Psychiatric Report

I. Identifying Information

JUANITO ADRIGADO CASUGBO, JR, 47 years old, male, Filipino,

Roman Catholic, with permanent address in Barangay Bago, Roxas City
presently working in Capiz Electric Cooperative, Inc. (CAPELCO), born on
April 29, 1976.

JENEFFER DE LA CRUZ CAGAY, 33 years old, female, Filipino, Roman

Catholic, with permanent residence in Barangay Adlawan, Roxas City,
presently unemployed, born on May 6, 1990.

II. Reason for Referral

The clients came in for psychiatric evaluation to determine the presence of

psychological incapacity as a ground for annulment of marriage.

III.Sources of Information

Psychiatric Interviews were done with the following persons:

1. Jeneffer Cagay
2. Juanito Casugbo Jr
3. Jenelyn Cagay (Mother of Jeneffer)
4. Ronelyn Benigno (Sister of Jennefer)
5. Jun Rey Cagay (Brother of Jennefer)

IV. Dates of Interview:

Interviews and examinations of informants were conducted from April 15,

2023, to May 29, 2023.

Psychiatric Report Juanito Casugbo, Jr and Jeneffer Cagay 1

V. Statement of Confidentiality

The clients wave the right to confidentiality of information with full

knowledge that this psychiatric report will be used as evidence in a court of
law.

VI.Psychiatric History

a. Nature of the Problem

The series of psychiatric interviews and evaluations aim to determine the

presence of psychological incapacity as a basis for the annulment of marriage.

b. Marital History

i. Premarital

1. Introductory meeting and friendship

Juanito knew Jeneffer knew each other since she was still in grade school. He
used to be her father’s co-worker at Capiz Electric Cooperative, Inc.
(CAPELCO). Juanito is 14 years older than Jeneffer. She recalled that he
used to go to their house to hang out with his father. Several times they
spent the night drinking with friends. He would even dote on her as her
younger sister. In reciprocation, Jeneffer regarded him as her older brother.

2. Courtship

When Jeneffer was in her final year in college, she was tasked to do on-the-
job training (OJT). She chose to do it in CAPELCO. While there, Juanito
became extra close to her. He spent time longer than usual in the office so he
can be with Jeneffer. He would wait for her during break time and lunch so
he can invite her to dine with him. Jeneffer was comfortable with him
because she grew up regarding him as her older brother.

Psychiatric Report Juanito Casugbo, Jr and Jeneffer Cagay 2

 As they spent more time together, Jeneffer and Juanito soon regarded
themselves to be more than having just a brother-sister relationship. When
they went out it was becoming more like a date. When her father saw what
was happening, she cautioned Jeneffer. He told her that Juanito is not good
to be her boyfriend. He knew his behavior because they have been co-workers
for a long time. As claimed by her mother, her father told Jeneffer that
Juanito is an alcoholic, stubborn, and rigid with his beliefs. He was often at
odds with people in the office. Jeneffer however did not see such behavior
with him during that time. Despite the warnings of her father, Jeneffer
continued seeing Juanito. To her was gentle and very generous. For a college
student who was showered with attention and gifts, Juanito was a breath of
fresh air from the seeming situation of wanting that Jeneffer had.

Several months after her OJT in CAPELCO, Jeneffer accepted Juanito to be

her boyfriend. They claimed that they did not mind the 14-year age gap
between them. During that time, Jeneffer was barely 18 years old and
Juanito was 32 years old. As a boyfriend, Juanito was regarded by Jeneffer to
be generous, but he was very possessive. He monitored the movements of
Jeneffer and would reprimand her if he suspected that she might be flirting
with other men. For Jeneffer it seemed like it was his endearment and it
made her feel special.

Jeneffer soon finished her OJT at CAPELCO and she graduated from her
two-year Computer Programming course. She applied for work and was
accepted at Gaisano Mall. Juanito however did not let go of her. They
continued their relationship and Juanito was often seen hanging out in
Gaisano waiting for Jeneffer. Still, as alleged, he was very possessive and
jealous. He would reprimand Jeneffer if he think that she was flirting with a
customer.

As his lover, Jeneffer became open to the physical advances of Juanito. They
became intimate and soon they have carnal knowledge of each other. It was
not long before Jeneffer became pregnant.

