Mental Health, Autism and the Cost of Stigma
By Karl M. Garcia
There is a simple reason many people still hesitate to see a psychiatrist:
Nobody wants to be called crazy.
But the fear is about more than one word.
It is about what the word implies.
“Crazy.”
“Baliw.”
“May diperensya.”
“Coo-coo.”
“Delulu.”
“Abnoy.”
“Retarded.”
“Weird.”
“Attention seeker.”
These words are not equivalent. Some are slang. Some are outdated. Some are explicitly derogatory. Some may be used jokingly among friends. Context matters.
But together they reveal something important about how societies often respond to difference:
When people encounter behavior or characteristics they do not understand, they turn the unfamiliar into a label.
The label makes the unfamiliar easier to explain.
It can also make the person easier to dismiss.
That is where stigma begins.
THE PROBLEM IS DEEPER THAN WORDS
It is tempting to make mental-health awareness a vocabulary exercise.
Don’t say “crazy.”
Don’t say “baliw.”
Don’t use psychiatric diagnoses as insults.
Don’t use “retarded.”
Don’t call someone “autistic” simply because they are socially awkward.
Don’t diagnose strangers on social media.
All of that is reasonable.
But vocabulary is only the surface.
The deeper process is:
Difference becomes a label.
The label becomes a stereotype.
The stereotype becomes an assumption.
The assumption creates distance.
Distance can become exclusion.
Exclusion can become discrimination.
And eventually, repeated exclusion can make another person’s suffering easier to ignore.
That is why stigma matters.
It is not merely about somebody being offended by an inappropriate word.
Stigma can influence whether people seek help, disclose a condition, remain in school or employment, maintain relationships, participate in community life and receive appropriate care.
The World Health Organization has repeatedly identified stigma and discrimination as barriers to mental-health care and social participation. Philippine research likewise points to stigma, shame, concerns about losing face, financial constraints and limited access to services as factors affecting help-seeking.
The more important question, therefore, is not merely:
“Are we using the politically correct word?”
It is:
“Does the way we think and speak make it easier or harder for another human being to ask for help and remain part of society?”
AWARENESS IS ONLY THE BEGINNING
There is a useful progression.
Awareness means knowing that mental health, disability and neurodevelopmental differences exist.
Literacy means understanding what those conditions actually are.
Sensitivity means recognizing that words and actions can affect people living with them.
Empathy means trying to understand another person’s experience rather than immediately judging it.
Action means doing something useful: listening, referring, accommodating, treating, protecting or supporting.
And then there is apathy.
“Not my problem.”
“They’re just being dramatic.”
“That’s how he is.”
“Let the family deal with it.”
Apathy matters because stigma does not always look like hatred.
Sometimes it looks like indifference.
Sometimes the most damaging sentence is not:
“You’re crazy.”
It is:
“I don’t care.”
AUTISM SHOWS THE PROBLEM CLEARLY
The issue extends beyond psychiatry.
Autism is a neurodevelopmental condition, not simply another form of mental illness. It involves differences in social communication and interaction and restricted or repetitive patterns of behavior, interests or activities. It exists across a wide range of abilities and support needs.
Yet autism is routinely misunderstood.
A child behaves differently and is called:
“Abnoy.”
“Weird.”
“May diperensya.”
“Attention seeker.”
“Pasaway.”
The problem is not that everyone using these words consciously intends discrimination.
The problem comes when the label becomes society’s explanation for the human being.
Different becomes defective.
That is the deeper cultural problem.
THE CHILD EVERYONE CALLS PASAWAY
Imagine a child who repeatedly leaves their seat, becomes overwhelmed by noise and struggles when the daily routine suddenly changes.
A teacher may initially see defiance.
Classmates may see someone strange.
Relatives may say:
“Kulang sa palo.”
“Spoiled.”
“Pasaway.”
Now suppose the child is autistic.
The behavior has not changed.
The interpretation has.
And interpretation changes treatment.
The teacher may begin considering sensory overload, communication differences, predictable routines and appropriate accommodations.
The family may seek assessment and support.
The child may gradually learn that being different does not mean being bad.
That distinction can affect an entire childhood.
Notice, however, what awareness does not mean.
It does not mean automatically diagnosing the child.
The same behavior can have many possible explanations.
The important first step is not diagnosis.
It is curiosity.
“What is this child experiencing?”
That question replaces condemnation with investigation.
“RETARDED” AND THE CONVERSION OF DISABILITY INTO AN INSULT
Another word exposes the problem even more clearly.
“Retarded” was historically used in terminology referring to developmental delay, but it became widely used as an insult. Contemporary professional terminology uses intellectual disability.
The important issue is not simply that terminology changed.
It is what happened culturally.
A term associated with disability became a synonym for stupid, useless or inferior.
