Mental Health Issue

COVER PAGE

EDITORIAL BOARD 2015-2016 Mica Araya Managing Editor Leanne Cassandra Chua Daniel Manuel Macrohon Article Editors John Gabriel Hernandez Photography Head

Francyn Rossi Yangson Print Publications

Denise Nicole Villanueva Editor-in-Chief Katrina Caballas Secretary General Nicole Bernadette Terre Finance Officer Ms. Maria Lourdes Almeda-Benito Adviser

Deputies Nicholas Cancio Rafael Mendoza Web Publications

Lordieliza Melendrez Associate Editor Kathrinna Feliz Alerta John Kevin Paulo Biadomang Web Editors Katrina Marie Hernandez Creatives Director

Mel Mara Paearl Cablayan Finance

Benjhoe Empedrado Creatives

CONTRIBUTORS Patricia Alvarado Jessica Io Angeles Benjhoe Empedrado Deano Reyes Michelle Wendy Te Creatives Lorenz Revillas Regine Rostata Compilers

Nicholas Cancio Lenard Ortiz Katrina Dela Cruz Alma Pabilane Jasper Dayanan Lee Ponce Romina Dilig Justin Soriano Rafael Mendoza Sheldon Wong Galicer Guinto Writers

Zenas Harvey Apal Maria Angela Bermudez Janina Jean Hernandez Jemar Mapili Katerina Perez Arenne Ramos Albert Song Cyrilla Ulep Photographers

IN partnership with ASIAN MEDICAL STUDENTS’ ASSOCIATION PHILIPPINES: Standing Committee On Public Health 2015-2016 Mica Araya National Officer for Public Health Lordieliza Melendrez Ateneo School of Medicine and Public Health (ASMPH)

Michelle Pia Anne Austria Carl Cedric Celera St. Luke’s College of Medicine – WHQM (SLCM)

Jasmine Diorka Suleik Cebu Institute of Medicine (CIM)

Fiona Pascual University of Perpetual Help - JONELTA Foundation School of Medicine (UPH-JFSM)

Charles Vanhill Raksham De La Salle Health Sciences Institute (DLSHSI) Maria Angelica Soriano Far Eastern University - Nicanor Reyes Medical Foundation (FEU-NRMF) Maria Patrizia Diaz Our Lady of Fatima University (OLFU) Mary Mirasol Manayon Pamantasan ng Lungsod ng Maynila (PLM) Marianne Michelle de la Rosa San Beda College of Medicine (SBCM)

Marc Delvin Quero Alexandra Clarisse Reyes University of Santo Tomas (UST) Harlene Viray University of the East Ramon Magsaysay Memorial Medical Center (UERMMC) Ysabel Ortiz University of the Philippines - College of Medicine (UPCM) Angelica Katrina Heredia West Visayas State University - College of Medicine (WVSU)

“If suffering like hers had any use, she reasoned, it was not to the sufferer. The only way that an individual’s pain gained meaning was through its communication to others.”

Diane Wood Middlebrook, Anne Sexton: A Biography

TABLE OF CONTENTS

MENTORING SHIT SB

BMC

2 The Mental Health [R]Evolution 3 Message to the Readers 4 EB Statements on Mental Health 5 The Status of Mental Health in Asia-Pacific 6 Hearing through the Noise 10 The Philipines’ Mental Health (MH) Act 14 Medical Students’ Mental Health: A Survey 18 Humanity in Medicine 20 Future Physicians, Mentally on the Verge?

22 Why is Mental Health Still so Stigmatized?

26 Muffled Mania 30 Inside Look 32 Open Letters 42 Arts and Minds

THE MENTAL HEALTH [R]EVOLUTION Whenever we hear the word ‘revolution’, we often associate it with the words rebellion, revolt and uprising. We think of the struggle between the classes and the ferocity that comes with it. While this is true, revolution also has another definition, a brighter aspect that comes after the upheaval. This word also stands for a dramatic and wide-ranging change, a pivot in history that altogether transforms our way of life and our way of thinking.

An example of this is the industrial revolution—a period in Western Civilization wherein slow processes stemming from hand production transformed greatly to more efficient methods with the aid of powered machines and factories. Likewise, in our country and several others across the globe, there is an ongoing revolution, one that often goes neglected yet plays a very essential role in our lives. The revolution which I am referring to is that of the mind—particularly, how one’s mental status is viewed and perceived in the society.

Zooming into the medical community alone, our stance on the value of a good mental status and consequently, how we discuss and handle the issues related to this, is still morphing. The view of psychology from the past was thoroughly focused on mental illness and it has only been in recent years wherein the concept of mental health was introduced. With this shift in focus, discussions and actions coursed towards maintaining, preserving and improving mental health, in addition to treating mental illnesses. Despite this radical change in viewpoint, many issues still abound, many discourse still to be had and much more resolutions to act on. This situation is very evident in a medical school setting, wherein several different factors contribute to hazards that can and does impair one’s mental health.

It is with these challenges in mind that SCOPE: The Official Student Publication of ASMPH (SCOPE ASMPH), in partnership with the Asian Medical Students’ Association-Philippines (AMSA-Phil), conceptualized and eventually concretized this publication. Realizing that there is a great need to address the mental health concerns of medical students, we sought to highlight The Mind Movement—an advocacy that is geared towards raising awareness on the importance and impact of Mental Health in medical schools and the medical community in general. Through this movement, we hope to more fully become effective doctor-leaders of the future. With contributions from fifteen medical schools nationwide and with the assistance of peers internationally, we were able to gain insights on the mental status of medical students, their opinions on mental health and how stakeholders are currently adaptive—or maladaptive—to these matters.

Within these pages you will find the thoughts and experiences—both good and bad—of medical students regarding mental health, all of which are equally important to highlight. We do realize that awareness on mental health issues is just the first step and indeed, professional help is of utmost importance especially for those who are experiencing mental health issues. Thus, through shedding light on these issues, coupled with the determination of when to seek medical help, we hope to more fully become effective doctor-leaders of the future.

There is still a lot to fight for in this revolution. And we hope that this production sparks the flame of necessary change—the one that we need in order to fully adapt an environment wherein myths, stigma and biases do not befall those who need psychological assistance—wherein the crusade of mental well-being is valued and cared for.

Better still, let’s turn this revolution into an evolution—one that does not entail haphazard catastrophe, one that is built collaboratively, one that means everyone comes through a better version of themselves.

Read on and let’s progress together in this evolution.

Sincerely,

Denise Nicole de Leon Villanueva Editor-in-Chief 2015-2016 SCOPE ASMPH

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MESSAGE TO THE READERS To us, dear future doctors

We are all aware of how rough and daunting the road to Medicine is. As we continue to pursue and fulfill the noble cause of the profession, it becomes natural to put our needs secondary to that of our patients, and subsequently end up neglecting our personal health.

In our country, the concept of mental health is still very new. Even in the medical community, many do not give much regard to mental health. Sadly, this helps perpetuate the stigma surrounding the issue. The Mind Movement aims to persuade the members of the medical community to challenge the stigma by beginning with ourselves.

As future leaders, we have the opportunity and capability to start an impetus for change. Through this campaign, we hope to not only raise awareness on the importance of mental health, but also to start a movement to prioritize mental health. After all, just as the WHO said, there is no health without mental health.

Neglecting our mental health, even unintentionally, affects both ourselves and the people around us. It influences how we feel, think, and act. Thus, just as important as recognizing signs of mental illness in our patients, we should also watch out for red flags in ourselves – no matter how often we are told or we think “gan’yan talaga, it’s a normal part of becoming a doctor.” We urge everyone to talk about their mental health – whether it be with a professional, or with friends and family.

Especially to those who may need the extra support, we hope you can feel the warmth and encouragement the medical school community is excited and ready to give.

“There is no need to be afraid of difficulties. We are capable of overcoming everything.”

–Pope Francis Sincerely,

Mica Araya National Officer for Public Health, AMSA Philippines

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If there is no shame in pursuing physical health, why must there be indignity in wanting to be mentally healthy?

As future health care providers, I think that we should not limit ourselves to only the biological and/or physical aspect of diseases. We should be aware, and in fact, should help spread awareness, that mental disorders can impede ALL aspects of our health, which may leave those affected unable to fully optimize their social and vocational contributions to society. I believe that if we continue to just shrug our shoulders and dismiss this issue, our country will remain a country plagued not just by crimes and corruption, but also with anxious, depressed, and mentally unhealthy citizens unable to help and cater to the psychological needs of its people.

Nicole Bernadette Terre, Finance Officer

Lordieliza Melendrez, Associate Editor

Every person experiences an emotional or mental burden at least once in their life.

For many of us, these are silent burdens that are rarely or minimally expressed, as if by not acknowledging it - it ceases to exist.

Advocating for mental health will not solve anything on the outset, but when one voice is similarly echoed by a multitude of others... it brings to life a sound that refuses to be ignored.

We need to make an effort to talk about topics that make us feel uncomfortable so that people who are actually experiencing this firsthand won’t be afraid to share anymore.

Katrina Marie Hernandez, Creatives Director

By opening discussions on mental health, we INFORM the community that mental health issues are very real, and are no laughing matter. By spreading mental health awareness, we allow the stories of those who have triumphed over mental illness to INSPIRE, especially those who still live in fear of judgment and discrimination. By advocating mental health, we EMPOWER patients, families, healthcare providers and communities to fight against the stigma, creating a healthier, happier, lovelier world!

Leanne Cassandra Chua, Articles Editor

Not talking about an issue openly makes people talk about it secretly. Talking about it secretly adds to the stigma of MH-as if it’s something wrong, something dirty, something abnormal. Which is a shame, because it’s something we can do something about; if we don’t talk about it, we can’t even begin to try and help others who have it.

Katrina Caballas, Secretary General

Kathrinna Feliz Alerta, Web Editor

Biopsychosocial model in practicing medicine states that biological, psychological, and social factors play a significant role in human function. As future doctors, we have a responsibility to address these factors because it will help our patients to lead a better life. Thus, mental health must be given importance in the similar manner we strive for excellence in addressing the biological aspect of medical practice.

John Kevin Paulo Biadomang, Web Editor

Future medical professionals are there to treat and comfort patient, and they must be aware of the invisible mental health problems. Medical education should encompass and explore all facets of health to serve as foundation for encounters that present with the obvious or with the inconspicuous.

Daniel Macrohon, Articles Editor MH issues are invisible forces that silently cripple a lot of people, even medical students. You may not know it but your friend, classmate, siblings, or YOU may have it. It is now the time to shed light on this issue, to recognize its reality and help lessen the psychosocial burden of those afflicted.

John Gabriel Hernandez, Photography Head

STATEMENTS ON

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THE STATUS OF MENTAL HEALTH

IN ASIA-PACIFIC

The Asia-Pacific region is known for embracing the great diversity amongst its people, whether these differences are due to their differing cultures, languages, levels of socioeconomic development and even their political systems. As a result of this diversity, it is not surprising that there is also wide variations in terms of its health care system, policies for mental health care and psychiatry training. In fact, throughout the region, various mental health issues still exist and are currently being discussed.

WHERE ARE WE NOW? An example of a mental health issue that is rampant in the Asia-Pacific is the lack of awareness and education regarding the prevalence of various mental health disorders per region. This may be problematic for it can result in people, who are already struggling with their conditions, to suffer more due to stigmatization, discrimination and human rights violations, among others. To illustrate this point, in various countries of the Asia-Pacific, pre-modern care (i.e. traditional family healers and/or religious persons) is still the method of choice in treating adolescents afflicted with mental health disorders. In fact, it can be said that the practice of traditional care indeed exists as the norm for many Asian countries, regardless of the availability of access to more modern and standardized treatments. As an example, in Taiwan, the elderly believe that mental illnesses are due to the presence of evil spirits, and as such, they often bring their grandchildren to temples for special ceremonies to ‘expel the evil spirits.’ These actions reinforce the stigma associated with mental health, thus preventing many afflicted individuals from seeking and receiving the health care that they need.

Aside from the lack of awareness, the poor availability of mental health resources in various countries prevent affected individuals from properly seeking help. In the Asia-Pacific region, women in general are at higher risk for depression

words by Yunyi Tsai (Iris), SCOPH Regional Assistant for Asia-Pacific International Federation of Medical Students Associations

and other mental health disorders. This is due to their experiences of gender discrimination, sexual harassment and domestic violence. However, despite these conditions, very few countries in the region actually have the resources that may be used to address and resolve these issues, thus aggravating their mental health problems.

Obviously, the poor availability and insufficient attention given to global mental health issues have a significant impact on the development and capacity of the young generation. Statistics show that up to 20 percent of the youth are in a poor mental health condition, with those living in lowincome countries making up 80 to 95 percent of this group.

WHAT CAN WE DO? Understanding mental health trends and gaps in resources is essential for improving the state of mental health in Asia-Pacific. The initiative step would be combating stigma and overcoming social barriers. There needs to be a push for developing sustainable programs to mitigate and correct the negative attitudes towards mental health illness. As such, promoting education and raising awareness among the public is a critical step in instigating change. In fact, these must be treated as a health priority within various governments. Moreover, seeking collaborations among stakeholders, researchers, psychiatrists, policymakers and professionals is essential to call for greater attention regarding these issues, and to come up with more innovative and efficient solutions.

To illustrate the importance of collaboration, there is a growing number of non-governmental organizations (NGOs) advocating for Mental Health found in various Asia-Pacific countries such as India, Thailand, Malaysia, Japan, and Korea. These NGOs have started tackling the numerous mental health problems found in their communities. For instance, the Community Mental

Health Nursing (CMHN) project in Indonesia which was created to increase access to mental health care in rural areas, provides mental health services through a mobile outreach service. The CMHN also provides a wide range of services in terms of education, support and treatment that incorporates not just the patients, but their families and the communities as well. In this way, they ensure that the communities also become part of the support network for mental health care. Another good example is the emerging network supported by the Asia-Pacific Community Mental Health Development (APCMHD) which involves 14 countries within the Asia-Pacific.

They have taken the first steps in facilitating the implementation of locally-appropriate policy frameworks for community mental health service reform. Their project aims to promote the best practice guidelines in community mental health care through knowledge exchange and sharing of practical experience in the regions.

All in all, it can be said that the best way to address mental health issues is through working together.