3. Engagement, Marriage Decision, and Planning

When Jeneffer missed her monthly period, she was alarmed and when she
tested herself for pregnancy, it turned out to be positive. She was scared and
worried about what her parents might do to her. When she told Juanito about
this, he was nonchalant. He told her that he will not run away from his
responsibility. When Jeneffer’s parents learned about her circumstances they
were livid with disappointment and embarrassment. They called Juanito and
his family who in turn offered marriage. Jeneffer’s father was very hesitant
about the planned marriage. However, he consented in the end because he did
not want to humiliate their family.

Psychiatric Report Juanito Casugbo, Jr and Jeneffer Cagay 3

 The preparation for the wedding of Juanito and Jeneffer was not at all
smooth. There were disagreements between the two parties as to whose
desires will be followed. On the eve of the wedding, while they were preparing
for the next morning’s ceremony, the two families confronted each other. The
family of Jeneffer expects that the preparation should be at their residence,
being the bride. However, Juanito’s family had a separate preparation at
their house. There were a lot of heated arguments between them and there
was a threat of physical violence ensuing. Jeneffer thought that her wedding
will not push through. The neighbors eventually called the police who
mediated between the feuding families.

ii. Marital

1. Wedding

The wedding took place on April 25, 2009, at 8 in the morning at Santa
Teresa de Avila Parish in Loctugan, Roxas City. It was officiated by Rev. Fr.
Ramon Hontiveros, Parish Priest. The members of the family of both couples
were present during the ceremony. They also had a handful of godparents
whom they picked from people who were close to them or had important roles
in their community.

A grand banquet was prepared after the wedding. It was well attended by
their friends, guests, and relatives.

2. Honeymoon

The couple did not have a honeymoon. They reasoned that she was already
pregnant so there is no need for one.

3. Life as a married couple

After the wedding, the couple temporarily stayed at Jeneffer’s house. It was
not a pleasant start-up for the couple as the feud between their families
continued. Jeneffer narrated that one afternoon she strolled away from their
house. She was pregnant and she wanted to have some exercise. She later
learned of a commotion in their house. The family of Juanito came and they

Psychiatric Report Juanito Casugbo, Jr and Jeneffer Cagay 4

 demanded that they should be living in their house and not in Jeneffer’s.
During the quarrel, Jeneffer alleged that her mother was hurt in a seeming
tug-of-war between the families. They were later brought to the barangay
office to have it settled. Jeneffer said that the issue was not settled for more
than a year. Later Juanito and Jeneffer decided to build a house of their own,
several meter’s away from Juanito’s parents.

Jeneffer claimed that Juanito started to become verbally abusive, right after
their marriage, but most notably after the birth of their first child. She said
that he was home drunk every day. Each time he was inebriated, he was
garrulous and would talk about a lot of things, especially those things that he
has not moved on. What scared Jeneffer was Juanito did not have any sense
of propriety when he gets mad. Several times he became unruly in public
which was very humiliating for Jeneffer. Their children could not sleep and
rest if he was drunk because of his aggressive and threatening behavior.

The alcohol problem of Juanito however was just part of what Jeneffer
dreaded. Since they got married, his jealousy became worst. He was
suspecting any man who get in touch with Jeneffer to be having an affair
with her. Her younger brother cried foul when he was accused of Juanito to
be having an affair with her because they were seen endearing each other.
The riders who were delivering food and items were also suspected.

Jeneffer claimed that 11 months after she delivered their firstborn, she again
got pregnant. She said that one evening, Juanito came home drunk. While he
was talking incessantly, he kicked Jeneffer and she fell out of bed. She was
scared that something might happen to her baby. The couple again had a
very nasty squabble.

In 2018, Jeneffer’s father died. She then decided to work. She was accepted
into Shakey’s Pizza. Jeneffer claimed that the jealousy of Juanito worsened
because of this. He suspected a co-worker as Jeneffer’s lover. He tried to
monitor the actions of Jeneffer and that co-worker. When her schedule was
on the closing time and she went home late, Juanito would be fuming mad.
He would accuse her of spending time with that co-worker. In the middle of
the night or early morning, the couple can be seen and heard shouting at
each other.

