COURTSHIP and MARRIAGE

Family, basic social group united

through bonds of kinship or marriage, present
in all societies. Mr. Victoriano Poria Jr. is a
fisherman in Baon San Isidro, Davao Oriental
and Mrs. Cepriana Lanida is a teacher. They
first met in a fish market when Ma’am Cepriana
bought fishes from Sir Victoriano. They began
to converse with each other and then later
became friends. Friendship wasn’t enough for
this two and so Sir Victoriano courted Ma’am.
The parents of Sir Victoriano approved of
Ma’am Cepriana because they find her very
educated. Ma’am Cepriana’s parents approved with Sir Victoriano because they
find him very hardworking and know how to fish and farm. After four months of
courting they became a couple. Since, Sir Victoriano and Ma’am Ceprianna’s
parents approved of each other it can be concluded that the family of the couple
has supported their relationship that can yield a good outcome for the couple and
their future children. Acceptance is a great deal for couple starting a family since
this can affect their life as a couple and family. Family conflict can affect a child or
an uninvolved party in many aspects.
Ma’am Cepriana and Sir Victoriano Sr. got married
two years after. They were married in a Catholic Church
(San Isidro Parish) on June 25, 1953 . Ma’am Cepriana
was 21 years old and Sir Victoriano Sr. was 23 years
old at that time. During the wedding ceremony their
families were present to support this joyous event.
Ideally, the family provides its members with protection,
companionship, security, and socialization.
Contemporary society generally views family as a
haven from the world, supplying absolute fulfillment. The family is considered to
encourage "intimacy, love and trust where individuals may escape the
competition of dehumanizing forces in modern society from the rough and tumble
industrialized world, and as a place where warmth, tenderness and
understanding can be expected from a loving mother, and protection from the
world can be expected from the father.
 PRENATAL
Prenatal care, essential for ensuring the overall health
of newborns and their mothers, is a major strategy to
help reduce the number of low birth weight infants.
According Ma’am Nelda their mother does not have
regular pre- natal check ups when he was pregnant
with Jaime. Pre natal care is important because lack of
it is associated with the birth of pre term infants and
various complications for women. Since, this is her sixth
pregnancy and considering the clinic is far form their
barrio she did not consider going for pre natal check up
as that important. Ma’am Cepriana never experienced
any sickness during pregnancy such as rubeola, rubella
and varicella but did experience cough and colds but
attended to this with the use of proper food, adequate
rest and drinking calamansi juice. She has good nutrition during her pregnancy.
The food that she takes in consists mostly of fruits and vegetables. Both the
nutritional state that a woman brings into pregnancy and her nutrition during
pregnancy has a direct bearing on her health and on fetal growth and
development.

BIRTH
Although labor usually proceeds without any
deviations for the normal, many potential
complications can occur. Jaime was delivered just in
their home via “NSVD”, a week earlier than expected
which lasted for 8 hours. A “hilot” attended the
procedure. According to Ma’am Nelda the delivery
was a success and did not encounter any problems
during the delivery process. In addition, in their place
the hospital is very far and the use of “hilot” in
delivering a child is very prevalent in their barrio. Any
complications during labor can have an effect to the
fetus even though, as verbalized by Ma’am Nelda that
during Jaime’s delivery there were no complications
the fact that he was home delivered can have many unpredictable complications
since, sufficient materials needed for a safe child delivery is not available and a
health center is not accessible. All of Mrs. Poria’s children are fully immunized.
 INFANCY (0- 1 yr)
Trust vs. Mistrust
Oral Stage

