LEARNING OUTCOMES

On successful completion of this module you will be able to:

1. Understand the theoretical underpinnings/foundation on how to manage and care for

different aspects of the self.

2. Hone new skills and learning for better managing of one’s self and behavior.

3. Apply these new skills to one’s self and functioning for a better quality of life.

OVERVIEW

The American Psychological Association (2017) describes stress as a feeling of being

overwhelmed, worried or run down. Stress can affect people of all ages, genders, and

circumstances and can lead to both physical and psychological health issues. By definition,

stress is any uncomfortable “emotional experience accompanied by predictable biochemical,

physiological and behavioural changes.” Some stress can be beneficial at times, producing a

boost that provides the drive and energy to help people get through situations like exams or

work deadlines. However, an extreme amount of stress can have health consequences and

adversely affect the immune, cardiovascular and central nervous system.

Since stress is investable to life, we have to learn how to handle and cope up with it.

More so, we have to be familiar with other approach to healthy lifestyle, which is self-care.

In this chapter, you will be introduced to the nature of stress, definition and its

components. Then will talk on the social and cultural dimensions of stress among Filipinos.

Lastly, taking care of oneself through self care and compassion will also be tackled.
“You must learn to let go. Release the stress. You were never in control anyway.”

― Steve Maraboli, Life, the Truth, and Being Free

 STRESS

• Refers to a pressure or demand that is placed on an organism to adapt or adjust (Nevid,

2005). It is any uncomfortable "emotional experience accompanied by
predictable biochemical, physiological and behavioral changes.“ (Baum, 1990).
And it is used to describe the physical, emotional, cognitive, and behavioral
responses to events that are appraised as threatening or challenging.

Components of Stress:

1. Stressors - events that cause a stress reaction.

2. Eustress - the effect of positive events, or the optimal amount of stress that people
need to promote health and well-being.

Has the following characteristics:

• Motivates, focuses energy.

• Is short-term.
• Is perceived as within our coping abilities.
• Feels exciting.
• Improves performance.

3. Distress - the effect of unpleasant and undesirable stressors.

Has the following characteristics:

• Causes anxiety or concern.

 • Can be short- or long-term.
• Is perceived as outside of our coping abilities.
• Feels unpleasant.
• Decreases performance.
• Can lead to mental and physical problems.

4. Stress Reaction – body’s observable response to a stress

STRESSORS

A stressor is “any real or imagine situation, circumstance or stimulus that is perceived to

be a treat” (Seaward, 2018, p.10). Grasping the given definition, it shows how powerful our
mind really is and how influential our beliefs and values are. It seems silly that an imagined
stimulus may cause so much damage. We might have been guilty or a victim of this imagined
threats too many times before or even currently. Our fears may really be always bigger that the
thing itself. Made believe thoughts may have paralyzed us in doing what could have been a
great opportunity or experience.

Seaward (2018) stated that the “list of stressors is not only endless, but also varies from
person to person” (p.10). But, as explained in so many psychology books and studies, we are in
control – only if we choose to be.

Types of Stressors:

1. Conflict - psychological experience of being pulled toward or drawn to two or more desires
or goals, only one of which may be attained.

Four major types of motivational conflicts:

• Approach – approach conflict – result when a person is caught between two or more
alternatives, each of which is positive or potentially reinforcing.
 • Avoidance – avoidance conflict – a person is faced with several alternatives, each of
which is negative or punishing in some way.
• Approach – Avoidance conflict – there is only one goal a person would like to reach, but
at the same time, would like to avoid.
• Double approach – avoidance conflict – the individual must choose between two or
more alternatives, each of which has attractive and unattractive aspects

2. Environmental Stressors
Environmental stressors are usually considered to fall into one of four distinct classes:
cataclysmic events, stressful life events, daily hassles, and ambient stressors (Evans and Cohen
1987). Cataclysmic events comprise sudden catastrophes that affect many individuals at the
same time. For instance, floods, major storms, earthquakes, volcanic eruptions, nuclear power
plant accidents, chemical plant accidents, and the discovery of toxic waste dumps belong to this
category. Cataclysmic events are seldom predictable, neither with respect to their beginning,
nor with respect to their course, but they are usually expected to be rather short.
Stressful life events are major incidents in the course of life that require major individual
adaptive responses. Such events include major changes in work, or residential environment,
e.g., beginning a new job, moving to a new residential area, major construction work in the
present residential area, or a major perceptible change in the operating conditions of a nearby
stressor. The event as such is usually short, but the behavioral consequences may be long, or
permanent.
Daily hassles are repeatedly occurring aversive events of ordinary life, such as
arguments with colleagues, crowded classrooms, and traffic congestions on the daily route to
work. Although they typically are more or less predictable, the individual has little means to
avoid such hassles, and the duration is rather short.
Ambient stressors is a term proposed by Campbell (1983), denoting more continuous
and intractable background characteristics of the physical environment. They often go
unnoticed, like the continuous hum of the air conditioning, the permanent dust in an industrial
area, and the faint hiss of the central heating system. Most people believe that they can adapt
to ambient stressors, and they consider the costs of coping with such stressors to be higher
than simply enduring them.
It is worth noting that man-made cataclysmic events, such as terrorist attacks, produce
more stress in the long run compared to natural calamities, like typhoons or earthquakes
(Feldman,2011). This is because natural calamities have clear resolutions while man-made
disasters do not. Having been given this information makes us realize that we or our fellow
human beings are the ones creating our own problems or our own poison.