Basing on the idea of community mental health care, we need to develop locally and culturally appropriate mental health services that could be implemented in both remote areas and the city. Community mental health service should be integrated into existing health systems to allow for easier and improved access to mental health services. By doing this, we may further improve the training of our psychiatrists, mental health care workers, and community leaders. This will then help in the provision of right education and proper services to everyone in the community.

In addition, due to the increasing surge of use of various technologies, we should make good use of technology through telemedicine, to offer professional care to geographically inaccessible communities. With these ideas and experiences in mind, we should do our best to step forward and hope that people could live happier and healthier in the near future.

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In the jungles of southern Palawan, tucked away in a remote intersection between the rivers and the mountains, lives the Kulbi tribe. This native group belongs mainly in an agricultural society who has thrived peacefully away from the outside world for much of their history. While their traditions are rich in art, music and farming techniques, they are truly unique in their acceptance of ‘self-inflicted death’. Suicide, or ‘voluntary death,’ is a practice the Kulbi people ascribe to without moral repercussions, and for very much of the same reasons prevalent in the outside world which they have been blissfully estranged from. Love problems, jealousy, sickness and grief are all universal reasons for taking one’s own life.

Textbooks have immortalized the most prevalent reasons for suicide, and we are taught the facts and the morality about it.

Oftentimes the medical reason behind a suicide is discussed, but the conversation tapers off after dissecting the lurid details about the family, financial status, relationships and other such facts surrounding the person. Perhaps mental health issues come to the forefront in Philippine society only when ‘high-profile’ cases bathe every news outlet, with the most recent incidence being the tragic passing of a young actress who was believed to be suffering from depression. Apathy, lack of awareness,

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A Situationer on Mental Health Issues in the Philippines words and photography by Romina Dilig and Leanne Chua

insensitivity or even ignorance might be to blame for the lack of urgency surrounding the topic of mental health. As it can be a very personal experience, much of the emotional and psychological struggles of a patient is intangible and may be unapparent to a casual observer. This alienation may be contributory to why mental illness does not cause widespread concern among the general public, despite the numbers indicating its crippling rampancy.

THE STATUS A study conducted by the World Health Organization (WHO) found that the Philippines had the highest prevalence of depression in all of Southeast Asia. From 1984-2005, the rate of suicide among Filipino males increased by 1,460%, and among Filipino females by 808%. This is a staggering increase within a 20-year period, which begs to ask

the question of whether suicide cases are merely underreported in the years prior. The most common methods used were hanging, shooting, and poison ingestion. For non-fatal attempts, it was found that barely 22% of those who self-harmed had seen a psychiatrist. In breaking down the data, 78.7% had adjustment disorder, 7.1% schizophrenia and 6.2% had manic depression. Among those, only around 38% were intoxicated with either alcohol or drugs at the time of the attempted suicide. Family and relationship problems continue to be the most prevalent reason for the self-harm, indicating chronic problems and stressors encountered at home.

A study conducted by the World Health Organization (WHO) found that the Philippines had the highest prevalence of depression in all of Southeast Asia.

these institutions are slowly legitimizing mental health as a serious and immediate concern—all of which are slowly being recognized by the leaders of this country.

THE CHANGES AND THE CHALLENGES

In addition, according to the aforementioned WHO report, the increase in the mental health disorders in the country may be exacerbated by the fact that the Philippines spends only 5% of its health budget on mental health, most of which goes to the maintenance of mental hospitals in the country. As is typical with the health system of the Philippines, the majority of mental health facilities are located in major cities, which further restricts their access.

One could always make an argument for cultural nuances as part and parcel of the problem.

Suicide prevention is a problem that is inherent in all of the Western Pacific, with government efforts preferentially deferring towards other competing health concerns. Moreover, the stigma attached to mental health issues prevent the public from speaking up about their needs, further estranging the policymakers to put these issues front and center.

The way we tiptoe around such things and how mental illness is seen as a taboo, however, is starting to decline. Dr. Peter Gatmaitan, the head of the Ateneo Loyola Schools Office for Guidance Counselling, believes that there is a shift in the discourse on mental health, beginning in 2013. Help-seeking behavior is rising in concordance with the rising numbers of cases. This has created a clamor loud enough for educational institutions to mobilize their resources towards prevention and intervention of self-harm, anxiety and depression. All three were noted to be pervasive among the population in the different universities in the country.

While some can argue that the rise in cases may simply be a result of more awareness—and thus more reporting—Dr. Gatmaitan posits that this is a true increase, and this is consistent with global patterns. The government and the different institutions already have facts and figures about mental health that is widely recognized and are difficult to set aside. By committing to changing how things work,

Despite this increasing awareness, the problem remains to be that help is not easily accessible.

There may be the awareness that help is available, but information regarding where to seek help, or which hotline to call, or even who to approach is not common knowledge in the general population. There are still intangible barriers, such as shame and stigma towards mental health, which prevent people from reaching out. The same can be said about the suicide rates and their underreporting in the country. Many Filipino families deny incidences of suicide and depression, for fear of its religious implications and societal repercussions. Other barriers, such as the lack of modeling or emotional regulation within families, also increase the hesitancy in sharing about personal problems with mental health professionals.

With regard to these challenges, the Department of Health (DOH) recognizes the need for more changes and action. They are currently trying to increase community awareness via grass-roots psychoeducation.

They are also reaching out to private efforts such as the Natasha Goulbourn Foundation to collect statistics and data analysis on referrals.

Suicide hotlines and websites are also slowly being established in the country to help people get more access to help.

Still, the majority of these current efforts for both research and service delivery are primarily being driven by private entities. One such endeavor is the launch of the Philippine Health Information System on Mental Health (PHISMH) by the Philippine Psychiatric Association in

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2014, which aims to kickstart a robust database and data collecting system for mental health cases throughout the whole country. They enlisted 14 public and private institutions in 8 different regions across the Philippines as their resource facilities, and intended the program to be turned over to The Department of Health once the trial period ends.

Villamor Air Base, providing counseling and case referrals to those who needed it.

Another recent example of a private effort is the response of institutions such as the Ateneo Loyola Schools Department of Psychology to the need for a first-aid psychologic debriefing of survivors from the recent typhoons in the country. This began in 2013 after thousands of Filipinos were severely affected by Typhoon Yolanda (internationally known as Typhoon Haiyan). Many trained psychologists volunteered to be the first-line aid for survivors from Samar and Leyte when they arrived at

Furthermore, the Philippine Psychiatric Association, with the help of Senator Loren Legarda, is pushing for the establishment of a Mental Health Act in the country. This act recognizes the severe lack of mental health practitioners in the country. According to recent data, there are only around an estimated 490 psychiatrists and 1000 psychiatric nurses for a population of more than 100 million. It also aims to protect the rights of people with mental health disorders by ensuring that there is a

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governing body that will oversee the programs and policies needed for the prevention and treatment of mental health among Filipinos.

Despite all these changes, however, it still remains to be seen that many challenges still exist in our country when it comes to mental health. As was observed, most of the efforts in mental health are solely focused towards service delivery, while mental health research

There is a shift in the discourse on mental health, beginning in 2013. Help-seeking behavior is rising in concordance with the rising numbers of cases.

THE VOICE IN THE NOISE

and education remains to be wanting. It can also be said that it escapes most people in the country that the provision of holistic mental care is a multi-sectoral effort: psychologists, guidance counselors, addiction specialists and social workers are also crucial to the mix. Most unfortunate, however, is that there is a lack of training for the general health practitioners in screening and managing common mental health problems. This is important because they are at the frontlines in receiving those who need psychiatric help.

Speaking about mental health is timely—and perhaps somewhat overdue. The psyche of the general population is easing towards a shift; there is more willingness to accept the reality that mental health is a very real and a very pressing concern. It prevails within all age groups in every sector of society, and there is this tentative but palpable resolve for our lawmakers to thrust mental health into the forefront of the discussion.

In spite of these, the push towards passing the Mental Health Act and creating a functioning mental health care system in the Philippines is still a gargantuan task. Synchronized efforts among the private practitioners, the government, and the general public are needed for the kind of inclusive, available, and formidable program we need –one that views the Filipino’s mental state as a holistic concept and a manageable condition.

Right now, the awareness and change in mindset among the general public are a monumental step towards the right direction.

However, much more needs to be accomplished before the tides truly change. Simply talking about the problem may not necessarily follow through with policymaking. A clamor and sense of urgency at the devastating implications of mental illness must be achieved to drive our laws and policies towards properly addressing them. The need for coordinated factual data and sufficient attention towards the issue may just be the key towards a substantial public health program for mental health.

It looks to be a long fight ahead, and we had just won the first scrimmage to earn us notoriety but it’s not enough to truly spark the wick towards a full-fledged revolution. As future health practitioners, we confront mental health issues more concretely and personally than most, and we must know how to deal with it, but like every health concern, it is still a matter of a public affair. The impetus for this change invariably involves all of us. Creating laws and a formidable system of healthcare delivery seem akin to creating mountains from a pile of pebbles, but we must all step up to this challenge for change.

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The Philippines’ Mental Health Act words by Rafael Mendoza and Lenard Ortiz photography by Zenas Harvey Apal and John Gabriel Hernandez

On July 8, 2014, the Indonesian parliament approved the passage of a National Mental Health Law, which had been stuck in deliberation limbo for five years. Indonesia is the latest among the Philippines’ neighboring nations to enact a comprehensive law on mental health. In the same year, Senator Loren Legarda filed Senate Bill No. 2450, or the Philippine Mental Health Act of 2014. Its latest version is Senate Bill No. 2910, filed by Senator Pia Cayetano last August 2015. The bill has undergone at least twenty revisions before its current iteration and is still in the hands of the Senate.

Other countries in the region that have passed a similar law include Singapore in 2008 and Malaysia in 2001. “Lagging behind” was how Dr. Michelle Marie Marinas, psychiatrist and member of the Philippine Psychiatric Association (PPA), described the situation of mental health legislation in the Philippines. In its explanatory note, Senate Bill No. 2910 discusses the importance of a mental health act. “People with mental disorders constitute a vulnerable sector of society,” it cites from the Mental Health Legislation and Human Rights, a 2003 World Health Organization (WHO) document. People afflicted with mental health disorders are prone to abuse and neglect in a variety of settings, health care included.

While there may be indicators such as suicide rates and postpartum depression, the data still paints an incomplete picture of the actual situation in the country. “In the general community setting, mental problems have become invisible,” says immediate past PPA President Dr. Ma. Luz Querubin.

“There’s very little statistics to provide us with an objective measure of how huge the mental health problem is. If we look at data in terms of illness alone, it is mostly underreported.”

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“Even if you have a bill, no matter how good it is, and no matter how well it’s crafted, you have to know the right people to advocate and push for that.”

- Dr. Michelle Marinas Psychiatrist The Medical City

DIFFERENT ITERATIONS OF THE MENTAL HEALTH ACT As previously mentioned, the Mental Health Act has undergone several rounds of revisions and thus, has led to different versions of the bill being passed to the legislation every year.

The earliest semblance the Philippines has to a mental health law came in the form of Senate Bill No. 2013 or the Mental Health Patients’ Bill of Rights. This was filed by Senator Miriam Defensor-Santiago back in May 2005, and was basically an enumeration of the basic rights of mental health care patients. Basic rights such as the right to receive quality treatment, a need for the patient’s consent in beginning any course of treatment and the right to refuse experimentation, solitary confinement and other forms human rights abuse were only some of the provisions included in the bill.

The mental health bill that followed was filed by then Senate President Juan Ponce Enrile in November 2009, and was called the National Mental Health Act of 2009 (Senate Bill No. 3509). Unlike the previous bill, this did not enumerate any patient rights but outlined specific actions to be taken by the government in addressing the issue of mental health in the country. The creation of the Philippine Council

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for Mental Health (PCMH) as an agency under the Department of Health (DOH) is one of the main points of this proposal. The created council will be responsible for policy formulation, inter-agency collaboration, and oversight of the National Mental Health Care delivery system in the country. Other provisions, such as reorientation and training of mental health professionals, research and development in mental health, and the improvement of mental health care services in regional and provincial hospitals, were also given attention.

SOURCES OF RESISTANCE

Succeeding iterations of the bill followed the format provided by the 2009 National Mental Health Act in that they focused on the Mental Health Council. However, this changed in the Philippine Mental Health Act of 2014 where most of the bill were allotted to expounding upon patient rights, and in the 2015 Philippine Mental Health Act which completely removed the creation of the Philippine Council for Mental Health. Instead, the bill seeks to use the structures currently in place - the DOH, the Commission on Human Rights, and the national and local mental health facilities - in providing mental health services. Integration of mental health care in the curricula of allied medical professionals was also discussed.

The same thing was said by Dr. Querubin. She states that, “… despite having a mental health program on paper [or legislation], the fact that we don’t have an allocated budget [for said programs and services] would mean that we won’t be able to effectively implement these programs in the cities and provinces.”

Dr. Querubin also posits that since there is no budget for mental health, other needed resources such as human capital are not available. In fact, she adds that mental health is given that little of a priority in the country to the point that there is no specific body within the structure of the DOH that handles the mental health program. It is currently under the broad responsibility of the Non-Communicable Disease Office.

The number of bills petitioned in the senate now begs the question of why Mental Health is still not a priority in our country. For Dr. Marinas, she believes that budgeting remains to be the main problem. According to her, mental health tends to take a backseat when it comes to the other concerns of the DOH. Obviously, people would tend to give more priority to more “obvious” diseases than the less noticeable mental health illnesses.

Lobbying for support in the Congress and Senate is another challenge usually encountered. “Even if you have a bill, no matter how good it is, and no matter how well it’s crafted, you have to know the right people to advocate and push for that,” Dr. Marinas says. “There are many issues that need to be addressed in this country, and sometimes, competing agenda may derail the bill.” Moreover, According to Dr. Querubin, this year’s election season complicates the matter even further, as campaigning will be the priority of many politicians. In addition, hearings on national issues, such as the Bangsamoro Basic Law and the Mamasapano clash, temporarily halt these legislative discussions.

Dr. Marinas, on the other hand, mentions that addressing the mental health stigma in the society is a crucial step to getting the needed support from the population. As observed, many Filipinos tend to equate mental health diseases with the supernatural and/or spiritual framework. As such, many afflicted Filipinos don’t get the treatment that they need, and are more often than not, “exorcized or chained to their homes” to get cured. Educating the Filipinos about the truth about the various mental illnesses should be the role of health care practitioners in order for us to better foster discussion for more innovative solutions for mental health care.