The first stage of Erikson’s theory of

psychosocial development occurs between
birth and one year of age and is the most
fundamental stage in life. Because an infant
is utterly dependent, the development of
trust is based on the dependability and quality of the child’s caregivers. According
to Ma’am Nelda their mother serves as their primary caregiver. She verbalized
that “ang mama jud namo ang nagalaga sa amoa, mama jud siya sa amoa,
hands on jud siya magalaga sa amoa”. Mrs. Poria attended to the basic needs of
Jaime and all of her children. Even if Ma’am Cepriana is the primary caregiver of
the Jaime it should be noted that Jaime is the sixth child of the family, the age
gap of each child is two years old and Ma’am Cepriana doesn’t have anyone to
help her in doing household chores having said this, a child, may be deprived of
enough attention that is necessary in the child’s growth and development. In
addition, Ma’am Cepriana does all the household chores and feed all her six
children including Jaime, an infant at this stage. Infants need the necessary
attention and care since, Ma’am Cepriana is very busy attending to household
chores, her other children and her husband then she might have not given full
care and attention the Sir Jaime needs. If a child successfully develops trust, he
or she will feel safe and secure in the world. Caregivers who are inconsistent,
emotionally unavailable, or rejecting contribute to feelings of mistrust in the
children they care for. Failure to develop trust will result in fear and a belief that
the world is inconsistent and unpredictable. The balance of trust with mistrust
depends largely on the quality of maternal relationship.

Oral Stage this occurs from birth to about 1

year, and the libido is focused on the mouth.
According to this theory, infant suck, for enjoyment,
relief of tension and for nourishment. As a child,
Jaime likes to put things in his mouth as verbalized
by Ma’am Nelda she stated that “magsige siya
butang ug masking unsa sa iyang baba labi na ang
iyang kamot kanang makitan nimo sa mga bata
mahilig magthumb suck”. There mother would
attend to this strictly because their mother find it very messy and has a fear that
Jaime might develop and overbite. She started weaning Jaime when he was a
year to a year and a half years old. Sucking is a surprisingly strong need. Being
fixated at this stage may mean an excessive use of oral stimulation, such as
cigarettes, drinking or eating.

At first, Jaime was breast then he had been bottle-fed with the milk Bona
and changed to Nestrogen after 2 months, sometimes positioned on bed and
there are only time that he is cuddled by her mother because his mother is very
tired from doing all the household chores. Cuddling is very important because
this makes the child feel secured and loved by his/ her care givers. Jaime, in his
2nd to 3rd month had been suspected to have baby meningitis and had “tipdas”
on his 8-9th month, which then was cured after 2 weeks. Having to have thought
to have meningitis may have an effect on both child and family because their
roles are altered and much attention should be given to Jaime. At this time his
older brother and older sister (Victoriano and Nelda) may have taken the role of
their mother temporarily.

TODDLERHOOD (1- 3 yrs)

Autonomy vs. Shame and Doubt
Anal Stage

Erikson defines the development of task of the toddler

age as learning autonomy versus shame and doubt. The
second stage of Erikson's theory of psychosocial
development takes place during early childhood and is
focused on children developing a greater sense of personal
control. Like Freud, Erikson believed that toilet training was a
vital part of this process. However, Erikson's reasoning was
quite different then that of Freud's. Erikson believe that
learning to control one’s body functions leads to a feeling of
control and a sense of independence. Our client was toilet trained by his mother
personally as explained by Ma’am Nelda. Sir Jaime was toilet trained before he
started to walked. His mother’s method was placing him in urinal or place Jaime
on her lap as she coaches Jaime to defecate by saying “uu..uu”. Ma’am Nelda
said that their mother is not that strict in toilet training, she verbalized “dili man
siya strickta…dili man pud siya mamalo…mangasaba lang siya sa ako mga
manghod kay hugawan man siya”. Jaime developed bowel control before he
reached the age of two. A few months after, bladder control followed. Children
who successfully complete this stage feel secure and confident, while those who
do not are left with a sense of inadequacy and self-doubt.
 Preschooler (3-6 yrs)
Initiative vs. Guilt
Phallic Stage

Erikson defines the developmental task of

the preschool period as learning initiative versus
guilt. Learning initiative is learning how to do
things. Children can initiate motor activities of
various sorts on their own and no longer respond
to or imitate the actions of other children or of
their parents. During the preschool years,
children begin to assert their power and control
over the world through directing play and other
social interaction. Children who are successful at
this stage feel capable and able to lead others.
Those who fail to acquire these skills are left with a
sense of guilt, self-doubt and lack of initiative.
Whether children leave this stage with a sense of
initiative outweighing sense of guilt depends largely
on how parents respond to self-initiated activities.
The role of parental figure is very important for the
child to be guided in his self-initiated activities. The
combination of comfort and discipline from parental
care plays an integral role in achieving initiative during this stage. Parent’s
discipline towards the child’s initiated acts will help him realize what is right from
wrong and parental comfort and reinforcement helps the client acquire learning
from his environment.

