[Second Opinion] Japanese punctuality, Filipino time

The author with friends at the summit of Mt. Fuji

by Gideon Lasco
Philippine Daily Inquirer

TOKYO — Whenever I’m in Japan, I cannot help but marvel at the people’s punctuality.

A recent experience was illustrative: My friends and I had just left Mount Akagi in Gunma Prefecture and were aboard the bus back to the train station, but just as it was about to depart, a passenger rose, talked to the driver, then faced the other passengers. In between apologetic bows, he asked if it was okay for us to wait for his friend who should be arriving in one or two minutes. He hadn’t even finished talking when his friend arrived, running. The friend was late for just over 30 seconds, but such a delay sufficed for him to make a public apology.

How did the Japanese acquire such an acute sense of time?

For a facile answer, one could cite a highly efficient and reliable transportation system — from extensive subway systems to the famed shinkansen — that makes it very easy for people to fulfill their commitments. Because it takes exactly 33 minutes from Asakusa to Shibuya via the Ginza Line, I know exactly which train to take if I’m meeting someone at Hachiko’s.

But even the Japanese who are in the Philippines are known to be punctual, which tells us that there’s more to their sense of time than the infrastructure that enables it.

Surprisingly, scholars aver that the Japanese sense of punctuality is actually a relatively recent phenomenon. Historian Takehiko Hashimoto notes that Westerners in the mid-19th century actually complained that the Japanese were always late! It was only decades later, as part of the Meiji-era reforms, that punctuality was institutionalized. Children, for instance, were instructed to arrive 10 minutes before the start of class.

A second wave of time consciousness — one that pervaded the people’s everyday lives — came after the war, aided by the proliferation of wristwatches, heavy industrialization, and the inculcation of Western values. Surely, this sense of time, too, fostered the rise of a hyperefficient transport system, making Japanese punctuality a “coproduction” of culture and infrastructure.

As for the Philippines, while it is easy to blame our tardiness on the traffic and the unpredictable weather — or label it as an immutable “mentality” — one way to look at it is to consider how time has always been relative, and not just in Einstein’s sense of the word.

Anthropologists point out that “clock time”—i.e., seconds, minutes, hours — is in itself a modern invention: Until very recently, events dictated the pace of the day in most societies. A colorful example of this “event time” is “alas-puno” — or when the jeepney leaves, not at a certain time, but when it is full. Moreover, temporal categories were broader: umaga, hapon, gabi—allowing for more pakiramdaman (“feeling each other”).

Even in professional contexts in the Philippines today, there is more leeway: Arriving one minute late will likely not merit an apology, but one hour would. Then there’s a “politics of time,” too: Some can arrive “fashionably late” because of—or to assert—their importance. Indeed, people’s conceptions of time are shaped by others’ expectations, even as these expectations also change over time.

Sometimes, I think the Japanese can be punctual to a fault: On a hike up Mount Fuji last year, our guides wanted to schedule everything — including sleeping and waking times — removing the fun in climbing Japan’s highest peak. My Nagoya-based friend Jeion also feels that the overreliance on schedules can lead to a “domino effect” when things go wrong. “Filipino time,” with its flexibility and improvisation, may be suited for situations beyond our control, or when time itself need not be micromanaged — as when one is on vacation.

But the Japanese sense of time remains a valuable trait, not just for self-improvement but also for national growth: It is no coincidence that the 1950s-60s — when the Japanese began to adopt their modern conceptions of time — also marked the beginning of their “economic miracle.”

What we should strive for, then, is neither a full dismissal of Filipino time nor a full embrace of Japanese punctuality, but the ability to make use of both.

Originally published in the Philippine Daily Inquirer: http://opinion.inquirer.net/106233/japanese-punctuality-filipino-time

Pacquiao-Mayweather: Sports and society in the Philippines

Thousands gather to watch a live telecast of the Pacquio-Algieri fight
in Puerto Princesa City Coliseum on November 22, 2014

by Gideon Lasco, MD

AMHERST, MASSACHUSETTS - In the aftermath of the Pacquiao-Mayweather fight, many commentators, both foreign and local, have pointed out how the Philippines “stood still” during the day of the much-awaited battle, how crime rates became zero (at least in some places), and how there were no vehicles in usually-crowded streets. The match, and Manny Pacquiao’s prospects for the future, will likely remain a “talk of the town” in the coming weeks and months.