Lastly, getting support from the population has also been proven to be difficult. Dr. Querubin thinks that Filipinos need to be informed as to what the act is all about. “[Mental health] is not an attractive topic because it’s abstract.

We need to make it more real for people to finally understand.” She adds that advocates have to put a face to mental health to inject the experience and discussion a sense of realism, a sense of truth and urgency.

LAST WORDS When asked what the future plans of action of the PPA are with regard to the MH Act, Dr. Querubin says that they will be releasing more promotional materials, as well as conduct online campaigns and advertisements in cinemas. They will also be “in conversation with the UN Commission on Human Rights to help with lobbying for the MH Act.” Furthermore,

the legislative committee of the PPA plans to “marry the Senate and [Congress] versions” of the bill, such that the two houses will receive the same version of the bill. This may facilitate smoother discussion of the bill on both floors.

And lastly, they are also trying to push through with a nationwide caravan that informs and educates people on the need for the Mental Health Act. This includes getting more celebrities to advocate on behalf of patients with mental illness.

Clearly, the road to a comprehensive mental health law is arduous and undeniably complex.

The bill’s passage might not even happen until the turnover to the next administration, and there is also the possibility of having to start all over again with its crafting, revising, lobbying, and debating. However, this does not mean that proponents and advocates should get discouraged. Efforts to educate and inform the populace on mental health are but small steps toward a society where mental health is taken seriously and effectively acted upon.

“[Mental health] is not an attractive topic because it’s abstract.

We need to make it more real for people to finally understand.”

- Dr. Ma. Luz Querubin Immediate Past President Philippine Psychiatric Association (PPA)

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Survey

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HUMANITY IN MEDICINE words by Mica Araya and Agustin Miguel Soriano photography by Albert Song

The medical community constantly experiences very high stress. As medical students, we spend hours studying and learning more than the average individual. In the first three years of medical education, there is the brutal struggle to finish all readings and requirements and the never-ending exams that inevitably leads to lack of sleep and skipped meals. As we go further up the road to MD and beyond, the amount of studying, learning, and working increases even more.

In the hospitals and communities, we have to constantly be on our feet and be prepared for every kind of patient. The medical profession demands for us to attend to our patients first before ourselves. This translates to unhealthy lifestyles, such as being sedentary, having improper diets and following bad sleeping times. Typically, doctors do not get to eat on time or properly until after attending to all patients. As an example, surgeons spend hours in the OR and can only rest until after the surgery is over. The pursuit of Medicine

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How ASMPH emphasizes the importance of humanity in medical school

is undeniably one of the most stressful paths there is. In line with this, it is not difficult to imagine how neglected personal mental health could become in the medical community.

“The process of medical education is dehumanizing.” Dr. Ma. Luz Querubin, the immediate past president of the Philippine Psychiatric Association (PPA) and the Associate Dean in the Ateneo School of Medicine and Public Health (ASMPH), summarizes the experience. As medical professionals, we deal with human beings all our lives, yet we struggle to keep our own humanity intact. With this as the conceptual rationale, the ASMPH came up with the Coaching and Mentoring programs to help students maintain their humanity as they go through medical school. Moreover, the school also aims to provide guidance in lieu of a Guidance Office with a more personal and

flexible approach through these programs.

Although the school “does not - in a conscious, purposive manner, increase mental health awareness, subliminally, there are the Coaching and Mentoring programs that are supposed to help,” says Dr. Querubin. The Coaching program is offered to first, second and third year students, and the Mentoring program is offered to fourth and fifth year students.

Academic coaching is offered to all students to help with academic needs.

During the first three years of medical education, the students are at that stage wherein they are not yet truly doctors, and the knowledge and experiences are more similar to

In addition, as a school of both Medicine and Public Health, the school curriculum integrates both biochemical and psychosocial impacts of various diseases, including mental illness.

Students also learn about advocacy campaigns and current events in public health to keep us aware of the situation the people in our country are in. We were also introduced to the Mental Health Act and encouraged to support it. As part of the Public Health curriculum, students may do research on any topic of interest, including mental health and illness. Students are also tasked to create and encouraged to propose sustainable projects or campaigns to help with public health issues in the country. Although not necessarily geared towards mental health promotion, many of the projects overlap with mental health. These are also initiatives aimed to ground us and remind us of the people who are most in need of assistance.

resilience, and helps strengthen relationships and support networks.

that of lay people. For this reason, the coaches are purposely not doctors. However, during clinical clerkship and internship, the issues will become more related to hospital life and community rotations. During these last years, the lay coaches may not be able to resonate with the students; this is why the responsibility of guidance will have been passed on by then to the mentors, who are medical doctors.

Ideally, the students and the coaches or mentors should be matched appropriately. But since there are more students than coaches, there is difficulty in the matching process. It is also hard to match with certainty since at the beginning, the school does not know the students well yet. However, during the Admissions interview, prospective students who disclose sensitive mental health issues are ‘tagged’ so that if they get accepted, they will be appropriately assigned to more clinically-inclined coaches to help them with possible psychoemotional adjustment problems in medical school.

Another effort to help students maintain their mental health is the Transition Seminar held for third year students to ease the transition to clinical clerkship. This started and continues to be an annual student-initiated and student-led project to help prepare incoming clinical clerks for the stress of clinical life. The school tries to be supportive of this by providing guidance and partial financial support for the event.

In ASMPH, the Psychiatry modules are only a small part of the medical curriculum. However, mental health is integrated into all the modules.

“It is very subliminal,” says Dr. Querubin, “our alumni are more adept at identifying emotional reactions of patients to illness, because it is not taught as Psychiatry, but as part of the general assessment of patients.”

Although there is plenty of room for improvement, the ASMPH tries to help promote and maintain the mental health of its students.

As Dr. Querubin explains, “While the school offers no concrete answers, it tries to pave a path.” The experience of mental health is different for every person. In our setting, instead of happiness, which is fleeting and turbulent - one moment you are happy, and the next you are sad because of an exam, Dr. Querubin suggests we look for inner peace; “Seek peace of mind. Always find time to identify your feelings and to deal with them.

You have to find ways by which you can take care of yourself [and] build relationships where you can be cared for. The humanity has to be maintained.”

Aside from these, students are also encouraged to pursue hobbies and other passions through school organizations. The organization culture is a big part of the ASMPH community. We have student organizations for sports, spirituality, nutrition and wellness, advocacies and many others. These are included in the student government structure recognized by the school administration. Through this formal structure and system, the school also provides financial support for these organizations. Having organizations allow for us to apply our learnings in MBA, and according to Dr. Querubin helps promote mental health as they serve as “outlets of stress and inducers of happiness.” Moreover, being part of these builds character and

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Future Physicians, Mentally on the

Verge?

An overview of the programs that make San Beda College of Medicine a mental health friendly institution words and photography by Galicer Guinto (SBCM)

Getting a medical degree is like being in between mayhem and pursuing a dream. Many would say that you must have the guts to make such a decision because it would certainly make you lose your mind, if not your life, once you get in. Indeed, a lot of factors must be considered before entering the ministry of healing. In fact, most medical students were warned that they must be equipped with the ‘necessary tools’ before entering the war zone that is medicine.

The most important amongst these ‘tools’ is our ability to constantly withstand stress and failures. To illustrate, there was a study performed by Debbie Cohen, a senior medical research fellow at the University of Cardiff. In this study, she stated that “the well-being of medical students at schools was dominated by what she called the hidden curriculum.” Hidden curriculum refers to the way doctors believe and at the same time, expect medical students to believe that they are invincible. Perhaps, this ‘hidden curriculum’ that she coined also exists here in the Philippines, as observed

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by the various things expected from us by our professors and mentors. Still, as medical students, we are aware that health is not solely limited to our physical health and our supposed inability not to get sick. In reality, the state of our mental health also plays a big role in our life as medical students. This now leads us to the question of “how mental-health friendly is your medical school?”

As medical students, it may not be that surprising for us to know that many of us are constantly stressed, anxious and depressed.

After all, most of us usually lack sleep, indulge in unhealthy eating, barely exercise and have small support systems. Not to mention the added stress of getting failing marks despite all those sleepless nights and hard work. In 2009, the Academic Medicine mentioned in a study that matriculating medical students began training with similar or better mental health than age-similar controls. However, their mental state continued to deteriorate over the

years in the field. Thus, the distress in medical students and residents support the concerns that the training process and environment contribute to the deterioration of mental health in future doctors. Therefore, necessary steps to help them must already take place during their early training years, also known as their first years in medical school.

In line with this, I am proud to say that the San Beda College of Medicine has a Program of Psychiatry. This is a 4-year program which courses through all four years of medical education, something that is completely unique among other medical schools. Psychiatry 1 deals with normality, the Filipino life cycle, and special populations. Therefore, even during their freshman year, the students of San Beda are already being familiarized with mental health concepts, which will prepare them as they move along medical school and overcome all the challenges at every level.

Psychiatry 2, on the other hand, deals with

Psychopathology. This involves learning about the various psychiatric diseases, and their means of diagnosis. The third year, Psychiatry 3, focuses on the diagnosis and management of psychiatric conditions, and on special populations. It is essentially the introduction to the clinics with emphasis on clinical competencies, communication skills, interprofessionalism, adherence to management and care, management of research findings, health systems management, personal and continuing medical education and adherence to professional, ethical and legal standards.

Finally, Psychiatry 4 is the clinical rotation in a general hospital setting. This year serves to integrate all the previous courses into actual patient interaction and care, thus allowing the students to embody the Benedictine core values with enough knowledge and strength on mental health.

In terms of teaching style, Dr. Vivienne Cleofas, the Program Head of Psychiatry, said that aside from the lectures that were given, other activities such as small group discussions, reflection papers, reaction papers, group dynamics, patient exposure and debriefing are also conducted during the 4-year program in Psychiatry. She also reiterated that the perusal of the topics in Psychiatry 1 would show the different topics for normality. The course in Psychiatry 3, on the other hand, includes the clinical rotation, which includes supervision.

This allows the consultants to help students process and make self-realizations regarding their experiences. And lastly, Psychiatry 4 is a month long rotation that has activities which address all the outcomes needed for mental

The training process and environment contribute to the deterioration of mental health in future doctors. health. She said that there is a more in-depth interaction with this rotation that allows the consultant and clerk to process the whole learning process.

In addition to the program, the Guidance Office and the Student Affairs Office of the San Beda also creates and implements programs and activities to help students manage their stresses and mental health. Dr. Cleofas also said that as the need arises, the College of Medicine’s Prefect of Student Affairs, Dr. Ana Marie Morelos, calls on the Psychiatry consultants for discussion on certain student issues.

According to Dijamco (2009), innovative programs for promoting student wellness have increased over the past few years, such as the implementation of extracurricular activities, which focuses on community-building among

students. In San Beda, these extracurricular activities are also present to exercise the Benedictine values imparted by the Bedan community. We have an annual Recognition Day at the start of the school year to honor those who have excelled in academics for the previous school year. We also have a 2-Day Freshmen Orientation and a Freshman Integration activity to warmly welcome the freshmen to the Bedan community. We also have retreats that give us time to reflect and meditate for 3 fruitful days and 2 nights. We also conduct an annual MedWeek to serve as our time off from our usual study routines and express our hidden talents in sports, singing, dancing, acting and the like.

No one would understand how grateful we, Bedan Med students, are unless one would be part of our community in the ministry of healing. Dr. Scott Rodgers, the associate dean of student affairs at Vanderbilt SOM, once gave a very strong statement, “You don’t want to lose your humanity by becoming a doctor.

Students should participate in activities outside of medicine, maintain personal connections and make their own physical health a priority.”

Indeed, mental health is considered as important as physical health. Therefore, it is a huge task that all physicians, medical students and educators must discuss the topic with a sense of urgency and optimism together. We cannot deny the fact that there are students who have mental health problems. As Shannon Alder once said, “Never give up on someone with a mental illness. When ‘I’ is replaced by ‘we’, illness becomes wellness.”

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WHY IS MENTAL HEALTH STILL SO

Stigmatized words by Lee Matthew Ponce photogtaphy by Arenne Ramos

THE CASE MH, a 23-year-old male was brought to the clinic. He was initially well and sociable until three months ago when he and his family met an accident. Except for MH who sustained minor physical injuries, none survived. His friends then noticed that he became distant and preferred solitude. MH refused to hang out with others and was frequently cutting work. There were also accounts of him speaking alone, and throwing things at those who approached. Neighbors began avoiding MH. They all thought he was ‘crazy’.

As the attending intern, how will you manage MH? Should you be cautious since he might hurt you? What should you tell his friends and neighbors? Given the above scenario, can we say that MH has a mental health problem?

The patient, who was initially sociable, suddenly transformed into an unfriendly individual. Changes in behavior were noted by peers and loss in productivity observed by colleagues. The worst part was that people started avoiding MH thinking he was dangerous and crazy.

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THE DEFINITIONS To better understand my points and discussion about mental health, let us first start with some definitions. According to the World Health Organization, mental health refers to “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community”. From this, mental illness is then defined in the Philippine Mental Health Act as “any mental or psychiatric disorder characterized by the existence of recognizable changes in the thoughts, feelings and general behavior of an individual brought about by neurobiological and psychosocial causes, and is manifested by behavioral symptoms with associated mental or emotional conditions.”

From the above definitions, it can be said that MH is battling a mental condition. But it is not the only issue that needs attention. Yes, it may be the underlying problem but its ‘sequelae’ must also be addressed. That is, the stigma attached to mental issues.

THE CONTEXT AND THE CAUSES Why is MH’s case important to understand?

MH’s case can be compared to the state of mental health in the country. Patients with mental conditions are frequently misunderstood by friends, colleagues and even their own families.

Many encounter difficulties in work and school due to bullying, harassment and discrimination.

The fear of being judged and ridiculed makes them reluctant to seek help. Ergo, they think nothing can be done for them.

It is not and never too late for us and for them. Let us give people like MH the treatment they deserve and put an end to the stigma that plagues society.

And I realized that the reason why things remain this way is because there is still a stigma associated with mental illnesses. And this stigma propagates fear. It propagates the belief that help is, and should not be, needed.

To better illustrate my point, think of the obsessive-compulsive nature of Monica Geller, one of the main characters from the hit TV show F.R.I.E.N.D.S. Her personality was a constant source of comic relief in the aforementioned show. Add to this is our typical avoidance of a taong grasa (vagrant) in the street, for we were taught that he would run amok and harm us.

The question now, then, is why is mental health still so stigmatized? After all, these disorders have already been recognized and treated for years.

