Iceberg

Hi, so… This podcast has never really had to have a trigger warning before or not like this one, but it would be irresponsible of me to not make sure you know, going into this episode, what it is I’m going to be talking about. I’m going to be talking about in a non-graphic, slightly removed way issues of drug abuse and mental illness, including suicides. Take care of yourself. Listener discretion advised.

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This probably won’t surprise you too much, but I am not a polished podcaster, am I? Of course not. Some episodes, like this one, are late. Sometimes I skip weeks. Oh and Searching for the Aswang needed to be entirely redesigned while it was in the beginning of its run. I’m still trying to find my stride with nonfiction podcasting in particular, and in the case of this show, even after a couple of years making it, I don’t have a great sense of what makes an episode topic work. A myth retelling or featuring a pre-Catholic deity or even a Catholic saint can be a nice and contained show, and there’s a sort of narrative arc innate to it, but all in all, I can still make the story my own. In my opinion, that’s how a podcast like this needs to run. It’s more of a direct and somewhat equitable dialogue between myself and what came before.

But I don’t always stick with that. You know the expression, “my eyes were bigger than my stomach?” Well, I don’t know what the podcast equivalent would be exactly, but I’ve got that. I’ve got that interwoven into my very DNA, it would seem.

It might not seem like it, but there are episode topics that I discover, fall in love with, and then have to cut. I get really excited about them and sometimes pour way too much time and effort into making them happen only to find that making an episode like the one I’m envisioning would actually be impossible. Normally, it comes down to me not being the right person to tell that story. More often than not, I just don’t have the correct expertise to translate what I’m seeing from more technical socio-historical analysis into a somewhat fun podcast episode. 

But hey, at least I have the decency to know when to back-down, right? Like, I’m not trying not to push my luck. I know, for the most part, when to stay in my lane. It might take me a while to figure it out, sure, but that’s in the privacy of my own home. You aren’t subjected to that. 

And I promise that’s relevant. Because, you see, now I don’t have any sort of padding in my release schedule. I did, once upon a time, but then a couple scrapped scripts happened, and now I’m back to the good ole skin of my teeth approach that I kind of hate.

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Which is relevant because two weeks ago, I had to scrap an episode at the last minute. And this week, I had to scrap an episode at the second to last minute. In both cases, I feel somewhat okay with it. The former episode would have been exceedingly boring, and the episode that was supposed to go up this week was equal parts illuminating and incendiary, also one that I couldn’t fully back up, so I scrapped it.

It was supposed to be a book review, of sorts. And here’s the thing. I’m sure you’re going to be able to guess what book I’m talking about when I give my vague and uncentered description. And that’s fine. I’m keeping it vague and uncentered because I don’t necessarily disagree with the author’s choice to write the book or the decisions made in writing said book, even if it might sound like it. I can’t speak for anyone else’s perspective, and I understand the author’s point, which also swept up a lot of emotions I have around the subject. But I also know that my thoughts on it are, potentially, needlessly complicated. And the irony of me potentially thinking too much about it isn’t lost on me.

But to blunt, I sometimes worry that Duterte’s war on drugs in the Philippines is more of an iceberg situation than anyone realizes on either side of the divide. It’s certainly not coming up in the conversations. Which is… Well, it’s a new rehashing of an old problem.

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I’m sure you who clearly care about Filipino issues and cultural identities know about the deadly war on drugs happening in the Philippines. And while this is a gross simplification, essentially, pushing drugs--or bringing that issue into your community, as it is portrayed--became a capital offense and your community members were free to serve as judge, jury, and executioner. By some standards, it might have been encouraged. Yeah, extra-judicial killing of those involved in drugs. Or those who were thought to be. 

If you live in the US or are familiar with US history, like the McCarthy trials or the Salem witch trials, you might know one way this can go wrong: accusations get thrown around without evidence but with plenty of personal vendettas and convenience. But even if that doesn’t happen, and there’s no reason right now to think that it has, the deaths of poverty-stricken drug users and the low-tier drug dealers likely doing it out of desperation to feed their own addiction or to literally feed themselves have been cruel and needless. Because at the end of the day, no one chose that lifestyle. No one wants to be addicted to drugs. It wasn’t something they set out to do. 