This collective preoccupation with a sporting event has parallels throughout the world. Football matches in many parts of Europe and South America can be very hotly contested - sometmes leading to riots and even deaths. When Brazil was defeated 2-1 by Uruguay in the 1950 World Cup final, two spectators committed suicide, highlighting the gravity of the loss among the Brazilians. More than 60 years later, Brazil’s defeat by Germany in the 2014 World Cup semifinal by a shocking 7-1 margin produced a similar sense of national humiliation, even as the country continues to take pride in their legacy as winners of five World Cups.

In like manner, the Olympic Games is a focal point of national pride in many countries. From the parade of nations to the singing of the national anthems of the victors, the Olympics is overtly framed as a competition of nations. Which is why the fact that we have not yet won a gold medal in the Olympics continues to be a sore point, even as we have rightfully celebrated those who have valiantly represented our country, such as boxer Manseuto “Onyok” Velascomin a silver-earning run in the 1996 Atlanta Olympics, and Michael Christian Martinez, whose performance in a Winter (yes, winter) Olympics was well received by many Filipinos.

***

The role of sports in societies can be viewed in many ways. Geopolitically, sporting success can be viewed as symbol and substance of nations’ prestige and power. Sports can be analyzed in terms of its economics, for instance, how it is used to promiote global brands like Nike and Adidas, or how sports can have real economic value for young people who can get scholarships and employment through it - but often in exchange for being displaced from their hometowns. Sports can also be viewed as fostering certain values among young people, such as competition and teamwork. Others have pointed out how sports can perpetuate gender ideologies, exemplified by the hunky, hypermasculine athlete and the sexy, feminine cheerleader.

But aside from these various perspectives on sports and society, I want to highlight two things that sports can do to the lives of everyday people beyond the entertainment value that people derive from them.

First, sports has an imporant role in creating and cementing communities around the world. In the US, I saw, for instance, how Peruvians living in the same city would gather to watch the football game of Peru against other South American countries. During the Pacquiao-Mayweather fight, I was in St. Louis, Missouri and I joined our kababayan in watching a pay-per-view organised by a Filipino catering group. Last November, I watched the Pacquiao-Algieri fight at the Puerto Princesa City Coliseum, and the atmosphere was electric: from the people standing and singing the Lupang Hinirang along with Pacquiao’s hand-picked Christian choir from General Santos City, to the collective cheers that go with every Pacquiao punch. The fight may have been in Macau, but there was an immediacy and intimacy to what was happening. Sports is one of the arenas where we can stand united as a nation, being on the same side.

Aside from bringing people together, sports also provides nations with heroes that can inspire us and show us what is possible. Dr. Bryan Lim, a medical resident at the Philippine General Hospital, shared how patients - some with their IV lines in tow, gathered to watch the Pacquiao-Mayweather game with doctors, nurses, and staff. Dr. Lim was touched by the words of a elderly patient who kept shouting, “Manny, Manny!” in her frail voice. Afterwards, the kindly lola explains: “When I see Manny Pacquiao, it’s like seeing us poor people, we go through a lot of difficulty but we keep fighting, we never give up.”

***

Perhaps, in keeping with our own experiences, one of the most admired qualities that we see in our athletes is diskarte, the resourcefulness and grit to overcome the odds. Regardless of the outcome, we are inspired by the story of someone who overcomes poverty to reach the highest levels of global stardom. We are inspired by a teenager who overcomes asthma problems and manages to compete in the Winter Olympics, supported by his family’s life savings and the donations of friends. We are inspired by a dragon boat team, who, despite lack of funding, manages to win five gold medals in an international tournament, eating rice that they had brought from the Philippines in order to maximize what little money they had.

Indeed, sports has the power to forge communities and inspire nations through the athletes’ life stories. This should further motivate us to support our players whenever and wherever they represent our country. Some of them are already superstars, but for others, public recognition and support will go a long way.

Moreover, there are times when diskarte alone is not enough. For our athletes to even reach the world stage in the first place; for them to get that extra boost that spells the difference between silver and gold, we need our government to give the support that they badly need.

Amherst, MA
May 20, 2015

Making sense of "Bawal umihi dito" signs in the Philippines

by Gideon Lasco, MD

Bawal umihi dito: It is an ubiquitous injunction in urban spaces, often boldly painted onto walls, and it translates to "it is forbidden to urinate here". The audience? Filipino men, many of whom continue to take the liberty of emptying their bladders in front of walls, electric posts, and yes, jeepney tires. Go to any densely-populated nooks of the metropolis and there's no denying the pungent odor of piss, which ironically juxtaposes with the aforementioned sign, as if to affirm its relevance by its violation.