Jeneffer alleged that several times she tried to separate from Juanito. She
desired to have a complete family which made her rethink her decision. She
did not want her children to go up away from their father, so each time she

Psychiatric Report Juanito Casugbo, Jr and Jeneffer Cagay 5

 left their house, she made it a point to go back when things were okay
already. Jeneffer claimed that Juanito had a very childish attitude and was
very sensitive to the remarks and feedback of others. He was jealous not only
of Jeneffer but of the state of other people as well. He observed that he tends
to covet what their neighbors have. He needed attention all the time and
could not graciously accept defeat, even with just mere conversations. He
hates when someone gives him counsel. He despised it when someone
meddles with his affairs. Several times he was observed to be throwing food
given by neighbors because he distrusts them.

Juanito thinks he is not the problem. It was rather Jeneffer who is at fault.
He accused her of not being able to manage their household effectively. He
claimed that he was giving all of his salary to her but she misuse it. He
accused her of drinking and gambling. He alleged that he loaned a hundred
thousand pesos from a certain bank and gave half to Jeneffer. He said that it
was supposed to be her capital for a small sari-sari store. However, the store
went bankrupt because she was not always in the store. Rather, he can see
her roaming around the neighborhood either gossiping or gambling. He
lamented at how he was ostracized by the family of Jeneffer, especially her
father. He said that he recalled her father saying to him that he regret being
his son-in-law. He claimed that it was probably because he belonged to
another religion before he married Jeneffer. He converted back to
Catholicism so he can marry Jeneffer in a Catholic Church. He howled that
until now, he has not reconciled with his old faith.

Juanito was strongly convinced that Jeneffer was having several

extramarital affairs. His strongest suspect was her co-worker at Shakey’s. He
alleged that one Monday morning he went to Shakey’s and Jeneffer was not
there. But he also said that it was her day off. He reckoned that she went to
meet her co-worker and they had a tryst because when he saw Jeneffer that
afternoon she was resting on their bed.

4. Child/Children

1. Jeannie Casugbo, born on September 16, 2009

2. Marckly Casugbo, born on November 4, 2011
3. Micah Mae Casugbo, born on December 26, 2012

Psychiatric Report Juanito Casugbo, Jr and Jeneffer Cagay 6

 iii. Post Marital

1. Separation and Decision to Separate

The crux of the couple’s marriage happened on September 29, 2019. For some
time before such time, they have been treating each other coldly. Both
claimed that they were there just for the children. Jeneffer was already lying
in bed and the lights were off when Juanito came home drunk. Juanito
claimed that he accidentally kicked Jeneffer. However, she said that it was
deliberate on his part. Irritated by his behavior, Jeneffer immediately turned
on the lights and confronted Juanito. A heated argument followed which later
prompted Jeneffer to say that she was leaving. As alleged, when Juanito
heard such words, he quickly grabbed a knife on top of their refrigerator. He
then thrust the knife several times at Jeneffer. She tried to block him with
her arms but she was hit in the neck. Their children were screaming as they
saw blood spurting out of their mother’s body. She was bathed in blood as the
knife hit a major blood vessel. Jeneffer was quick in applying pressure to her
wound. As alleged, Juanito did not stop there, he grabbed a pillow and tried
to suffocate his wife. Jeneffer said that she can see murder in his eyes. He
was said to be saying that if she will leave him, it was better for him to just
kill her than other people will make use of her.

The children were traumatized by what they saw. The eldest and second
children scrammed and asked for help. The help came just in time and she
was rushed to the hospital. She was in the operating room for several hours
and was placed in the intensive care unit for several weeks. She was on a
respiratory ventilator for several days as several vital parts of her neck were
injured.

Jeneffer survived the ordeal. Juanito was allegedly not supportive in any
way. As claimed, he never showed up in the hospital. It was Jeneffer’s sister
who provided help and support. When she went out of the hospital, they were
faced with a tremendous hospital bill, which according to Jeneffer’s sister
claimed, they are still paying now.

They filed a complaint against Juanito but in the end, they just settled for a
compromised agreement. Jeneffer claimed that she did not want their
children to have a father who is a convict. As agreed, Juanito has to give
support to their children. However, Jeneffer’s family alleged that for two (2)
years he was not giving support. And when he finally gave money, it was
allegedly not enough.

Psychiatric Report Juanito Casugbo, Jr and Jeneffer Cagay 7

 2. Post Separation

Currently, Jeneffer and their three children are living separately with
Juanito. Since she does not have a formal job, she has been dependent on the
support of her siblings. She claimed however that she found peace and
comfort being away from the tormenting and agonizing moments with
Juanito. Their children are in school and would visit their father from time to
time.