3. Major Life Changes - cause stress by requiring adjustment.

It seems counter-intuitive that a wonderful event like getting married or having a new
child could substantially increase stress to the point where we become uncontrollably angry.
However, with major life changes, our regular routine is interrupted and disrupted. New
children require attention all hours of the day and night, often resulting in sleep deprivation for
new parents and short tempers. Horrified new parents can find themselves glaring in anger at a
colicky baby who will not stop crying and has them at their wit’s end.
It is clear that even positive life changes cause extreme stress. For example, when we
are planning a wedding, we desperately want everything to be perfect. For women especially,
we may have dreamed about the “perfect” wedding since we were a little girl. As an adult, our
vision of the perfect wedding is constrained by budgets, family expectations, time parameters
and a number of other restrictions. Soon what should be an exciting and joyful experience can
turn into a nightmare that makes eloping suddenly seem like an attractive option. Even after
the wedding is past, adjusting to a new marriage can be challenging, to say the least. Even for a
couple who may have been living together for a time prior to marriage, adjusting to the idea of
being “married” and blending two lives, finances and cultures together can be extremely
challenging and stressful, and give rise to angry outbursts when we feel we are not being heard
or understood. (This article is electronically protected – Copyright © Associated Counsellors &
Psychologists Sydney PTY LTD)
 Of course, not all life changing events are positive ones. Losing a job, going through a
divorce or having a major death in the family, can all be extremely stressful. The resulting
emotions associated with these events can include depression and grief, fears about financial
fall-out, anger, anxiety and of course, stress.

There are different kinds of psychological test use to measure one’s adjustment from a
major life events:

• Social Readjustment Rating Scale (SRRS) - assessment that measures the amount
of stress in a person’s life over a one-year period resulting from major life
events.
• College Undergraduate Stress Scale (CUSS) - assessment that measures the
amount of stress in a college student’s life over a one-year period resulting from
major life events.

4. Everyday Sources of Stress

• Pressure - the psychological experience produced by urgent demands or expectations

for a person’s behavior that come from an outside source.
• Uncontrollability - the degree of control that the person has over a particular event or
situation. The less control a person has, the greater the degree of stress.
• Frustration - the psychological experience produced by the blocking of a desired goal or
fulfillment of a perceived need. Possible reactions:
• Aggression - actions meant to harm or destroy. Aggression is a maladaptive
reaction to stressors.

1. The frustration-aggression hypothesis claimed that aggression was

always caused by frustration.

2. It is now realized that there are other sources of aggression.

 • Displaced aggression – taking out one’s frustrations on some less threatening or
more available target, a form of displacement.
• Escape or withdrawal - leaving the presence of a stressor, either literally or by a
psychological withdrawal into fantasy, drug abuse, or apathy.

STRESS REACTIONS

How do we respond to stress? Usually the body begins to react before a full analysis of
the situation is made, but a return to a state of calm is also imminent. There are different
theories explaining our reaction to stress.

Cognitive Appraisal Approach

The model "Theory of Cognitive Appraisal" was proposed by Lazarus and Folkman in
1984 and it explained the mental process which influence of the stressors.

According to Richard Lazarus, stress is a two-way process; it involves the production of stressors
by the environment, and the response of an individual subjected to these stressors. His
conception regarding stress led to the theory of cognitive appraisal.