Occasionally, the sign is accompanied by the threat of fines, i.e. 500 pesos. In some cases, a municipal ordinance is even invoked, complete with penalties such as imprisonment, as if to make sure that the would-be audience will be convinced about the veracity and seriousness of the sign.

But the very existence of these signs call for some thoughts on this matter. What does it mean for our society? How does it bode for our future?

It is a masculine privilege to take a piss in a very convenient way; it is one of the most obvious gender differences a child observes as he or she grows up. The female toddler is laughed at when she pisses, which requires her to assume an inferior, I.e. squatting position. On the other hand, male children find it fun to manipulate their penises, "shooting it in the toilet bowl" when called for, among themselves; there is some experimentation, like as a contest of having the tallest, farthest stream of piss, an early exploration of sexuality. Today, "pataasan ng ihi"  it continues to be a metaphor for male rivalry. Developmentally, it precedes other forms of male contests, such as "palakihan" (having the largest penis). These things suggest that urinating is not seen as an embarrassing activity at all for many Filipino males; it may be labelled as mischievous, but it is not shameful.

It is very likely that for the longest time, nobody bothered to have male urinals, particularly in rural areas where the bare earth is still visible everywhere. After all, it only takes a few hours before the urine, and its smell, is drained by the soil.

But urbanization took place: villagers flocked to cities, and villages became cities. What was once soil was covered with cement; the open spaces became farther and farther away from people's homes. Backyards became smaller, and more people lived in lesser space.

Sanitation became a problem. Where nearby streams freely flowed through villages, carrying, in the cities, pipes and sewer systems were required, and with it, a financial cost, a need to subscribe to water. Comfort rooms, a taken-for-granted feature of modern living, became unreachable to many, especially the homeless, and those living in the slums. Those of us who have always lived with water faucets may likewise take for granted the availability of water, which in many areas have to be collected and transported to their houses. This is the origin of the term 'pila balde' - a queue of pails as they wait their turn for a fill of water. Some of those pails have come several hundred meters away, and having brought it thus far, you will not waste it just to rinse away urine.

I once had the opportunity to ask a slum dweller how she disposes of human waste considering that her houses consisted of a tiny room in a patch of iron sheets and wooden planks. "I just throw it away," she said laughingly, adding, "like a flying saucer".

There are no more open spaces in the city - save for the rivers, the lakes, and the ocean which have become the unfortunate receptacles of human waste and pollution. Of all the structures of the metropolis: the buildings, the subdivisions, the malls, the only one that is truly accessible to the general public is the street, and thus it is in the street where petty crimes happen, where money is earned in ways that skirt the boundaries between legal and illegal, and yes, it is the locus where offences such as urinating occur.

In 2003, the MMDA embarked on a program to populate the metropolis with pink urinals for men. More than a decade later, it is unclear whether this initiative have had an impact, which, given the number of men in the cities, would at best be minimal. In fact, in 2012, an INQUIRER article reports how a government audit found that, aside from millions of pesos wasted on the program, “...the purpose of procuring such urinals was not satisfactorily achieved as manifested by the foul smell coming from most of the urinals installed.” You could almost see the article's title coming: MMDA urinals leave stink in COA report. 

***

"Bawal umihi dito", as the MMDA experience shows, is not simply a numerical deficiency of toilets in our streets. It a sign that we have not fully come to terms with the urbanization of our society.  Not too ago, people lived with the bare earth and rolling streams which cleansed their environments. Alas, the habits of this bygone era persist in the city, which is a concrete jungle, where evaporation takes time and drainage takes forever.

Moreover, it is a symptom of the overcrowding of our cities, a shared adaptation to limited resources, a lack of access to water and sanitation, and the poverty of the environment.

Finally, it is an example of how people flaunt the law, how people know that not all laws are implemented, and how people who are 'madiskarte' can get away with many things in the country. It's not just Bawal umihi dito, but "Bawal tumawid dito" (you cannot cross the road here) and "Bawal magtapon ng basura" (you cannot throw away garbage) and many others that are oftentimes ignored. In this specific form of ordinance, we saw how it is permitted by cultural norms as a privilege of masculinity. I would argue that it is also enabled by a general attitude towards the law that is not helped by government officials being seen as lawbreakers, instead of lawmakers and law-abiding exemplars.