Addiction doesn’t happen in a bubble. But I can understand why, in the Philippines, that supposed bubble is all anyone seems to see.

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Addiction is classified as a mental illness by the US Department of Health and Human Services, which opens up the language of comorbidity or illnesses happening in tandem with each other. Those who suffer from addiction have a high probability of having any number of comorbidities. There is a genetic overlap between the tendency for substance abuse and other mental illnesses, environment stressors like childhood abuse can trigger both or either/or, and those who lack access to or fear standard medical interventions might turn to drugs as a means of self-medication. That understanding--to an insufficient extent--informs medical practice. Which is not to dismiss the American war on drugs and the many ways it has failed our communities. This medical approach is too often compartmentalized in the larger social consciousness, but having that option at all isn’t worth nothing. Considering it’s not an understanding that is globally accepted, we’re technically one step ahead, even if we are definitely not where we should be.. 

In fact, some places don’t even have the figurative linguistic framework to acknowledge the mere possibility of addiction as illness or the illnesses related to it--those things that can increase one’s likelihood of falling into that despair and all the social ills related to it, like drug abuse. And unfortunately, the Philippines is very much one of those places.

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In terms of even understanding the more socially acceptable and related comorbidities associated with addiction, it’s not going to great. A study by Andrea B. Martinez and others released in 2020 estimates that 6 million Filipinos suffer from depression and/or anxiety, the third highest rates in the region. Suicides could be as high as 3.2 death for every 100,000 except no one can be entirely sure because the potential for underreporting is so high. And it is so high partially because the cost associated with getting treatment is more than high enough to be a deterrent, which also means that medical histories can’t be entirely accurate, but also, there’s the stigma of it all. It isn’t impossible that reports are less than honest simply to spare the family emotional turmoil. After all, it’s not like a crime was committed and a murderer needs to be found and caught. So it’s a minimal potential for a fallout that is easily eclipsed by the benefits.

And hey look, we’re getting into an area that I am woefully under qualified to comment on, but I can say a certain amount of things safely and accurately. Filipino culture is one that emphasizes humor and resilience as a solution to mishaps and hiccups that happen in life. For everything else, there’s your family. Filipino culture comes with a very strong built-in support network. And these things will get you the worst of a typical day, month, or year. The problem is that mental illnesses can go so much more beyond that. A mental illness is no where near the same thing as a bad day.

Listed in the sources is a CNN Philippines article that goes more into this from a personal lens. In this article, the author relates his own bipolar diagnosis and the experience surrounding it. The highs and lows of bipolar disorder can’t easily be managed by the sufferer or loved ones or a good joke. Bipolar disorder goes so far beyond that. And this article is coming from the perspective of someone who managed to find a better place with medical interventions they were able to get. Not everyone can say the same thing.

Also listed in the sources is an NPR article in which the author interviews a young Filipina who is trying to understand her mother’s dismissive reaction to her struggles, labeling them a matter of ‘thinking too much’ and preferring the Bible--or a random page of said Bible--to any form of formal intervention.

This isn’t an uncommon story. In fact, many young Filipinos have noticed that their parents are (quote) “pulling from the same script.” (end quote)

Ultimately, that author pulls in an expert to help understand this story and to wrestle with the issue of collectivism within Filipino culture, which E. J. R. David explores in his book Brown Skin, White Minds. Filipinos care about family and community seemingly more than any other group of people does. And as a result, we are more concerned about social perception and acceptance than other people. That has implications. And sometimes, this silent suffering or failure to address our bigger issues is done to avoid shame and the stigma, not just for ourselves but for our families who still have to be able to show their faces in the community, even if we have made peace with social isolation. On a related note, sometimes it’s an attempt to save our parent’s pride because we know it wasn’t their fault. We may know, in fact, that it was no one’s fault. It’s just… complicated, and not everyone knows that.

