia did not take the
death of their child very well.
24. Counsel: Do you have any
other patients, if any, that
is/are related to Cynthia?
Answer: Yes.
25. Counsel: Like whom?
Answer: Her husband and her two
brothers?
26. Counsel: What were they
consulting from you, if any?
Answer: Her husband was suffering
from anxiety, while both of her
brothers had post-traumatic
stress disorders (PTSD)
27. Counsel: What are your usual
interactions with the patient
since she came to you?
Answer: She undergoes through tests,
therapy, interviews and
counseling.
28. Counsel: Have you
encountered, if any, patients
with similar symptoms as
Cynthia?
Answer: Yes, I have.
29. Counsel: What was your
diagnosis, if any?
Answer: After almost a year of
sessions, I diagnosed her with
Histrionic Personality Disorder,
also known as HPD.
30. Counsel: Based on your
extensive experience as
psychiatrist, do you consider
your ability substantial
enough to give such a
diagnosis?
Answer: Yes, I have had other
patients with HPD before
31. Counsel: Can you please tell
this Court what Histrionic
Personality Disorder is?
 Answer: Histrionic Personality
Disorder is a personality
disorder caused by a
combination of genetic and
environmental influences, the
actual development of which is
usually triggered by a life
situation.
32. Counsel: What is it
characterized by, if any?
Answer: It is characterized by a
pervasive pattern of excessive
emotionality and attention
seeking. Most patients with this
condition do not believe they
need therapy or help, making
diagnosis difficult.
33. Counsel: What else, if any?
Answer: People with HPD are
frequently labeled as divas or
attention-seekers. They thrive
on seeking attention, pull
people in orbit with them.
34. Counsel: What do you mean,
if any?
Answer: A person with HPD will act
theatrically or dramatically to
draw attention to themselves
through exaggerated emotions
and expressions.
35. Counsel: What else, if any?
Answer: They have intense seeming
emotional state, their emotions
shift rapidly, as opposed to real
feeling of emotion
36. Counsel: What else, if any?
Answer: They value their physical
appearance as a tool to manipulate
people and to continue to be the center of
attention.
37. Counsel: What else, if any?
Answer: They are inappropriately
seductive or provocative actions where
other people would not accept as
acceptable behavior, there’s a lack of
filter as to when actions are appropriate
or inappropriate mainly because of the
driving force of wanting to be the center
of attention – that trumps all other social
norms on how to act
38. Counsel: What else, if any?
Answer: They are easily swayed by
opinions of others. They tend to believe
that their relationship with others are
stronger that they really are
39. Counsel: What else, if any?
Answer: As to their communication style
– style over substance, it is difficult to
find substance but is a very theatrical
way of presenting themselves
40. Counsel: What else, if any?
Answer: Those are the common traits of
a person with HPD.
41. Counsel: Did you immediately
diagnose her with HPD?
Answer: No. There were other prior
diagnoses.
42. Counsel: Like what other
diagnosis, if any?
Answer: Many people who have HPD
receive a diagnosis after they go
into therapy for depression or
anxiety, usually following a
failed relationship or other
personal conflicts. In this
patient’s case, she suffered
major depression for about a
month, as well, prior to my
diagnosis.
43. Counsel: So, according to your
diagnosis, is it possible for HPD
to coexist with depression?
Answer: Yes.
44. Counsel: What do you mean,
if any?
Answer: The emotional roller coaster,
the lack of stable relationships,
and the unfillable craving for
attention wear on them. In
relation to this, a comorbidity
exists between HPD and
depression.
45. Counsel: How so? Can you
please elaborate to this
Honorable Court how it came
to be?
Answer: In psychology, comorbidity
refers to more than one
disorders or diseases that exist
alongside a primary diagnosis,
which is the reason a patient
gets referred and/or treated.
46. Counsel: What else, if any?
Answer: You can remember the word
because the prefix, co-,
indicates that things go
together, and when we think of
serious illnesses, it can
sometimes make us feel
morbid. HPD is a self-esteem
driven disorder. Naturally,
depression comes along with it
since if the patient does not
receive enough attention she
seeks from others, this creates
such anxiety and depression
which affects her behavior.
47. Counsel: How severe was her
depression when she came to
you?
Answer: Not quite.
48. Counsel: Why do you say so?
Answer: When she came to the clinic
for consultation, it would
mostly be about her concern on
regaining her previous weight
so she could go back to the
work she loved to do, which as
for her, involved dancing on
stage. It was more about her
weight issues rather than what
her husband believed to be
caused by their child’s death.
49. Counsel: What about her HPD,
was it severe?
Answer: It was.
50. Counsel: In your expert
opinion, how serious was her
HPD?
Answer: I would say 8 of 10. It was a
very difficult diagnosis.
51. Counsel: Why do you say
difficult?
Answer: It is because HPD is not a
very apparent mental illness
that you see quickly. It would
only be after a lot of sessions
that her symptoms became
obvious.
52. Counsel: Is it curable?
Answer: Generally, yes, through
psychotherapy sessions.
53. Counsel: If so, for how long?
Answer: It depends on the patient’s
case.
54. Counsel: What about
Cynthia?
Answer: Chances are close to
unlikely, in Cynthia’s case.
55. Counsel: In a scale of 1 to 10,
how severe is her HPD?
Answer: I would say 8 or 9
56. Counsel: So, is it still curable at
that rate?
Answer: Yes, however, in this case,
even the patient doesn’t
recognize her condition.
57. Counsel: What do you mean, if
any?
Answer: The patient refuses to admit
that she has HPD. It would then
be difficult to prescribe the
proper medication and therapy
to cure her or improve her
condition.
58. Counsel: So, are you saying
that in her case, her condition
is incurable?
Answer: Yes
59. Counsel: What are