Society converted a condition into an insult.
That is stigma expressed through language.
A person can have an intellectual disability without being worthless.
An autistic person is not automatically unintelligent.
A person with a psychiatric disorder is not automatically dangerous.
A person who needs support does not lose dignity.
A disability is a condition. It is not a measure of human value.
THE ADULT WHO WAS “JUST WEIRD”
Not every autistic person is identified during childhood.
Some adults reach their twenties, thirties, forties or beyond having spent years being described as:
“Odd.”
“Too sensitive.”
“Socially awkward.”
“Obsessive.”
“Difficult.”
“May sariling mundo.”
These descriptions may identify observable behavior.
But they may completely miss the underlying explanation.
An adult may eventually seek an autism assessment after encountering information that helps make sense of lifelong experiences.
The person did not suddenly become autistic.
They acquired a framework for understanding themselves.
That matters because without an appropriate vocabulary for difference, people often invent explanations.
And invented explanations frequently become moral judgments.
THE FAMILY THAT DOES NOT KNOW
Imagine a Filipino family whose child communicates differently, struggles with transitions and has unusual sensory sensitivities.
The family does not know what autism looks like.
Relatives offer explanations.
“Spoiled.”
“Kulang sa disiplina.”
“Gadget.”
“Masungit.”
“Lilipas din iyan.”
Some families fear the diagnosis itself.
They worry about relatives.
They worry about school.
They worry about the child’s future.
They worry about money.
They worry about being blamed.
That fear does not necessarily mean a lack of love.
Sometimes it comes from too little information and too much stigma.
Love without understanding can still lead people in the wrong direction.
THE OPPOSITE ERROR: DIAGNOSING EVERYBODY
There is an equally important danger on the other side.
Awareness must not become amateur diagnosis.
Someone who avoids parties is not automatically autistic.
Someone with a special interest is not automatically autistic.
Someone who does not make eye contact is not automatically autistic.
Someone who is highly organized is not automatically autistic.
Likewise, not every sad person has depression.
Not every angry person has a psychiatric disorder.
Not every eccentric person is mentally ill.
Not every person displaying narcissistic behavior has narcissistic personality disorder.
And not every bad decision requires a psychiatric explanation.
Awareness should make us more careful about assumptions, not more confident about diagnosing strangers.
A meme is not a psychiatric evaluation.
A TikTok video is not a clinical interview.
A political disagreement is not a diagnosis.
A difficult personality is not automatically a disorder.
THE PERSON WHO IS AFRAID TO SEE A PSYCHIATRIST
Return to the person considering psychiatric care.
They may not actually fear the psychiatrist.
They may fear everything that follows the label.
Will my family think I am crazy?
Will my employer know?
Will friends treat me differently?
Will people think I am dangerous?
Will the diagnosis follow me forever?
That is why psychiatric consultation should not be treated as a declaration of insanity.
It should mean what seeing any other physician means:
Something may be affecting your health, and you want it assessed.
A psychiatric evaluation can result in a diagnosis.
It can also clarify that a feared diagnosis is not present.
Treatment may involve medication, psychotherapy, psychosocial interventions, rehabilitation or combinations of these approaches.
And the person remains a person throughout the process.
Diagnosis should be a tool for care—not a weapon for humiliation.
THE FAMILY THAT WAITS
Consider a young adult whose mood, sleep, social behavior and academic performance have changed dramatically.
The family notices but interprets it as laziness or attitude.
“Pagod lang.”
“Nag-iinarte.”
“Kulang sa disiplina.”
Someone eventually suggests professional help.
The family hesitates.
“Baka isipin nilang baliw ka.”
The family may believe it is protecting the person from embarrassment.
But concealment can also delay assessment.
Sometimes protection becomes postponement.
This is where stigma becomes a health issue.
THE STUDENT WHO LOOKS LAZY
A student repeatedly misses deadlines.
The teacher sees poor performance.
Classmates see someone who does not care.
Parents see irresponsibility.
Perhaps the student really is disengaged.
Perhaps there is anxiety.
Perhaps depression.
Perhaps a learning difficulty.
Perhaps a family crisis.
Perhaps something else.
The point is not that every failure deserves a psychiatric explanation.
The point is that we often decide what behavior means before asking what caused it.
A better question is:
“Something seems to be interfering with this person’s ability to function. What is happening?”
That question preserves both compassion and accountability.
THE EMPLOYEE WHO HIDES
Imagine an employee experiencing significant anxiety or depression.
The person worries that disclosure will affect promotion, assignments or how colleagues perceive them.
So the employee says nothing.
Performance eventually deteriorates.
Management sees a performance problem.
The employee experiences a health problem.
Those are not necessarily the same thing.
Workplaces need standards.
