SEPTEMBER 2006

Health and the Filipino

Stress and the Filipino

Sure, Filipinos are resilient, but this doesn’t necessarily mean we don’t feel stressed.
by Michael L. Tan
TUESDAY, SEPTEMBER 19TH, 2006

HOW DO we say we’re stressed in Filipino?

We don’t. Well, at least not in a way that we would in English: I am stressed. It

just doesn’t work out; we don’t, as far as I know, have a word in any of our
Philippine languages for stress and being stressed.

But that doesn’t mean we Filipinos don’t ever experience stress. We feel it all the
time and we see it producing illnesses, both physical and mental, both fleeting (as
in having to run to the toilet) and serious, life-threatening ones. Because stress
affects the body’s immune system, we can say all ailments are in one way or
another stress-related, from asthma to singaw (canker sores), to cardiovascular
ailments and even infectious diseases.

There’s also a tendency to dismiss stress-related illnesses as “psychological,” and

that these are self-limiting, easily resolved. The fact is that stress can so
overwhelm people that they lapse into depression, resorting to destructive
behavior, directed toward the self, or toward others.

The drug companies, especially those producing vitamins, have tried to cash in,
pushing their products through advertisements showing stressed people and
dangling promises: with our product, you can meet the many stresses of life, and
of the world, and survive without falling ill. One vitamin has even gone to the
extent of incorporating the word “stress” into its brand name.

But doctors — at least reputable ones — will tell you that medicines are of limited
use for handling stress. Vitamins can help you to deal with the harmful chemicals
produced in the body that come after stress, but as long as you don’t deal with the
stress itself, you eventually lose out.

Besides the vitamin ads, the media bombard us with all kinds of articles about,
and ads for, New Age therapies that supposedly help us deal with stress — to
name a few, yoga and meditation, spas offering massage and aromatherapy,
soothing music interspersed with sounds of birds and frogs. But these are often
expensive fads with exaggerated claims.
Not enough’s being done to understanding stress in its local context, yet stress is
mediated through culture: from the very nature of the stressors, to the ways we
respond to the stress. Understanding this local context might help us develop
more culturally appropriate, and therefore more effective, ways to deal with
stress.

STRESSORS ARE not universal. For example, we say “noise” is stressful, but
what exactly is noise?

Culturally, we have different thresholds for these sounds. I have a nephew and a
niece who were born and bred in Canada, and they find the Philippines too
“noisy”: the jeepneys, the arcade games in malls, even the way people talk. Yet
they have no problems tuning into hard rock music on their iPods.

My nephew and niece also find crowds stressful; yet a Filipino sees a crowd and is
delighted, “Uy, masaya.” Westerners crave privacy; the Filipino is stressed by
solitude. We’re not alone, of course, in finding pleasure in crowds and
camaraderie. Culture adapts to circumstances and we are only one of many
countries with large dense populations that have learned to live with the
maddening crowds, complete with the noise. The Chinese, for example, refer to
“merriment” as re nao, the words for “hot” and “noisy.”

While we enjoy noise, we’re quite sensitive to olfactory assaults. Filipinos will
claim some odors are so bad they cause a stomachache. We sniff everything, from
food to lovers, and the smells we find good, we tend to indulge to an excess. No
wonder aromatherapy’s taken off in the Philippines, as did those terrible car
fresheners and deodorizers.

Beyond these sensory stresses, we Filipinos do face many sources of stress,

around work and livelihood mainly. Farmers worry about drought and
typhoons; urbanites go berserk with tyrannical bosses and vicious gossipy office-
mates.

Rural or urban, we all face the stresses of family, perhaps more so than in
Western countries. We like to say we are family-oriented, with relatives always
on hand to help out. But the extended Filipino family can be stressful too, with all
its
obligations. Overseas workers have a particularly difficult time with all the
expectations family members have back home. I’ve met Filipinos overseas, from
Hong Kong domestic workers to physicians in the United States, who postpone
returning home for years because they dread the jeepneyloads of relatives waiting
for pasalubong (gifts).