Juanito on the other hand continues to work in CAPELCO and does side-line
jobs on weekends. He claimed to be close to his children and gives them
financial support. He still drinks at least one bottle (“lapad”) of whiskey every
night to soothe his nerves. He still maintains that the incident on September
29, 2019, was Jeneffer’s fault and she still has several extramarital
relationships. The couple has not been in communication since they parted in
2019.

3. Family, Personal, Social, and Occupational History

Juanito

Juanito is a native of Brgy Bago, Loctugan, Roxas City, Capiz. He is the

fourth of the nine (9) siblings in the family. He was only nine (9) years old
when his mother died. His father remarried five (5) years after. He then had
another four (4) siblings in his father’s second marriage. Juanito claimed that
life has never been the same without her mother. Although his stepmother
was also caring, he felt unloved and seemingly abandoned. He claimed that
her stepmother would always give priority to her children. Since there are 13
children in the family, Juanito became no stranger to deprivation. From the
basic needs of food and clothing to his emotional and psychological needs,
Juanito as a child has been wanting.

Juanito started his education at Tanque Elementary School in Roxas City. As

a pupil, he was observed to be a bit reserved and shy with people whom he
did not know. However, he was animated if he was with people whom he
trusted. In terms of academic performance, Juanito was average. He passed
his subjects along with his peers. He participated in school activities as

Psychiatric Report Juanito Casugbo, Jr and Jeneffer Cagay 8

 required by his teachers. He transferred to the now Don Gervacio Diaz
Elementary School in Bago, Loctugan, Roxas City when his mother died.
When he was in the fifth and sixth grades, he went to Calamba, Laguna. He
had an uncle there who took care of him. He pursued his education and
finished his elementary education in Calamba.

Juanito claimed that life was difficult for him during grade school. Not only
did he lose his mother, but he was deprived of a lot of things as well. He
remembered that he went to school with only rice and a piece of locally made
chorizo as his lunch. Whenever he was given money as an allowance, it would
not be more than fifty centavos. Since they did not have enough money,
Juanito and his siblings walked to and from school every day. They barely
had new clothes as other priorities prevailed. He remembered having to sell
ice candy for him to buy new shirts.

After graduating from grade school, Juanito moved back to Roxas City. He
pursued high school at Roxas City School for Philippine Craftsmen. This
school was originally a home industries school conceive to provide training to
out-of-school youths and adults in line with the government's trust in
promoting cottage industries. He was still a high school freshman when his
father required him to help in their repair shop. He however claimed that this
was not new to him because as a child he grew up watching his father do car
repairs. In high school, Juanito had several crushes but he did not have the
courage to court or pursue them.

After high school, Juanito has to take a break from school because of financial
difficulties. For a while, he worked in the shop of his father. Later his father
proposed that he will go to a maritime school. However, he refused. He
wanted to become a chemist because he believed that he is intelligent. As a
compromise, he agreed to a two-year automotive course.

When Juanito was already in college, he said that he left home. He said that
he wanted to flee from her stepmother who did not treat him and his siblings
well. He went to live with his grandparents. When he obtained his automotive
degree, Juanito was hired by Capiz Electric Cooperative, Inc (CAPELCO). It
was in CAPELCO when he developed a relationship with Jeneffer, an OJT.
Later Jeneffer became his wife.

Psychiatric Report Juanito Casugbo, Jr and Jeneffer Cagay 9

 Jeneffer

Jeneffer was born and raised in Brgy. Adlawan, Roxas City, Capiz. She is the
third of seven (7) siblings in the family. She has four (4) brothers and two (2)
sisters. His father used to work on the farm then later he became a painter at
Capiz Electric Cooperative, Inc (CAPELCO). As a child, Jeneffer was
observed to be friendly and well-mannered. She was obedient to her parents
and her elders. Her mother said that she did not have much problem with
Jeneffer growing up.

Jeneffer had her basic education at Adlawan Integrated School, Roxas City.
As a pupil, she was average in terms of academic performance. She was a bit
shy and withdrawn in school. She joined activities as required by her
teachers, otherwise, she would prefer to go home and play during her vacant
hours. During weekends, Jeneffer was expected by her mother to help with
their domestic chores and she complied joyfully.

