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THE SHARED SELF: A PHENOMENOLOGICAL STUDY ON THE

LIVED EXPERIENCE OF THE FILIPINO MENTAL HEALTH


CAREGIVERS

Arianne Joy S. Magaling, Lou Jazzel D.Punzalan and Hanz Nicole L. Torino
Bachelor of Science in Psychology

Abstract

This study aimed to explore on the lived experiences of the Filipino mental health
caregivers. Their intrinsic and extrinsic values were unfolded using
phenomenological method, particularly the “pamamaybay” and “kapwa-oriented”
approach. Significant implications were found in terms of value cultivation for
human development and communal well-being. Whereas karangalan, lakas-ng-
loob, pagpapahalaga, pagpapakatotoo. pakikiramdam, panlipunang-pagtanggap,
and pansariling-kakayahan were revealed to be the mental health caregivers’
intrinsic values, kagandahang-loob, katarungan, positibong-pananaw, and tiwala
were found to be their extrinsic values. The findings suggested that beyond the
complexity in relationship building in the Philippine psychiatric setting, both
caregivers and patients attain functionalism, which promotes self-sufficiency
necessary for maintaining one’s dignity. The shared self revealed the Filipino
mental health caregivers’ revolving strengths, developments, and morality fiber.
Extension of “self” limits the shadow casts within the patients (others). Filipinos
are proven to have strong self and cultural values embedded unconsciously
within their lives.

Key words: shared self, intrinsic values, extrinsic values, Filipino mental health
caregivers

Introduction

Filipino mental health caregivers are the frontline of primary healthcare.


They provide the basic knowledge on the mentally challenged patients’
limitations and essential self-care like feeding and bathing which are practical
steps necessary to leave the care setting. Thus, caregiving fits the formula for
chronic stress, physical and psychological strain, and the capacity to create
multiple hassles on life domains. However, despite the fact that caregiving is a
challenging role, being a mental health caregiver sets an edge for the Filipinos as
they are believed to be highly relational, endowed with high spirits of positive
affects and natural coping mechanism.
Philippine Psychiatric setting is complex and demanding but is also an
area where one can execute the paramount of the self. On its ongoing
development, current researches are imperative which can fill the gap of
knowledge to extend measures that may contribute to integration of its
development.
According to World Health Organization, the low priority in mental
healthcare is a significant barrier to progress. Currently, the Philippines has only
a national mental health policy, Administration Order 8, S2001 and laws
governing this are only contained on various parts of the law (i.e Magna Carta,
Penal Code, Dangerous Drug Act). Furthermore, a study conducted by WHO
(2007) revealed that only few mental health caregivers receive relevant trainings
related to human rights. Hence, there is a need to strengthen, to promote, and to
advocate researches on Philippine Psychiatric setting as it extends the capacity
of mentally ill patients to grow, develop, and gain rights for self-sufficiency and
maintaining dignity. It is one of the strategies of the National Mental Health
Program to encourage the development of research culture which shall support
studies relevant to mental health, with clinical behavior and knowledge
management. Consequently, values as the core strengths of Filipinos can be
analyzed and cultivated to attain the human development and communal well-
being. Thus, a study that aimed at exploring on the ‘intrinsic’ and ‘extrinsic values
of the Filipino Mental Health Caregivers using a phenomenological approach is
deemed indispensable as there is an ongoing trend today that policies be moved
closely aligned to what really matters to people as they characterize themselves.

Methods

Research Design. The study utilized the phenomenological approach with


the integration of ‘kapwa-oriented’ research, “pamamamaybay” approach (Odal,
2001) to derive an in-depth analysis and reflection in the lived experiences of the
Filipino Mental Health Caregivers. Pamamaybay approach is an indigenous
method of gathering data that gives a clear view about the nature of “person-in-
the-world”. This approach may create a value and appropriate attitude to develop
a framework of making people positive about them and lead them to a desired
future. According to Sherman and Cohen (2008), affirming core values promotes
a positive self-image because it provides a means by which individuals can
secure a sense of being competent, good, and self-determining in the face of
life’s challenges.
Participants of the Study. As a phenomenological approach posits, five (5)
Filipino Mental Health Caregivers from different mental health institutions in the
Philippines were selected through snowball technique. The participants (a) are in
their young adulthood and adulthood (19-40 years old); (b) can be single or
married (d) have an everyday direct contact with the Mentally Ill Patients.
Generally, they have been in handling and caring mentally ill patients for 1.9 to
17 years.
Research Instrument. To explore on the lived experiences of the
participants, interview guide questions validated by a panel of experts in the
mental health setting served as the research instrument. The guide focused on
(a) demographic data; (b) regular time allotment for their patients; (c) ratio of
patients to caregivers;(d) daily routine as caregivers; (e) happiest experiences; (f)
handling unexpected situations; (g)effects of their social interaction with the
patients; (h) motivation at work; and (i) questions assessing ‘intrinsic’ and
‘extrinsic’ values.