Primary Appraisal
In the stage of primary appraisal, an individual tends to ask questions like, “What does this
stressor and/ or situation mean?", and, “How can it influence me?" According to psychologists,
the three typical answers to these questions are:

1. "this is not important"

2. "this is good"
3. "this is stressful"
 To better understand primary appraisal, suppose a
non-stop heavy rain suddenly pours at your place. You might
think that the heavy rain is not important, since you don’t
have any plans of going somewhere today. Or, you might say
that the heavy rain is good, because now you don’t have to
wake up early and go to school since classes are suspended.
Or, you might see the heavy rain as stressful because you
have scheduled a group outing with your friends.
After answering these two questions, the second part
of primary cognitive appraisal is to classify whether the
stressor or the situation is a threat, a challenge or a harm-
loss. When you see the stressor as a threat, you view it as
something that will cause future harm, such as failure in exams or getting fired from job. When
you look at it as a challenge, you develop a positive stress response because you expect the
stressor to lead you to a higher class ranking, or a better employment.
On the other hand, seeing the stressor as a “harm-loss" means that the damage has
already been experiences, such as when a person underwent a recent leg amputation, or
encountered a car accident.
Secondary Appraisal
Secondary appraisals involve those feelings related to dealing with the stressor or the
stress it produces. Uttering statements like, “I can do it if I do my best", “I will try whether my
chances of success are high or not", and “If this way fails, I can always try another method"
indicates positive secondary appraisal. In contrast to these, statements like, “I can’t do it; I
know I will fail", “I will not do it because no one believes I can" and, “I won’t try because my
chances are low" indicate negative secondary appraisal.
Although primary and secondary appraisals are often a result of an encounter with a stressor,
stress doesn’t always happen with cognitive appraisal. One example is when a person gets
involved in a sudden disaster, such as an earthquake, and he doesn’t have more time to think
about it, yet he still feels stressful about the situation.
General Adaptation Syndrome (GAS)
The fight-or-flight response (also called
the stress response) is a physiological reaction
that occurs in response to a perceived threat or
danger. This enables the body to take action
quickly, and is intended to keep us out of
(physical) harm’s way. Unfortunately for our
health, this response also occurs when we are
not in any immediate physical danger, but are
still experiencing stress. For example, this can happen when someone is running late for an
appointment or class, and is feeling stressed about trying to get there.
The physical changes that occur during this response can cause wear and tear within the body if
the perception of stress persists. Here are a few examples of such bodily changes:

 Heart rate increases

 Blood pressure increases
 Blood sugar (i.e. glucose) levels rise
 Respiration rate increases
 Muscles tense up
 Perspiration increases
 Pupils dilate

The fight-or-flight response is also recognized as the first stage of the General Adaptation
Syndrome.

Stages of the General Adaptation Syndrome

Homeostasis is a state of physiological calmness or balance, and occurs when our bodily
functions are running smoothly in conjunction with low stress levels. When exposed to
stressors, this causes an imbalance to occur as the body responds to the perceived threat, and
then tries to return to normal functioning.
The general adaptation syndrome (GAS), developed by Hans Selye, describes the pattern of
responses that the body goes through after being prompted by a stressor. There are three
stages: alarm, resistance, and exhaustion.

 Alarm – This occurs when we first perceive something as stressful, and then the body
initiates the fight-or-flight response (as discussed earlier).
 Resistance – If the perceived stress continues, the body stays activated at a higher
metabolic level in an effort to offset the persistent stress. The body cannot maintain this
level indefinitely, and its resources will eventually deplete.
 Exhaustion – Prolonged exposure to the stressor will result in the depletion of the body’s
resources, and the resulting wear and tear will suppress the immune system and cause
bodily functions to deteriorate. This can lead to a variety of health issues and illnesses,
including heart disease, digestive problems, depression, and diabetes.

Signs and symptoms of stress overload

Common warning signs and symptoms of stress overload.

Cognitive symptoms:

 Memory problems
 Inability to concentrate
 Poor judgment
 Seeing only the negative
 Anxious or racing thoughts
 Constant worrying
Emotional symptoms:
  Depression or general unhappiness
 Anxiety and agitation
 Moodiness, irritability, or anger
 Feeling overwhelmed
 Loneliness and isolation
 Other mental or emotional health problems
Physical symptoms:

 Aches and pains

 Diarrhea or constipation
 Nausea, dizziness
 Chest pain, rapid heart rate
 Loss of sex drive
 Frequent colds or flu
Behavioral symptoms:

 Eating more or less

 Sleeping too much or too little
 Withdrawing from others
 Procrastinating or neglecting responsibilities
 Using alcohol, cigarettes, or drugs to relax
 Nervous habits (e.g. nail biting, pacing)

Stress, Illness and the Immune System

The immune system is a collection of billions of cells that travel through the
bloodstream. They move in and out of tissues and organs, defending the body against foreign
bodies (antigens), such as bacteria, viruses and cancerous cells.
 When we’re stressed, the immune system’s ability to fight off antigens is reduced. That
is why we are more susceptible to infections. The stress hormone corticosteroid can suppress
the effectiveness of the immune system (e.g. lowers the number of lymphocytes). Stress can
also have an indirect effect on the immune system as a person may use unhealthy behavioral
coping strategies to reduce their stress, such as drinking and smoking. Stress is linked to:
headaches; infectious illness (e.g. ‘flu); cardiovascular disease; diabetes, asthma and gastric
ulcers.

