Are Filipinos really that happy?
Eric S Caruncho
Philippine Daily Inquirer
Publication Date : 15-07-2008



Much has been made about how happy Filipinos are as a nation, despite widespread poverty, natural and man-made disasters, political turmoil and economic hardship.

In fact, a few years ago when the country ranked sixth in the World Values Survey, a US-funded study that ranks the countries of the world according to subjective happiness, the local media made much of the fact that we were the only Asian country in the top 10.

The gods have seen fit to punish our hubris: in the most recent World Values Survey, our ranking plummeted to 38th. Other Southeast Asian countries have also overtaken us in the happiness ratings, among them Thailand, Singapore, Malaysia and Viet Nam. Still, all things considered, 38th out of 99 slots ain't too bad.

But are we really that happy?

Media reports tend to sensationalise incidents of suicide, hostage-taking, billboard-climbing and various other freak-outs that the more unfortunate Filipinos fall victim to. The unreliability of health statistics would also seem to indicate that the incidence of depression, psychosis and other mental health problems may be higher than the figures indicate.

On the whole, however, our mental health picture is optimistic.

“In general, the Filipino has a healthy mind,” says Dr Joselito Pascual, a psychiatrist, toxicologist and substance abuse specialist connected with the Department of Psychiatry and Behavioural Medicine of the University of the Philippines College of Medicine.

“But we're not immune to mental illnesses,” he hastens to add. “We may be prone to these illnesses which can be brought about by a number of factors: substance abuse, severe poverty, economic deprivation, rejection or relationship problems. These are the more common causes of mental breakdowns among Filipinos."

Pascual teaches at the UP College of Medicine and practices psychiatry at the Philippine General Hospital and the Makati Medical Centre.

“Based on what I know and my observations as a psychiatrist, a toxicologist and a substance abuse specialist, my initial answer is that happiness is relative,” he says. “It really depends on your priorities: one person would put a premium on money, another on education. For a farmer a good harvest would mean happiness, for a doctor a good practice. For a retiree, having a pension and seeing his children grown up and enjoying their lives would be happiness.”

Filipino culture, especially the value it places on family ties and extended family relations, is also a factor, the doctor suggests.

“We are very familial,” he says. “There is an extended family system so there is always someone to look after you, unlike in individualistic cultures often seen in Western countries where if they have a problem, they're on their own. Even in a hospital setting, we have the “bantay” support system where family members stay with the patient so he doesn't feel that bad about his medical condition.”

Filipinos, he says, are also easy to please. “Mababaw ang kaligayahan (easily pleased). I don't interpret that as something negative, but as a positive. When we talk about basic necessities, give the average Filipino three square meals a day and he's content. As long as a regular employee can feed his family and send his children to school, he's satisfied. “

But, he adds, that doesn't mean we should let our guard down.

“Being happy makes us less susceptible, but it doesn't make us immune to mental illnesses such as depression and psychosis,” he says. “There are individual parameters for pain. An individual presented with a severe stress like the death of a loved one or a break-up with a girlfriend or boyfriend could feel depressed and might eventually attempt suicide. If he or she is genetically predisposed, he can develop major depression and it could become so severe that he could develop a major depressive disorder with psychotic features.”

Other factors such as substance abuse could increase the likelihood of developing such problems, he adds. “Depression is common,” says Pascual. “Filipinos are very emotional people so we're also prone to depression, but that is the reactive form, not the clinical form.”

He explains that reactive depression is a normal response to circumstances, and will eventually fade away as the situation normalizes and the individual adjusts. On the other hand, depression that leads to impairment in the person's social, occupational, intellectual and spiritual functioning can be considered clinical depression, and calls for psychiatric intervention. And such problems might be more common than one might think.

“In the Philippine General Hospital (PGH) alone we see about a thousand patients a day for various psychiatric problems, the bulk of which are major depressive disorder or schizophrenia,” he says. Many more cases, he suggests, are unreported.

“The average Filipino confronted with depression may initially seek the help of a loved one, or a priest, then a doctor, perhaps the family physician, and then later a psychiatrist or psychologist,” he says. “In some cases they may go to a herbolario (traditional healer) because in the provinces there is still a strong belief that mental illnesses are caused by kulam (witchcraft) or maligno (evil spirits), or by being possessed.”

In extreme cases, these mental illnesses could lead to suicide or attempted suicide. Statistics show that the Philippines has the lowest suicide rates in Asia. A 1993 study by the World Health Organisation indicated that 2.5 Filipino males and 1.7 females committed suicide for every 100,000 population. According to Pascual, however, these figures may only be the tip of the iceberg, since many cases remain unreported.

Pascual himself has conducted a study profiling the Filipino suicide attempter. It indicated that the average Filipino suicide attempter is female (although males are more likely to succeed in killing themselves). She is between the ages of 22 and 30, single, has a high school diploma, and is unemployed. The most likely method chosen would be poisoning, the most likely trigger an interpersonal conflict or a relationship problem.

Pascual has also conducted studies indicating that substance abuse is strongly linked to suicidal behaviour. A survey of suicide attempters showed that a large number of them tested positive for alcohol and methamphetamine hydrochloride.

“To commit suicide is wrong but you also have to consider that it is an illness, it is a symptom of an underlying condition such as depression or psychosis or substance abuse,” he says. The best way to treat such problems is through a comprehensive approach that includes pharmacological and psychosocial interventions, he adds.

“Science has taught us that these conditions can be brought about by biological factors such as imbalances in the brain's neurotransmitters' dopamine, serotonin, glutamate,” says Pascual. “If you have these imbalances then you can have the symptoms of depression, suicidal ideations or auditory hallucinations. So the most common method of treating these conditions is through pharmacology.”

“On the other hand, we also have psychotherapy because if you only give medication and not address the main problem causing the depression or psychosis, the patient won't get well. So psychosocial factors should be considered. In the PGH, we adhere to the bio-psychosocial approach. We don't only adhere to the biological treatment of mental illness, but we also deal with psychosocial intervention. That is very important. The environment he's surrounded with has to be dealt with also, the parents, for one.”

This is what is sometimes referred to as ;talk therapy'.

“There is really more to it than talk,” he hastens to add. “Because when one talks, he gains insight. And that will lead to change. More often than not the patient will think of ways of changing and coping with the problem. So pharmacotherapy and psychotherapy combined is the best.”

One thing going in our favor though is our much-vaunted quality of resiliency. “We may be prone to depression because of the number of problems that we face, but somehow we as a culture are so resilient that we always find a way to rise from our falls,” says Pascual.

In a way, he adds, this resiliency and optimism helps Filipinos recover faster from any mental illnesses they may suffer.

Good article. I can relate to it in terms of what I see in people.

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