After grade school, Jeneffer went to Capiz National High School for her
secondary education. Like in grade school, the performance of Jeneffer inside
the classroom is average. She passed her subjects and she was promoted to
the next level at the end of each school year. Jeneffer confessed to having
several crushes during high school. She however did not have any motivation
to have a relationship because she was scared of her parents.

Jeneffer went to Hercor College in Roxas City after high school. She pursued
a degree in computer programming. This is a two-year program that Jeneffer
finished on time. When she was in her second year, someone courted her.
They had a brief relationship as her boyfriend went to Manila. When he was
there their communications faltered. After some time, they just deemed
themselves separated.

In her final year in college, Jeneffer and her classmates were required to do
On-the-job training. She chose CAPELCO because her father also worked in
such a place. While in CAPELCO she became close to Juanito. Soon she
married him.

Psychiatric Report Juanito Casugbo, Jr and Jeneffer Cagay 10

VII. Mental Status Examination

Juanito

General Appearance, Behavior, and Attitude: Juanito was seen in

the house of his boss in Panay, Capiz. He was repairing a vehicle when
the undersigned caught up with him. He was dressed in a white shirt
with a thick jacket and a hoodie even when it was around 38 degrees
Celsius. His face was flushed and his hands had fine tremors. He was at
first seemingly hostile but when the undersigned introduced himself he
calmed down and offered a seat. He became cooperative and responsive
to questions and queries.

Speech: Juanito spoke at a rather fast rate and a higher tone of voice
with a normal rhythm. No speech patterns indicative of a neurological
deficit were noted.

Mood and Affect: Juanito had a euthymic mood and could express a
full range of emotions. His mood is appropriate with his affect. At times
during the interview, he can be seen irritated and disgusted especially
when he was talking about the alleged infidelity of his wife.

Perception and Thoughts: Juanito denied having delusions or other

psychotic symptoms. However, when he was talking about the alleged
infidelity of his wife, the concreteness of his thinking can be appreciated.
His belief about the philandering behavior of his wife is tantamount to
having paranoid delusions. He denied having phobias. He talked at
length justifying his behavior and the circumstances that led him to stab
his wife on September 2019.

Sensorium and Cognition: Juanito was oriented to time, place, and

person. No obvious deficit in memory was noted, although a formal
memory test was refused. Other tests in executive functioning were not
fully done because he refused.

Impulsivity: At the time of the interview, Juanito showed fair impulse

control.

Insight and Judgment: Juanito has fair test judgment and poor
insight.

Psychiatric Report Juanito Casugbo, Jr and Jeneffer Cagay 11

 Jeneffer

General Appearance, Behavior, and Attitude: Jeneffer was initially

interviewed at the clinic and subsequent interviews were done via
internet video. She came in a black and white polka dot blouse, a denim
jacket, and dark plaid pants. Her shoulder-length hair was tied at the
back and she was wearing eyeglasses. She was clean and dressed
appropriately for her age and social status. Jeneffer was cooperative and
attentive to the undersigned. She responded to questions and cues
appropriately.

Speech: Jeneffer generally spoke in a normal tone of voice with a

normal rate and rhythm. At times, she spoke with a high pitch to
emphasize a point. She answered questions directly and with confidence.
No abnormal speech patterns were noted.

Mood and Affect: Jeneffer had a euthymic mood and could express a
full range of emotions. Her mood was appropriate with her affect. She
denied having depressive symptoms or suicidal ideas. She showed
disdain for the behavior of her husband and recalled how this has
traumatized her emotionally, psychologically, and financially. She cried
at one point as she recalled one of her challenging situations. She denied
having anxiety symptoms.

Perception and Thoughts: Jeneffer's thinking was linear, logical, and

coherent. She denied having delusions or other psychotic symptoms, and
there was no apparent perceptual disturbance noted upon further
observation and examination. She denied having phobias.

Sensorium and Cognition: Jeneffer was capable of sustained attention

to environmental stimuli and was oriented to time, place, and person. No
deficit in memory was noted, and she demonstrated good concentration,
attention, and calculation skills. She has adequate information, good
abstraction, good proverb interpretation, and good visuospatial ability.

Impulsivity: At the time of the interview, Jeneffer showed good

impulse control.

Insight and Judgment: Jeneffer has good test judgment and good
insight.