According to the World Psychiatric Association, mental health is still stigmatized due to the mentally ill’s personals beliefs (self-stigma) and the society’s propagation of the idea that the mentally ill are at fault for their conditions (public stigma). Self-stigma is to the internalization of the mentally ill of the belief that they are less valued because of their psychiatric disorder, while public stigma suggests that majority of citizens in the country believe that people afflicted with mental diseases are 1) crazy and dangerous, 2) contagious and 3) different.

Citing the experiences of John Nash, the protagonist from the movie “A Beautiful Mind”, let us tackle these plausible explanations why discrimination exists against mentally ill patients.

“They are crazy and will harm us”.

In the Philippines, there are various stories of killing rampages in the media, wherein mentally unhealthy individuals were known for shooting their family members to death.

In the same way, think of John Nash’s portrayal in the movie, A Beautiful Mind.

He was depicted as someone who easily attacked his wife because the ‘voices’ told him to. Various media analysis of film and print typically show that people with mental illness are homicidal maniacs who need to be feared, further strengthening the stigma associated with mental health conditions.

While it may be true for those who are under the influence of illegal substances, or those with severe psychosis, we should remember

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that not all patients with mental health problems are hostile. In fact, the majority actually have mood problems that usually respond to medications and counseling. As such, these threats concerning mental health patients are preventable, and mostly, untrue. Indeed, looking at it from a different angle, they are the ones in danger of experiencing neglect, abuse, and maltreatment from society, not necessarily us who are not suffering from any mental condition.

“They may be contagious.”

People still have this unconscious belief or fantasy that mental illness is actually contagious, and as such, they must stay away from the mentally ill. In a study conducted by Marsh and Shanks, people believe that alcohol abuse (56%), anorexia (35.6%) and depressive disorder (32.2%) may be transmitted through close contact with the person affected, as if the mood problems may be transmitted via respiratory droplets. Clearly, the presence of such beliefs in society further reinforces the stigma and social isolation felt by individuals suffering from mental illnesses. These beliefs are almost absolutely false, but without proper education, they remain as predominant false concerns in our society.

“They think differently from us.”

Others marginalize the mentally ill because they think differently from us, the same way that society marginalizes people who are different. It cannot be argued that there are changes in the brain chemistry among patients with mental health problems. Imbalances in neurotransmitters affect their mental status and behavior. For example, in the same movie A Beautiful Mind, John Nash suffered from schizophrenia and has faulty dopaminergic signals. This explains his hallucinations, delusions and erratic behavior. For our patient MH, his neighbors may be avoiding him because they cannot decipher what he really thinks. They cannot explain why he threw objects at people who came close. The quick and easy way out then is avoidance—lessen contact and interaction with MH, John Nash and other patients with mental problems.

But is this reasonable? Imbalances in neurotransmitters can occur to everyone, especially during times of stress. From the definition of mental illness above, inability to cope with stressful events may manifest as an observable behavior such as irritability, violent acts or mood changes. I am sure that at least once in our lives, we have experienced this feeling.

Everyone has experienced instances wherein nothing seems to go the way we want them to be. As a result, we get mad and become aggressive. If this is so, then this reasoning is not valid for us to ostracize people with mental health problems on the basis of differing thought processes. We can be subjected to the same stressors and manifest similar behavior. It is just that mental health patients have faulty repair mechanisms to bounce back from stressful events. As such, instead of stigmatizing them, they should be given the intervention and external help that they need.

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THE CALL FOR ACTION AND CHANGE Given the abovementioned reasons, it may seem like that nothing more can be done for people like MH. Fortunately, the problem on mental health is not a hopeless one. Lawmakers in the country are discussing a mental health act which is a sign of development regarding this issue. Various lectures and awareness campaigns are being conducted to promote mental health among students and professionals alike. But all of these would not suffice if we fail to understand the fact that they are like us.

Given a choice, it is foolish to think that anyone would want to become ill. If you get sick, you will incur costs and loss of productivity. Whether it may be a simple flu or something as worse as cancer, nobody will choose to be ill. That is why we invest on vaccines, medicines and preventive measures just to protect ourselves from getting sick. But sometimes, it just occurs.

No matter how meticulous we become in terms of hygiene and health, we cannot completely avoid getting sick.

The same can be said for mental health patients.

They, too, did not choose to become ill. Their sickness came from a trigger which they did not want to experience. From our case above, MH’s symptoms began to manifest after experiencing a traumatic event. He did not choose to suffer from that, but it just happened. We have to understand that some things are just beyond human control. Getting sick, whether physically or mentally, is sometimes unavoidable.

If we finally start accepting the fact that mental illness is just like any other physical illnesses, then we can be more proactive in preventing and treating diseases of the mind.

And if we finally start accepting the fact that mental illness is just like any other physical illnesses, then we can be more proactive in preventing and treating diseases of the mind.

Remember that it was our knowledge that microbes can be spread through direct contact that encouraged us to practice handwashing.

When we feel sick, we seek medical help. When we see someone in distress, we do not hesitate to give a hand. The same goes for mental health patients. If we notice something is wrong, we try to determine the cause. We help them get the help they need, instead of telling them that “this is all in [their] head, and they should just suck it up.�

Let us remember that people like MH are ill and require attention. When I say help, I am talking not only medical treatments but also psychosocial. While medicines coupled with proper treatment may work wonders for these individuals, understanding and acceptance are also important for their recovery. It is not and never too late for us and for them. Let us give people like MH the treatment they deserve and put an end to the stigma that plagues society.

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Photos in this article are artistic representations using volunteer models, and not of the actual person being interviewed

Thethird thirdfloor floor erupted in celebration.

It The erupted in celebration.

It was the was of theOSCE, end of OSCE, and the whole school end and the whole school was filled was students filled with students in various phases with in various phases of celebration of celebration andher relief.

Janet had (notspent her and relief. Janet (not real name) real last name) spent sobbing the last five minutes the fivehad minutes in the back sobbing in the back staircase; sure staircase; she was sure that she she hadwas failed.

“I that she had failed. reading remember reading about“Iallremember of those cases,” she about allsadly of those cases,” she went thought sadly thought to herself.

“What wrong?” to herself. “What went wrong?”

It was her third time to rewrite the text she It was her third to time rewrite thewould text intended to send her to parents.

How she explain intended to send parents.

How she to them that to on her top of her removal wouldshe shehad explain to them top of exam, also failed the that most on important her removal exam,Worse, she had the exam of the year? shealso had failed appeared most important exam of mentors. the year?With Worse, incompetent in front of her that she had over appeared incompetent frontfelt of looming her head, Janet hadinnever her mentors. that looming over her farther from herWith dream.

head, Janet had never felt farther from her dream.

It hadn’t always been like this It hadn’t always been like this.

The first year of medical school was a flurry of emotions—excitement in wearing the white transeswas for the first uniform, over makingschool The firstdread year of medical a flurry time and anxiety over making ain good impression, of emotions—excitement wearing the among others. But despite through this transes white uniform, dread overgoing making adjustment, performed school. for the first Janet time and anxietywell overin making Her gradesimpression, weren’t on the same others. level as But the a good among grades earnedthrough her a latinthis award in college, despitethat going adjustment, but everyone had always her that Janet performed well intold school.

Her medical grades school was college ever weren’t ona far thegreater samebeast levelthan as the grades was. spite ofher this,ashe earned above-average that Inearned latin award in college, scores in her exams, frequently out that late but everyone had was always told her into the night withwas different of people medical school a fargroups greater beast and readwas. about thanrelentlessly college ever In lecture spite oftopics this, and she completed requirementsscores weeksinin earned above-average heradvance. exams, She elated toout finally the waswas frequently lateimmerse into theherself nightinwith world of medicine. drifted into different groups ofExciting people days and relentlessly exciting nights, when topics she often herself read about lecture andfound completed in bed, already thinking about the many requirements weeks in advance.

Shethings was 26 | MENTAL HEALTH ISSUE

she would the next day. elated todofinally immerse herself in the

world of medicine. Exciting days drifted She a greatfound deal into tackled excitingmedical nights,school when with she often of energy, and already so she wasn’t to herself in bed, thinkingsurprised about the find drained needing manyherself thingsutterly she would do and the next day.the

occasional recharge—not just physically, but also she felt She mentally, tackled especially medical when school withthata her efforts not enough.

I saw how great dealwere of energy, and“When so she wasn’t effortlessly of my classmates memorized surprised some to find herself utterly drained anatomy, whilethe I could barely recall the names and needing occasional recharge—not of thephysically, structures but evenalso aftermentally, studying especially Netter and just the trans over over, I would really feelnot so when she feltand that her efforts were Mga effortlessly two days akosome wala down,” she recounted. enough.

“When I saw“how sa niyan and sometimes, I’d have a hard of mood my classmates memorized anatomy, time then, I’d always bounceofback whilesleeping.

I could But barely recall the names the .” soon enougheven structures after studying Netter and

the trans over and over, I would really feel so down,” she recounted. “Mga two days ako wala sa mood niyan and sometimes, I’d have a hard time sleeping. But then, I’d always bounce back soon enough.”

On the surface, Janet and many other students like her appear to be high-functioning individuals, or at the very least, faring reasonably well. As the public’s concept of mental illness has been shaped by the likes of Sisa of Noli Me normally suspectother that Tangere On the, nobody surface,would Janet and many someone performing class and studentswho likewasher appear well to inbe highmaintaining healthy social could possibly functioningaindividuals, or life at the very least, be afflicted with a mental Furthermore, faring reasonably well.illness.

As the public’s medical like illness Janet are conceptstudents of mental hasusually been forgiven shaped for—and are of expected by the likes Sisa of to Nolibe—undergoing Me Tangere, regular and downs” because of schoolnobody“ups would normally suspect that related stressors. reasons, itwell is easy someone who For wasthese performing in to say and that maintaining Janet was managing wellsocial and that class a healthy life her occasional was a with healthy coping could possiblyrecharge be afflicted a mental mechanism.

Ironically, itmedical is this high-functioning illness. Furthermore, students like demeanor may mask an underlying mental Janet arethat usually forgiven for—and are condition. expected to be—undergoing regular “ups

and downs” because of school-related In an articleFor recently published in Psychological stressors. these reasons, it is easy to , scientists frommanaging the University of Review say that Janet was well and Virginia and McMaster University argue that her occasional recharge was a healthy

that depression might Ironically, be an adaptation for coping mechanism. it is this analyzing complex problems. intense high-functioning demeanorThe that may bouts mask of usually associated with depression— anthinking underlying mental condition. called rumination—have been demonstrated in many studies to be recently highly analytical in nature.

In an article published in This analytical way of thinking, which reduces Psychological Review , scientists from complex problems smaller the University of into Virginia andcomponents McMaster that can be considered at a time, can be University argue thatone depression might very productive.

The most important aspect of be an adaptation for analyzing complex this process The is thatintense it must be uninhibited—and problems. bouts of thinking indeed, researchers with arguedepression—called that many of the usually associated symptoms of—have depression make sense in the light rumination been demonstrated in of analysis needing to be uninterrupted. many studies to be highly analyticalThe in decreased desireanalytical for company, or the to nature. This way of inability thinking, derive from other activities, problems keeps the which pleasure reduces complex person focused on the problem.that It is therefore into smaller components can be not hard to imagine may considered one atthat a depression time, can itself be very contribute to the productivity in some productive.

Theveneer most of important aspect of depressed people. this process is that it must be uninhibited—

and indeed, researchers argue that many

Another of thought which dispelsmake the of the line symptoms of depression myth high-functioning individuals cannot sensethat in the light of analysis needing to have mental illnesses that theredesire appears be uninterrupted.

Theisdecreased for to be a or correlation between intelligence company, the inability to derive pleasure and symptoms of keeps mental the illness, such fromother other activities, person as anxiety.

A recent study by focused on the problem.

It is conducted therefore not psychologist Alexander Penney showed that hard to imagine that depression itself may verbal intelligence a positive relationship contribute to the had veneer of productivity in with Anxiety Disorder (GAD), some Generalized depressed people. depression and social anxiety. The study showed intelligence a unique Anotherthat lineverbal of thought whichwas dispels the predictor of worry and rumination severity. myth that high-functioning individuals Daniel his colleagues the there Royal cannotSmith haveand mental illnessesfrom is that College have also found that a appearsof Psychiatrists to be a correlation between high IQ in childhood is associated bipolar intelligence and other symptomswith of mental disorder adulthood. to that,study there illness, later suchinas anxiety.ToAaddrecent is also age-old by wisdom in the form ofAlexander the adage conducted psychologist ‘ignorance is bliss’.that This seemsintelligence to suggest that Penney showed verbal had the more intelligent a person is and the more a positive relationship with Generalized they knowDisorder about the (GAD), world, thedepression more likely they Anxiety and are to overanalyze and worry things. that social anxiety. The studyabout showed

verbal intelligence was a unique predictor

Medical are generally well beyond of worrystudents and rumination severity.

Daniel above-average intelligence.fromMany are Smith and his colleagues the Royal particularly in academics or critical College of gifted Psychiatrists have also found thinking.

EvenIQ when they are notisatassociated their peak, that a high in childhood

with bipolar disorder later in adulthood. To add to that, there is also age-old wisdom in the form of the adage ‘ignorance is bliss’. This seems to suggest that the more intelligent a person is and the more they know about the world, the more likely they are to overanalyze and worry about things.

Medical students are generally well beyond above-average intelligence. Many are particularly gifted in academics or critical thinking. Even when they are not at their peak, they are able to outperform the average person in deriving solutions, connecting concepts and storing an abundance of information. This allows mental illness to fly dangerously under the radar as the affected person continues to suffer in a dysfunctional state.

Like Janet, many medical students experience symptoms of depression and anxiety on a regular basis, a fact which has been supported in literature since the 1970’s. The sheer amount of knowledge expected to be mastered in a severely constricted timeframe, combined with the high-stakes nature of dealing with human lives, makes for a fertile environment for the worry, stress, and fatigue that many of us know all too well.

“Everybody in med school seemed to be going through something,” Janet shared. “I was at a family reunion when I complained to my tita, who is an ophthalmologist at a well-known hospital, about my constantly twitching eyelid and how it only started in YL5. She said, ‘Stressful talaga mag-aral ng medisina, ‘no? Nako, marami ka pang mararamdaman, ‘di lang ‘yan.’ I figured that she and many others went through similar stuff in medical school, but they seemed to get over it. I guess it’s just part of the experience.”