Mental-health awareness does not mean eliminating performance expectations.
It means distinguishing accountability from humiliation and, where appropriate, creating reasonable pathways to support, treatment and accommodation.
Understanding is not the opposite of accountability.
THE HEALTH PROFESSIONAL WHO DOES NOT SEEK HELP
There is another irony.
Doctors, nurses and other healthcare workers may understand mental illness extremely well and still hesitate to seek care themselves.
Will colleagues think I am unreliable?
Will patients lose confidence?
Will my career be affected?
Will people treat me differently?
Knowledge does not automatically eliminate stigma.
A person can understand mental illness intellectually and still fear its social consequences personally.
That is why mental-health culture must change inside healthcare institutions as well as outside them.
WHEN THE LABEL OUTLIVES THE CONDITION
Imagine someone who receives treatment, improves and returns to ordinary life.
Years pass.
The person works.
Builds relationships.
Raises a family.
Contributes to the community.
But someone still remembers:
“Siya yung nagpa-psychiatrist dati.”
The episode ended.
The label did not.
This is one of stigma’s cruelest features.
The illness can change while the social identity remains frozen in time.
Recovery therefore requires more than symptom reduction.
It also requires social reintegration.
A diagnosis should help someone access care.
It should not become a permanent social sentence.
WHEN THE INTERNET BECOMES THE PSYCHIATRIST
Social media has intensified another problem.
A celebrity behaves strangely.
A politician makes an outrageous statement.
A content creator becomes emotional.
A stranger posts something incoherent.
Within minutes, thousands of people begin diagnosing the person.
“Bipolar.”
“Narcissist.”
“Psychotic.”
“Delulu.”
“Crazy.”
But a video is not a psychiatric evaluation.
A political disagreement is not a psychiatric symptom.
A bad decision is not necessarily a disorder.
Eccentricity is not pathology.
Mental health is too complicated to diagnose with a meme.
This is particularly important in political discourse.
People should be able to criticize a politician’s words, policies, decisions or conduct without pretending to diagnose the person’s mental health.
Likewise, people should not be dismissed as mentally ill simply because their political views are unpopular.
Disagreement is not diagnosis.
THE “DELULU” QUESTION
“Delulu” illustrates why context matters.
It is internet slang, often used playfully to describe unrealistic optimism, fantasy or expectations.
In many settings, it is harmless humor.
Humor has a legitimate place in human life.
Filipinos joke about politics, celebrities, romance, bureaucracy, family and almost everything else.
The objective cannot be a humorless society in which every imperfect word becomes a moral offense.
That would create another problem.
The better objective is contextual intelligence.
Ask:
Is this clearly a joke among friends?
Is somebody being singled out because of an actual disability or mental-health condition?
Is a diagnosis being used as an insult?
Is somebody being excluded because of a label?
Is the joke replacing actual understanding?
Those questions are more useful than mechanically asking whether a word is politically correct.
POLITICAL CORRECTNESS IS NOT THE SAME AS EMPATHY
Political correctness can become a superficial vocabulary exercise.
People learn which words are discouraged, substitute another word and assume the problem has been solved.
But somebody can use perfectly acceptable language while behaving cruelly.
And somebody can use an imperfect word without intending harm.
Language matters. Intent matters. Context matters. Consequences matter.
The mature objective is not linguistic perfection.
It is human dignity.
That means we should correct harmful language without making people afraid to discuss mental health, autism or disability at all.
We need people to ask questions.
We need families to talk.
We need teachers to notice.
We need employers to respond appropriately.
We need friends to listen.
We need patients to feel safe seeking help.
And we need society to become better at correcting ignorance without humiliating the ignorant.
Sensitivity should open conversations, not close them.
EMPATHY DOES NOT MEAN EXCUSING EVERYTHING
There is an equally important distinction.
Empathy does not mean agreeing with everything someone says or does.
It does not mean eliminating boundaries.
It does not mean excusing harmful behavior.
It does not mean abandoning accountability.
A person can be mentally unwell and still need to take responsibility for harmful actions where responsibility is appropriate.
A person can also behave badly without being mentally ill.
Understanding a cause is not the same as approving the behavior.
We can understand a person without excusing every action.
This distinction matters because anti-stigma advocacy can fail if it creates a false choice between compassion and standards.
There is no contradiction between saying:
“This person deserves dignity.”
and:
“This behavior cannot continue.”
FROM LABELING TO DISCRIMINATION
There is a broader social pattern worth recognizing.
Ignorance says:
“I don’t understand this.”
Stigma says:
“There is something wrong with people like that.”
Discrimination says:
“People like that should not have the same opportunities.”
Apathy says:
“Their suffering is not my concern.”
Dehumanization says:
“They are less deserving of dignity.”
