In 2001, Hollywood came out with a remarkable movie entitled, A Beautiful Mind. Based on the life story of John Nash, a Nobel Laureate in Economics, the film is a poignant, emotionally-charged motion picture that describes the life of a cerebrally-brilliant academic who goes through excruciating and terrifying spells of schizophrenia. It depicts how his mental condition gradually takes over his mind and how his life disintegrates with each passing day.
Today, there are millions of John Nash equivalents in our midst. A few glaring differences though — many of them are not geniuses like Nash, many of them are not aware that they have the ailment inside them, and, many of them don’t get the necessary attention and rehabilitation prospects that Nash had during his time.
In the Philippines, only a very few John Nash’s are lucky enough to have access to psychologists/therapists. Likewise, only a few have the courage to talk about their condition with a healthcare professional, not so much because they cannot afford but because of two reasons (which many will not admit) – 1) apprehension over the stigma that will be attached to them once other people know that they are having consultation sessions with mental health practitioners; 2) there isn’t much understanding of this condition, thus, many people are terrified of facing it and dealing with it.
Truthfully Insane Realities
One in five individuals are suffering from a mental health issue. With a population of 100 million, there are currently only 700 psychiatrists and a thousand psychiatric nurses. Between 17%-20% of Filipino adults experience psychiatric maladies, while 10%-15% of Filipino children, aged 5 to 15, undergo mental health problems.
Based on statistics taken from the World Health Organization (WHO) archives, the Philippines has the highest documented incidence of depression in Southeast Asia. In 2004 alone, the Department of Health reported 4.5 million cases. On the other hand, the National Statistics Office (NSO) indicates that mental health ailments are the third most common types of ill health for Filipinos. Additionally, a 2010 national census found 1.4 million people with known infirmities and showed that mental disability attributed 14% of all disabilities. In the same NSO study, 88 cases of mental health problems were reported for every 100,000 Filipinos.
Unfortunately, as a public health concern, mental health appears to be not a priority as demonstrated by its omission from health insurance packages. And though the government-managed insurance firm, Philippine Health Insurance Corporation (Philhealth) recently added mental illness under its coverage, it is only for severe conditions and hospitalization is only for a short duration of time.
Even in the medical community, many practitioners look down upon psychiatry as a medical practice, as confirmed by no less than National Center for Mental Health key player Dr. Bernardino Vicente.
As of December 2014, the country has five mental health bills drafted. These are the National Mental Health Act of 2009 (SB 3509) initiated by Senate President Juan Ponce Enrile, the National Mental Health Act of 2010 (HB 1419) introduced by Representative Susan A. Yap, the National Mental Health Act of 2010 (HB 3390) which was instigated by Representatives Rufus Rodriguez and Representative Maximo Rodriguez Jr., the Philippines Mental Health Act of 2014 (SB 2450) sponsored by Senator Loren Legarda, and the Philippine Mental Health Act of 2014 (SB 2484) spearheaded by Senator Vicente Sotto III. Of the five, the bills from 2014, (SB 2450 and SB 2484), were the most enhanced, as they had an all-embracing description of a) the mentally ill, b) the rights of the mentally ill, and c) the policies planned to address the needs of the mentally ill.
All five bills support the integration of mental health into the national health care delivery system. Based on these five bills, an agency to be called the Philippine Council for Mental Health (PCMH) will be under the auspices of the DOH and will oversee the evolution and distribution of all mental health services in the country.
There is growing evidence pointing to Filipinos’ hesitancy to seek professional help for mental health issues. For instance, the study conducted by Hechanova and colleagues (2013) indicated that intent to seek online counseling among Filipinos working abroad was low. In another study headed by Bello (2013) surveying 359 Filipino college students, only 22% of these learners sought professional help for an academic or non-academic issue, while there was a considerably higher inclination to ask assistance from friends and family members than from professional counselors and psychotherapists.
Filipinos’ views of mental health also affect the attainment of mental health services. Filipino families whose members suffer from mental illness charge the patient as the one responsible for possessing the illness at the outset. The patient is spurned by being told that — “Nasa utak mo lang yan” (It’s all in your head) or “Mahina lang loob mo” (Your will is just weak). As a result, the patient is prompted to help himself/herself instead of being helped. Furthermore, these families customarily keep the condition of the patient as a hush-hush issue because of the stigma attached to it. In rural areas, mental illness is perceived to originate from spiritual dynamics and paranormal activities like “kulam” or being wooed by supernatural beings. Thus, this perception of curses and sorcery pushes families to seek the mediation of faith healers (albularyo) and not of mental health professionals.
Another case to illustrate such perception is the study initiated by Brolan, Dooren, Gomez, Fitzgerald, Ware, and Lennox (2014) on intellectual disability and treatment choices in Negros Occidental. The study revealed that the favored cure or management was getting the help of a suranho (shaman or medicine man). “Informants explained that family members contact the suranho to cast out ‘the bad spirit’ that has possessed the body of the person with intellectual disability, due to the belief that the person with intellectual disability became possessed after an unfortunate encounter with a ghost or spirit” (Brolan et al., 2014, p. 76).
Suranho practices cover absorption of herbal extracts or blessed water, the use of talismans and charms, sultry liniments or lotions, making some offerings to the spirits, chanting of prayers or supplications, and the employment of ginger and smoke from charcoal fires (Brolan et al., 2014, p. 78). The study likewise disclosed that while suranho’s way of treatment is not at all times effective, some families still do not ask medical intervention and simply give up. Reasons for not seeking medical treatment include a combination of economic difficulty, misinformation and lack of education on mental disabilities, thereby making the suranho the recognized, and sometimes, the only treatment of choice.
Stigma & Defending the Family Name/Reputation
Family reputation/name has been acknowledged to be principally vital to Asians, most especially, Filipinos. Hence, they are inclined to turn to their families first prior to seeking the advice of mental health professionals and other outsiders. This is to elude damaging judgment which leads to delays in seeking professional mental health care and proper management of the condition (Lin, K, Inui, Kleinman, & Womack, 1982).
What Can Be Done
It may take a while before a comprehensive national law on mental health can really be legislated. For now, it is important that everyone takes a serious look at mental illness. It shouldn’t be viewed as a condition triggered by some bad spirits and ghosts or some mysterious dalaguet trees but to accept the fact that the human brain can go haywire anytime.
For government entities and non-government bodies, it is essential that current information on the subject matter be gathered so that a useful database can be built. After all, a good database is necessary and crucial in the drafting of an effective, comprehensive and highly inclusive law.
For the remaining “sane” individuals in society, let us not look at insane people (except those who flipped as a result of drug use) with revulsion and antipathy. They never chose to have that illness and it is never their intention to become a “blight” to our civilization. They are just so unlucky that their mental thresholds cannot put up with life’s battering. Therefore, let us be compassionate and let us help fast-track that law that may be able to help these people who, once in their lives, have a beautiful mind.