Stress is a fact of life in medical school. This paradigm is so deep-seated in our chosen profession that even our non-medically inclined family members and peers fail to be surprised. This is, perhaps, the greatest myth regarding mental health that we encounter as medical students: that any bad feeling—physical, or otherwise— remotely associated with the pressures of being a medical student is merely growing pains. It’s as if the systematic whittling away of our sanity is part of a “trial by fire” that everyone in the medical profession undertakes. It’s something that even our consultants went through in the early MENTAL HEALTH ISSUE | 27

stages of their careers. It doesn’t help that we medical students are expected to see the warning signs early on, and to cope with these problems on our own with advice like “Itulog mo lang ‘yan” or “You just need a friend to talk to” coming left and right. What’s more, against the larger backdrop of our country’s sociocultural woes, depression and anxiety are hardly glaring to a nation where hunger and poverty pervade. In an environment where slumps and ills are par for the course, where mental illness is a “first world problem,” and where struggles with the workload are spun into lighthearted jokes between friends, saying that you have depression or anxiety usually means getting muffled into the background noise.

I just accepted na hirap lang talaga ako matulog,” she said. “But when I showed up late to a final module exam because of trouble sleeping the night before, I knew I needed help.”

She eventually sought consult with a sleep specialist in a well-known medical facility, but upon review of her history, she was referred to the department of psychiatry.

It was at the end of the first year of medical school when Janet was told that she had bipolar II disorder.

So why the need to take this more seriously?

Because ultimately, “itulog mo lang ‘yan” is simply not enough. Talking to a friend, no matter how well-meaning, can only go so far. In an interview with GMA News Online for a feature on depression, Dr. Randy Dellosa, the owner of a psychiatric facility in Quezon City as well as the resident psychiatrist for various local reality TV shows like Pinoy Big Brother and The Biggest Loser, talks about the need for more serious intervention in dealing with these problems: "The problem with talking to a friend is they're not therapists. If you keep on telling them your problems, they'll tire out eventually," Dellosa said.

"Psychotherapists are professional friends. They know how to create compassionate distance and they'll be neutral, objective and help the depressed person."

In Janet’s case, her tipping point remained vivid. “Sometimes, I would wake up in the middle of the night and I would be palpitating and worried about something— but I couldn’t tell what. I wouldn’t be able to sleep again after waking up, no matter how short my sleep was. At some point,

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“The diagnosis rattled me. I couldn’t imagine being trusted with people’s lives when I knew that I was unstable,” Janet said. “I remember a few days after learning that I was bipolar, I cried myself to sleep because I was so afraid that I would be a danger to myself and my future patients. I was scared that I would be forced to quit med if people found out!”

As future medical professionals, our mental health—as with any aspect of our health— affects not just ourselves. Underplaying the gravity of mental illness may entail long-term effects on our eventual practice of medicine. Ignoring or providing bandaid solutions to mental health issues not only compromises our well-being, but can also impair our ability to render quality health care in the long run.

According to David Hellerstein, professor of Clinical Psychiatry at Columbia University, the effects of untreated depression covers a range of behavioral problems such as increased absenteeism at work, alcohol consumption, smoking and poorer physical health. “Brain imaging studies have shown that untreated (or chronic) depression is associated with atrophy of parts of

the brain related to working memory and higher cognitive functioning,” says Hellerstein. If this is true, was Janet right to worry that she is unfit for the medical profession, where patients’ lives are on the line? Should medical schools screen for symptoms of mental disorders in their applicant pool in the interest of protecting the quality of healthcare?

The answer, of course, is no. In the Magna Carta of Disabled Persons, Philippine Law defends the rights of the disabled against unlawful denial of admission to any education course based on their handicaps or disabilities, among which mental illness is recognized. While it is true that mental illnesses are serious and have deleterious effects, and while it is important for people like Janet to get treated and undergo therapy, to say that their mental illness renders them incapable of becoming good doctors is overt discrimination.

This discrimination is not so much an act of malice as it is a product of a poor understanding of mental illnesses and how they are treated, along with pervasive stereotypes of mental illnesses that have existed for generations. The widespread notion of a psychiatric patient as a thrashing, violent person needing the restraints of a straitjacket is a far cry from the equally popular picture of a doctor who is calm, capable and in control. The misconception that mental illnesses are untreatable and lifelong afflictions also intensifies the fear that these people will hold the life of others in their hands.

On the contrary, mental illnesses are some of the most treatable conditions in medicine. The Depression and Bipolar Support Alliance reports that 80% and 70-85% of those treated for depression and bipolar disorder, respectively, show an improvement in their symptoms, with most of these people recovering completely.

Therefore, the belief that Janet and others like her are automatically unfit to become medical professionals has no legitimate basis.

“After I was diagnosed, my psychiatrist put me on mood stabilizers and told me to see her every two weeks. At first, I was very compliant, but soon became tired of the whole thing. I didn’t like that the pills made me gain weight and I didn’t feel like the therapy was very effective,” explained Janet. “I was also concerned about how much the sessions and drugs were costing my parents, so I started going less and less. Eventually, I just stopped going.”

“Then OSCE happened,” she continued.

“Parang ‘yun na ang lowest point ng buhay ko. At some point, I thought that it would be better if nawala na lang ako. Or if I got hit by a car or something so that I wouldn’t have to deal with this mess. And this scared me, because I never thought I would be having suicidal thoughts.”

This realization is what finally urged Janet to see her psychiatrist again and give treatment another chance. “I wish I could say that I started feeling better right after continuing the treatment, but I didn’t. It took a lot of work between me and my doctor. But despite my doubts, my patience paid off, and eventually it felt like it was starting to work. My eyelid even stopped twitching!” she laughed. “I realized that even as a med student, I still had misconceptions about mental illnesses, which prevented me from dealing with my situation properly. Without them, I would have gotten the help I needed sooner.”

To this day, Janet continues to receive treatment for her bipolar II disorder. She is happy to say that she passed both OSCE and her removal exam. While medical school no longer fills her with anxiety, she still has challenging days every now and then. And on those days, she only has one thing to say: “It won’t always be like this.”

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INSIDE LOOK AN INTERVIEW The life of a medical student was never meant to be easy. Our days are typically filled with hours of lectures, hundreds of pages of books to read, countless body parts needed to be memorized, and various drugs and diagnostic methods that must be learned.

Now, try imagining going through those dayto-day hurdles of medical school, but with a mental health issue. Seems impossible, doesn’t it?

Truth be told, there are a good number of our fellow medical students who do face these challenges. We just never really notice because they simply continue to face these struggles by themselves, without them really giving us the slightest indication. The best we can do is to not have bias or assume 30 | MENTAL HEALTH ISSUE

Note: Photos in this article are artistic representations using volunteer models, and not of the actual person being interviewed

words by Nicholas Cancio and photography by Maan Bermudez

anything about our peers, realize that we all have our own dragons to slay, and know in what way we can really be of help to others.

In this way, we can help lessen the stigma around mental health issues and create a friendlier and welcoming environment for our fellow students to be open with us.

One of our peers was willing to open up and share his struggle with a mental and emotional challenge and how he has come to terms with and triumphed over it. The interviewee has asked for anonymity and will be referred to as John throughout this article.

GOING BACK TO THE BEGINNING John is a medical student who was diagnosed with obsessive-compulsive disorder (OCD).

When asked when it all started, he claims that, “[he] probably had OCD ever since [he] was younger,” Although back then, he didn’t know that what he was dealing with was OCD. According to him, the condition and its symptoms became more prominent and noticeable during his high school years. “I had its classical signs, such as obsession with neatness, cleanliness, and the like. Initially, I thought it was simply perfectionism, but there were certain patterns that indicated otherwise.”

He also mentioned instances wherein he would be too bothered to move on from a certain task, such paying excessive attention to the smallest of details, getting distracted by misaligned objects, and having to read a page twice before he could proceed to the

next page. “I always needed to make sure, it was like there was a compulsion for me to really know the content, or else I wouldn’t be able to leave the page and move on.”

He also related that back then, things were really in a vicious cycle. Whenever he started to feel the stress, and his concentration would begin to fail and the rituals would start taking over, he would simply tell himself that he needs to “power it through”, not really knowing that this would further aggravate his stress and symptoms.

These kinds of things continued until he went to college. According to John, things were better for him during his college years. With the all the time that college has provided, it was easier for him to manage and cope whenever he felt the anxiety building up again. The symptoms still persist, but generally, he felt more or less in better control during those years.

THE ESCALATION AND THE CALL FOR HELP However, it was when he got to medical school where it all began to escalate. “It was during the Head and Neck Module,” he recounts. The pace of lectures increased and the load began to pile up, and he noticed his past issues came back. “There is that transition period from college to medical school that students go through, and it was also a transition period for me. And when it got to the Head and Neck module, my stress level was already really high. That’s when I started to feel the same things I did back in high school.”

It had gotten so bad that he was unable to concentrate on anything. It has even started to affect both his work and relationships. “I couldn’t concentrate on studying. I would read a page from our transes, and think that I don’t really know what I was reading, so I would start all over again.”

Knowing that these things are not okay and that he already needed help, John decided to actively seek help about his condition.

He approached one of the doctors who taught Psychology during the Principles and Perspectives module. “I told him about my symptoms and the things that I feel. Soon after, I was having regular consultations with him. I was diagnosed with OCD.”

We have an obsession with naming things, so if you were able to name or define something you become less afraid of it THE AFTERMATH After he was diagnosed, John reported that he was not exactly surprised. He had always thought that what he has is OCD after having done countless researching in the past. After all, he claims that he has always known himself as that – conscious about neatness and perfection—so he was ready to hear it.

At the same time, knowing what he had was a huge sigh of relief for him. He says that talking to the doctor really helped because it gave him both knowledge and reassurance. “We have an obsession with naming things, so if you were able to name or define something, you become less afraid of it,” he says. Thus,

after knowing what it was, not only did it ease his mind, but it allowed him to take the necessary actions to manage his OCD. “Of course, after learning I had OCD, I was not able to get back into the zone immediately,” he recounts. Instead, the diagnosis helped him in the sense that the knowledge helped him to take the necessary actions to manage his condition. “Eventually, I learned how to manage it better, and eventually I was okay.

Ngayon, mas manageable na siya kaysa nung Head and Neck.”

John related how he coped with his condition before and after his consultations. He now understands that continuing to work despite the lack of focus and the onset of his rituals was actually counter-productive. Instead, he learned to pace himself better. After his consultations, he learned that if the work was beginning to pile up, and his stress levels were starting to rise, he should stop and take a break. He would do this by taking breaks, letting loose and suspending thoughts about his tasks. “For example, after I recognize na medyo maraming gagawin, I need to practice a better kind of pacing for my work. Kapag pagod na, tama na.”

FINAL WORDS Many illnesses, disorders and issues are not fully understood, and thus, a stigma is built around them. It is because of these that John, while willing to share with SCOPE ASMPH his experiences on having OCD, would still prefer to remain anonymous. When John consulted with his doctor and asked why there was this stigma, his doctor said one major reason is that people view having mental illnesses as “kahinaan ng loob” (weakness of the heart).

This is not to say that John isn’t open about it.

In fact, he has gone a long way in being able to talk and being able to tell his friends and family about it. He also says that if the topic were to come up in casual conversation, he would not mind and have no trouble sharing about his OCD. Being future medical professionals, we must take this as a challenge as well to help educate the others that mental health issues are not things that diminish who we are, but rather are realities anyone can face but do not lessen who they are or who they want to be in any way. The best we can do is to not have a bias and not propagate the stigma, and instead, be more knowledgeable about what they are going through.

At the end of everything, John had a couple of words for those also facing mental issues.

“It’s not something to be ashamed of if you have a condition like this. It’s something that can be managed. I’d like to consider it like diabetes or hypertension, [as if it were] a chronic condition. It doesn’t mean that you’ll give up on it or on yourself. Precisely because of its chronicity, you must recognize it head on, and as early as you can so that you can better manage it for the rest of your life. And probably, but I’m not sure, baka may mga upside siya. Once you recognize that, it probably won’t be as much of a curse as you thought before. It could even be a blessing in disguise.”

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OPEN LETTERS

We asked medical students to send in letters reflecting their messages to (1) peers who are overcoming internal conflicts and (2) to the family and friends of those who are overcoming inner conflicts. The letters we received reflect the support of medical students toward each other, as well as their innermost thoughts which are rarely stated, but need to be heard.

Hello to the younger me, For all the things you’ve put me through over the years, I never regretted being you. You were always an anxious kid. I just didn’t think that your anxiety was, you know, not ‘normal’ until I was older and wiser, and a little more experienced with life. My memories with you are still as vivid as new, and even though I may not feel the same way anymore, I still understand you. You were always so scared of talking to people, so fearful of being judged and made fun of. The ironic thing was, none of the things you were so afraid of ever happened to you. No one ever bullied you, or laughed at you in front of people, or got offended by something you did. Maybe that’s because of all the measures you took to make sure it never happened. When someone you didn’t know well enough tried to make conversation, you just flashed an uncomfortable smile. You were so good at avoiding eye contact, at pretending you were busy doing something else – even while you were miserable and wilting inside. You desperately wanted to be liked for yourself, and yet so sure were you of your general ineptness and unlikeable personality that the more you wanted to be accepted, the more you hid inside yourself. The only people you really talked to were friends (I’m surprised you even found some) and at the slight slip-up of something inappropriate you said or did, you froze up, your chest constricting, your hands growing cold and your mouth going dry. Your friends described you as moody, because you could be happy and smiling one moment and then sullenly unresponsive the rest of the day. Truth was, those mood swings only meant that you thought you messed up and were so sure your friends secretly hated you. It sounds like something a normal teen would go through except, of course, you felt this way every day. Every single day. Every day of your teenage life. It wasn’t until college that you realized how you felt most of your life had a name. You were a SAD person. You had social anxiety.

I know you never thought it was possible. I know you believed that you were bound to feel the way you did forever.

But I am glad to tell you that people can change and I am a testament to that. You didn’t know what being better looked like, or what normal was. So granted, changing wasn’t easy. It wasn’t even palpable. It was more like a death march towards a destination you forced yourself to believe was real. You just keep walking hoping you reach it someday. I woke up years later realizing I feared life a little less and then a little less, all thanks to you. Fear was the boogey monster under your bed, the constant shadow that chased you most of your life. You did what you could, and you were brave. You conquered areas of your life one skirmish at a time, more akin to guerilla warfare than any outright war. But if I could go back to you and tell you how to do it all over again, I would sit you down and tell you this.