It will take more than municipal or city ordinances to cleanse the streets of putrid smell. It will take a nationwide effort to be disciplined in things large and small, a respect for the law which goes hand in hand with the respectability of the lawmakers and law enforcers, and inclusive growth that will reach the slums, the poorest of the poor. Finally, a civic consciousness should emerge that goes beyond "tapat mo linis mo" towards "tapat natin, linis natin".

Quezon City
January 7, 2015

Tagay: Why there's no Tagalog word for "cheers" and other notes on Filipino drinking culture

by Gideon Lasco, MD

I was with my family in a restaurant in Tagaytay, and the discussion went to wine. My brother-in-law, an American with a keen interest in Filipino culture, inquired about the Tagalog word for "cheers". To which, we couldn't come up with an answer. In social gatherings, "Cheers" is used, and in more informal settings sometimes men also use "kampay" which comes from the Japanese "kanpai"(乾杯). "We just use cheers, I guess," we replied, to his disappointment.

The question lingered in my mind, and I felt that to answer his question adequately, we need to look at Filipino drinking culture, which predates the coming of the Europeans.

When Magellan arrived in the Philippines in 1521, his and his men found alcohol being drank by the locals. Aquino and Persoon (2008:198) notes: "That the inhabitants prepared their own drinks and and were big drinkers were what the Spaniards discovered when they landed in the Visayas." Antonio Pigafetta, Magellan's chronicler, took note of the tuba, distilled wine from coconut, which he considered to be "stronger and better", comparing it to Spanish brandy (Fernandez, 2013). 

The tuba is still around, with the same process unchanged for several centuries, and so have other kinds of indigenous liquor, such as the lambanog of Batangas and Quezon, the basi of the Ilocos Region. When I went to Southern Cebu last year to climb a mountain, there was tuba available at the trailhead.

How do people drink these beverages? In what context? Drinking, as in many cultures around the world, is for celebrations, and for enacting social relationships (Heath, 1976). But what is interesting is the way liquor is drunk in the Philippines (2011:199).

Only one glass is used and a tangero (person assigned of pouring gin in the glass) is assigned. He pours out the same amount in the glass and passes it around, everyone drinking, with no one spared. The tagay ('shot') may be immediately followed by another shot of 'chaser' (water or Coca-Cola). This goes on in rotation until the supply ends or drinkers surrender or are 'dead drunk', whichever comes first.

(I must offer an addendum by saying that the tanggero doesn't always pour the same amount in the glass. When there are women in the group, he may put less, and when he wants to make someone really drunk, he puts more!) 

There are other niceties of this ritual, including offering the first portion to the ground, for the spirits. This draws on Filipino folk beliefs. There are unwritten rules, and participants are expected to join the drinking until the liquor has ran out. Finally, then there is the pulutan - the finger foods that come with the drink. I've had interesting forms of pulutan - dog meat in and raw fish in Batanes - and this ought to be an interesting topic for Nutritional Anthropology. 

Interestingly, it seems that tagay has always been part of Filipino drinking culture, as it appears in the earliest Spanish-Tagalog dictionaries. In the Miguel Ruiz vocabolario of 1630, an entry for tagay is as follows: 

La racion de vino ya echada en la escudilla que se da y deputa para uno, mana ang tagay mo: esta es tu racion o porcion de vino; Um: l. managay: repartir o dar de beber vino, o cosa que emborracha; y si. m. magtagay, an: aquien: y si. m. Pagtagayan, i. l. ipanagay.nombre: tagayan: la escudilla diputada para beber vino; Catagayan: una escudilla de vino. ff. Patagayin. y mejor. Papanagayin: a quien se manda dar de beber; y si. m. Papagtagayin, Patagayin:a quien, y si. m. Papagtagayan. ipa: l.ipapanàgay: el vino que; y si. m. ipapagtagay. sinonimos: tudyo, baric. Vide: singgàlong.

Then, as now, tagay is defined as the rationing of the liquor around the group using just one cup. Strikingly, this cup is also given a name in the same vocabulario passage, one that is familiar in street corners on Friday nights: tagayan.

Lending credence to the antiquity of this practice, the 'sharing of the glass' also figures in one of the most iconic scenes in Filipino history, the 'blood compact' between Miguel Lopez de Legaspi and Sikatuna (Katuna), where the two sealed their alliance by sandugo, means of sharing a glass of liquor mixed with their blood (see Aguilar, 2010 for an interesting discussion of the blood compact).