These are not necessarily stages that every person or society passes through in a fixed sequence.
But they can reinforce one another.
Repeated stereotyping can normalize exclusion.
Exclusion can make suffering less visible.
And when people are repeatedly portrayed as inferior, dangerous or disposable, more severe forms of hostility can become easier to justify.
Most insensitive jokes never reach that point.
It would be irresponsible to call every joke hateful.
But it would also be naive to pretend that language, social norms and repeated exclusion have no consequences.
The deeper question is:
What kind of human beings does a culture teach us to see as worthy of understanding?
THE PHILIPPINE PROBLEM IS ALSO CAPACITY
There is a major hole in many mental-health discussions.
We tell people:
“Don’t be afraid to seek help.”
But what happens when they seek help and cannot find affordable, accessible care?
Stigma is only one barrier.
Money matters.
Distance matters.
Waiting time matters.
The availability of professionals matters.
Confidentiality matters.
Referral systems matter.
Continuity of care matters.
Community services matter.
The Philippines has made policy commitments toward integrating mental-health services into primary and community care. But awareness campaigns cannot carry the entire burden.
You cannot normalize help-seeking without building somewhere for people to go.
A person who finally finds the courage to seek help should not encounter another wall.
The system must provide a pathway from:
recognition → assessment → referral → treatment → follow-up → recovery → reintegration.
That is mental-health infrastructure.
THE BARANGAY MATTERS
Imagine someone experiencing psychological distress in a community where there is no psychiatrist nearby.
The first person they talk to may be:
A parent.
A spouse.
A friend.
A barangay health worker.
A general practitioner.
A teacher.
A religious leader.
Or nobody.
That first point of contact matters.
The local system does not necessarily require a psychiatrist in every barangay.
But it needs people who know:
What signs should raise concern?
What can be managed locally?
What requires referral?
Where is the nearest appropriate service?
What happens during a crisis?
How is confidentiality protected?
How does the person return to ordinary community life?
This is the difference between mental-health awareness and mental-health infrastructure.
AUTISM AND DISABILITY NEED INFRASTRUCTURE TOO
The same principle applies to autism and disability.
Awareness cannot stop at posters and social-media campaigns.
Families need access to assessment.
Children need appropriate educational support.
Teachers need training.
Parents need information.
Adults need pathways to assessment and support.
People with higher support needs need services that continue beyond childhood.
Employers need to understand reasonable accommodation.
Communities need to understand that inclusion is not simply allowing someone to be present.
Inclusion means making participation possible.
A ramp is not merely a symbol of disability awareness.
It allows someone to enter a building.
A classroom accommodation is not merely a gesture of kindness.
It can make learning possible.
An accessible diagnostic pathway is not merely a service.
It can give a family an explanation from which useful support can begin.
CONTACT CAN CHANGE PERCEPTION
Information matters.
But human contact can be even more powerful.
It is harder to maintain a stereotype about “mentally ill people” when the person you know is your friend, colleague, neighbor, relative or respected professional.
Likewise, autism becomes less abstract when the autistic person is someone you know and value.
That is why people with lived experience should have a voice in mental-health and disability conversations.
Not as objects of pity.
Not as inspirational props.
Not as representatives of an entire diagnosis.
But as people whose experiences can teach the rest of society what statistics cannot.
THE PROBLEM WITH AWARENESS AS PERFORMANCE
We have become much better at saying:
“Mental health matters.”
But awareness can become another form of performance.
We post an infographic.
Share a quotation.
Use the correct terminology.
Then somebody in our own family struggles and we tell them to pray harder.
We call an employee unstable.
We call a student lazy.
We laugh at an autistic child.
We gossip about somebody seeing a psychiatrist.
We use “autistic” as an insult online.
We use disability terminology as shorthand for stupidity.
That is the gap between awareness and behavior.
Awareness says:
“I know mental health and disability exist.”
Empathy says:
“I will change how I treat you because I know it matters.”
Action says:
“I will help create conditions in which you can actually participate and receive help.”
EVEN RESILIENCE CAN BECOME A BARRIER
There is another Filipino paradox.
We value resilience.
“Kakayanin.”
“Laban lang.”
“Malalampasan din.”
These can be powerful expressions of hope.
But resilience becomes harmful when it is interpreted as refusing assistance.
We do not normally consider someone weak because they see a cardiologist after developing heart disease.
We should be equally careful about treating mental-health support as evidence of personal failure.
Asking for help is not the opposite of resilience.
Sometimes it is how resilience is sustained.
MENTAL HEALTH IS ALSO A SYSTEM ISSUE
Mental health cannot be left entirely to psychiatry.
Housing matters.
Education matters.
Employment matters.
Poverty matters.
Violence matters.
Bullying matters.