Stress responses have an effect on digestive system. During stress digestion is inhibited.
After stress digestive activity increases. This may affect the health of digestive system and cause
ulcers. Adrenaline released during a stress response may also cause ulcers.

Stress responses increase strain upon circulatory system due to increased heart rate etc.
Stress can also affect the immune system by raising blood pressure. Hypertension (consistently
raised blood pressure over several weeks) is a major risk factor in coronary heart disease (CHD)
However, CHD may be caused by eating too much salt, drinking too much coffee or alcohol.
Stress also produces an increase in blood cholesterol levels, through the action of
adrenaline and noradrenaline on the release of free fatty acids. This produces a clumping
together of cholesterol particles, leading to clots in the blood and in the artery walls and
occlusion of the arteries.
Stress can also have an indirect effect on illness as it is associated with all manner of bad
habits (coping strategies), for example smoking, drinking alcohol to excess, poor diet due to lack
of time, lack of exercise for the same reason, lack of sleep etc.

Factors Influencing Reactions to Stress

• Personality Differences
• Type A Personality versus Type B Personality
• Type A and Type B behaviour is a theory of personality which describes two ends of a
continuum of personality which is linked to stress levels. Individuals often have
elements of both personalities.
• This theory was developed from work by cardiologists Freidman and Rosenman (1959)
• Type A behaviour is exhibited by being ambitious, organised, impatient, and like to be
punctual. They can also be irritable. Type A personalities are hard workers and career
orientated.
• Type B behaviour is essentially the opposite from type A. Type B personalities are
relaxed, not competitive and generally not as ambitious as their Type A peers.
• Individuals with a type B personality are therefore less likely to experience high levels of
stress and will generally score lower on stress levels measurement. This is because they
experience none of the urgency and competitive pressure that someone who is Type A
will feel.
• This means that the stress response does not occur in the body. As a consequence of
this, it is argued that Type B personalities are less likely to suffer from stress related
illness such as heart disease and illnesses resulting from a depleted immune system
response.

• Emotional Expressiveness

When we fail to express our emotions, our brain can often go into the fight-
or-flight state. This is a physical reaction to stress that sets off a chain of events
throughout our bodies. It increases our heart rate, slows digestive functions and
makes us feel anxious or depressed.

• Optimists versus pessimists

A study released on July 23, 2013 found that optimists have a better biological
response to stress than pessimists. Researchers at Concordia University's
 Department of Psychology have found that “the stress hormone” cortisol tends
to be more stable in people with a positive outlook.

• Perceived Control Over Stressors

• Having a sense of control over a stressful situation reduces the impact of stressor
and decreases the feelings of anxiety and depression. • Your sense of control
had to be realistic to be adaptive. Unrealistic perceptions of control over
debilitating diseases can add to the stress. Sometimes the control needs to be
refocused. oWell-adjusted cancer patients accepted that they could not control
the disease, but they could control the consequences. Deciding what you can
control and what you can’t control is hard.
• Social Support

Social support has been widely studied as a factor that minimizes the
effects on stress. Not only does social support help people feel less stressed, but
it can also actually improve your health and decrease their mortality risk.

Sources of Coping and Strength

Coping is the process of spending conscious effort and energy to solve personal and
interpersonal problems. In the case of stress, coping mechanisms seek to master, minimize, or
tolerate stress and stressors that occur in everyday life. These mechanisms are commonly
called coping skills or coping strategies. All coping strategies have the adaptive goal of reducing
or dealing with stress, but some strategies can actually be maladaptive (unhealthy) or merely
ineffective. Maladaptive behaviors are those that inhibit a person’s ability to adjust to particular
situations. This type of behavior is often used to reduce one’s anxiety, but the result is
dysfunctional and non-productive. The term “coping” usually refers to dealing with the stress
that comes after a stressor is presented, but many people also use proactive coping strategies
to eliminate or avoid stressors before they occur. Personal choice in coping strategies is
determined by personality traits and type, social context, and the nature of the stressor
involved.
Coping Strategies
While psychologists disagree on the specific classification of the hundreds of coping strategies
available today, distinctions are often made among various contrasting strategies. The three
most common distinctions are appraisal-focused, problem-focused, and emotion-focused
coping strategies.
Appraisal-Focused Strategies
Appraisal-focused strategies attempt to modify thought processes associated with stress.
People alter the way they think about a problem by approaching it differently or altering their
goals and values.
Problem-Focused Strategies
Problem-focused strategies aim to deal with the cause of the problem or stressor. People try to
change or eliminate the source of stress by researching the problem and learning management
skills to solve it.
Emotion-Focused Strategies
Emotion-focused strategies address the feelings associated with the stressor. People modify the
emotions that accompany stress perception by releasing, distracting, or managing their mental
state.
A typical person will employ a mixture of all of these strategies when attempting to cope
with stress. Skill or prowess at employing these strategies changes over time.