This, I believe, answers my brother-in-law's question. We do not say "cheers" because in our drinking culture, we do not raise our glasses and join them together, as Europeans do. This is because when we drink, there is only one glass. Thus, while we do bring our glasses together, we are joined in one glass, which is passed around in what we call 'tagay'. 

Today, beer has become a very popular drink in the country, and San Miguel Beer has become the iconic Filipino beverage. In cosmopolitan settings, so have cocktails and wines. But in much of the country, consumption of hard liquor - gin, rum, brandy, and of course tuba and lambanog - remains very high.

*** 

Whatever form the inuman takes, we do say "cheers", as we have already absorbed the word, just as we have acquired the word serbesa 'from the Spanish cerveza.  But we have a deeper idea of sharing, of coming together, which is the 'tagay', drinking with just one cup, signifying and substantiating the ties that bind us together.

Quezon City

January 7, 2015

REFERENCES

Aquino, D. M., & Persoon, G. A. (2011). TRADITION AND CHANGE: BEER CONSUMPTION IN NORTHEAST LUZON, PHILIPPINES. Liquid Bread: Beer and Brewing in Cross-Cultural Perspective, 7, 197.

Fernandez, D. G. (2013). Historias, Cronicas, Vocabularios: Some Spanish Sources for Research in Philippine Food. Budhi: A Journal of Ideas and Culture, 5(3 6.1), 259-275.

Francisco, J. (ed.) (1997). Bocabulario Tagalo by Miguel Ruiz (1630[1997]). Pulong: Ateneo de Manila University, Quezon City.

Heath, D. B. (1976). Anthropological perspectives on alcohol: An historical review. Cross-Cultural Approaches to the Study of Alcohol: An Interdisciplinary Perspective, 41-101.

Pasalubong, pabaon, utang na loob, and Marcel Mauss' notion of gift exchange

by Gideon Lasco, MD

I was in Russia with a group of Filipinos last month and on our last full day in Moscow, we devoted a big amount of time visiting the Izmailovsky Market, touted by tourist brochures as a ‘souvenir paradise’. As soon as we arrived, my friends lost no time in buying Matryoshka dolls of all sorts of styles and sizes. The ones who bought the most number are those who worked in big companies or government institutions. “Syempre pagdating mo hahanap ka nila ng kahit ano, maski keychain!” (“Of course when you get back, they’ll look for something from you, even just a keychain!”) Another companion, realizing that what she had just bought for her mother was just the price of a mineral water bottle in Moscow, said: “Nakakahiya naman, eto lang ang iuuwi ko!” (“This is so embarrassing, [if] this is all I’ll bring home!”) and she proceeded to buy a more expensive one.

We Filipinos have all sorts of gift-giving opportunities (or responsibilities). The one I described in the above illustration is the institution of pasalubong: a traveller is expected to bring back souvenirs for his family and friends. Through repetition and diffusion of ideas, the pasalubong becomes ‘ritualized’ and ‘standardized’ for particular places: for Davao, durian candy; for Baguio, a walis tambo (broom) or else peanut brittle, and for those coming abroad, chocolates, keychains, canned goods. Whenever my father goes on foreign trips, we as children were always entitled to ask for one pasalubong each.

Another institution is the pabaon, in which a visitor is given gifts in the places he visits. Whenever I visit my relatives in Negros Occidental, they would make sure that I have a box full of local delicacies to take home with me. Knowing their propensity for pabaon, I have to be careful in mentioning things that I wish to buy, or even things that I admired in their house, because they will be sure to buy it themselves - or give it to me.

Marcel Mauss in his classic The Gift says that gifts are “in theory voluntary but in fact they are given and repaid under obligation” (1990:1); attached to them are obligations both on the part of the giver and recipient, encouraging reciprocity, fostering solidarity and strengthening social ties. Gifts speak of the giver’s generosity, prestige, and wealth, and the recipient’s ability to match the giver’s good virtues.

Our gift-giving institutions can be used to support Mauss’ theory, and I can say this from an emic perspective. For the traveller who comes home, the pasalubong he brings back serves a way to attach value to particular people he missed during his time away from home. The pabaon and pasalubong becomes a vessels through which social relations can travel, and geographic and social distances are bridged.