Family relationships matter.
Social isolation matters.
Digital environments matter.
Community matters.
A psychiatrist can treat a condition.
But psychiatry cannot by itself fix domestic violence, extreme poverty, an abusive workplace, school bullying, social isolation or an inaccessible health system.
Sometimes the patient needs treatment. Sometimes the environment needs treatment too.
That does not mean every social problem is a psychiatric problem.
It means health exists inside a social environment.
THE COMMON THREAD IS NOT DIAGNOSIS
Autism is not schizophrenia.
Intellectual disability is not mental illness.
Depression is not autism.
Social awkwardness is not automatically a disorder.
And unusual behavior is not automatically pathology.
These distinctions matter.
But the subjects share a broader social problem.
Society often turns difference into hierarchy.
Different becomes strange.
Strange becomes defective.
Defective becomes inferior.
Inferior becomes someone we can laugh at.
Someone we can exclude.
Someone whose suffering we can ignore.
The common denominator is therefore not diagnosis.
It is how society responds when a person’s mind, body, communication, behavior or abilities differ from what the majority expects.
THE OBJECTIVE IS NOT TO MAKE EVERYONE “NORMAL”
Perhaps even the word “normal” creates the wrong expectation.
The objective should not be to make every autistic person behave like everyone else.
It should not be to make every person with a psychiatric condition appear indistinguishable from everybody else.
It should not be to force every person with a disability into a single model of acceptable behavior.
The objective should be:
Dignity.
Safety.
Participation.
Opportunity.
Functioning.
Appropriate treatment.
Appropriate accommodation.
And the freedom to be more than a diagnosis.
WHAT SHOULD WE ACTUALLY CHANGE?
Not every Filipino needs to become a mental-health professional.
Not everyone needs to memorize diagnostic criteria.
But society can become better at five things.
1. RECOGNIZE
Notice significant changes in mood, behavior, communication, development or functioning.
2. DISTINGUISH
Do not confuse mental illness with eccentricity, disability with inferiority, autism with mental illness, or bad behavior with psychiatric disorder.
3. RESPOND
Listen without immediately diagnosing.
Encourage appropriate professional assessment when warranted.
4. ACCOMMODATE
Where appropriate, adjust environments and systems so people can participate.
5. PROTECT
Respect privacy, dignity and rights.
Do not turn someone’s diagnosis, disability or difference into gossip or entertainment.
These are modest demands.
But they require a major cultural change.
THE TEST OF A HEALTHIER SOCIETY
We should not measure progress merely by the number of awareness campaigns we conduct.
We should ask harder questions.
Can a student ask for help without being mocked?
Can an autistic child enter a classroom without being treated as a disciplinary problem simply because adults do not understand the behavior?
Can parents seek an autism assessment without feeling that their family has been disgraced?
Can an employee disclose a mental-health difficulty without automatically becoming professionally suspect?
Can a person with intellectual disability participate in society without being treated as lesser?
Can a psychiatric patient recover without carrying a permanent social label?
Can we criticize someone’s actions without diagnosing them?
Can we disagree politically without turning psychiatric language into a weapon?
Can we joke without dehumanizing?
Can we correct insensitive language without humiliating the person who used it?
Can we distinguish a person from a condition?
Can we distinguish a condition from a stereotype?
Can we distinguish compassion from excuse-making?
Can we distinguish accountability from cruelty?
These are harder questions than whether somebody used the correct word.
THE DEEPEST REFRAME
Perhaps the cultural change we need is not to eliminate every word that can offend.
It is to change what happens after we notice that another human being is different or struggling.
Awareness tells us that difference exists.
Literacy tells us what we may be looking at.
Sensitivity tells us to be careful.
Empathy tells us to care.
Action tells us to do something useful.
Ignorance tells us to guess.
Stigma tells us to label.
Discrimination tells us to exclude.
Apathy tells us to walk away.
And repeated dehumanization can make exclusion seem acceptable.
The answer is not to create a society where nobody ever makes a joke.
It is not to make everyone afraid of saying the wrong thing.
It is not to diagnose every difficult personality.
It is not to excuse harmful behavior by invoking mental health.
It is not to pretend that every difference is a disorder.
It is something more demanding:
A society capable of seeing the person before the label.
That means we can still laugh.
We can still criticize.
We can still disagree.
We can still hold people accountable.
But we become more careful about turning human suffering into entertainment, diagnosis into insult, disability into a synonym for stupidity, autism into a punchline, or difference into evidence of inferiority.
Because the person sitting across from us may not need a lecture.
They may need a teacher who understands.
They may need a parent who listens.
They may need a doctor.
They may need a psychologist.
They may need a counselor.
They may need medication.
They may need an assessment.
They may need an accommodation.
They may need a safer environment.