circumstances or events, if any,
that gave rise to her condition?
Answer: Personality disorders are
normally triggered by a life
event or trauma experienced by
a person. In Cynthia’s case, the
trigger of her HPD was the
abuse she had experienced as a
child.
60. Counsel: How does this relate
to her HPD?
Answer: That was what triggered her
condition
61. Counsel: What is a trigger?
What does it mean?
Answer: A trigger is a reminder of a
past trauma. This reminder can
cause a person to feel
overwhelming sadness, anxiety,
or panic.
62. Counsel: Would it mean that
her HPD sprung since
childhood or teenage years?
Answer: Yes
63. Counsel: How so?
Answer: This past trauma that
Cynthia experienced as a child
makes her continually anxious
and consistently troubles her
self-esteem. As a reaction to
this trigger, she would behave
in such a way to forget this
trauma by keeping her self-
esteem high.
64. Counsel: Can you elaborate,
if any?
Answer: It is because of this abuse she
had experienced, to cope up
with this trauma, her brain gives
a stimulus that makes her act
differently.
65. Counsel: What do you mean,
if any?
Answer: After such trauma, when
Cythia started to get suitors and
realized how she so loved the
attention she was given,
opposite to the trauma she
experienced, it became a part of
her personality. Since it brought
up her self-esteem, she
continued doing whatever it
takes to keep having that
attention, so she keeps feeling
uplifted.
66. Counsel: Will this have any
effect on her marriage, if any?
Answer: Yes
67. Counsel: How?
Answer: Cynthia did not have any
past relationships. This is
because she cannot maintain
them because of her HPD. She
possesses traits which cannot
allow her to be in a true and
long-term relationship.
68. Counsel: Like what traits? Can
you please elaborate?
Answer: It would start off as
something good in the courting
stage but if her partner cannot
maintain pampering her or
giving her compliments to keep
her high self-esteem, she would
find it from somebody else.
69. Counsel: What else, if any?
Answer: Most people call this
cheating, but a patient with
HPD will not see this as
something wrong because this
is part of the process of her
satisfying her self-esteem
needs.
70. Counsel: What else, if any?
Answer: She would always be
uncomfortable in situations
wherein she is not the center of
attention and would act very
dramatically, as though
performing before an audience,
with exaggerated emotions and
expressions, to maintain this
attention.
71. Counsel: What else, if any?
Answer: This causes her to either
dress provocatively or exhibit
inappropriately seductive or
flirtatious behavior, or even
both.
72. Counsel: What else, if any?
Answer: She would also be sensitive
to criticism or disapproval.
73. Counsel: What else, if any?
Answer: She would be bored by
routine, be self-centered and
rarely show concern for others.
74. Counsel: What else, if any?
Answer: Because of her HPD, she
would maintain these by being
 so manipulative as to engage in
pathological lying and sticking
to them as if it were of her real
memories.
75. Counsel: What do you mean,
if any?
Answer: It means that in order to keep
having a good image of herself
and for people to keep giving
her attention, she would do
whatever it takes, whether it be
socially appropriate or not, to
keep the attention she so seeks.
76. Counsel: So, are you saying
that because of her HPD, she
cannot perform any or most of
her marital obligations?
Answer: Yes.
77. Counsel: How so?
Answer: Like I said, she does not
know that whatever it is that she
is doing like cheating, is
something that is wrong.
Basically, she has a need, and
she does everything to satisfy it.
It is something uncontrollable
and uncurable.
78. Counsel: How so?
Answer: It would be useless for any
efforts to be done by anyone to
convince her otherwise since
she will not accept it as the
correct way of doing.
79. Counsel: In that sense, what is
she incapable of doing to
protect her marital relation
with her husband, if any?
Answer: Achieving emotional or
sexual intimacy is difficult. She
may play a victim or try to
control their partner using
seductiveness or emotional
manipulations.
80. Counsel: What else, if any?
Answer: As she is more concerned of
herself and is truly self-
centered, she is incapable of
giving any type of support to
her partner.
81. Counsel: What else, if any?
Answer: Also, as she does not have
the concept of fidelity, she is
prone to cheating with multiple
partners she would evaluate as
someone more fit or supportive
of her self-esteem needs.
82. Counsel: What else, if any?
Answer: Also, because of her
manipulative nature that comes
with her HPD, she is a
pathological liar incapable of
giving proper and honest
responses to her partner.
83. Counsel: Is her HPD so grave
to have any effect on her
marriage, if any?
Answer: Yes
84. Counsel: How so?
Answer: She is incapable of truly
loving her partner as her self-
love is so great, it will just leave
her partner broken into pieces,
physically, emotionally and
psychologically.
No further questions, your honor.
My witness is ready for cross
examination, Your Honor.
Qualifications
a. Must have a valid license to
practice medicine in the
Philippines as certified by the
Professional Regulations
Commission.
b. Must have graduated from a
Psychiatry residency training
program in a Philippine
Psychiatric Association, Inc.
accredited institution.
Major Depression is a mood disorder
that presents feelings of extreme
sadness, loss of interest or
pleasure, decreased energy, feeling
of guilt or low self-worth,
disturbed sleep or appetite and
poor concentration.

According to reports by WHO,

depression will be the second
leading cause of disability by 2020
and it could also be the second
largest killer after heart disease by
2020. Depression affects millions
of people worldwide.

Anxiety disorders are a group of

mental illnesses that cause people
to feel extremely frightened,
distressed, or uneasy during
situations in which most other
people would not experience the
same feelings, as defined by the
National Alliance on Mental
Illness (Nami).