When important favors are requested and given, another important concept comes up: that of utang na loob. Often translated as ‘debt of gratitude’, this value suggests that there are particular favours rendered that cannot be quantified or repaid in monetary terms. The only way to ‘repay’ it is to return the favour when an opportunity arises. A doctor who offers free medical consultation to a lawyer can expect free legal advice in the future. One cannot find a more Maussian example of gif exchange in the Philippines than the concept of utang na loob.

Gift-giving traditions, however, can be dysfunctional, too. I have relatives in the United States who said that the ‘enormous cost’ is hindering them from coming home to the Philippines. “But the airfares are not expensive anymore!” I countered, only to hear an interesting rebuttal: “It’s not the airfare that’s expensive, it’s having to buy pasalubongs for everyone!” Here, we see how an institution that is supposed to mediate social relations instead becomes a hindrance for them.

Then there are the gift exchanges during the Christmas season: they  are so institutionalized that it sometimes become routine and meaningless, as when picture frames and cheap wines accumulate during Christmas season. I am even hearing a new term, ‘regift’, which happens when a person who receives a gift passes it on to another person as his own gift. The spirit of gift-giving is gone; it is seen as an obligation, which people seek to fulfil as easily as cheaply as possible.

Then, of course, there is utang na loob, which enacts an allegiance on the part of the recipient to the giver, can get in the way of other allegiances, including professional ones; when utang na loob is invoked to override even national laws, it gets in the way of national progress. Dominating today are headlines about Janet Napoles, the businesswoman who is alleged to have institutionizeed corruption in the upper echelons of government. Anecdotes about a senator being given a 65,000-peso Mont Blanc pen as a ‘gift’ raise the question of ethical conduct, because of the expectation of reciprocity implicit in such an act. In fact, in other countries there are laws that criminalize politicians’ receiving of gifts – or failure to declare the like - to avoid exactly that. But how can one draw a line between the personal and professional? When students give gifts to their teachers; when employees give gifts to their employers; and when a private citizen gives pabaon to the assessor who just visited his own house to calculate property taxes, we see how institutions can be both functional and dysfunctional in our everyday lives.

Gifts, meanwhile, remain a powerful institution, a valuable currency and medium of social interactions in the Philippines.

Manila
September 2012

REFERENCES

Mauss, M. (1990). The Gift: The Form and Reason for Exchange in Archaic Societies, trans. WD Halls. New York and London: WW Norton.

Circumcision or Mutilation? A critical appraisal of a study that finds PTSD among circumcised Filipino boys

A boy gets circumcised during a surgical mission in Palawan, Philippines (Gideon Lasco, 2014)

A critical appraisal of the study entitled “Ritual and Medical Circumcision among Filipino boys: Evidence of Post-traumatic Stress Disorder” by Samuel Ramos and Gregory Boyle

By Gideon Lasco, MD 

To all Filipino males out there: Would you entertain the thought that as a child, you were “mutilated” and “criminally assaulted” through the procedure of circumcision? An Australian study says just that.

In a paper entitled “Ritual and Medical Circumcision among Filipino boys: Evidence of Post-traumatic Stress Disorder” published in 2000, authors Samuel Ramos and Gregory Boyle studied circumcision among boys aged 11-16 in Batangas, a province in Southern Luzon, Philippines. According to their findings, a majority of the boys had post-traumatic stress disorder after circumcision, and uses the findings to support the general statement that circumcision is a form of physical violence.

How valid is their paper? Can circumcision, which is accepted by over a billion people, be in reality a form of mutilation? This piece is an exercise that critical explores the connection between the “anthropological reality” presented by the authors and the “emic reality” as experienced by myself, who belong to the culture that is the subject of the paper.

This piece uses the qualitative critical appraisal questionnaire by the Critical Skills Appraisal Programme network (http://www.casp-uk.net/).

1 Was there a clear statement of the aims of the research? 
The authors state that they aim to investigate the psychological consequences of “partial penile amputation”. The authors then connect the relevance of this study in building the case that the Filipino practice of male circumcision is “in reality, criminal assault. Evidence of post-traumatic stress disorder (PTSD) would be used as the parameter by which psychological consequence (i.e. harm) would be measured.

2. Is a qualitative methodology appropriate? 
To their credit, the authors employed qualitative methods, which comprise the first half of the paper. Thereafter, an interview is sent out. For such a sensitive, multi-factorial topic such as circumcision, qualitative methods are truly appropriate to make sense of the practice, whether or not in conjunction with a quantitative paper.