They may need time.
Or they may simply need somebody to stop laughing long enough to ask a question without judgment:
“Are you okay?”
And if the answer is:
“No.”
the next question should not be:
“Are you crazy?”
It should be:
“How can we help?”
That is the point at which awareness becomes empathy.
Empathy becomes action.
And action becomes culture.
Because the goal is not a society in which nobody is autistic, nobody has a psychiatric condition, nobody has an intellectual disability and nobody behaves differently.
That society does not exist.
The goal is a society in which human difference does not automatically become a reason for humiliation.
We do not have to make everybody the same.
We have to become better at making room for people who are not.
That is what mental-health awareness should ultimately mean.
Not merely knowing the right words.
Knowing the human being behind them.
I once had a Cebuana university student boarder who is originally from Negros Oriental. If I recall she shared that after her (single) mother was committed to the Negros Oriental Provincial Hospital’s Talay Mental Hospital she lived with her lola for a while before being adopted by a tita who had immigrated to the US with the tita’s American husband.
Mental health stigma in Asia is not only a Philippine phenomenon, exists as a heavy social stigma both in East Asia (Japan, South Korea, Vietnam) and in Maritime Southeast Asia (Philippines, Indonesia, Malaysia). One would wonder what is the common connector between East Asia’s Confucian culture and Maritime SEA’s Austronesian culture?
Some commonalities:
• A collectivist culture where one’s relational self is within the context of the social group as opposed to the individual as an isolated unit.
• An emphasis on social harmony which necessitates the imperative of saving face, not just at the individual level but more importantly at the social group level.
• Mental health viewed as a disturbance of social harmony that disturb the spiritual balance with nature, further layered by syncretic religious views which see mental distress as lack of religious belief (of Christianity or Islam).
• Fear of bad karma or unappeased ancestor or nature spirits which may create moral imbalance that may manifest as mental disorders that carry into subsequent generations.
I have never met a Filipino who was seen as weak due to seeking relief (medical or traditional shamanistic) for physical ailments as society understands that physical ailments, which can be seen, can be cured. But mental health, which cannot be seen, incurs heavy social risk as it can be seen as unregulated emotion and thus the sufferer somehow having disturbed social (i.e. spiritual) harmony which now puts the entire community at risk.
To the Western-informed cultural frame and social mores, this seems silly, uncaring, or perhaps even backwards, but I don’t think the lower classes think of it as such. Lower classes might even resent the imposition of such imported ideas when it does not seek to reflect the existent indigenous cultural understanding.
The ex-boarder was intensely ashamed to admit her mother was institutionalized for schizophrenia. Shame upon the person is equated with shame upon the social group (the extended family and community). Families often hide their family members who are experiencing mental distress as to not allow them to become institutionalized in prison-like sanatoriums. Instead, families would try to seclude the affected family member at home or within the community. When the mental health condition becomes too severe, the affected person might even be tied or chained to an immovable object at home so they cannot hurt themselves or others. I once read an old 1970s report when I was following the Human Rights Campaign (LGBTQ rights group) #BreakTheChains campaign in 2020. I had no idea at that point that Indonesia had banned the practice of pasung in the late 1970s, as I have seen pasung in Indonesia more than a few times when traveling through the rural Indonesian provinces. The implication in Indonesia and Malaysia are that those who experience pasung as LGBTQ (e.g. transgender). In the Philippines, this practice also quietly exists in rural areas and is called shackling, remaining less than uncommon in Mindanao especially. Families are trying to cope the only way they can when they cannot obtain support. It is an expression of survivalism.
I don’t have a very high view of albularyos (mananambal in Cebuano) I’ve met in urban areas. A lot of them are charlatans and witch doctors. But clearly in pre-colonial times shamans and native healers had a role to play in bringing the imbalanced back to balance with respect to spiritual harmony (i.e. social harmony). There are albularyos in rural provinces who have real knowledge passed down across generations back to the times of babaylan and asog. It might be useful not only to import external ideas that are beneficial, but to adopt such ideas properly into the native context. I don’t agree with the nationalist framing of Sikolohiyang Pilipino, but Dr. Virgilio G. Enriquez did have a big point in arguing that in order to address Filipino needs, things need to be first be put into a Philippine context which respects Filipino culture rather than replaces it.