Adaptive vs. Maladaptive Strategies

Coping strategies can also be positive (adaptive) or negative (maladaptive). Positive

coping strategies successfully diminish the amount of stress being experienced and provide
constructive feedback for the user. Examples of adaptive coping include seeking social support
from others (social coping) and attempting to learn from the stressful experience (meaning-
focused coping). Maintaining good physical and mental health, practicing relaxation techniques,
and employing humor in difficult situations are other types of positive coping strategies.
Proactive coping is a specific type of adaptive strategy that attempts to anticipate a problem
before it begins and prepare a person to cope with the coming challenge.
Negative coping strategies might be successful at managing or abating stress, but the
result is dysfunctional and non-productive. They provide a quick fix that interferes with the
person’s ability to break apart the association between the stressor and the symptoms of
anxiety. Therefore, while these strategies provide short-term relief, they actually serve to
maintain disorder. Maladaptive strategies include dissociation, sensitization, numbing out,
anxious avoidance of a problem, and escape.
Coping Abilities
The capacity to tolerate or cope with stress varies among people. The root of stress is
the cognitive appraisal of an event as stressful or stress-inducing. Primary appraisal is the
extent to which a person perceives an event as benign or threatening and harmful. Secondary
appraisal is the estimation of whether a person has the resources or abilities necessary to deal
with what has already been deemed stressful. An individual can effectively cope with stressors
by appraising stressful situations and having confidence in their ability handle situations that
are stressful.

Brain regions associated with stress: The brain is a vital

element in the experience of stress, because the mind must
both perceive an event as a stressor and judge the ability to
deal with that stress.

Variations in Coping Abilities

Coping ability and strategy selection vary depending on personality, gender, and culture.
A person with a positive demeanor and outlook on life will perceive less stress and be better
equipped to handle stress when it does arise. Those people who employ a static view of the
world will perceive more stress and be less adept at addressing the stressor in their lives. Men
and women also assess stress differently but tend to cope with stress similarly. Evidence shows
that men more often develop career- or work-related stress, while women are more prone to
stress about interpersonal relationships. The small amount of variation in coping-strategy
selection shows that women will engage in more emotion-focused coping while men tend to
use problem-focused strategies.

Culture and Coping Strategies

Culture and surroundings also affect what coping strategies are practically available and
socially acceptable. Some cultures promote a head-on approach to stress and provide
comforting environments for managing stressful situations, while others encourage
independence and self-sufficiency when it comes to coping with stress. A person’s perception
of stress and ability to cope with that stress are products of many different influences in life.

Stress reduction methods

Stress reduction methods can be thought of as serving two functions. There are restorative
techniques for reducing the unpleasant and unhealthy emotional effects of stressful events that
have already occurred, and there are preventative techniques that can help you avoid
succumbing to stress in the first place (or at least buffer against and reduce the impact of
upcoming inevitably stressful events).

Constructive Coping Tactics

any instrumental approach to stress management that is generally considered to be

adaptive or otherwise positive. Examples include planning and strategizing, seeking help
and support from others, reframing the situation, and meditating. Constructive coping
strategies are task relevant and action oriented and are divided into one of three
categories: problem-focused coping, emotion-focused coping, and appraisal-focused
coping. They rely on realistic assessments of stressors and available coping resources,
and their use is associated with better physical and mental health outcomes than the
 use of other strategies (e.g., active coping, passive coping, defense mechanisms).
Research suggests that constructive coping is likely to be used when stressors are of
high intensity or when there is little negative emotional arousal generated in the context
of the stressful experience or event.
Stress and the Filipino

Sure, Filipinos are resilient, but this doesn’t necessarily mean we don’t feel stressed.