3. Was the research design appropriate to address the aims of the research? 
The research design calls for the measurement of post-traumatic stress disorder (PTSD) among children who underwent circumcision; an outcome showing PTSD is then used as a justification in labeling circumcision as “violence”. They used the DSM-IV criteria (a listing of psychiatric conditions) to define PTSD.

There are serious flaws in the research design. In the first place, the very premise of the study is the diagnosis of PTSD according to the DSM-V criteria. How valid is the DSM criteria, especially when doing cultural research? To show how dynamic and arbitrary this criteria is, homosexuality was once part of DSM-II, and today there is growing criticism of DSM particularly with its cross-cultural applicability (Kleinman, 1987; Faraone and others, 2003, Hinton and Fernandez, 2011). Circumcision definitely presents with pain but there is a need for a much deeper analysis before someone becomes qualified to say that it is “violence”.

PTSD is defined in the DSM-V as a condition that "may develop after a person is exposed to one or more traumatic events, such as sexual assault, warfare, serious injury, or threats of imminent death" (APA, 2013), and thus it is highly questionable for circumcision to be included in this category, given that while it presents with "pain", it is a very tolerable kind of pain that is indeed likened as "kagat lang ng langgam" (just like the bite of an ant). In circumcision missions I have attended, it is the boys themselves who volunteer to be circumcised, and there is no sign of emotional trauma on their part after the procedure.Whether or not the boys in questions actually had (or have) PTSD can be subject to further technical questions in many levels.

Finally, the short-time frame given to the study limits its reliability. There are culturally-sanctioned forms of short-term pain and suffering which would find vindication in the future.

4. Were the data collected in a way that addressed the research issue? 
If research issue is “prevalence of PTSD among Filipino boys who undergo circumcision”, the sample is limited and cannot represent the population in question. Moreover, if the research issue is expanded to deal with issues of “harm” and even “criminal assault”, then measurement of PTSD alone gives the researchers with very limited, weak data.

5. Has the relationship between researcher and participants been adequately considered? 
The bias of the researchers on the practice in question is glaring throughout the paper, evidenced by their semantics. For instance, the use of “mutilation” is preferred in this paper, which itself indicates a value-judgment. In effect, the researchers have already stated their preference for the ultimate outcome of their research in question.

6. Have ethical issues been taken into consideration? 
Since the respondents are minors, there are issues of informed consent and confidentiality. Steps undertaken to address these were mentioned in the paper. Ethical approval was also given by their home university in Australia, but I would think that ethical approval from a panel in the Philippines would have been more appropriate.

7. Was the data analysis sufficiently rigorous? Is there a clear statement of findings?
Hasty generalizations abound in the data analysis. For instance, the paper declares: "Despite some methodological limitations, the present study clearly demonstrates the causal role of circumcision in the development of PTSD among Filipino boys." The use of “Filipino boys” is already a misrepresentation, because they were just studying a small section of a province within the Tagalog region.

The next statement is even stronger : “Evidently, there is strong evidence of a causal relationship between circumcision and resultant psychological trauma.” Again, this sweeping claim is not backed with any hard evidence,

The study also does not study the converse of the population, i.e. non-circumcised boys, and whether or not they had any “psychological trauma”. The embeddedness of both circumcised and non-circumcised males within society is ignored, and in this study, only psychological factors are considered, without any attempt to contextualize the definitions to the local culture.

8. How valuable is the research? 
Circumcision is an important practice in the Philippines and many parts of the world, and has been extensively well-documented. However, a research that gives judgments based on a very weak methodology and biased investigators cannot be assigned much value in this growing body of literature on ritual circumcision.

CONCLUSION 
This paper is an example of how “sociological” and “anthropological” studies coming from the outsiders’ (i.e. etic) perspective can be out of touch with the reality they claim to study. Circumcision is as detached from mutilation as an anthropologist is from a judge. Yet, this case underscores the need for us Filipinos to study, understand, and appreciate our own culture. Going back to the circumcision study, the researchers declare: “[Circumcision] is in reality criminal sexual assault.” In reality? Perhaps there is such a thing as an "anthropological reality", portrayed by social scientists and anthropologists, and then imagined (and reimagined) by the rest of the world. If applied on a culture, it can lead to (mis)perceptions that remind us that we have to be a voice in defining our own reality, for if we do not, others will.