But the balikbayan in California has the advantage of distance. The poor migrants
who go from impoverished rural areas to work in big cities face even greater
stress from family relations, who can easily contact their now “rich” urban
cousins for a share of the pittance these earn in the city.

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.

ALL THAT discussion should have stressed you by now, and made you wonder:
given the deteriorating economic and political situation in the Philippines, are we
about to see an epidemic of stress-related ailments?
I think we’re already in that epidemic, and too little is being done to help
Filipinos tackle stress.

I’ve intentionally used the verb “tackle” rather than “treat” because there is a
tendency to medicalize stress, to look for drug treatments that could lead to new
dependencies. The drug companies push all kinds of “antidepressants” to doctors,
who are then quick to prescribe them to stressed patients.

Sessions with psychiatrists or psychologists are more effective than drug

treatments, but again, low incomes may prevent many Filipinos from getting the
“talking therapy” they need. That is why we need to be able to tap what we
already have in culture, looking into how families and communities can be
mobilized to help people with their stress.

I feel community health workers are under-utilized for mental health. Given
some training, they can learn to help their barangay residents with stress. That
includes essentials about counseling, for example, not resorting to that
notorious sulsol (“Oh yes, your husband is really terrible, and mare, you know I
just didn’t want to tell you but we’ve all known all this time that. . .”)

In the United States, studies are showing that somatization syndrome is best
handled with what’s called cognitive restructuring, helping patients to take on
new lenses as they revisit their problems. Instead of wallowing in self-pity as a
victim, cognitive restructuring helps people regain some sense of control.

We have that in our folk therapies — note how, in bangungot, we’re supposed to
try to move a finger, a toe, any part of the body. It’s not a symbolic act; it actually
means taking control of one’s own body, and the failing spirit. It’s a powerful
metaphor that can be used to explain other stress-related ailments and
syndromes.

I’m ambivalent about New Age therapies such as meditation and aromatherapy,
but mainly because the type offered by spas and health resorts are just totally
inappropriate. Since we’re a very olfactory people, I think there is a place for
aromatherapy. Sadly, we’re importing expensive aromatic oils when there are
local plants that can be used; in fact, some of the most expensive aromatic oils are
extracted from local plants we take for granted, like ylang-ylang.

But I do see a place for many traditional therapies being rechanneled toward
stress management. The manghihilot can be “reinvented” so his or her skills with
therapeutic massage can be applied not just for sprains, but also for broken
hearts and weary spirits.
Massage and aromatherapy, however, are only the externals. Stress management
is really helping people to dissect their own feelings, to understand where their
distress is coming from. The solutions may not always be easy — all the
aromatherapy and meditation in the world will not raise low wages.

But community action can help to make the stress more tolerable. Communities
should be urged to create their own safe spaces where people can seek some
refuge. Filipino-style, such spaces need not be totally quiet, but they do need to
give some sense of safety, of sanity in a mad world. Filipino-style, too, we need to
think of how these therapeutic spaces might work out as places where people can
engage in social activities, without becoming more agitated. Alternatives could be
offered: gardening, cross-stitching, bingo…anything that calms the mind. You
don’t need to be in the lotus position to meditate.

Ultimately, stress management is a matter of helping people to recognize that the

world, which seems so stressful, can also be a source of joy and pleasure,
fulfillment and renewal. The therapies being dangled around are really meant as
appetizers, ways of inducing the depressed the person to garner enough strength
and courage to re-engage not just the world, but life itself.

Michael L. Tan is a medical anthropologist. He is currently chair of the

anthropology at UP Diliman, Quezon City. He also writes an op-ed
column, “Pinoy Kasi,” for the Philippine Daily Inquirer.

Posted in: Health and Environment, i Report, Stories

Tags: healthcare, stress