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Amidst the overwhelming social pressure to suffer in silence or turn our miseries into acts of martyrdom a la Catholicism and religious devotion, seeking mental health resources is an act of self-preservation, and by mentioning the self, it isn’t hard to mistake that for selfishness, but that’s not accurate. Self-absorption sees the self as the end all and be all, but self-preservation does, in fact, serve the community. In a community, loss is felt by everyone and everyone loses something of value. Hence the complication. Psychology doesn’t neatly fit into the Filipino vocabulary because it is an act for the self that helps the whole. Whereas, in Filipino culture, the emphasis is on the whole, and the rest is supposed to sort itself out. 

Having been raised abroad, I know that’s not true. I know that some things don’t just fix themselves like the grief I carry after losing my father at a young age or the guilt over the role I had to play in his end of life care. As much as I love my family, no one can make that sort of thing okay. Children shouldn’t have to lose their parents. That’s an indisputable fact. And no joke can make me miss him less. Therapy can and really did help me move the emphasis in that narrative to something less self-destructive. 

And having watched numerous episodes of Intervention--as terrible as that show may be for any number of reasons--I see more of that hurt in those suffering from addictions than I do the cartoonish evil forces of Satan’s corruption sneaking drugs to children or whatever the narrative is. Because the narrative itself is something I don’t fully understand. 

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Honestly, sometimes I have to think, despairingly, that ending the drug war in the Philippines or even preventing it in the first place wouldn’t have done too much. Considering that seemingly most of the dead were those who would have still been too poor to afford the high cost of professional help, I don’t think a rescue was coming. There shouldn’t have been a war against anything but a fight to save those who were suffering in a way that the larger community wasn’t inclined to see. 

In 2018, the same President Duterte that started the drug war in the Philippines signed the Mental Health Act otherwise known as Republic Act 11036, which was the first time it was written into law that all Filipino citizens had a right to mental health services. 

At the time, though, the specific rules and regulations greenlit by that act needed to be hashed out. And between then and now, a global pandemic has hit, likely setting this issue on the back burner while that famous collectivist spirit was invoked to protect the elderly and the infirm from COVID-19. At the time of its passage, officials did recognize the recent uptick of suicides--an evil related to drug addiction and its many comorbidities--and how younger people were especially hard hit. They weren’t in denial about it and were actively working to take on the challenge, but in some ways, I can’t be as optimistic as I want to be. 

With one foot on each side of the ocean, I can still feel the divide between American perceptions of mental health, which still aren’t great, mind you, and the silence in the Philippines. Not to discredit the experts that were meant to fix this issue and are certainly trying to do so. They definitely know more than I do, but the inability of perspectives to transfer over as easily as words do has been something I have felt and has serious repercussions for something like this. The scientific literature never considered this. 

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It has operated in a framework informed by the world of those who practice it and has essentially assumed objectivity in that. Frankly, I think a more dramatic shift is needed than what anyone is anticipating. We may have to witness the reinvention of a wheel? But which wheel is it going to end up being?

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This has been a production of Miscellany Media Studios with music licensed from the Sounds like an Earful music supply. Thanks for listening! Find more information about our shows at miscellanymedia.online or follow us on Twitter @miscellanymedia for updates on current and future projects.

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Sources: 

National Institute on Drug Abuse. (2020, July 24). Comorbidity: Substance use disorders and other mental illnesses drugfacts. Retrieved March 10, 2021, from https://www.drugabuse.gov/publications/drugfacts/comorbidity-substance-use-disorders-other-mental-illnesses

Martinez, A.B., Co, M., Lau, J. et al. Filipino help-seeking for mental health problems and associated barriers and facilitators: a systematic review. Soc Psychiatry Psychiatr Epidemiol 55, 1397–1413 (2020). https://doi.org/10.1007/s00127-020-01937-2

Tugade, R. (n.d.). We need to talk about mental illness in the Philippines. Retrieved March 10, 2021, from https://cnnphilippines.com/life/culture/2017/04/25/mental-illness-stigma.html

Gharib, M. (2018, November 22). How I learned to talk to My Filipino mom about my mental health. Retrieved March 10, 2021, from https://www.npr.org/sections/health-shots/2018/11/22/669960524/how-i-learned-to-talk-to-my-filipino-mom-about-my-mental-health

Tomacruz, S. (2018, September 11). Is the Philippines ready to address mental health? Retrieved March 13, 2021, from https://www.rappler.com/newsbreak/in-depth/philippines-readiness-address-mental-health