After the death of our client’s mother, a revolutionary

change had occurred. As he began to initiate things to do as
a child, mother figure was not present during that time to
guide him as he grows. Moreover, not only did Sir Jaime lost
his mother but he also lost the care and attention from his
father because Sir Victoriano Sr. after the death of his wife
became busy in managing their farm. As an effect, the
child’s behaviors and actions were not guided. He was not
presented to the reality of right from wrong. As he began to
assert his self to do things by his own, no one would praise and reinforce the
good deeds that he has done, he felt alone because he lacks attention and that
had created the shadows of guilt in the heart of our client when he was in this
stage making him feel guilty and regret the day he was born. Our client generally
felt guilty whether his actions are right or wrong because no one would reinforce
or discipline his actions. Erikson believes the preschooler is entering a wider
range of social interaction and is developing a more purposeful behavior in order
to deal with challenging responsibilities. This is a time where children may begin
to develop feelings of guilt and begin to feel anxious. Furthermore, it is common
that mothers are the primary and the best teachers to their children, because of
her early death, no one would fully guide our client’s growth and development
and assist him in socializing with others except her and that made our client feel
guilty as he would try to mingle with other children of his same age who has both
mother and father. A major effect of this is very apparent as the child joined to
group of friends who are of bad influence because no one would guide and watch
over him.

At the very moment, it can really be observed that the client is feeling guilt
deep inside him. The root of this guilt is expressed in his restlessness and
anxiousness. He is guilty of being hospitalized and being placed away from his
family because of abusing substances, he verbalized “ gago man gud ko ba mao
na naa ko diri, unta wala na lang na ko ni gibuhat. Hahahaha (client laughs)”.

During the preschool period, children’s pleasure zone appears to shift

from the anal to the genital area. Freud called this period the phallic stage.
Masturbation is common during this phase. At the age of 5 or 6, near the end of
the phallic stage, boys experience the Oedipus complex whilst girls experience
the Electra conflict, which is a process through which they learn to identify with
the same gender parent by acting as much like that parent as possible.

In Oedipus complex a male child begins to be attracted to her mother and

in order to win her attention, the child identifies with his father. Because of the
lost mother figure, Sir Jaime did not feel the balance of care that should be given
by both father and mother. Because of the early death of the client’s mother, he
basically did not undergo the Oedipal complex and the effect of this could be
seen in the client’s relationship with the opposite sex as he reached his
adulthood stage. With the absence of mother figure, our client’s perception of a
woman is different because he was not able to receive the full caress of her
mother and that is why he was not able to have a lasting relationship with the
opposite sex.

At the present, it is quite evident that the client show no interest in having
relationship with his opposite sex and when we asked him why he answered
“wala koy panahon anang mga babae, mao lang man gihapon wala mana silay
gamit”. Base from this statement, it clearly depicts the effect of the early loss of
the client’s mother to his perception on women.
 School Age (6-12 yrs)
Industry vs. Inferiority
Latency Stage

This stage covers the early

school years from approximately age 5
to 11.Through social interactions,
children begin to develop a sense of
pride in their accomplishments and
abilities. Erikson viewed the
developmental task of school – age
period as developing industry versus
inferiority, or accomplishment rather
than inferiority. During the preschool
period, children learned initiative – how
to do something. During school age, children learn how to do things well.
Children who are encouraged and commended by parents and teachers develop
a feeling of competence and belief in their skills. Those who receive little or no
encouragement from parents, teachers, or peers will doubt their ability to be
successful.

The latent period is a time of exploration in which the sexual energy is still
present, but it is directed into other areas such as intellectual pursuits and social
interactions. This stage is important in the development of social and
communication skills and self-confidence. In this stage the child’s libido is
directed in his activities in school and activities that require social interaction and
development of one’s skills.