Data Gathering Procedure. The“pamamaybay approach”which was


founded on the indigenous ways of getting into the philosophical presuppositions
of ‘person-in-the-world’ by exposure/observations, sharing stories, in-depth
interview, inter-subjective validation, personal reflections and thematic
documentation and interpretation (Titular,2013) was used. The secondary data
were sourced from the reviewed literature and studies of the same phenomenon.

2.Shared Stories

1. 3.In-Depth
Exposure/ Interview
Observatio
n

5.Personal
6.Thematic 4.Intersubjective
Reflection
Documentation Validation

Figure 1. Pamamaybay Approach (Odal,2001)

Data Analysis Procedure. Firstly, an in-depth interview was conducted which was
audio-taped with the participants’ consent. The verbatim transcription of the
taped-interview was encoded to extract, classify, and summarize the participants’
responses. The development of catalogued-emerging codes into a pattern called
themes followed. The themes were grouped to form clusters (superordinate and
subordinate themes). Extraction of excerpts from the original transcript using a
quotation that best captured the essence of their thoughts, emotions about what
is being studied was made.

Co-Researchers 1.Re-collecting the narrated stories


and their own reflections
Lived Experiences 2.Re-viewing the shared stories Writing the eidetic
and reflections
insights and the
Beliefs/Values 3.Re-reading the selected relevant
implications of the
literature and materials to enrich
the reflection study
Goals
4.Writing analytical reflection

Figure 2.Process of Doing Reflective Analysis and Interpretation (Titular, 2013)


Results and Discussion

Themes were categorized based on established Filipino Value System by


Virgilio Enriquez and was integrated with values that was found and deemed
essential in the Philippine psychiatric setting.

3.1 Intrinsic Values. The table summarizes the Filipino mental health caregivers’
intrinsic values. These values were categorized based on their choices,
commitments and self-development.
Table 1
The Intrinsic Values of the Filipino Mental Health Caregivers
Superordinate Sub-ordinate Example of Illustrative Text
Themes Themes
1.Pakikiramdam a. Pandama (Sensing) “Kapag disturbed ang pasyente, usually
nagcu-curse at nagmumura, definitely, di mo
kayang magbuild ng anumang rapport”

b. Kutob (Intuition) “During admission stage, sa tingin pa lang,


minsan alam na namin kung magwawala”
2.Lakas ng Loob a. Tapang (Courage) “Kailangan na lakasan ang loob. Ang pagiging
mental health caregiver ay lakasan ng loob.”

b. Determinasyon “Kapag mahina ang loob mo (biliang isang


(Determination) caregiver) , ikaw ang masasaktan”
3.Pagpapakatoto a. Inis (Annoyance) “Minsan nga lang talagang mayayamot ka
o (self) siguro, dahil minsan, syempre minumura
ka (ng pasyente)”

b. Pagganyak “ Unang una, nagiging motibasyon ko ang


(Motivation) plano kong pagsunod sa wife ko sa ibang
bansa. Motibasyon ko din ang sunod kong
magiging trabaho”
4.Panlipunang a. Pang-unawa “Masarap lang sa pakiramdam na naiintindihan
Pagtanggap (Understanding) namin ang mga may mental illness”

b. Katatagan “Kapag sinasaktan na kami ng pasyente,


(Resilience) mahirap iyon kasi hindi naman namin pedeng
gantihan”

c. Kasanayan “Dati takot ako. Noong una,may takot, pero


(Proficiency) ngayon
normal na (ang mgs kinakaharap na sitwasyon
bilang isang icaregiver)”
5.Pansariling a. Kapasidad (Capacity) “Basta lahat sila pwede kong i-handle hangga’t
Kakayahan kaya ko.”