By Michael L. Tan

HOW DO we say we’re stressed in Filipino? We don’t. Well, at least not in a way that we
would in English: I am stressed. It just doesn’t work out; we don’t, as far as I know, have a word
in any of our Philippine languages for stress and being stressed.
But that doesn’t mean we Filipinos don’t ever experience stress. We feel it all the time
and we see it producing illnesses, both physical and mental, both fleeting (as in having to run to
the toilet) and serious, life-threatening ones. Because stress affects the body’s immune system,
we can say all ailments are in one way or another stress-related, from asthma to singaw
(canker sores), to cardiovascular ailments and even infectious diseases.
There’s also a tendency to dismiss stress-related illnesses as “psychological,” and that these are
self-limiting, easily resolved. The fact is that stress can so overwhelm people that they lapse into
depression, resorting to destructive behavior, directed toward the self, or toward others.
The drug companies, especially those producing vitamins, have tried to cash in, pushing
their products through advertisements showing stressed people and dangling promises: with
our product, you can meet the many stresses of life, and of the world, and survive without
falling ill. One vitamin has even gone to the extent of incorporating the word “stress” into its
brand name.
But doctors — at least reputable ones — will tell you that medicines are of limited use
for handling stress. Vitamins can help you to deal with the harmful chemicals produced in the
body that come after stress, but as long as you don’t deal with the stress itself, you eventually
lose out.
 Besides the vitamin ads, the media bombard us with all kinds of articles about, and ads
for, New Age therapies that supposedly help us deal with stress — to name a few, yoga and
meditation, spas offering massage and aromatherapy, soothing music interspersed with sounds
of birds and frogs. But these are often expensive fads with exaggerated claims.
Not enough’s being done to understanding stress in its local context, yet stress is mediated
through culture: from the very nature of the stressors, to the ways we respond to the stress.
Understanding this local context might help us develop more culturally appropriate, and
therefore more effective, ways to deal with stress.
STRESSORS ARE not universal. For example, we say “noise” is stressful, but what exactly is
noise?
Culturally, we have different thresholds for these sounds. I have a nephew and a niece
who were born and bred in Canada, and they find the Philippines too “noisy”: the jeepneys, the
arcade games in malls, even the way people talk. Yet they have no problems tuning into hard
rock music on their iPods.
OH, BUT the Filipino is resilient, we keep hearing. But the scenes of smiling and laughing
Filipinos, singing and dancing (and drinking) away can be deceptive. Quite often, we deal with
stress by trying to be “happy.” I put that in quotes because the Filipino term is masaya, which is
really more of an externalized merriment. Masaya is social camaraderie, it’s making cheer and
quite often we do it precisely because there have been unhappy events, stressful events. The
best example is that of a death — our wakes are notorious for its merry-making, but that,
precisely, is part of our stress-coping mechanism.
We have folk psychology, maybe even folk psychiatry, at work here, Filipinos aware of
how dangerous it is to allow stress to consume us. We warn people about excesses as a cause of
illness, and that includes the excessive emotions generated by stress. The word dalamhati is
graphic, describing an inner sadness (from the Malay dalam, inside and hati, the heart or the
liver, believed to be seats of our emotions) that slowly consumes the person. But for all the talk
about our communitarian orientation, of helping friends to overcome stress, social pressures in
the Philippines can also be counterproductive with the way we sometimes force people to
repress the stress. “Enjoy!” we urge them, not realizing there are limits to resilience.
 There are power dimensions to all this, such as those found in gender. Contrary to
stereotypes about women being more expressive, Filipinas are actually more prone to dealing
with stressful situations through tiis (endurance) and kimkim (repression). Check out the local
scenes of merriment: it’s usually men having a good time, bringing out the beer and toasting
their problems away, while their women look for ways to make ends meet.
Men, too, are expected to keep their feelings in check, but more out of masculine values
of strength and stoicism. Men are generally not allowed to cry, much less to go into hysterics;
and this probably helps to explain why more men suffer from cardiovascular disease.
Many Filipinos will express their stress by complaining about recurring headaches, or
abdominal pains, accompanied by dizziness, nausea, fatigue. Doctors used to dismiss these as
being all in the mind, but it has become clear the physical pain and distress may be quite real,
that the pent-up stress is expressed through the body.
These vague symptoms have been labeled as “somatization syndrome,” and are often
hard to treat, partly because medical professionals still haven’t figured out the biological
processes involved. Culturally, too, people may attach labels that don’t quite reflect the actual
part of the body that’s affected, as when they say that they’re suffering from nerbyos or
“nerves.” Nerbyos doesn’t necessarily mean being nervous; it’s often hypertension or high blood
pressure, for example, and a health professional or caregiver may miss the problem.
Then, too, there’s the intriguing bangungot, those sudden deaths, usually at night,
associated with nightmares. The term itself is derived from bangon, to rise, and ungol, to moan.
Young healthy men, like the late actor Rico Yan, die mysteriously and the diagnosis is
immediate: bangungot. The medical world remains stumped, attributing the deaths to
everything, from pancreatitis to congenital defects in the heart, but too little has been done to
explore the stress angle. Similar “culture-bound” illnesses are found also in other neighboring
countries and the deaths tend to be reported in international medical journals because they
often occur in people who are away from home. The first cases reported in U.S. medical
literature involved Filipinos in the U.S. Navy. In recent years, medical reports have included Thai
men doing construction work in Singapore, and Indochinese refugees who have just relocated to
the United States.
