key: cord-1047685-h25wq7o3 authors: Kahambing, Jan Gresil S. title: Mental health issues of massage therapists who practice sex work during COVID-19 in the Philippines date: 2021-07-13 journal: Asian J Psychiatr DOI: 10.1016/j.ajp.2021.102768 sha: 83184690797241757f4e35a5113c28a4c4986b8a doc_id: 1047685 cord_uid: h25wq7o3 nan 'Amidst an atmosphere of fear, rife with wild speculation and rumor, information is vital,' says the editor, and 'when gathered and processed more rapidly, however, its quality can be compromised' (Tandon, 2021) . This article, which partly adopts a verstehen design, focuses on the mental health issues of massage therapists who practice sex work during the pandemic in Tacloban City, Philippines. As verstehen, the study does not directly address the issue of human trafficking (Kahambing, 2020) but prefers to put hermeneutics and empathy (James and Komnenich, 2021) to find out the mental health issues of massage therapists during the pandemic. Without rushing directly to gather data during the rise of cases, the inputs patiently gathered here are a year after the global announcement of Coronavirus disease 2019 . The information gathering commenced from December 2020 to June 2021. Due to the sensitive and taboo nature of this issue within the Philippines, which is predominantly Catholic, the informants prefer not to be extensively treated as separate cases even if promised incognito identifications. Rapport, openness, and broad consent are established via casual and non-structured conversations in many sessions. All informants are women, which limits this study and calls for links to gender studies. The male therapists, reports one informant, are often on-call for their clients. Massage therapists are not sex workers per se, but that they welcome the possibility of sex work within the practice of massage therapy. Not all massage clinics and spas within Tacloban have therapists who practice sex work. However, 6 massage clinics that have are within the vicinity and have been the research locale of the author. The process is often homogeneous: the customer picks a girl, a short amateur massage session spanning 15− 20 min first, and then the negotiation for sex follows. The term 'sex worker' is not a preferred identification according to them. They do not also prefer the term 'masseuse' because of its stigmatized connotation (Richards, 2017) . They prefer the job title 'massage therapist.' One informant embraces the term 'bayaran' (someone who gets paid for sex) and acknowledges this as part of her identity along with the low regard for such a label. This label opens attitudes of empathy for mental health. Learning their mental health issues can initiate acceptance and healing (Litam, 2019) . With the negative impact of the pandemic, there is an increased struggle for those who don't have permanent jobs. The root cause of doing sex work within the massage clinics remains to be the anxiety of getting by due to low socioeconomic status. The therapists are stay-ins in the clinic since they are not from Tacloban. Some are from the area and nearby towns who casually clock in, as in the case of the married ones whose husbands work away and are unaware. During the pandemic, the number of girls in massage clinics, however, is significantly reduced. In some clinics, more than 50 % went home during the lockdown last 2020 due to fear of contracting the disease. Unable to find work, others were forced to come back to be able to provide and send money to their struggling families. Having more children to support means more reasons to work harder. They are bracing the pandemic measures to travel back to Tacloban to work again, conscious of the fact that COVID cases are rising in the area. The massage therapists mostly come from relatively far places in other provinces like Butuan, Davao, Bohol, Samar, Calbayog, and Cebu. The reason for this is the avoidance of stigma: 'people know me at home, so I move here because of anonymity since knowing that I am in a massage clinic puts a label' says one participant from Davao. Some are careful enough not to say they are in Tacloban but another place. Another participant, upon going back to her hometown, prefers to lie during police/military checkpoints on borders and claims she works in a department store rather than a massage clinic to not let the other passengers know. The term 'massage therapist' itself has a stigma attached to sex work. During the pandemic, the customers are lesser and the bargain for sex increases. Sometimes cheaper offers (10− 20$ over the 50− 65$ average price) are accepted rather than nothing. Those who have connections to social media sites resort to bargaining transactions for a scheduled or pre-negotiated visit to the clinic. This can be a problem since the girls often do not want that their regular customers have the contact numbers of the other girls. Fights on this matter, one reports, occur among themselves. This leads to a stressful working environment. There are peer issues such as silent treatments and an increased sense of competition. When this happens, the girls become self-conscious of their physical features in correlation to the preferences of the customers. Moreover, customers who are drunk and irate add to the problems at work when monetary negotiations fail after the sex act (e.g. paying less). There are also reports of customers stealing money and items from the massage rooms. Despite having stressors at work, there are coping mechanisms. The informants relay their empathic support towards each other. They 1) give or pass customers to those who have not been picked, 2) discuss or process problematic clients after, 3) bond and eat together, 4) occasionally, go to getaways such as beaches and resorts, and 5) serve as crying shoulders to those with accumulated heavy emotional baggage. Support is more given to new ones who are oblivious to the transactions in the job. There is a high degree of survivability of sex work in disasters. In hindsight, one informant claims that even during natural disasters, that is, the recent onslaught of the super typhoon Yolanda (international name: Haiyan) last 2013 that devastated Tacloban, domestic and international volunteers and professionals who are temporarily residing in the place to distribute reliefs and offer services would line-up in massage clinics to buy sex. Massage therapists who practice sex work during the time earn approximately $720 per day and those who missed it wished they were in Tacloban during the disaster. In considering mental health issues, 'having a good and empathetic support group and confidence in one's belief are potential factors for recovery' (Kahambing and Edilo, 2020) . In conclusion, however, this does not cancel out the fact the mental health considerations vary among massage therapists. As was shown in other settings (Puri et al., 2017) , the burdens are disproportionate. The burdens of the informants differ within work (e.g. instances of implicit body or age shaming as most customers prefer skinny and younger ones) or outside work (e.g. family matters, number of children, partners, etc.). And then there is the threat of having a client exposed to the virus. As existential needs of attaining a sense of normalcy in uncertain times are very specific (Egargo and Kahambimg, 2021) , the mental health consideration of massage therapists who practice sex work need to be coupled with empathy. As a recommendation, other factors such as the unjust structures leading to this setup can be further explored. None. The authors report no declarations of interest. Existential hope and humanism in COVID-19 suicide interventions Dilthey's philosophy and methodology of hermeneutics: an approach and contribution to nursing science (In)visible children and Covid-19: human trafficking in public health ethics. MALIM: Jurnal Pengajian Umum Asia Tenggara (SEA Stigma, exclusion, and mental health during COVID19: 2 cases from the Philippines She's just a prostitute: the effects of labels on counselor attitudes, empathy, and rape myth acceptance Burden and correlates of mental health diagnoses among sex workers in an urban setting Massage Therapist VS. Masseuse: What's The Difference. Odyssey COVID-19 and suicide: just the facts. Key learnings and guidance for action The author is grateful to the informants for their openness. He also wishes to thank the editor, the anonymous reviewers, and the journal staff for considering this work.