Psychiatric Report Juanito Casugbo, Jr and Jeneffer Cagay 12

VIII. Physical and Neurologic Examination

Jeneffer

Physical Examination showed prominent scars on her neck area which was
reminiscent of the stab wound she sustained on September 2019. The rest of
the physical examination and neurological examinations of Jeneffer were
within normal limits and with no remarkable findings.

Juanito

Physical Examination showed flushing of the face and tremors of the hands
indicative of possible beginning withdrawal symptoms. The rest of the
physical and neurological examinations of Juanito were within normal limits
and with no remarkable findings.

IX. Psychiatric Diagnoses

Juanito

301.0 (F60.0) Paranoid Personality Disorder

305.00 (F10.10) Alcohol Use Disorder

Jeneffer

None

Psychiatric Report Juanito Casugbo, Jr and Jeneffer Cagay 13

X. Forensic Opinion

a. Basis for Diagnosis

Based on the Diagnostic and Statistical Manual Fifth Edition (DSM-5)

criteria, Juanito fulfilled the diagnosis of Narcissistic Personality
Disorder (NPD). This is evident in the history provided by the
informants. Specifically, Juanito has shown:

A pervasive distrust and suspiciousness of others such that their

motives are interpreted as malevolent, beginning by early adulthood
and present in a variety of contexts, as indicated by six of the seven
symptoms:

1. Suspects, without sufficient basis, that others are exploiting,

harming, or deceiving him

2. Is preoccupied with unjustified doubts about the loyalty or

trustworthiness of friends or associates.

3. Is reluctant to confide in others because of unwarranted fear

that the information will be used maliciously against him or
her.

4. Reads hidden demeaning or threatening meanings into benign

remarks or events.

5. Persistently bears grudges (i.e., is unforgiving of insults,

injuries, or slights).

6. Has recurrent suspicions, without justification, regarding

fidelity of spouse or sexual partner.

Psychiatric Report Juanito Casugbo, Jr and Jeneffer Cagay 14

 Also based on the DSM-5 criteria Juanito fulfilled the diagnosis of
Alcohol Use Disorder (AUD). Specifically, Juanito has shown:

A problematic pattern of alcohol use leading to clinically significant

impairment or distress, as manifested by ALL of the diagnostic criteria,
occurring within a 12-month period:

1. Alcohol is often taken in larger amounts or over a longer period

than was intended.

2. There is a persistent desire or unsuccessful efforts to cut down

or control alcohol use

3. A great deal of time is spent in activities necessary to obtain

alcohol, use alcohol, or recover from its effects.

4. Craving, or a strong desire or urge to use alcohol.

5. Recurrent alcohol use resulting in a failure to fulfill major role

obligations at work, school, or home.

6. Continued alcohol use despite having persistent or recurrent

social or interpersonal problems caused or exacerbated by the
effects of alcohol.

7. Important social, occupational, or recreational activities are

given up or reduced because of alcohol use.

8. Recurrent alcohol use in situations in which it is physically

hazardous.

9. Alcohol use is continued despite knowledge of having a

persistent or recurrent physical or psychological problem that is
likely to have been caused or exacerbated by alcohol.

10.Tolerance, as defined by either of the following:

1. A need for markedly increased amounts of alcohol to
achieve intoxication or desired effect.

2. A markedly diminished effect with continued use of the

same amount of alcohol.

Psychiatric Report Juanito Casugbo, Jr and Jeneffer Cagay 15

 11.Withdrawal, as manifested by either of the following:
1. The characteristic withdrawal syndrome for alcohol

2. Alcohol (or a closely related substance, such as a

benzodiazepine) is taken to relieve or avoid withdrawal
symptoms.

b. Psychodynamic Formulation

The evolution and development of a personality disorder trace its roots in

the person's childhood. The eventual character and the kind of
relationship the person may establish as an adult may largely depend on
the pattern of interpersonal relationships the person received as a child.
Understanding interpersonal relationships at multiple levels of analysis
will help define psychopathology, describe the preconditions and
contexts, and understand its origins and nature. (Sroufe, 2000)

More than three decades of research have established two fundamental

dimensions of parenting as risk factors for psychopathology: (1) harsh
treatment (hostility, criticality, rejection); and (2) lack of clear, firm
discipline or supervision (e.g., Farrington et al.,1990; Maccoby & Martin,
1983; Patterson, Debaryshe, & Ramsey, 1989). These factors together,
and in interaction with other variables, are often especially predictive
and at times capable of differentiating various pathological outcomes.