In the case of our client, the encouragement and appreciation from the
parents were not felt because of the death oh her mother and the less attention
given by his father. Because of his mother’s death, our client’s father became
busy with his farm trying to forget the loss of his wife and as an effect, the
performance of our client in the school was not attended. The client’s thirst for
attention and appreciation from his Father in his school activities was not
quenched and this had led to the child’s declining grades and performance and
made the child to become inferior and feel useless. In addition, our client usually
feels being inferior being compared to his brothers and sisters who had done well
in school. He shared to us that he doesn’t like the feeling of being compared
which his father usually does to him when he was in elementary. Because of
being inferior he resorted to join group of people who indulges in illicit drugs at a
very young age as a means of an ineffective coping in order to suffice his hunger
for love and appreciation. It is in that group that he felt being “high”, being
superior as they bully other pupils in school which he did not feel in his family.
For us, the child’s failing grades were not caused by the influence of his
barkadas but it is his lack of attention and appreciation from his father that drive
him to seek the approval of peers and friends of bad influence. The attention that
he cannot get from his family is filled by the attention of being a “siga” and “astig”
in their group. The love and care that he cannot get from his family was
compensated by the feeling of being one in a nonsense brotherhood of addicts.

At present, if you would try to observe Sir Jaime, you can really notice that
deep inside him is a feeling of inferiority. With a short hours of interaction, you
may say that he is not a type of person who has feelings of inferiority because he
is very participative, active and full of enthusiasm but all of these were just only
his façade and they are just superficial. His actions and behaviors do hide his
inferiority by using the ego defense mechanism of compensation. He raises his
voice and shouts, join the activities actively, and act as if he knows everything
just to conceal his inferiority. According to Freud, children who lack the
reinforcements and appreciation from their parents would tend to express their
inferiority through insecurity. Our client would only like to be just a follower than
leading the group and it is quite evident that he is envious with other residents in
the hospital; this was observed when he insisted to sing more 5 songs because
he did not want a fellow resident to sing more than what he sang.

ADOLESCENCE (12- 18 yrs)

Identity vs. Role Confusion
Genital Stage

Erikson believes that the new interpersonal dimension that emerges

during adolescence is a sense of identity versus role confusion. During
adolescence, children are exploring their independence and developing a sense
of self. Those who receive proper encouragement and reinforcement through
personal exploration will emerge from this stage with a strong sense of self and a
feeling of independence and control. Those who remain unsure of their beliefs
and desires will insecure and confused about themselves and the future.

GENITAL Stage Begins at puberty involves the development of the genitals, and
libido begins to be used in its sexual role. However, those feelings for the
opposite sex are a source of anxiety, because they are reminders of the feelings
for the parents and the trauma that resulted from all that.

At this stage without a mother to guide

him properly as said by Ma’am Nelda, Jaime was
a boy who was influenced by his friends. He
would always go out and would drink, smoke,
gamble and even take marijuana. Ma’am Nelda
also said that he gets into a lot of trouble such as
fighting with other people. Ma’am Nelda
verbalized “pag naay away o samok siya jud
nagpasimuno ana”. His interpersonal relationship
with other people was not good. These were the effect of the lack of attention and
care that the client experienced from his family. Because of lack of guidance and
attention, our client doesn’t know what the right role to embody as he relates with
his family and the people around him. He thinks that he can get the attention that
he needs every time he is scolded and reprimanded by his father and his brother
and sister. According to Erikson, a strong
influence from the parents will guide the child
to the roles that he should perform. Because
our client is a male, he is expected to help his
father in the farm but according to Ma’am
Nelda, our client’s father was frustrated
because he turned out to be an addict who
always stays with his barkada’s place. Our
client was expected with a lot of roles, but he
was not able to accomplish in identifying to
where he really belongs because of the lack
of love and attention from his father, the only parent left that should be assisting
his son in the endeavors that he may take. Our client’s father was not able to
assist his son in the right path because he had made himself too much busy in
order to cope up with his wife’s death and because of this; our client became
astray and was not able to fulfill his role as a son, as a brother, as a student, and
as a responsible citizen. Because of his frustrations in fulfilling his roles, he
resorted to engage in taking drugs and in joining friends of bad influence in order
to fill the feelings of emptiness because it is where in his friends that he could
feel his role of being a brother in their brotherhood that is only present when
there are drugs to bond them and it is where in his barkadas that he feels the
sense of belongingness; no expectations just a happy-go-lucky life - very perfect
to make him forget the painful things that he had experienced in his life.