Thanks again for that bridge connecting Asia nand Austronesian culture
even then, one very specific case I remember was awful, that of how they started calling PNoy as Abnoy even from the start of his Presidency, which is insidious as “abnormal” in everyday Filipino speech can mean anything from “a bit weird” – all the way to implying someone is mentally ill or deficient as a person.
even more disgusting was how DDS later latched on the autism of Kris Aquino’s son to imply (I saw it in comment sections) that Aquinos were “lahing Abnoy”, and thus a clan that never had been fit to rule a country. What I fleetingly have seen now (I am not as deep into Filipino stuff nowadays as years ago, we have enough craziness in our part of the world these days, which I don’t want to talk about here as it is extremely complex) is that some people picked on Kris Aquino’s kid again recently.
our beloved PNoy has a very traumatic upbringing, his dad was an absentee father who was often in and out of jail for his political beliefs. and PNoy was left as the man of the house at a young age, it was his job to protect his mother from coup takers and look after his sisters as well. he never married, he was already sickly but keep his sickness private, he died of diabetes complication. may he rest in peace. I think, PNoy willed his home in tarlac to kris’ son, kuya josh.
those who picked on kuya josh are now being picked on as well. they lost their job that would have been ultra lucrative had they not been insensitive. and now they are facing the condemnation of the nation and also a possible court case: transgression against a republic act that protects the dignity of persons with disability.
On a related note.
Complaint filed vs podcast hosts for mocking Josh Aquino | Philstar.com https://share.google/AbTWNp2OH1uq7g3Xg
thanks po. mabuhay si kuya josh!
I know of a case that happened in Albay of as late as the 1990s, in an ostensibly middle-class Filipino clan – among some of my folks in fact who were outwardly super Catholic.
When I heard of it from a firsthand source I trust, I started wondering if I had real aswang among my relatives, even if the poor person was “just” kept in a dark room not shackled.
Dr. Enriquez was my brother’s Ninong BTW, and in many ways he was right as that culture is very strong beneath the surface, and fighting what is beneath the surface only can lead to the worst parts of it coming out in stuff like Dutertismo.
P.S. some degree of professional help WAS tried with the relative I mentioned, even if I don’t know the whole story but did know the person, and what I was told is that they went to get help a bit too late to really be helpful according to one doctor plus they didn’t fully trust the NIMH at that time which might have been correct.
P.P.S. none of the people directly involved with the saddest last chapter of that person’s life are still alive today, which is why I will not go into further specifics.
Some have postulated that aswang (first documented by the Spanish chroniclers in the 16th century) becoming the terrifying malevolent creatures understood today to have come from either a Christian innovation (to cast babaylan as demonic) or Islamic demonology introduced by way of what’s now Indonesia (where there’s the similar suanggi).
It could also be that in more spiritual cultures, people who were emotionally or mentally divergent from the baseline were also seen as having greater spiritual powers. See the accounts of the most powerful babaylan likely being transgenders.
I see Dr. Enriquez’s work as a serious, early attempt to re-direct the cultural habits towards positive ends. Something I’ve been thinking about a lot for quite a while. It’s quite sad that he died very young (in San Francisco). Dutertismo might seem incomprehensible to educated Filipinos, but it is very much the continuance of the cultural operating system, albeit in the form that was corrupted starting when the principalía no longer needed to answer to performance-conditioned loyalty while maintaining the performative aspect.
I now recall something I read somewhere about how the Balinese treat what Westerners call trauma. In the cosmology of their healers, apparently they see trauma as a part of a person’s spirit having been separated, and they take people for instance to the site of an accident to ceremonially reunite that part of the spirit with the rest.
Wondering to what extent the real “mananambal” (which means healer in both Bikol and Waray it seems) have or had similar practices. P.S. though those intolerant of mental illness in the Philippines often express their opposition in an older version of Westernization or maybe just a Western coating, aka God-fearing family values etc. as opposed to the more modern Western ideas they indiscriminately call “woke”. The many layers of the Filipino add to making a lot of conversations confusing and frustrating.
In the Philippines, cultural beliefs surrounding spirit possession (sapí or langkap) frequently overlap with undiagnosed mental illnesses such as schizophrenia, bipolar disorder, and clinical psychosis. Traditional views often attribute erratic behavior or hallucinations to supernatural causes, but modern medical, legal, and psychological assessments confirm these are severe psychiatric or neurological conditions requiring clinical care. [1, 2, 3, 4]
Key Media Reports and Clinical Perspectives
Legal and Academic Precedents
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after super typhoon yolanda, some rescue workers found persons shackled to shed. some of those shackled were found to have no living relatives, with no one to look after them, the baranggay stepped in. some of the shackled were abused, few women were impregnated.
these days, we have modern medicines to make those with psychosis and mental illness function as normal as possible, and able to do activities of daily living. those meds may have unwanted side effects but the side effects are manageable. meds may have to be taken for the duration of one’s life, and subject to doctors review as meds have to be calibrated now and then. big disadvantage is when medication is stopped without doctors knowledge, things may go pear shape and there is escalation of symptoms.
being institutionalized is nothing to be ashamed of. though institutions need volunteers to help care for the inmates. some inmates have no living relatives, others are abandoned by their families. some have wandered of, with no ID and not knowing who they are. their language and intonation maybe give away as whether from the city or from the province, but if no one is looking for them and no one reported them missing, they will not be found.