REFERENCES
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. pp. 271–280.

Faraone, S. V., Sergeant, J., Gillberg, C., & Biederman, J. (2003). The worldwide prevalence of ADHD: is it an American condition?. World Psychiatry, 2(2), 104.

Hinton, D. E., & Lewis‐Fernández, R. (2011). The cross‐cultural validity of posttraumatic stress disorder: implications for DSM‐5. Depression and anxiety, 28(9), 783-801.

Kleinman, A. (1987). Anthropology and psychiatry. The role of culture in cross-cultural research on illness. The British Journal of Psychiatry, 151(4), 447-454.

Thoughts on Filipino words: Lakad (to walk)

Students walk outside  university campus in Palawan, Philippines (Gideon Lasco, 2014)

by Gideon Lasco, MD

Lakad, to walk, does not, in its common usage, evoke images of speed, yet in a nation where things are slow moving - or not moving at all - it has become a euphemism for getting into motion a number of things, from romantic relationships to bureaucratic procedures.

Among teenagers, 'ilakad' means to be a go-between between a boy and a girl. Usually, it is a person of influence who performs this act, by saying nice things about the boy, or creating opportunities for 'boy meets girl'. The performance of 'Lakad' is the antidote to one of the traits ascribed to Filipino males - torpe, which came from the term 'torpid': shy, slow, bashful. Of course, it does not always end up as intended: the boy may end up falling in love with the girl who performs the 'lakad', and that may have been her intent in the first place.

Then, there is another usage of 'Lakad', one that adults encounter more than teens: the facilitation of procedures in the face of a sluggish bureaucracy. There was a time when an application for a driver's license took a month; is it not possible for the application to walk instead of crawl? Same goes with petitions, lawsuits, job applications, and so forth. A way was found to circumvent this pace: ipalakad, to have someone 'walk through' the task at hand, that is, "to make things happen".

The term 'lakad' does not only imply speed, it is also implies access. The performer of the 'lakad' or the 'taga-lakad' can literally walk through the doors not accessible to the general public, and in so doing, facilitate things. He or she is, oftentimes, an insider, a creature who can not only walk (lakad) but also has many hands, a term which translates more vividly as 'maraming galamay', a metaphor for well-connected individuals.

On the other hand, he may just happen to be at the right place at the right time. When I used to work in a government hospital as a medical intern, it was very common for friends, family, family's friends and friends' family, to ask me if I can facilitate the admission of their sick. Amazingly enough, this facilitation - this special access - is sanctioned informally by the institutions themselves; in our case, the relatives of doctors, nurses, hospital staff are euphemistically termed 'extensions'.

What the performers of lakad have in common - among teenage social circles and institutions alike - is that it is people with influence who perform this act.

Possessive of speed and access, amid the backdrop of lethargic, opaque institutions, lakad is an all too convenient term that glosses over whatever illegalities or unethical practices that come with it. It offers not speed in the sense of a race car or a runner, but of speed only in relation to the norm. A government employee who sees himself as upright but has not been promoted for a decade, should he not act? Or in the case of benefits of a retired public school teacher who just died: Doesn't his widow have the right to speed things up if she can, in the name of her children and their future?

There is a whole moral economy in which the performance of 'lakad' is embedded. The beneficiary becomes indebted to the performer of the act and his debt is called utang na loob, a term pregnant with meaning. It will not be surprising if a doctor would return the favor to a lawyer who saved him from a lawsuit by waiving his professional fees in the future. My American brother-in-law wryly commented that Filipinos give each other too much gifts but in a nation where people rely on others to 'set things into motion', it is not too surprising.

We Filipinos have adapted to the bureaucracies and exigencies of life, and have become - wittingly or unwittingly - participants, or experts ourselves. If you get old enough, you'll have an entire ensemble of people to call on to for all sorts of things, from filing your taxes to registering your car. It becomes a way of life, as indispensable in being Filipino as Meralco bills and occasional typhoons.

It is not entirely a sorry state of affairs.

I know of one who needs 'lakad', and that is our nation. Diplomats, politicians, businessmen, people with influence, can advance our cause, and promote our nation's interest. The problem with lakad is that for every person who goes ahead, someone is left behind. But this is not true for larger schemes, such as national endeavors, where everybody benefits. Indeed, if all of us help to 'make lakad' our nation, then it is no longer a walk among shadows. It becomes a march to progress.