At present, it is very evident that the client hungers for belongingness and
acceptance. It is really evident that the client until now seeks the feeling of
acceptance through identifying himself and conforming his roles with fellow
residents in order to win their acceptance. You can really observe that the client
really tries to mingle and join the group of residents in the hospital. He joins
participative in order to project that he wants to identify with his fellows. He acts
as if he knows everything and that he is good in doing things to impress and gain
other’s approval. These behaviors are really manifestations that the client wants
approval, love, belongingness and acceptance through identifying himself with
his fellows.

EARLY ADULTHOOD (18- 30 years)

Intimacy vs. Isolation

This stage covers the period of early adulthood

when people are exploring personal relationships.
Intimacy is the ability to relate well with people not
only with members of the opposite sex but also with
one’s own sex to form a long- lasting friendship.
Erikson believed it was vital that people develop
close, committed relationships with other people. A
balance between intimacy and isolation makes love
possible as we must know how to be alone in order to
learn to truly love. Having a balanced stage 6 will help
tremendously later in the coming stages when unwelcome or unexpected
isolation surfaces, for example, the death of a spouse or a loved one. Those who
are successful at this step will develop
relationships that are committed and secure.
Remember that each step builds on skills
learned in previous steps. Erikson believed that
a strong sense of personal identity was important
to developing intimate relationships. Studies
have demonstrated that those with a poor sense
of self tend to have less committed relationships
and are more likely to suffer emotional isolation,
loneliness, and depression. Our ego should also
be prepared for rejection, the challenge of break-
ups, and isolation, being alone. Erikson believes we are sometimes isolated due
to the above. We are afraid of rejection; being turned down, our partners
breaking up with us. We are familiar with pain and to some of us rejection is
painful, our egos cannot bear the pain.

A loss of mother can affect a person’s perception of what a woman is their

function in society and the role they play in a child’s life. Although, sir Jaime can
relate to both opposite and same sex as his he, still has not established a family
of his own or even find a woman that he would want to marry. According to
Ma’am Nelda, Sir Jaime, had his girlfriend namely “inday” but their relationship
did not last long. In addition, Ma’am Nelda also stated that his brother Jaime, did
not share anything about his relationship with women including that of Inday’s. If
intimacy is not achieved at this time the individual will feel isolated, just like Mr.
Jaime’s case. Fear of sharing oneself with another and fear of not achieving
intimacy are common fears in this stage. According to Dr. Stanley Greenspan, a
clinical professor of Psychiatry at George Washington University Medical School,
an individual may battle with intimacy issues their entire lives. According to
Victoriano, when he gets upset or have problems most of the time he goes to him
and pour out all her grief and sorrow. Then, he just listens and tries to give pieces
of advice. Sometimes, he just keeps it to himself though, like what happened in
Japan. His family is trying to help him in times of Jaime’s crises; they started from
encouraging him to voice out or express his feelings and problems. As they said,
Jaime is not used to share problems to her family. There are instances that he
preferred sharing feelings with Victoriano, since he thinks that he would just
receive sermons from his father if he has problems. In addition Mr. Jaime Poria
may not be ready for commitments yet. He may have fears in handling
relationships with the opposite sex. Jaime’s brothers and sisters all love him,
Victoriano claimed, only that Jaime distances when they sincerely reach out,
especially when it comes to expressing his feelings.

MIDDLE ADULTHOOD (mid 20’s – late 50’s)