Paranoid Personality Disorder describes individuals characterized by

suspiciousness, mistrust, irritability, and emotional coldness. They
appear hypervigilant about anticipated dangers and are likely to put
others on the defensive by being accusatory and judgmental. These
persons perceive and act upon the environment in this manner all the
time. In paranoia, the impulse and its derivative ideational content are
projected onto the environment where it can be defended externally.

In Paranoid Personality, there is a constant flow of aggressively

determined projections from the patient to the environment that
establishes a world that is dangerous. This world becomes the reification
of the patient's intolerable feelings and thoughts. The relationship with
the world and its occupants is understandably dangerous given that it is

Psychiatric Report Juanito Casugbo, Jr and Jeneffer Cagay 16

 constantly being populated by these aggressively determined projections.
The internal world of the patient is prevented from maturing beyond the
infantile level given that the negative part-objects are being projected
and are thus unavailable for integration with the positive part-objects
that are retained. A vicious cycle ensues such that the projections are
reintrojected as perceptions of hostility and danger. An intensification of
the splitting process keeps the patient's libidinally determined part-
objects (positive part-objects) from being contaminated by these
perceptions of danger and affords a false sense of objectivity and
perspective. The patient has effected an internal polarization of
aggressive and libidinal part-objects with the former being attributed to
the perception of external events and the latter to the patient's rational,
objective mind. Emotional restrictiveness would be a by-product of a
process that maintains the basic simplicity of good-bad, me-not-me
distinctions caused by the splitting defense. This restriction of affect is
typical for this character.

With all of the above descriptions of the psychodynamic machinations, it

must be remembered that these processes are not operating independent
of reality. Cameron (1963) notes that the origin of the Paranoid
Personality is likely an environment that was hostile, unloving, possibly
abusive, but certainly not conducive to the development of basic trust.

With these theories discussed above, one can safely infer that Juanito’s
disorder has been fostered by the hostile, unloving ang possibly abusive
environment he endured during childhood. His mother died when he was
in grade school. His father remarried but Juanito has not felt the
sympathetic connection with his stepmother. Having 13 children in the
family, one can only surmise the hardship, deprivation, and distress he
had to endure which created an environment where a paranoid
personality disorder can thrive.

Alcoholism is one of the most common psychiatric disorders. A

Department of Health Survey in 2021 revealed that around 40.1 percent
of Filipino adults drink alcohol while 15.5 percent are tobacco smokers,
(https://www.philstar.com/nation/2021/08/18/2120717/40-pinoys-
drink-15-smoke-doh-survey). Alcohol is a potent drug that causes both
acute and chronic changes in almost all neurochemical systems. Thus
alcohol abuse can produce serious temporary psychological symptoms
including depression, anxiety, and psychoses. Long-term, escalating
levels of alcohol consumption can produce tolerance as well as such

Psychiatric Report Juanito Casugbo, Jr and Jeneffer Cagay 17

 intense adaptation of the body that cessation of use can precipitate a
withdrawal syndrome usually marked by insomnia, evidence of
hyperactivity of the autonomic nervous system, and feelings of anxiety.
Therefore, in an adequate evaluation of life problems and psychiatric
symptoms in a patient, the clinician must consider the possibility that
the clinical situation reflects the effects of alcohol. (Kaplan 2006)

Many factors affect the decision to drink. An interplay between genetic

and environmental influences contributes to many medical and
psychiatric conditions, and, thus, a review of these factors in alcoholism
offers information about complex genetic disorders overall. Alcohol use
disorder runs in families, with 40%-60% of the variance of risk explained
by genetic influences. The rate of this condition is three to four times
higher in close relatives of individuals with alcohol use disorder, with
values highest for individuals with a greater number of affected
relatives, closer genetic relationships to the affected person, and higher
severity of the alcohol-related problems in those relatives. A three- to
fourfold increase in risk has been observed in children of individuals
with alcohol use disorder, even when these children were given up for
adoption at birth and raised by adoptive parents who did not have the
disorder. A variety of theories relate to the use of alcohol to reduce
tension, increase feelings of power, and decrease the effects of
psychological pain. Perhaps the greatest interest has been paid to the
observation that people with alcohol-related problems often report that
alcohol decreases their feelings of nervousness and helps them cope with
the day-to-day stresses of life.