I would tell you that the only way to overcome anxiety is to force yourself to do exactly what makes you tremble and sweat. You never knew it then, but fear has two enemies: perseverance and desensitization. When you keep putting yourself in the situations you hate and live through it again and again—like a horrible nightmare stuck on repeat— something predictable happens. You grow just a bit more numb, a little less anxious, a little more free. The worst thing you can do with fear is to run away from it, because fear feeds on fear. My dear, I’ll tell you again. Fear feeds on fear. The only time it dies is when you finally stop running, face it head on and taunt it, “Come at me. Let’s see exactly what you can do to me.”

I know fear is part of human life. But I wish, with all that I have, that it had been part of yours a little less. When I think of all the people you could have met, all the moments you could have recaptured, all the avenues you could have explored, it makes me sincerely sad. But it also makes me determined to live out the rest of our life doing all the things you never could. You’ve already experienced a lifetime’s worth of fear enough for the both of us.

Now, it’s my turn to live out the rest of it fearlessly for you.

Yours, LSC (ASMPH)

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To N— No, I will not give up the coffee. Not one of the five cups a day. Eight ounces used to be enough to detonate my heart.

Lately I’m a little thick-skinned, a little too difficult to rouse from the cold stillness of sleep, the safety of solitude. Never mind. This is all it takes for me to get on my feet and pull on the white clothes and show. I know what the doctors say about the beverage, or about how the heart continues to beat even when the brain crashes in four minutes without oxygen, but what do they know about actually being warm and dead? In any case, the coffee absolutely cannot go.

Pretending that caffeine-induced tachycardia is some indication of my still being alive has been a favorite preoccupation. But that is merely physiologic: the few moments between reaching for the 3-in-1 and lying supine is far more complicated. I never remember anything: not what you told me about the muscles involved in smiling, not that the world keeps demanding my presence, unaware that I lie in a wooden box and all I need is people bringing flowers and candles.

I never remember to be good to you; oh, but if I could, I would afford myself the same benefit of the doubt. But most days, I only manage a hastily thrown together amalgamation of despair, self-deprecation and an unspeakable emptiness. I never remember to be good to you, to acknowledge that you bear the pain of being alive, a different but nevertheless valid suffering. The sunlight still filters through the window, but they cast the shadows of demons over my bed and on the bottom of my cereal bowl. I never remember to hear you. My ears are busy with the blaring of low horns and drums clapping like thunder, over and above the quiet melancholy behind your vapid, small talk.

You grapple every day for the magic words that will fix me, thinking that if you laughed enough it would saturate everything around you (my tired bones included) with the luminescence our favorite children’s stories are endowed with. But truth is often stranger than fiction: you are easily the singular most cruel reality in my milieu, the yardstick that conveniently exists to remind me that I am a sorry excuse for breathing flesh. See, you are blithe, toothache-inducing, blinding—the monument erected in loving memory of a parallel present quickly slipping away as I reach out to catch it with my hands.

And I am no good with juxtaposition. Not when I drift in this bubble, in this twilight, separate—while you cradle everything that ever mattered to me in the crook of your hands. You bound, carefree, through the day, and tell me it is all perspective. You laugh and your bones have not given up on you, and you tell me it is all perspective. I am sharp everywhere and it is only this ice that keeps these pieces together, and you tell me it is all perspective. I cannot see or hear anything in this narrow, asphyxiating wooden box, and you tell me it is all perspective.

I did not hear the stars when they whispered the cosmic breath of life in your ear. Had I known, I would have killed to hear its voice.

The caffeine makes my heart sing. These days, it’s a funeral dirge; every night I fall asleep hopeful. I do not like to think that I was ever suicidal, but there is an inexplicable despair in every bright morning. In between what should have been the last prayer and the moment light struck my irises, long hands resuscitated my arrested heart again, and poured horror all over these empty lungs, enough to last the day with you, and the rest of it.

So I get up, and pull on some white clothes, and show.

From Me (ASMPH)

MENTAL HEALTH ISSUE | 35

Dear Anxiety, I hate you.

I absolutely hate you. I loathe every part of you. I hate how you have filled every single space inside of me. I hate how you seemed to be everywhere. Even those insignificant little crevices that I’ve always thought were filled, were okay. I have nothing of my own. My thoughts are not my own. My actions are not mine. My relationships are not completely mine. I share them all with you. And I hate you for that.

I hate you so much.

I hate that you’re always here, manipulating my insides, causing my chest to tighten, my heart to race, my vision to blur, my mouth to dry, my stomach to twist and my breathing to become impossible. You make me wish I was dead just so all these crazy thoughts running through my head would just stop. Just so I can finally breathe.

I hate that you won’t stop.

I hate that you won’t stop standing behind me, reminding me of my past mistakes. Please stop leaning over my shoulder, whispering all my flaws and mistakes in my ear. I am already aware of these. And I hate you so much for knowing them, for knowing everything. I hate that you know every flaw, every weakness, every worry and every fear. And that you exploit them at every single turn.

But you know what, Anxiety?

I don’t think I completely hate you.

In fact, there are rare times when I find myself thanking God for giving me you. Thank you for teaching me that people who always act and look happy may not always truly feel that way. Thank you for bringing me so low that I can never imagine doing this, what you’re doing to me, to someone else. Thank you for helping me remind people that they are loved, because you and I know that you will never let me feel that way.

But then again, those are rare moments. I still hate you most of the time.

I hate that every single day, you have me waking up on edge, with my mind racing, making lists in my head of all the things I have to do. You force me into trying to plan my day, my actions, the way I stand, the way I talk, the eye contact that I make and always, always panicking that somehow I’ll screw something up, that I’ll screw everything up. I hate you for making me feel like I am always bouncing around, and never feeling like I can sit still and breathe. I hate you for making me feel like I have to always move from one thing right to the next, in fear that if I left my mind to wander, even just for a second, you would take over. And that I would have a full-fledged panic attack.

I hate you so much.

I hate that you make me feel like I can never get enough air in my lungs. I hate that there are days when you make me want to stay in bed because of your whispers, the whispers that suddenly turn to yells. Yells that are so loud in my head that I think I’m going deaf. Or crazy. Or maybe both. I hate you. I HATE YOU. I HATE YOU. I want to scream how much I hate you in the same way you’re screaming at me now for my every failure, and that my friends and family hate me too.

I hate you so much it makes me want to cry.

You make me feel like I cannot face people because I am not worthy of taking up the same space. You cause the nights where I cannot sleep, so I try so hard to stay busy, so I can push myself to exhaustion just so I don’t think. You keep me awake by critiquing me on my day, and showing me how every small thing can change the course of my whole life, and how I fail at every turn. And I cannot turn it off. I cannot turn off my thoughts, your voice¸ no matter how irrational I know they may be. I cannot follow logic and it makes me even more upset, thus allowing you to take over my insides, and throw me into a panic attack.

I hate you, Anxiety, but not as much as you and I hate me.

Sincerely, Your Target (ASMPH)

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Dear Friend, Are you tired? Think you’ve reached your limit?

Have you ever thought of quitting? Was there ever a day when you just thought about not getting up anymore? Are there days when you question what you’re doing and why you’re doing it?

Congratulations. You’re back to feeling human.

You are not weak. You are simply tired. And that is okay. There’s nothing wrong with allowing yourself to feel vulnerable. You are human. You have limits. You need rest.

Remind yourself of those things and you’ll be okay. Take a breather. Close your eyes and clear your thoughts. Meditate.

Feed not only your body but also your spirit.

Pray. Ask for guidance and strength. Let Him fill your soul with courage and correct insight. Let his love fill you with hope. He has never left you. He feels your pain. He rejoices in your efforts. He holds your hand and laces his warm hands around you in your difficult times.

Then, start walking slowly. Go at your own pace. Do not run from your responsibilities but instead journey with your newfound knowledge. Relish the forward steps you take closer to your dreams.

Go back to the things you enjoy most. Live a little. There is, after all, life beyond white walls.

Talk to people. Be with people. You are never alone. Have the audacity to ask for help. You are loved. You are cared for. Don’t be afraid.

Replace your sorrow with laughter and astonishment at your miscalculations and missteps. Look at the past with much fervor and allow your experience to ignite your confidence. Reflect but do not ponder. Live and learn.

Pat yourself on the back for all of the times you succeeded. All of the times you tried. All of the times you dared to go back to the world of medicine.

You are growing. You are climbing up.

It is difficult. Yes. There are days when you feel that there is no way but out---again, remind yourself, you are human.

You make mistakes. You crumble. You come out short.

But that’s okay. The doors will always be open for you one way or another. Despite the whirling emotions riding up inside you, go forth.

You can do it. I know you can.

Be honest, despite your lowly demeanor, do you not find yourself still able to smile?

You know why? Because you still want this- your dream. You still try. And trying is all that matters.

If you are strong enough to dream it then you are definitely worthy to live it. Keep on trying. Cry if you must. In fact, do cry. Do shout. Let it all out. Allow yourself to feel.

Be human.

I repeat. Be human.

Be sane. Be you.

You will thank yourself one day for allowing yourself to go through ups and downs. Every day gets more challenging but each day that pass by only makes you stronger and closer to your dream.

Are you tired? Think you’ve reached your limit?

Have you ever thought of quitting? Was there ever a day when you just thought about not getting up anymore? Are there days when you question what you’re doing and why you’re doing it?

Good. Questioning only means that you want it.

Congratulations, you are human.

And people who will need us in the future, will need people like us to take care of them. People who feel. People who live and understand limits. People who will not quit.

Humans.

Yours truly, KFMR (UST)

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Dear Family and Friends, How many times have you said, “It’s going to be OK.” It’s almost Pavlovian.

You hear someone talk about something that makes them feel bad and you don’t really know what to say. You feel like you need to say something anyway so without thinking about it—because that’s what you always say, because you don’t have to think about it, because it can’t hurt, right— you say, “It’s going to be OK.” And it’s not wrong, not per se. You don’t mean any harm. There are probably times when you don’t really mean it. Saying something that can’t really mean anything but that you want things to go better for someone can’t be intrinsically bad. So it’s a go-to thing. And if you don’t really know enough about someone, and maybe they shared something because, well, you were the only one there, it’s simply the safest thing to go with.

So you say, “It’s going to be OK.” You really hope it, too. Even if it’s in that ‘we-don’t-really-know-each-other-but-I-don’t-wish-you-harm’ kind of way. And it can’t possibly be taken wrongly. It can’t possibly mean you actually want the opposite. It’s just not something that can be taken in the wrong way.

But as most things you do that you do too often, it kind of loses its meaning. And as most things that you hear too often, it kind of loses its sincerity. At the time, when I wasn’t in remission yet, I was hearing it a lot. And I kind of stopped believing it.

Because maybe they were talking about something that constantly ran through their head, thinking about it so often enough that it overwhelms most of their musings and they can’t think about anything else. And yet, you reply with something you tell everyone, something you don’t even need to think about anymore, something you say every time someone shares something to you because you’re the only one there.

It’s almost Pavlovian. And you don’t mean it in a bad way. And they don’t mean to take it the wrong way.

But it’s a Band-Aid for a gaping wound, and the wound may be fresh, and the wound may have already festered. And it doesn’t really help.

So you ask yourself what helps. You ask yourself what you should say because you honestly want to help. And you don’t mean to be submissive, you don’t mean to try to solve something big with four simple words. You don’t mean to reduce what their feeling to something that can easily be brushed off.

You just want to help.

Unfortunately, there are no guidelines on how to respond. You watch someone talk and their eyes are a little shifty, their hands are shaking a little, and they talk about the exam the next day and how they can’t study because they’re too worried to. You talk to someone you’ve only seen this one day out of the five weekdays you’re supposed to be seeing them and they tell you it’s the first morning in days that they’ve felt they could actually make the effort to go to school. You listen to someone who clicks their pen four, five, six times before they sign their name on the attendance sheet that’s going around. They tell you they’ve had to increase their medication because they’ve had to use gloves more and they haven’t been feeling clean enough until they’ve put on two layers of gloves and washed their hands thrice after.

And you don’t know what to say or do.

But what you haven’t realized is that you already have.

Because they’re tired of themselves, tired of hearing their thoughts, and maybe they’re starting to hate that they’re different. They think people are starting to get annoyed with their mere presence and most people don’t even look them in the eye because there’s something wrong with their heads, and it’s abnormal. People still mostly try not to notice them.

But you’re there and you’re listening and it’s great. Because maybe they’re sick of themselves but you’re not and it’s one of the most refreshing things. Maybe they spend a good part of their nights over-thinking the most mundane things and they are constantly drowning beneath the weight of their ruminations, but you’re there and they don’t feel like they need to flail too much to stay afloat.

So you’re like a tether, a buoy, something, someone who’s there and who’s present and who listens patiently. Despite them thinking how irritating they must be, how repetitive their thoughts are, how it’s always, always the same thing and they’re so, so tired.

But you’re not, so you’re there.

And you listen.

And that time you spend with them just listening, offering an ear, maybe a squeeze of the shoulder, maybe a short hug of support, it’s not Pavlovian. It’s not an automatic response that takes little thought. It takes everything. It takes all your heart and your mind. And maybe it’s the seventh time that day that they’re talking about it, but your eyes don’t waver, and your hand on their shoulder is no less firm. And it’s just your presence, you think.

But for them, it’s not just your presence.

It’s you. It’s a part of you. It’s time you take in that day that you willingly, selflessly give.

And it’s not Pavlovian.

It’s enough.

Yours, Anonymous (ASMPH)

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My Dear Friend, No matter how many years of studying human behavior, may I ever understand you and the struggles you face every single day? No matter what the books and different studies say, or how the social media depicts you, it still appears to be an incomplete representation of who you are.

I have listened to you, time and time again. I have heard your cries, your doubts and your anxieties. Each time we talk, it’s as if I am talking to both you and your depression.

Sometimes I cannot tell which one I am speaking to anymore, it’s as if the both of you have blended so well.

However, there are times where I can see you, and only you, and those are the times I hold on to. I see your hopes, your strength and your courage to keep on going.

You stopped asking for advice years ago. That’s fine, because I ran out of words to say as well. Now, most of the time, I just sit and listen. I don’t always understand what you need at the time, nor do I know what I am supposed to do or say. A lot of times it’s as though you have nothing to say either, and sometimes the silence between us says so much more.