b. Kagalingan “Kapag may mga bagay sila na sinabi sa’yo,


(Competency) isipin mo rin sa sarili mo na pwede kaya ito o
hindi?”
6.Karangalan a. Dangal (Honor) “Ang pagiging nurse ay hindi lang isang
profession, isa din itong vocation. Kahit dito,
sa Pilipinas mababa ang sweldo, kapag
healthcare provider ka, psychiatric setting man
o hindi, pwede ka pa ring makatulong”

b. Pagpapahalaga sa “Kapag ilalabas(ang mga pasyente), syempre


Sarili (Self-Esteem) masaya, dahil doon mo rin makikita na
umepekto ang nursing care mo, ang
propesyon mo”
7.Pagpapahalaga a. Pagkalinga at “Parang nagiging anak namin sila kapag
Pagiging nandito. Kami ang nag-papakain, nagpapaligo
Responsable (Care at iniintindi namin sila..”
and Responsibility)

b. Pagaalala (Concern) “Di ako natatakot na masaktan. Ang medyo


pinangingilagan naming ay ang masaktan ang
pasyente.”

Table 2 summarizes the kind of “self” that the caregivers possess. As


shown, such “self” is seen not only as individuals but a “self” that is peculiar to
the capacity to render to different stimuli functionally, to initiate, and to guide their
own behavior.
Pakikiramdam is pivotal interpersonal value that revolves around the
“heightened sensitivity” of sizing up the situation (De Guia, 2005). It covers how
Filipino mental health caregivers sense and predict the mood of a patient in a
particular situation. Pandama (Sensing) is the ability to know the state of the
patient while the natural ability to predict patient’s emotion without any scientific
proof (kutob) is reported to be of great help for the caregivers to manage the
patients.
The value of Lakas ng Loob or the inner strength coming from one’s
capacity to hope and persevere, as defined by Titular (2013) covers tapang or
the caregivers’ ability to conquer fear and employ strength, and Determinasyon
which is described as the fortitude for the drive to attain the process of helping
the patient (others).
Another intrinsic value is Pagpapakatotoo. The caregivers reported how
important it is to recognize negative emotions such as inis or the state of being
irritated for some deviant behavior shown by the patients. Also, Pagganyak,
which shows other things they value for their own sake, is revealed which also
serves as the driving force to continue their motivation at work were reported.
Panlipunang Pagtanggap which is fundamental to any human being
(DeWall, 2011), is manifested by showing Pang-unawa sa Kapwa or
understanding the nature of the patients, the shadow that casts in patients in the
outside world, and the adversity they have. By doing so, the caregivers attained
katatagan the process of adapting well in the face of adversity, trauma, tragedy,
threats or any significant sources of stress. Proficiency or Kasanayan also helps
them to adjust and to promote more competent and sensitive caring capacity.
Pansariling Kakayahan enables the caregivers to practically apply the
theoretical concepts they have gained, and thus help them accomplish the
desired tasks as caregivers. Possessing these intrinsic values help them achieve
Karangalan which represents a sublime notion of one’s “personhood” or
pagkatao( Gripaldo, 2005). Dangal unveils the pride and worthiness of their
profession itself together with Pagpapahalaga sa Sarili that comes from a sense
of achievement when they see the development of the patients from the fruition
of their hardwork
The cited themes led to Pagpapahalaga that is represented by the
caregivers’ empathy by providing the patients what is necessary for latter’s
health, welfare, maintenance, and protection. This is fourfold in the ‘Kapwa’
Theory.According of Yacat (2012) which posits that the “shared self” must start
with the “I” (caregivers). In the process of psychiatric social interaction, the
“intrinsic values” would help the patient for the recovery that lies ahead
(Townsend, 2011). Hence, all human beings have the capacity to grow and
develop. In this sense, this proves that not only mentally ill patients are in their
way of development. Filipino Mental Health Caregivers are also in the process of
growth where they are able to be self-critical, manage personal emotions,
conquer fears, employ and enhance necessary skills. According to Ortigas
(2008), the Self (Ako) must have self-awareness to have awareness of Others
(Kapwa). Thus, this produce creativity in relationship that will then result to
effectiveness in the ability to effect growth and change in one’s self.
Consequently, in this process, Filipino Mental Health Caregivers regain dignity,
expression of authentic selves and an ongoing self-development. Thus, both
emanates the quality to grow and develop embedded in ‘Kapwa’ theory that
ikaw-at-ako-ay-magkapantay.