The psychiatric diagnoses most commonly associated with alcohol-

related disorders are other substance-related disorders, antisocial
personality disorder mood disorders, and anxiety disorders. Although the
data are somewhat controversial, most suggest that persons with
alcohol-related disorders have a markedly higher suicide rate than the
general population. (Kaplan 2006)

Juanito justified his use of alcohol as his coping against the challenges in
his environment. He claimed that his use became worst after his
marriage when he always felt distressed by the alleged infidelity of
Jeneffer and also her inability to manage their household well.

The marriage of Juanito and Jeneffer is a union meant to shatter from

the start. Jeneffer was not ready to become a wife or a mother at 18.

Psychiatric Report Juanito Casugbo, Jr and Jeneffer Cagay 18

 Juanito himself was not capable of rendering an environment of trust
where mutual understanding, care, and support can thrive. Jeneffer got
pregnant at a very tender age and they were forced to marry because of
parental and societal pressure. The blossoming of Juanito’s personality
disorder and the worsening of his alcohol problem hastened when he was
subjected to the rigors and challenges of marriage. Juanito’s disorders
prevented him from recognizing his shortcomings which posed a great
threat to the safety and life of Jeneffer and their children. What followed
was the eventual crumbling of their marriage.

c. Prognosis

There is no cure for Personality Disorders. These disorders are complex

in nature, and the defects in the character of these persons are woven
into their core personalities and are unlikely to change even with
intervention.

A person with Paranoid Personality Disorder very rarely seeks

intervention for their condition. Often they distrust others and it poses a
challenge for healthcare professionals because trust and rapport-
building are important factors of psychotherapy. As a result, many
people with PPD may not follow their treatment plan and may even
question the motives of the therapist. As in the case of Juanito,
intervention would be almost impossible considering that he is oblivious
to his condition and how his behavior has caused pain to others,
especially to Jeneffer and their children.

Alcohol Use Disorder is formidable to manage. Alcohol is widely

available in many forms. For someone who is constantly exposed to
stress, like Juanito, acquiring alcohol is very easy. Hence maintaining
him in an alcohol-free and stress-free environment would be impossible.
Denial is very prominent in the case of Juanito. This will prevent further
steps of intervention because Juanito will not acknowledge that he has a
problem.

At present, there is no known cure for Personality Disorders, and

Alcohol Rehabilitation Program is challenging. Alcoholic easily slips
back into their old habits. Hence, if Juanito and Jeneffer are forced to

Psychiatric Report Juanito Casugbo, Jr and Jeneffer Cagay 19

 live together, it will only bring so much frustration, despair, and trauma
to both of them, their children, and their significant others.

d. Recommendation

The symptoms of Juanito mentioned are severe in proportion, and it has

caused clinically significant impairment in his functioning as a husband.
He dismally failed in performing his role of providing the necessary
ingredients for a meaningful marriage. Specifically, Juanito has been
unable to fulfill the following obligations of marriage as stated in Title
III of the Family Code of the Philippines:

Art. 68. Juanito failed to live with Jeneffer and observe mutual love and
respect, and render mutual help and support.

Article 69. Juanito failed to fix the family domicile.

Article 70. Juanito failed to provide adequate financial support to their

family.

Art. 71. Juanito failed to manage their household.

This failure to fulfill these obligations did not stem from his mere refusal
to perform these tasks but mainly from his disorders, Paranoid
Personality Disorder and Alcohol Use Disorder. Personality disorders are
enduring and with no known cure. Alcohol Use Disorder can likewise be
very challenging to manage. The established history above clearly
showed that Juanito already manifested the symptoms of these disorders
before marriage and has contributed significantly to the failure of their
marital relationship. Juanito continues to display the symptoms of his
disorders up to the present day. The undersigned, therefore,
recommends, for the well-being of both parties, that their
marriage be nullified.

DIOSDADO V. AMARGO JR. MD, MMBM, FPPA

Psychiatrist
Room 238 SPICE Bldg.
St. Paul’s Hospital, Iloilo City
31 May 2023

Psychiatric Report Juanito Casugbo, Jr and Jeneffer Cagay 20