I just hope that in those long silent moments that we share together, you hear the silence say that I am still here for you no matter how many times you repeat to me the same story again and again. I hope you hear my commitment to stay with you, no matter how long you need me to be there. I hope you hear the silence say how much you matter to me, and that I know that you are so much more than your struggles and your pains.

I also hope you know that you are not a burden, but my friend and my biggest inspiration.

You are special to me, and I don’t want to ask you to cheer up and just forget about your worries. I just want you to know that you are loved deeply, and everything else will follow after that.

Yours sincerely, Ramon Antonio H. King (UST)

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To the person whom I have not understood for so long, How are you?

I would ask you this question almost every time I would text you. It was like a template for me: “How are you? Me, I’m fine. A little bit busy with school stuff.” You’re okay, too, you would often say in your reply.

When you were a kid, you were quite a difficult one: you were odd, you often didn’t get along with the other kids. I tried to understand you, and I stood up for you, even when some kids would tease you and make you cry. You would often throw tantrums, act up, be so difficult, until you got what you wanted. I did throw tantrums, too, when I was younger, but then I grew up. And as I did, I learned that there were some things in life that would not go the way I liked, and I needed to be fine with it. Growing up should teach us how to deal with emotional stresses and get past these things. I learned this lesson, and you did not.

You were even more difficult when you grew up. I’d be lying if I said that I never hated you for being difficult. To be honest, I was mad at you often. You were getting more out of hand. I couldn’t comprehend where we went wrong in guiding you. You would even say that you felt neglected and I just didn’t understand how you could ever feel that way when we always have been so supportive of you, even when you were being so unreasonable. You couldn’t deal with your own problems, and instead, you’d be more of a problem to us. I was angry at you for being so emotionally weak. I mean, come on, every person in this planet has a problem of his own and I didn’t understand why on earth could you not adjust to yours like a normal human being. I hated you for making us deal with your demons, when we had our own demons to deal with.

That was the situation before. Now, I mostly hate myself.

I learned from medical school that patients with psychological problems need to be dealt with utmost understanding. But I am writing this letter not from the perspective of a medical student. I am writing this letter because I want to let you know that whatever happens, you can talk to me. I want you to know that I now understand. I now know what I could do to help you. That if you could not cope with your problems like a ‘normal’ person could, I’d be more understanding. That if you act so crazy sometimes that I really can’t understand you anymore, I’d be more patient. That if things become so bad that I lose all my patience, I’d find some way to be more loving. That’s the root of it all, really. I love you. We love you, and I hope you know that. I want you to know that I understand you more now than I ever have.

That I am now capable of being the person you can depend on.

Don’t ever think that you are alone in whatever this is. Don’t ever feel that we gave up on understanding you. Because, yes, we may not be able to understand you all the time, but we will never give up trying. Talk to me, to us. Please always remember that I am here to help you with everything that I have. Anytime.

I pray that the time will soon come that when I ask you how you are, you mean it when you reply you’re okay.

Yours, Alma Pabilane (ASMPH)

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Dear Friend, I know that beneath your blank canvass is a hodgepodge of emotions that you did not bargain for. You’re trying your best, but your eyes don’t shine like they used to. There’s a sad undertone to your smiles. I’m here to tell you that I see through that, and you are not alone. Everyday may feel like a raging battle you have to go through. Happiness seems like an overwhelming pursuit and I know it’s rough. You’re hurting so deeply inside and your struggle isn’t a pretty sight but I want you to know that I am very proud of you—for always deciding to get up and to live through it.

I understand how difficult it is for you to trust anyone right now. Not everyone can fathom the weight of what you’re going through, and others would go as far as judging and ridiculing your plight. Please don’t listen to them. Listen to who matters, and right now, all the negativities don’t. Let me tell you something you should always remember: you are a beautiful person. You are not your depression, you are not your faults, you are not your illness, you are not your dark days, and more importantly, you are not a reflection of those who cannot love you. You are beautiful. In this world of criss and crosses, you matter. You are worth the time, attention, and love that you crave. You are worth it and I will never get tired of saying this: you are beautiful. I understand that you don’t want any of these dark clouds that loom over you. I don’t want this for you as well, however, I do not want to disrespect your feelings. I will not tell you to snap out of it like you’re making this up because I know you’re not. I know that if you had it your way, you’d have gotten over this. Take all the time you need, feel it if you must but while doing so, don’t forget that you are not alone. In your silent screaming, don’t think that nobody hears you. I do. I hear you, and I’m here for you. I’ve seen you stand up for something you believe in. Believe in yourself once more. You are strong.

Being in medical school is, in itself, an already demanding feat and having these emotions live through your body isn’t making it any better.

Try to communicate, no matter how hard. It might feel like you’re all alone in a sea of people but there’s always a person out there who wants to help you. I want to help you. It’s important that you have to want to help yourself, too. Let us in, let us help. As a fellow medical student, I understand the kind of environment we have to thrive in. I will not pretend to fully grasp the kind of pain you’re in right now, of having to fight off persistent emotional wars with yourself. Even so, this doesn’t make me want to reach out any less. Although in our level of understanding, even with the knowledge of psychiatry and all, I know the social stigma still exists. Perhaps it is also the reason for your decision to isolate yourself. School work piles up and none of it makes much sense anymore. For a second it feels like the world is starting to crash down on you. But let me tell you this, my dear, it isn’t. If everything feels too much, perhaps you can take a break from school. Loving yourself is an utmost priority especially in our chosen profession where we will dedicate our lives to serving our fellowmen. There is nothing selfish with choosing to love yourself, because how can you give out compassion as a future doctor if you feel hollow and empty inside? In this seemingly dark place, there is always hope somewhere. It’s not always found at the end of the tunnel, sometimes you don’t have to look far. The light you need is within you, you are what you need.

If only I could banish your demons myself, I would. But at the end of the day, it will always be up to you. I know sometimes you want to run away from your own being, sometimes you face the mirror and cry as you ask the reflection ‘Who are you?’, and sometimes you just hate yourself outright. How many times did you question your existence? How many times did you think about death? How many times did you think it was a good idea? I shudder at the thought of you wanting to die.

It breaks my heart because I don’t want you to do that. Knowing that you, my friend, are in a crippling and unforgiving state of pain hurts me too. Please don’t hate yourself. Don’t quit on life, because life isn’t quitting on you. You have a purpose and you matter a lot. If only you can see the kind of person that you are, you are amazing. You might ask, why. Well, it’s because you are you. That is more than enough reason. You are so full of promises and potential, you are so full of life. You are, and will always be, good enough.

Sometimes life has a way of making us feel insignificant. Our problems can seem so absurd in comparison to the universe’s greater scheme of things, but don’t let that be a reason for you to keep all that to yourself. There is nothing to be ashamed of, don’t hide. No, you are not selfish, you are not a nuisance, and you aren’t wasting my precious time. Quite on the contrary, actually. I want to be here.

I want to listen to you. There is nothing too trivial or nothing too silly to cry about if it means killing your demons and letting out your most terrible thoughts. I am here. No amount of pushing away is going to change that. There is nothing more important than your mental health, and we’ll work on making things better together. I miss you and your genuine smiles. I miss the peals of laughter you make that echoes along the corridors even after you’re done. I miss the life in your eyes. Until then, I hope you know and remember that I care, I believe in you, and I love you. You are a beautiful sight to behold, in every way, and I hope the day comes that you see yourself the way I see you. And I am not alone in saying those things—you are incredibly loved by your family and friends. No matter what, I will never give up on you and your darkness. I will hold your hand through all of this so you know that you are not alone and that despite the storms you’re experiencing right now, life is still beautiful, as you are.

Much love and light, Pauline Krissel Sandico Esta (UPHR-JFSM)

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ARTS AND MINDS

Compiled in the next few pages are visual and literary artworks sent in by students from Asian Medical Students’ Association (AMSA) member schools depicting their experiences and understanding of mental health, and how they view its significance.

MIND HEALING Louise Mae Javier (UERM)

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LUCID DREAMS OF LOVE Hyacinth Jan P. Lasco (CIM)

As she walks along the hallways, She keeps her downcast, averted gaze.

Withdrawn from the life in the crowd, You never hear her say her thoughts out loud.

She looks quite normal but her hair was a little unkempt.

An invisible wall was around her and no one would dare attempt, To offer a smile, a conversation, a lending hand But then he approached her; many didn’t understand.

He asked her what was wrong She has kept her silence for so long.

So now she decides to open herself As she tells this stranger, “I hate myself.”

All those years she was trying to be strong Suppressed all her fears and smiled all along No one bothered to ask if she was alright So she kept crying herself to sleep at night.

But today, someone has finally noticed her And as his love tries to take the cloud of blur Out from those fake smiles and sad eyes It made her unveil from her disguise.

He was like serotonin and dopamine to her He uplifted her broken soul and gave her the power To appreciate her life more than ever, To worry less, and to see the world with wonder.

Everyday with him was like seeing the rising sun All the darkness of yesterday is gone Her eyes are now glowing with love and passion Her head is on his shoulder as they look at the horizon.

At the end of the day, as the sun starts to set They share a moment they would never forget He says it’s time to come back to reality As the hallucination stops, she wakes back to her lucidity.

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HIMBING Jasper Dayanan (ASMPH)

Isa, Dalawa, Tatlo, pintig ng puso ko sa karimlan ng mapayapang gabi, dilat ang mga mata ko sa katahimikang nakakabingi buhay ang pandinig ko sa lungga ng walang tinig, sumisigaw ako Nagsimula ang lahat sa istorya ng pagkabigo Damdamin ay umasa, sumugal at naglaro Sumigla, lumigaya, naisipang magbago Gumuho, nalungkot, nalasing sa paglaho Hindi masisi ang taong mahal kaya sa sarili’y nagmistulang hangal sa gitna ng dagok, nanatiling bukal ang pagibig na hinugot sa taimtim na dasal Gayunpaman ang lason ay hindi maalis Sinipsip ng ugat na uhaw sa paglilitis Araw-araw nangangahas malimutan ang bigkis Gabi-gabi’y nagluluksa, wala pa ring mintis Dumaan ang bagong taon at nakaraos din Inakalang matatamasa ang pahingang inaasam rin Ngunit di matulak kabigin, ako’y naninimdim sa sariling di makawala sa hawla ng lagim Ibang klaseng pagsubok sa aking karanasan ang kalabanin ang sariling pagkamulat sa bawat gabing nagdaraan Tila ba ang higaan kung saan ang pagod ay laan ay sinumpa ng demonyo upang pasan ay madagdagan Ang oras na ninanais na mabigyan ng saysay ay unti-unting nasusunog habang ako ay may malay Galit, poot at pighati ay inihanay sa isang buong siklo ng aburidong nawawalan ng husay Tumitilaok na ang manok nang ako ay dalawin ng ninanasang antok na walong oras na nakabinbin Kay sarap bumigay sa imbitasyong nakahain subalit obligasyon sa bawat petsa ay nagaabang din Sa silid ng kaalaman ako’y nakikipagdigma sa matang pumipikit at bumbunang humihiga Boses ng kalinawang nagdinig oyayi sa dukha lupasay ang katawan at mainit ang mukha Lumipas ang buong araw at wala pa ring tulog Natatakot sa patibong ng kama’t baka mahulog sa isang buong siklo na ang lakas ay hindi ka ihuhubog sa hulmahan ng pahinga kung saan makakatulog Isa, dalawa, tatlo, tibok ng puso ko sa karimlan ng mapayapang gabi, ipagdasal niyo po ako sa katahimikang nakakabingi, pakinggan niyo po ako sa lungga ng walang tinig, sumisigaw ako

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ONE OF THOSE BAD DAYS Deano Reyes (ASMPH)

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A LIFE BEHIND...

KFMR (UST)

There is a life behind the books.

A being that seeks knowledge, Asks questions, Finds answers, Learns.

There is a life behind the dream of a white coat.

An entity that breathes, Feels, Aches, Fights.

There is a life behind the tireless caregiver.

A person whose effort goes beyond what he or she is capable of.

The effort that goes miles just to provide you with relief, To provide you with comfort, To provide you with a remedy.

There is a life behind the pristine stethoscope-equipped.

A person who tries, A person who cries, A person who creates mistakes.

There is a life behind a person of Medicine, One who shares your pain, One who feels vulnerable, One who also seeks help.

There is a life behind one who gallantly tries to save it.

A life that sometimes crumbles------but never wavers.

A life that loses temperament-----but regains composure.

A life that more often thinks objectively and mechanically----but never loses sight of sentiment.

A life that works to make a living----but ultimately strives to achieve wealth in the restoration of health in people.

A life that often puts itself last and prioritizes others.

A life that continuously grows strong in experience-----but is always humbled.

A life that is nourished by both triumphs and failures.

Human.

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SOMETIMES I PRETEND DV (ASMPH)

Sometimes I pretend that I’m okay Hoping that it will come true Sometimes I pretend that I am strong Hoping that I won’t need love Sometimes I pretend that there is hope Hoping that I’ll make it through Then I feel my parent’s warm embrace As if to say that there’s hope Then I feel friends’ hands on mine As if to say that there’s strength Then eyes wide open I realize It’s not pretend anymore

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CORNERED SILENCE Ida Tan (UST)

My eyes, awake in the middle of the night There was not a sound, not a thing in sight What made me keep up, I asked myself I had been losing track of time, an endless road of anxiety While living my life as if I were trapped, chained, haunted My ears, they wander, and wonder to the dark corners of the room I could hear the Silence whisper Sly little nothings, incompetent fool!

These voices, these thoughts An endless cycle of wrought madness I close my eyes, I shut my ears The air grew heavy as the chanting rises to a crescendo A grayscale kaleidoscopes to an abyss of spite I realized I couldn’t breathe Surrendering to this madness, only to be ironically set free Oh, sweet breathe of Life!

Why must I carry on with this burdened heart?

Oh, my tired soul!

Would we survive again, another sleepless night?

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EXPLOSIONS Aithusa (UST)

You wanted my words sealed Yet you’re trying to provoke me And so, I don’t want to see anymore Don’t want to stir up all the memories Because everyday feels like Explosions inside this body Bursting through these scars Invisibly been there since then.