3.2 Extrinsic Values. Extrinsic values were categorized based on their moral
obligations, moral virtues and related strengths. Fundamental principles that
revolve within the society were also enveloped. Thus, by contrast to intrinsic
values, extrinsic values are gained from the social interactions that pertain to the
benefits of the ‘others’ extensively.
Table 2
The Extrinsic Values of the Filipino Mental Health Caregivers
Superordinate Sub-ordinate Example of Illustrative Text
Themes Themes
Kagandahang a. Altruismo (Altruism) “Hindi ko na hangad na umasenso sa
Loob buhay, ang hangad ko na lang
makatulong sa mga pasyente”
Awa (Compassion) “Naroon ang awa. Hindi lang sa
pasyente, kundi maging sa kaanak.”

Pakikiramay (Sympathy) “Posibleng maging depressed din ang


kaanak, kaya pati sila kailangang
damayan.
Katarungan Pagtitimpi (Resistance) “Kailangang laging mag-ingat dahil
hindi pwedeng saktan ang pasyente”
Iyon ang mahirap - mas nasasaktan
kami sila ay nasasaktan.”
Katwiran (Reason) “Laging naming iniisip na kahit
nayayamot kami, hindi dapat, dahil
nandito sila para alaagaan”
Tiwala Pakikipagpalagayang Loob “Nagpapakilala kami na nurse kami dito
(Relationship Building) at nandito kami para tulungan sila.”
Positibong Pagkatuto (Learnings) “Noong pumunta ako dito, nagkapuso
Pananaw talaga ako sa mga mentally challenged
patients. Natuto akong
pahabain ang pasensya ko, unawain
ang ang bawat isa.”
Paggabay (Guidance) “Best approach ang pakikipag usap sa
kanila,

The profound and powerful meaning of ‘extrinsic values’ outlines the ethos
of sharing, seeing, and caring by the Filipino Mental Health Caregivers to employ
genuineness and humanity that is embedded unconsciously within them.
Kagandahang Loob is the value relation of Filipino dimension of
conscience by acting purely for the sake of others. Filipino mental health
caregivers showed value of altruism by doing whatever benefits the patient in
need regardless of their motives. They also expressed sentiment of pakikiramay
upon seeing the patient and their families struggle.
Katarungan conceptually refers to carrying consideration with the fairness
in the defense of certain basic rights of the patients (Panopio, et. al., 2007). This
theme is supported by the positive value of pagtitimpi or fundamentally
understanding the behavior of the patients by not inflicting harm unto them
despite their deviant behavior. This is a way of helping the patients maintain their
dignity.
Tiwala is another major theme that was extracted from the mental health
caregivers’ lived experiences. This theme served as the initiation of rapport and
relationship building and believed to be the preliminary task of the Filipino mental
health caregivers that must be fulfilled.
Positibong Pananaw is seen as a constructive view of life to build a healthy
outlook. It describes Filipino mental health caregivers’ way of learning
(pagkatuto) from their line of work and everyday experiences with the patients
(others). The value also brings out the communal well-being of both the patients
and the caregivers which results to growth, development, and optimism.
Strongly, Tanauan (2012) noted that ‘Kapwa’ points out the meaning of
“love” in the space that Filipinos share as one humanity. Hence, by living to its
meaning, men become true to the loving purpose of life. Also, “shared self” is a
notion that opens up heart doors of the “I” to include “others”. It bridges the
deepest individual recess of Filipinos with anyone outside himself, even total
strangers (De Guia, 2005).On a study conducted by Reyes (2014), he
considered ‘Kapwa’ theory parallel to the authenticity of a person through living a
life of inter-personal self-giving. Person is essentially a “we” term. Person exists
in its fullness only in the plural. Also, according to Jocano (2000), it is given to
observed Filipino traits that what makes a virtuous person composes a
dimension of compassion, the act of altruism, together with self-worth and
dignified relationships. Extrinsic values are found out that the value is pursued
not for in its own sake but for the sake of something else, especially for the
benefits it will bring about (Bunnin, 2004) Profoundly, Manauat (2009), defined
Filipino caring as a broad sense that carries a variety of meanings.  To care is to
feel concern (be bothered, worry, love, think about), to show concern (hug,
caress, pay a visit, spend time with) and understand what the other is going
through (empathize, sympathize).Ultimately, it is the context of caring that will
further illustrate why it is a value.