 I wouldn’t be surprised if bangungot is reported as well among our 8.5 million overseas
Filipinos. The Filipino is so attached to home and hearth that we even have a term namamahay,
missing home, to describe a range of symptoms, from insomnia to constipation that plagues us
when we are away from home. That’s stress too. And with men, given the cultural imperative of
suppressing their distress, we might expect nightmares, some with fatal endings.
ALL SAID, there’s a political economy of stress involved, meaning power relations shape
the way one experiences and expresses stress. Common sense tells us the poor suffer much
more daily stress, from battling the traffic while commuting, breathing in more of the toxic
fumes, dealing with tyrannical bosses and snakepit offices. Poor women are doubly burdened,
having to deal with the tribulations of work, as well as of the home, running after the needs of
husband and children.
Public health analysts in Western countries have produced voluminous literature on how
poverty interacts with stress to cause illnesses and death. Earlier research tended to be
simplistic, explaining high illness and death rates among the poor as being due to their lack of
access to good health care. But more recent research has shown that the problems of poverty
also relate to power and autonomy. The poor are less healthy because they suffer more stress,
not just from what I described earlier, but also from the inequities in power. The poor are more
prone to feeling helpless and will have less self-esteem — all that contributes to a more rapid
deterioration of health when confronted with stressors.
Men may be more prone to the problem of this “political economy of stress,” since they
have to live up to higher expectations of gender. A jobless man, for example, may be more
adversely affected by stress because of a loss of pride. Machismo also blocks him from taking up
jobs that he thinks are beneath his station. So he ends up drinking with the barkada, which is
then interpreted as “resilience” and an ability to be happy. His wife, meanwhile, will pick up odd
jobs here and there, doing laundry, mending clothes; ironically, that again generates stress for
him, as he feels his masculinity threatened.
The macho imperatives around stress are inevitably tied to alcohol and drugs. Younger
male Filipinos are particularly vulnerable, given their struggles with identity, masculinity and
self-esteem, unable to express their frustrations and resentment. Drugs are one way of dealing
with the stress, with all its attendant problems. It’s significant though that the most abused
drugs are metaphetamines, which are “uppers” or stimulants. Again, the Filipino response to
stress is to look for more stimulation. The nerve cells fire away until, frayed and exhausted, the
user develops paranoia (borrowed into Filipino as praning) and then psychosis.
Others take out their frustrations through violent behavior. The phenomenon of the
amok, favorite fare for our tabloid newspapers, used to be the subject of racialized descriptions
from Western anthropologists, who thought that those belonging to the “Malay race,” including
Filipinos, were especially prone to going on a violent rampage, sometimes with hostage-taking.
ALL THAT discussion should have stressed you by now, and made you wonder: given the
deteriorating economic and political situation in the Philippines, are we about to see an
epidemic of stress-related ailments?
Sessions with psychiatrists or psychologists are more effective than drug treatments, but
again, low incomes may prevent many Filipinos from getting the “talking therapy” they need.
That is why we need to be able to tap what we already have in culture, looking into how
families and communities can be mobilized to help people with their stress.
In the United States, studies are showing that somatization syndrome is best handled
with what’s called cognitive restructuring, helping patients to take on new lenses as they revisit
their problems. Instead of wallowing in self-pity as a victim, cognitive restructuring helps people
regain some sense of control.
We have that in our folk therapies — note how, in bangungot, we’re supposed to try to
move a finger, a toe, any part of the body. It’s not a symbolic act; it actually means taking
control of one’s own body, and the failing spirit. It’s a powerful metaphor that can be used to
explain other stress-related ailments and syndromes.
I’m ambivalent about New Age therapies such as meditation and aromatherapy, but
mainly because the type offered by spas and health resorts are just totally inappropriate. Since
we’re a very olfactory people, I think there is a place for aromatherapy. Sadly, we’re importing
expensive aromatic oils when there are local plants that can be used; in fact, some of the most
expensive aromatic oils are extracted from local plants we take for granted, like ylang-ylang.
 But I do see a place for many traditional therapies being rechanneled toward stress
management. The manghihilot can be “reinvented” so his or her skills with therapeutic massage
can be applied not just for sprains, but also for broken hearts and weary spirits.
Massage and aromatherapy, however, are only the externals. Stress management is really
helping people to dissect their own feelings, to understand where their distress is coming from.
The solutions may not always be easy — all the aromatherapy and meditation in the world will
not raise low wages.
But community action can help to make the stress more tolerable. Communities should
be urged to create their own safe spaces where people can seek some refuge. Filipino-style,
such spaces need not be totally quiet, but they do need to give some sense of safety, of sanity in
a mad world. Filipino-style, too, we need to think of how these therapeutic spaces might work
out as places where people can engage in social activities, without becoming more agitated.
Alternatives could be offered: gardening, cross-stitching, bingo…anything that calms the mind.
You don’t need to be in the lotus position to meditate.
Ultimately, stress management is a matter of helping people to recognize that the world, which
seems so stressful, can also be a source of joy and pleasure, fulfillment and renewal. The
therapies being dangled around are really meant as appetizers, ways of inducing the depressed
the person to garner enough strength and courage to re-engage not just the world, but life
itself.
Michael L. Tan is a medical anthropologist. He is currently chair of the anthropology at UP
Diliman, Quezon City. He also writes an op-ed column, “Pinoy Kasi,” for the Philippine Daily
Inquirer.