The main reason why families hide their family members who have mental health issues is not only due to social shame, but also because they are afraid their family member will be “taken” from them and placed into a mental hospital. There is some truth to that as sanatoriums (including the Talay Mental Hospital in my first comment) used to literally be prisons for mentally ill people. So secluding or shacking is a survival mechanism when they see no other option. Sadly as you pointed out it also opens the vulnerable person to being sexually assaulted, often by male relatives. Today the Talay Mental Hospital is no longer a prison-like hospital. I forgot the name and due to habit I still call it the Talay Mental Hospital, but they have changed their name as well to reflect a kinder, softer, treatment-first approach which respects both the patient and the family.
talay mental health ward is still in the same place though it has extended to include rehab and behavioral center. I doubt if shackling is still practiced these days, so archaic yan, as shackling is for slaves, in my view. these days mental health patients but only those in acute state of psychosis where they are most manic and incoherent, are restrained by soft velcro attached to their beds to stop them from hurting themselves as well as others. same in seclusion where patients are placed in a well padded room where they cannot hurt themselves by flinging themselves against the wall. both seclusion and restraint are only for a very short while, for they must be seen by psychiatrist within 24hrs or less, then they will be sedated to calm them down.
mental health is being made into mainstream health so dont be surprised if you see mental health patients presenting in emergency depts of hospitals. people waiting in emergency are sometimes traumatised by the manic actions and unusual behavior of the mentally ill. and if the mentally ill has no life threatening condition like heart attack, they just have to wait for service like anyone else.
being mainstreamed, mental health is no longer stigmatised and people may just have to learn to forego their phobias of the mentall ill, and accept that the mentally ill is just like anyone else, to be treated like anyone else.
To simplify things, the way external religion and jurisprudence was introduced into the Philippines, Malaysia and Indonesia diverged greatly. The introduction of Christianity and European jurisprudence to the Philippines was a project of incomplete indigenization (because the Spanish never fully territorially subjugated the Philippines) causing a dividing line between the Hispanized (and later Americanized) elite and middle class with the masa. In Indonesia and Malaysia Islamic religion and jurisprudence was centrally syncretized into the adat indigenous customary system (adat means “custom” or “habit” in Arabic). The Americans, like the British in Malaya and the Dutch in Indonesia largely kept what prior colonizers (either physical colonization like in the Philippines case or cultural colonization in the Malaysian/Indonesian case), adding layers on top of that. It seems the adat system was more flexible in syncretizing native customs and habits with external ones.
Since mental health was viewed as a spiritual matter, and therefore religious, adat was probably able to carry on more of the indigenous Austronesian practices. By the way, Bali is predominantly Hindu in majority Muslim Indonesia, so adat is also flexible enough to accomodate different religious systems as well.
This is largely due to binary Christian framing which is black-or-white, negative-or-positive. In Indonesia and Malaysia, Islamic framing is also often binary (due to Islam also being an Abrahamic religion) and mental health is framed as demonic, stemming from lack of faith. There are many similarities with how elite and educated Filipinos view the subject. Austronesian spiritual practice allowed for grades, shades, and degrees in all aspects of life, including that which intersected with spiritual harmony, which can be seen in other Austronesian or Polynesian cultures which managed to survive for longer without being colonized.
in philippines, catholic orders like the one run by sisters of st vincent de paul in cebu city and the brothers of mercy in bulacan cater for treatment of the mentally ill and provide psychiatric clinic. the catholic church have a number of patron saints associated with mental health.
though there are quasi? religious orders like the jehovahs witness that refused western treatment and intervention, and prefer prayers and meditation instead.
Dropping a link.
https://bworldonline.com/the-nation/2026/10/09/785907/mental-health-group-opposes-blanket-social-media-ban-for-minors/?utm_source=vuukle&utm_medium=talk_of_town
what is the average age of those in the mental health group that opposes the blanket social media ban for minors? in their days of yore, social media is not as feral as it is now where misinformation, preachers of hate speech, radicalisation and extremism are as rampart as dengue and measles. with dengue and measles, we have vaccination to protect ourselves. with feral social media we have no protection except maybe to pull the plug and disconnect.
minors being young, immature and with developing brain, are not in the best position to judge the workings of the social media. mostly lacking in both hindsight and foresight, minors are so impressionable that they are easily lead by the nose and take almost anything as truth. they follow trends even if that means eventually killing themselves! social media make it so easy, so effortless, with no consequences in the offing, but wait until minors found out how difficult it is to navigate the real world, how irresponsible social media can be.
there are social media sites that should be banned for minors.