3.3 Implications
The dynamics of the intrinsic and extrinsic values of the Filipino mental
health caregivers contribute to the development of the ‘shared self’ that brings an
extended sense of self in the Philippine Psychiatric setting. Through these
values, not only the patients (other) are developed into a constructive milieu but
also the ‘self’ (caregivers) which is continuously being able to fuse oneself
through understanding beyond differences and growing rather than isolation and
stagnation.
Within these values, with or without limitations, is where Filipinos can
produce great advancement to human and socio-economic development (Titular,
2013). In the rapid advancement of the world, every society must cultivate
strengths to continue moving forward. Hence, in this gradual expansion, human
helping is a major key to attain good and functional society.
Consequently, the mentally ill patients, together with the Filipino Mental
Health Caregivers must not be barred by human limitations to attain
‘functionalism’ as in the case of the social stigma for them. The shadow casts of
their mental illness, the nature of their difficulties, and circumstances, often limits
their opportunities for further human growth and development (Townsend, 2011).
However, although the patients (other) are mentally challenged, there is
an extent to a large degree of rebuilding ‘functionalism’ for the society, their
families, and most especially, for their own selves. Thus, according to Seligman
(2011), what matters in life includes an account of people’s responsibilities and
obligations toward others and their interpretation of the sort of the society that
they affirm as good. Deeply in connection, Suu Kyi (1994) noted that “the true
development of human beings involve much more mere economic growth. At its
least, there must be a sense of empowerment and inner fulfilment. This alone will
ensure that human and cultural values remain paramount”.
The Psychiatric setting in the Philippines, as in the core value of ‘Kapwa’
theory, is a proving ground that “I” and “other” are one (ikaw-at-ako-ay-iisa)
through ‘shared self’ because both caregivers and patients attain goals and
development in the process of social interaction producing communal well-being.
On the Philippine moral recovery context (Licuanan, 2010), the goals of (1) sense
of common good, the ability to look beyond selfish interests, a sense of justice
and a sense of outrage at its violation, (2) the value and habits of discipline and
hard work and (3) the value and habits of self-reflection and analysis, the
internalization of spiritual values, and an emphasis upon essence rather than on
form are developed by Filipino mental health caregivers. This is seen at their
developing capabilities in their achievement connected to the daily life of patients
(other) that is implemented by the act, particularly to their profession,
occupations, and jobs.
In all, the contribution of the ‘shared self’, with or without limitations,
produces great advancement to the human and socio-economic development by
being functional of both the ‘self’ (Filipino mental health caregivers) and ‘other’
(patient) in the rapid advancement of the Philippine society. In a current wave of
modernization where there is conflict, trouble, violence, and risks, Filipino mental
health caregivers are one of those who still work to build human development
beyond the fundamental challenge of the promotion of shared human values and
necessary skills.

Conclusions and Recommendations

Conclusions.The Filipino mental health caregivers developed intrinsic


values such as karangalan, lakas ng loob, pagpapahalaga, pagpapakatotoo,
pakikiramdam, panlipunang pagtanggap, and pansariling kakayahan. These
values were considered authentic as the participants expressed themselves
through their choices, commitment, and openness to change their values for the
promotion of social-harmony and self-growth.
On the other hand, the extrinsic values of the Filipino mental health
caregivers include kagandahang loob, katarungan, positibong pananaw, and
tiwalawhich all encompass moral virtues, moral obligations, and their related
cultural strengths.
The intrinsic and extrinsic values may directly or indirectly influence each
other in the process. However, the goal is to produce human development or
‘functionalism’ for both the Filipino Mental Health Caregiver(‘self’) and the
mentally ill patients (‘other’). It is gained from the ‘shared self’’ of the Filipino
mental health caregivers. Thus, these values are major keys to attain communal
well-being and social development.

Recommendations. With the research performed and the derived


conclusions, it is recommended that Filipino Mental Health Caregivers with years
of experience in the Philippine psychiatric setting may promote and advocate the
growth and development they gained through various programs and seminars to
motivate other Filipinos to render services in this area. The results of the study
may also be integrated in the related trainings such as values formation and
psychosocial care for newly hired and inexperienced Filipino Mental Health
Caregivers to (a) add measure of the extent to human-related trainings, (b)
lessen violence such as aggression and (c) promote a holistic personality in the
Philippine psychiatric setting. As the National Mental Health Program encourages
the development of research and culture capacity, this study may be reviewed,
like in other countries, for the development of the core principles in the Philippine
psychiatric setting to build more competent, fortified, and culturally sensitive
mental healthcare necessary for attaining human and socio-economic
development. The future researchers are encouraged to consider Filipino
Psychology as the corpus of the knowledge to promote cultural development and
to be able to look for our own values beyond looking on outsiders’ point of view.

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