Taking Care of Self

Self-care is actually comprised of
7 different pillars, that when combined,
result in physical, mental, emotional, spiritual, psychological, social, environmental, and
professional well-being.

Self-care is….

1. Knowledge and Health Literacy

Having the desire to learn more about health and wellness in the hopes of living a healthy
lifestyle. This does not mean you need to be well-educated on the subject currently. Showing
yourself self-care is finding the motivation to gain access to, understand and use any
information that is provided to you to promote and maintain good health. You reading this
article is a perfect example of how you are showing yourself self-care by contributing to your
knowledge and health literacy. Way to go! This is important as poor health literacy has been
shown to result in poorer overall health, riskier behaviour and less self-love and respect.

2. Mental Wellbeing, Self-Awareness and Agency

The ultimate goal of self-care is achieving overall wellbeing. Caring for your mental wellbeing is
an excellent way to do just that, which is why self-care is about making sure areas such as life
satisfaction, self-esteem and optimism are all in a positive place. If one or more are struggling,
self-care is using your knowledge and health literacy skills to take action to change this. This
could mean seeking help from a professional, conducting your own research, or using tools you
already know to improve your overall well-being.

3. Physical Activity
Self-care is also about finding time in your day to get some form of physical activity. This can
look different to all of us. For some, this could mean going for a 5-10km run. For others, this
could mean practicing yoga at home for 10 minutes or even taking your dog out for a walk.
Sometimes, self-care is even getting out of bed on those days where the thought of that seems
impossible.

4. Healthy Eating
What we put in our bodies has such a powerful influence on our overall wellbeing. When our
gut is out of wack, there's a good chance that we are too. This is why self-care is also about
eating healthy - the best you can. Now nobody is perfect – eating “clean” all day, every single
day is unrealistic. Chances are you are going to indulge every once in a while. On these
occasions, self-care is about not feeling guilty about your choice and enjoying what you are
eating to the fullest. On all the other days of the week, self-care is about being mindful of what
you eat! Choosing organic foods over processed or pesticide-filled foods is one way to do this.
Other ways would be to watch your sugar intake, limit your caffeine and alcohol consumption,
or making sure you are getting all the vitamins and nutrients you need. Not sure what is
considered “healthy eating”, taking a cooking or nutrition class, or reading a book/article on the
subject is an excellent way to perform an act of self-care! Not sure what vitamins or minerals
you are lacking? Consider speaking with a naturopathic doctor about your options. In the
meantime, you can check out some of our articles on healthy eating.

5. Risk Avoidance and Mitigation

By avoiding or limiting your use of toxic substances and risky behaviour, you are automatically
showing yourself self-care. This can include things like avoiding tobacco and alcohol use,
avoiding dangerous situations or choosing not to put yourself in situations that you know make
you feel uncomfortable or anxious. Self-care can also be choosing to use natural body products
over instead of toxic ones (ie. sunscreen, bug spray, etc), limiting your WiFi exposure, using salt
lamps in your home, etc.

6. Good Hygiene
Of course, self-care is about taking those long epsom salt bubble baths, or going to the spa. But
self-care does not have to be as elaborate as this. For some of us, having a shower or brushing
our teeth is a huge accomplishment in our day. This is still self-care.

7. Rational Use of Products/Services

Some of us use vitamins and supplements to manage our overall mental and physical wellbeing.
Some find benefit from pharmaceuticals and professional counselling. Others find relief by
going to the gym or their favourite exercise class. Whatever works best for you, self-care is
sticking to these products and services, but using them in a way that’s safe and effective for
you! And hey, sometimes we slip or fall out of our routine. In these times, self-care is forgiving
yourself and getting yourself back on track!