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LITTLE MISS Mel Mara Pearl Cablayan (ASMPH)

She is the little girl with clammy hands wiped on whitewashed jeans. She is shuffling steps on waxed floors and the keening screech of a chair being pulled back. She is crooked spine and chaffed elbows on wooden armrests. She is fingers drumming on a vandalized desk. She is the deliberate ignorance of her own distorted reflection on tinted windows. She is untouched plate of food, face made up and smile stretched too wide over bleached teeth. She is the constant nagging urge to turn back because sweetie, were you fool enough to believe you’re brave enough to try?

She is lips gripped by teeth and wounds picked open by fingers looking for something to do.

She is conversations blurred into white noise accentuated by the bass of her own too loud heartbeat. She is knees shaking and cold skin and short breath and that stupid useless exercise of taking ten deep breaths that never seem to work but she will do it anyway because that’s what they told her and it’s a whole lot better than not doing anything.

She is surreptitious glances from the other end of the room. She is conversations practiced in the mirror that never go the way they should. She is ten chapters down the road borne out of a single smile. She is mouth hanging open, dry throat and unformed syllables struggling and failing and come on, it’s quite obvious this isn’t going well. She is warning signals and too wide eyes; the sudden onslaught of extravagant excuses stumbling and racing each other out of her mouth. She is unlaced shoes and too long goodbyes and the relief brought by sounds muted by the closed door she left behind.

With relief comes regret and then overbearing guilt because honey, you’re just not trying hard enough.

She is a dark room with small piles of unwashed clothes and an unmade bed. She is vision blurred with tears barricaded by a broken ego. She is unscarred flesh and scabbed over mind.

When the clock reads 11:11, she is wishes made out of sheer desperation.

She is dreams wrapped in flesh and whispered prayers made with secrets. She is what-if’s and could-have-been’s and I-should-have’s on top of what’s-wrong-with-me’s.

She is made out of rejection letters, missed calls, and failed tests. She is crafted by shadow rumours and the cloying tendency to feel sorry for herself because she keeps telling herself maybe people are better off without you. She’s built on white lies, blinding spotlights, and the persistent echo of raised voices and they’re swaying with the weight of all the expectations she’s never going to meet because no, you’re probably not the one they’re looking for.

But she is not you and you are more than her.

You are the constant reminder to keep trying and each renewed conviction not to let your pain bleed into all of you, then to the people around you.

You are conservative smiles and tentative touches. You are sure hands that wield your craft.

You are made of soft skin and steady bones built to carry so much love and I want you to see yourself the way the people who love you see you because you are so attuned to your faults that you’re having a hard time seeing the bigger picture.

You are the gratefulness for the silence and serenity of early mornings. You are valued words of comfort and assurance and dear you are not a burden but an anchor and I know it’s not easy but maybe you can let someone else carry the weight every once in a while.

Because the little girl is growing up and she’s demanding attention and sweetheart, I never see you anymore.

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PONDER WONDER GTP and MMRM (PLM)

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DEAR YOU Dalmas Andres Binumnga Jr. (SBCM)

I screamed for your help.

I cried every drop of my tears.

I bled to death until I’m numb.

You did not take away the pain with you.

When you left, I told myself with self pity.

That maybe I can forget and start anew.

But it was a lie, wasn’t it? Lie is a constant manner.

You made me feel too pathologic to exist.

Everytime I hear the comforts of my friends.

Their words were like white cloaks.

Cementing and burying my tormented soul.

Then I just got lost in my own pretending.

Like I do not care. Like I do not want my joy.

I’m not fine! So don’t lie to my broken heart.

Saying that you’re gonna be all right.

Being pathetic to your self is not okay. It never will.

Had you heard me crying? Had you embraced me?

That’s what I thought. You never did.

I don’t want their pity because I have too much.

I don’t want solitude because I have enough.

I never wanted pain. But it haunts me every night.

I don’t want to cry. I just want to decay ‘till I’m gone.

Is it difficult to just tell me I’m screwed?

Instead of telling me to move.

Is it hard to slap me with the truth?

Because if you did.

This lie I made been long dead with you.

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But no matter what I do to get peace.

This grief consumes me alive.

I didn’t wish to be bitter for real.

My grief offered me this self-destroying deal.

The pain. The tears. The scream. The fear.

You’d never know all of these. But I did.

You left me because writing a period is easy.

And the getting-over skills part are not my forte.

But in so much terrible pain, allow me to bail.

Let me grief for me. Let me cry for what I become.

Let me sing my funeral song.

Let me speak of my dead speech.

Allow me to sob one last time to bid my farewell.

Because when I’m done feeling worthless and unnoticed.

I will strike down all the walls you made into my world.

I will turn these to dust and put the shatters in your urn.

Yes! No more blues! No more guilt!

No more cold feelings to feed me after all these years.

I will crawl even if you still want me dead.

I will move until I knock down your ghost.

I will rebuild the bridges I burnt for you.

I need to cross all the sufferings I’ve been through.

I will leave my bitterness and my loathness.

Just the way you left me to oblivion.

Just the way you left me to rot in my own prison.

You left me. You didn’t want me. That’s it!

But baby I will say this once, I will hold you no more for me.

UNTITLED Giormaru C. Cuntapay (UPHR-JFSM)

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A MESSAGE TO MY DEPRESSION LM (ASMPH)

I used to have my life together.

I knew what I wanted; Where I wanted to go, What I wanted to do, How I wanted to live, Who I wanted to be.

And then you came.

And I forgot everything.

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THE PUSH KFMR (UST)

Never fear emotion.

Embrace it. Acknowledge it. Do something about it.

Medical students are not robots. We breathe, we laugh, we hurt, we rejoice, we live. The connotation that we must be stern entities who hold our fort and set aside all unnecessary feeling still is, to me, quite controversial.

Nowadays, it seems that the border to feeling human and being human continues to grow grey. Perhaps it comes with the expectations and workload that medical school demands. It comes with our own perception of what and how we should be.

Often times, we become the person we envision us to be. Yet, sometimes, we don’t. And that is disheartening.

Disappointing. Overwhelming.

But allow me, based on my own experience, tell you this. To feel vulnerable is to be human.

It simply means that we are willing to be humbled. Broken down into pieces and be patched up into something even better. As it is true that no broken mirror could ever be pieced perfectly back together again, it will still equip itself with a glint of clarity of its reflection. It is only through our broken pieces where we can see the beauty of our scars. These scars do not define us but instead hone us into better people. We say that some scars are so deep that no sort of suturing could ever make it go back to the way it originally was. In my opinion, we should put aside our yearning to go back to who we were, but instead strive to be someone better.

Yes, it is a process. A process that sometimes we may even fail to push through but still, trying is better than not moving. The fear of everyday failure is consuming. The stresses and the pressures in our field are overwhelming and in time could worsen should it not be addressed.

It seems that we are now living in a time where media and the perception of others take the first spot of consideration in terms of decision-making. We ponder on what others may think of us and we begin to forget the purpose of our decisions and who it was intended for--yourself. Of course, it is unavoidable that we are at times looked down upon by others, but that shouldn’t stop us from doing what we love and standing once again in our own two feet. To experience failure is to open a door to examine ourselves and slowly correct the mistakes that we have done. Our failures will not define us. It should never. But instead, it should push us to see actual hope and clarity.

There is already a social stigma that one who seeks help is weak. One who cannot find it in themselves to fix their own problems is not suited in our profession. I say contrary. For me, admitting our own weaknesses and seeking assistance can only label us one thing--human. Strong people. Brave people--- people who are willing to embrace change for the better.

No one will ever take being human against us.

When we wish to serve others and improve their quality of living and remedy all their aches and pains, we must first learn how to heal ourselves.

Sometimes we find ourselves stuck in situations where seemingly, all hope is fleeting away. It is normal to feel saddened but we must learn not to be burdened and consumed by our negativity. We must learn how to seek for help and how to acknowledge that we need it. It is difficult. In fact, it is very difficult to accept our own limitations.

Saying is very different from doing.

It takes a while for us to make first steps to recovery but the beauty of it is we can control when and how we can make ourselves feel better. Giving up on ourselves, especially in our own lives is not the answer. We are a community. We commune. We are united. Who better to share your feelings with than with the same people who experience the same things as you do? You may even gain more respect and encouragement when you open yourself to others.

We are not alone.

We must not forget that our emotions are just as important as our other bodily aspects. To have a healthy mind is to have a healthy heart and ergo body. When we suffer inside, it will surely eat up whatever good we see on the outside.

With that said, I think the core step to take to save ourselves from drowning in an abyss of all-consuming despair is to have courage.

I repeat, never fear emotion. Never fear the heart. Never fear failure. Never fear to be human.

Try. MENTAL HEALTH ISSUE | 57

ABYSS

Jessamine Edith S. Ferrer (UST) In the abyss, there is silence In the abyss, you imagine your own world In the abyss, you can relax Too comfortable No need to be afraid No one will ignore nor reject you You don’t even have to move Just let yourself fall Close your eyes As you sink down never realizing You’re just a prisoner of your own self

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ONE TUESDAY EVENING Alfie F. Calingacion (CIM) I hate idle time. Past hurts resurface and you experience what you felt before.

Let me take you back to when it started. Five years ago, I began dating a girl who was just a dream that I once knew. Her smile. This was what drew me to her. She had that perfect smile that could make anybody melt deep inside. Her every move made me love her each day-- the way she talked, the way she laughed, the way she surprised me with her texts and calls, the way she called my name, the way she held my hand, the way she teased me and the way she loved me.

It was summer of last year, two days before our fourth anniversary, when she left me. She said that I deserved someone better, but I felt that the list went on. I felt so rotten. I started experiencing bouts of insomnia, pessimistic worry and decreased energy. I began losing weight with diminished interest in normal activities. Worst of all, I had suicidal ideation. I was diagnosed with depression.

I miss her so bad. What really bites is that the moment I wanted her to be with me until my dying days, she had to let go already.

I have my share of not being able to hold the other end of the line, and I definitely have my regrets. I know I could have given more, but I was too scared. If only I believed more, maybe she would not have decided to leave. In the end, all I had were regrets and apologies for my lack.

I desperately hope for things to go back to how they were. I hope to wake up from this bad dream. I do not want to throw away all those memories that easily. But I was mistaken because it was that easy for her to get on with this life, and that was the last nail that shut the coffin of hope.

Now, what? I am here writing about a love lost as if it would do me good. It’s just hard to wake up being depressed, with the thought enters your mind that, “I’m here in pain and she’s somewhere else happily moving on.” Maybe the only good thing that came out from the break up was this essay I was able to write for her. I’d gladly give up writing good essays if it would make her come back. What good are essays if they’re inspired by heartbreaks?

Now, I sit here unable to move on and simply hanging on to hope that is quite unsure.

Until my prayers are answered, my heart would be an empty vessel because one Tuesday evening, I lost the world. And my life has never been the same.

MENTAL HEALTH ISSUE | 59

LOVE IS MY CUP OF COFFEE Deborah Meribole (CIM)

“He said he has a crush…on you!” Her beautiful brown eyes widened, twinkling with humor. I knew what she thought I was going to say. I also knew that she didn’t know that my heart had begun its habitual dilibup, dilibup, dilibup. It does that every time I hear anything remotely romantically related.

“He…he does?”

“Yup. I know.”

“He must not have seen me properly. No one likes me.”

She didn’t reply to that. Probably wondering whether I was kidding or not. Probably decided it was safest not to answer, just in case, you know…I was serious. I rapidly changed the topic. My self-esteem issues weren’t exactly, should we say, teasing girl-gossip material.

I got home, stripped my clothes off and stared in the mirror again. You know, to see if anything was different. I read in a biology book somewhere a long time ago that a woman reaches her maximum beauty at 21. At 22, I was still waiting. “Hmm. Maybe my body could pass. Maybe he likes whales.”

I flopped my arms. Poked my belly. I stared at my legs. I hate how they look in jeans. Like elephant trunks...

“Shine! Good thoughts, pleasing thoughts…” Mom’s words. I tried. I swear, I tried. But it was hard, especially when you have a mirror in your head, telling you all the things you are getting wrong, got wrong, and will get wrong. It’s a hard life.

I sighed, and thought about him again. He was tall, brown, and his hair was a mass of rebellious curls. His voice was rich and rather deep, and his smiles always reached his eyes. He absentmindedly ruffled his curls when he was nervous. I notice things – the consequence of reading way too many novels. For a second, I forgot about my disproportioned body parts, and sat cross-legged and semi-naked next to my mirror. I closed my eyes and imagined. What if…he was the one? “Shine!

He’d forget you tomorrow.”

With a new dose of bittersweet reality, I stared at the mirror again. It must have been dark. He must have been drunk. I would accept any excuse for his supposed crush. You see, love was like my coffee: I couldn’t drink it if it wasn’t freshly brewed. I love coffee, but it must be properly made: from ground, exotic coffee beans, crushed slowly and deeply by the grinder, hot and with more sugar and cream than most find tolerable. The aroma must tingle all my senses; the sight must make my heart leap for joy. There are fewer things I despise more than the cheap, easy fix they sell at the shops - I’ve drank it a couple of times: it sucks.

I got up and put on my clothes, my deep introspection at its end. “You alright, heart? It will work out if it should.” The clocked ticked 12:00 noon. I grinned and stuck my tongue at the mirror. Time for my midday cup of coffee.

60 | MENTAL HEALTH ISSUE

MELT DOWN Jessamine Edith S. Ferrer (UST)

As soon as I recover So wait for me Until my radiance comes back After all frustrations melt Until this memory washes off from my body

MENTAL HEALTH ISSUE | 61

NATAPOS DIN Anonymous (ASMPH)

62 | MENTAL HEALTH ISSUE

OF DARK CLOUDS AND SILVER LININGS Glenn Marlon Tiu (CIM)

I bet they tell you living life is difficult enough And with dark clouds in your head it’s twice as tough Oh I did not mean for that to rhyme That’s not how this writing ought to be Because with dark clouds in your mind, Darkness is all you see So I ask my blackened heart to tell my blackened mouth To seek light from a lighter cloud Tell me again that you love me I am merely a cloud who seeks your light Still I can never see, A love not meant for me So blame this cloud for playing with fire Fire once thought to only bring light You see, dark clouds are filled with tears And where water flows, fire never wins In its wake came down ashes so dark— It darkened the dark clouds darker The sun shines bright in a farther place I can only see you with some grace And with my lonely heart I count Only of numbers and of doubt At this moment I come to see, I can not love if I can not love me So with your mastery tell me, Who you see exactly Because all I see is who I am A dark cloud Waiting for the water to pour Crying these tears out ‘til there is no more

MENTAL HEALTH ISSUE | 63

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