In all female patients diagnosed as cases of depressive reactions, separation was invariably one of the factors leading to the illness. The causes which combined to bring the woman to the brink of depression were several and varied. The last straw might be quite trivial or too obvious to be ignored—an unwanted pregnancy, a fight with her in-laws, a surgical operation, a sister ailing with a fatal disease, a religious retreat, a prolonged illness of a child, a neighborhood burglary, etc. The patient’s history revealed that she had been adjusting at an optimal level until something happened. This “something” was on the order of a separation from loved ones either in a literal or symbolic way. The emotional reactions immediately attendant to the separation might not be noticeable or obvious to the patient or her family. In retrospect, from this event could be traced the beginning inroads into her emotional equilibrium; and since that separation, things were never the same again. Following other psychological events, and depending on the load of stress they brought and the patient’s ability to utilize coping mechanisms, depression might be staved off for a shorter or longer period.

The separation aught be actual or symbolic, or it might merely be a threat, e.g., when husband had a serious heart attack. The most common symbolic separations were those involved in the growing up process as was described in the adolescent girl and the married groups. Getting married, without the time and opportunity to work out impending separations, was a frequent starting point for depressions. The ,nervous breakdown which came after the second or third baby, or after the supposed lack of husbandly attention or of acceptance by in-laws was merely an added insult to the original injury, which was the unresolved separation from the parents. How often the first regressive as well as reconstitutive steps consisted of a return to mother for a visit. The woman in menopause, who found herself increasingly alone, with her children grown-up and with a basically non-gratifying marital situation, experienced the same kind of separation-depression. She then tried to seek, whenever she could, the old ties to mother. If these were no longer available, there might be a sister or an aunt who was still around. Their presence helped significantly to keep the depression on less seif-annihilistic levels.

Actual separations, in terms of geographic distance, were taken poorly. The separations were occasioned by trips abroad by either husband or wife as part of work or study. The interesting observation, though, was that the depression occurred after the separation had terminated and reunion with the loved one had taken place. Often, several months or a year had already elapsed before the symptoms became obvious. Asked to recall their emotional state during the separation, they seemed to have repressed all the anguish and feeling of emptiness during that period. They had kept themselves busy with work, housekeeping, or a hobby; friends and relatives dropped in all the time. With pain and effort, they recalled memories of the terrible strain of the separation and the agonizing attempts they made to minimize or assuage the pains. One woman who went abroad for a doctoral degree, leaving a husband and two children behind, recalled how she wrote home every single day. There were several like her who did the same thing and regularly called by overseas telephone, some of them two or three times a week. A few became attached to a maternal figure, usually at the same place of work or study. This was usually an older woman who reciprocated the dependent relationship. Looking for co-Filipinos abroad was of course the first thing they did, but this was not enough unless a special relationship with one of them was formed.

It seemed easier for the woman to be left in the Philippines, with many of her old “security operations” readily available, than to leave. However, this mitigating factor did not avert the depression which followed. One woman1 whose husband had to be in Guam for a year, said she and her mother-in-law became very good friends which was about the last thing she expected to happen. They had always been at war and, in fact, upon the husband’s return, the hostilities resumed. Another patient, whose husband spent six months in Australia, recalled that during his absence, everything happened to her. She had an appendectomy, a tonsillectomy, and a sinus operation. A common recourse was to return to the parental home. Several women left in the province by their husbands, packed bag and baggage for Manila where in addition to relatives, they found less isolation.