Generativity vs. Stagnation

The developmental task of middle age is to

establish a sense of generativity versus stagnation.
People extend their concern from just themselves and
their families to the community and the world. During
adulthood, we continue to build our lives, focusing on
our career and family. Those who are successful
during this phase will feel that they are contributing to
the world by being active in their home and
community. Those who fail to attain this skill will feel
unproductive and uninvolved in the world. People with
a sense of generativity are self-confident and better able to juggle their various
lives. People without this sense become stagnated or self absorbed. Those who
have devoted themselves to only one role are more likely to find themselves at
the end of middle age with a narrow perspective and lack of ability to cope with
change.
When Sir Jaime was still 34 years old he went to Japan and worked as a butcher.
He also verbalized “malungkot man didto”. After three years he came back to the
Philippines the reason was that their stay was illegal. When he came back to his
hometown he worked in their land. According to Ma’am Nelda, when Sir Jaime
returned from Japan there are lot of changes occurred. He became more inclined
in helping his neighbors and other people than helping his own family and
relatives. This had hurt the feelings of his relatives. The reason for his change of
heart was unknown to his family and relatives. Even though, his family felt this
way they, still love and took care of him. His older brother Victoriano and older
sister Nelda are the ones who spend for his hospitalization and medications.
Despite that Sir Jaime changed his way of dealing with his relatives he still
maintain good contact and relationship with them. Ma’am Nelda also found out
“nagshabu man daw to siya didto ingon sa iyang mga kauban sa amoa”. As Mr.
Jaime Poria explore potential careers here and in Japan, and develop his talents,
he also became intimate or close to his life's work. He felt connected to the world
through his work and by giving of this aspect; he felt the rewards of feeling an
important part of the world. He was so desolated upon the non reimbursement of
his earnings in Japan that is why he was not able to invest in his own car, house,
etc. He hid not felt a strong connection with those things he have worked hard to
achieve since in the first place, there was no proper compensation for the efforts
and sacrifices he put into the job. Tin stead of seeing independence from
financial burden, he was so depressed to found out that because of what
happened, he must work hard to open the door to opportunities and even harder
to succeed. This can lead to a real sense of isolation as others move on in life,
leaving some in menial jobs paying little more than minimum wage. One
significant task in this stage also is to perpetuate culture and transmit values of
the culture through the family (taming the kids) and working to establish a stable
environment. Strength comes through care of others and production of
something that contributes to the betterment of society, which Erikson calls
generativity, so when we're in this stage we often fear inactivity and
meaninglessness. As one can trace, Mr. Jaime Poria has no kids to tend yet, so
basically this aspect of transmission of culture and values is not yet applicable.

Precipitating Factors Predisposing

• Depression Factors
• Inability to cope • Age
up with • Genetic
external stimuli • Race
• Peer influence • Sex
• Environmental
factors
• Death of
Mother
• Japan
Experiences
 FIRST ADMISION
He was first admitted at Dr. Mabungga
Rehabilitation center on March 2004 and
stayed for a year.
He was admitted due to behavioural changes.

SECOND ADMISSION
Readmitted at Dr. Mabungga rehabilitation
center last February 2005. He stayed for a
month.

THIRD ADMISSION
Admitted at Davao Mental Hospital on July 4,
2008 and stayed there for two weeks.

FOURTH
FOURTH ADMISSION
ADMISSION
Readmitted
Readmitted at Dela Cerna Hopsital last
at Dela Cerna Hopsital last October
October 4,4, 2008.
2008.
He
He waswas admitted
admitted duedue to
to reoccurrence
reoccurrence of of symptoms
symptoms
such
such as as MNA,
MNA, restlessness,
restlessness, always
always pacing
pacing back
back andand
forth,
forth, difficulty
difficulty inin falling
falling asleep,
asleep, bathing
bathing more
more thatthat the
the
usual
usual without any reason and increase in libido. In
without any reason and increase in libido. In
addition,
addition, thethe client
client also
also told
told his
his older
older sister
sister Nelda
Nelda to to
readmit
readmit him
him because
because he he doesn’t
doesn’t know
know what
what he he is
is feeling
feeling
and
and if he will not be admitted he will be better of
if he will not be admitted he will be better of to
to kill
kill
himself.
himself.

MEDICATIONS GIVEN
• Lithium Carbonate
• Laractyl

Experienced SIDE EFFECTS: dry mouth,

restlessness, headache
 When our client comply with his medications he can
be productive and is able to relate well with is family
and relatives. But, when he doesn’t take his
medications for more than three consecutive days he
begins to manifest behavioural changes and begin to
have MNA, restlessness, always pacing back and
forth, difficulty in falling asleep, bathing more that the
usual without any reason and increase in libido. The
family will readmit him again

If treated: If not treated:

Medical Management Relapse of illness
Adjunctive recurrence of the signs
Management: and symptoms of the
• Art therapy disorder
• Occupational
Therapy
• Music Therapy POOR
• Remotivation PROGNOSIS
therapy
• Milieu therapy

GOOD
PROGNOSIS