Professional Documents
Culture Documents
General Data: Lucas is a 51 year-old male, married, self-employed, high school and ministerial
school graduate, former minister of an international Christian denomination religion that originated
Sources of information and reliability: Patient (poor reliability), Wife (fair reliability)
Christian denomination religion that originated in the Philippines when he met Erica, the 16 year-
old daughter of a deacon in the locale where he was assigned. Ericas father entreated Lucas help
to get her back after she went away with her non-church member boyfriend, and they were able to
track her down and bring her home. Of Erica, he thought, May nangyari na siguro. Hindi na siguro
virgin. When Lucas met Erica, he thought that she had a pretty face and was immediately
attracted to her. He denied having recurrent, intense sexually arousing fantasies and sexual urges
about Erica and only conceded that he found her physical features attractive and thought about her
only when he saw her. Afterwards, while Lucas was working with Ericas father on a mission, and
while his wife and 2 sons were away visiting her parents in Cavite, Lucas was invited by Ericas
family to stay with them as it was raining hard and it would be difficult for him to go home. That
night, Erica allegedly came to his bed and fanned him, as there was no electric fan where Lucas
was staying. As she lay beside him on the bed while fanning him, Lucas thought that she was there
because she wanted to be with him. He felt excited and sexually aroused at the time and thought
that he was being given the opportunity to act on his desires for Erica. He started hugging and
kissing her, and when she did not struggle and let him kiss her on the lips, his sexual excitement
increased and he thought, Gusto niya. He thought that Erica wanted to have sexual intercourse
with him, too, because she did not resist him and did not make a sound when he removed her
clothing and had intercourse with her without using contraception, after which Erica put her clothes
back on and slept with him the rest of the night. Lucas felt pleasure and satisfaction at the time and
did not feel any guilt or regrets about what he had done. It was only on the next day, when he woke
up that he felt scared that people will find out what happened and tell his wife or his superiors and
he will be reprimanded, so he left early for home without waking up Erica and her family, and since
then avoided them all. After 2 months, the district minister called him and his wife and asked Lucas
if he had sexual intercourse with Erica, to which Lucas admitted to doing so but insisted that what
happened between them was consensual. Lucas was told that Ericas parents reported that he
raped her and got her pregnant and was claiming that he was the father of her child, whom he
refused to believe and instead, insisted that the father was Ericas boyfriend. Because of this
complaint, he was fired from being a minister and ex-communicated from church. He and his family
were told to leave Aurora immediately and he was forbidden to contact Erica again but no legal
case was filed against him. Lucas felt intense regret at what he had done because of the painful
consequences of his actions such as the loss of his status in the church, his wifes hurt and
disappointment in him, and the loss of his salvation. He asked his wife to forgive him, and she did
because Lucas told her that he only did it because of temptation, blaming Erica for tempting him
and causing him to stray from his marital vows, and in the end, promised her that he would never
do it again. Lucas also believed that Ericas parents purposely let him sleep with her because they
knew that she was already pregnant with her boyfriend and wanted him to take the fall. He also
believed that his enemies in their locale influenced Ericas family to report him so that he will be
He could not do anything to overturn the churchs decision at the time, so he and his family
went to Laguna to live with his in-laws for 2 years. He was sad about what happened to him and
blamed himself for being weak in the face of temptation, but did not let himself think about it and
did not talk about it with his family. He immersed himself in work by opening a sari-sari store and
working as an insurance salesman, intent on providing for his family even though he was not a
minister anymore. He was proud of attaining a perfect score in the licensure exam and was happy
when his company offered to send him to Switzerland for managerial training, but turned it down
that he might be reinstated if he was able to get a letter of forgiveness from Erica and her family.
He told his wife and his mother about this and on his urging, they actively pursued the matter,
personally going back to Aurora to talk to Erica and her family and finally getting a letter of
forgiveness from them, which Lucas submitted to their church and used to have himself reinstated.
When he was finally given his assignment in Catanduanes, he immediately left his job without
collecting his final commission and went back to his ministerial work because he believed that if he
died not fulfilling his ordained mission from God, he would not be saved according to the teachings
of their church.
In the interim, he continued serving as a church minister at several locales in the country for
8 years with no reported incidences of sexual offending. He fulfilled his duties to oversee worship
services and increase his congregation. Though he was friendly and inviting to everyone, he
interacted more with female teenagers because he felt more comfortable with them and treated
them like friends, teasing them and joking around with them. While doing so, he made enemies in
almost every locale he was assigned to where he was not successful, from a barangay captain
whom he believed was threatening his converts, to a rival minister from another religion whom he
11 years prior to consult, he was assigned to a locale in Catanduanes and met Jenna, a 14
year-old female church member, who was active in church and helped out in the renovations that
Lucas had started. Lucas noted that he was attracted to her because she had a pretty face and
body, and believed that she was attracted to him, too, because she was always smiling and
friendly towards him. He felt happy when she would tease him and tell him that he was handsome,
and believed that she was flirting with him, which aroused him and made him feel like kissing her.
He had known Jenna for a month when his wife left to visit her parents again, and while she was
away, he felt his growing attraction come to a head as he saw Jenna alone in the sound room of
their church. He felt an intense desire to kiss her on the lips and when she passed in front of him,
he held her arm and kissed her. He thought that Jenna was amenable to him kissing her because
she did not turn or push him away as he was doing so, and was only surprised but not objecting to
his advances. After kissing her, Lucas felt happy and satisfied and let her go, and Jenna left
immediately. Lucas was not aware how Jenna reacted to what he did and believed that he did not
do anything harmful as it only a kiss. Unbeknownst to him, the church caretaker saw him kiss
Jenna and immediately reported him to the district minister. He believed that Jenna did not want to
file a complaint against him and even wanted to retract her statement confirming what happened,
but that the caretaker allegedly threatened his supervisor that he will be the one ex-communicated
if he will cover up what happened. He was again dismissed from his ministerial duties but this time
He and his family went home to Cavite and lived with his parents. During this time, he
resigned himself to the thought that he did not deserve to be a minister because he could not break
away from temptation. He again poured all his effort in working for his family by selling cooking oil
and pirated DVDs because he did not want his family to experience the poverty he experienced as
a child. His father had poor health at the time, and on his deathbed, entreated Lucas to find a way
to get his position back and become a minister again. He sought out the help of his classmate who
had a high-ranking position at the central office of their church and advised to get a letter of
forgiveness from Jenna and her parents, with his classmate giving him financial assistance to do
so. He went back to Catanduanes and was able to get the letter and forward it to the central office.
Camarines Norte and Masbate. He spent the next 6 years fulfilling his ministerial duties
2 years prior to consult, he was assigned to a remote locale in Masbate. Patient felt
attracted to several adolescent females in the locale, several of whom he was beginning to
indoctrinate. One of them was a 12 year-old girl, Lily, whom he started training as a track and field
runner as part of their locales delegation to their churchs provincial sports fest. He had known Lily
and her family for 3 months and was friendly with her parents whom he was indoctrinating, even
helping them out financially when they were in need. He began feeling attracted to her the more
that he spent time with her. She was tall for her age and Lucas saw her as matured na ang
katawan. He started kissing her goodbye on the cheek upon leaving their home, and when she
did not turn away from him and also kissed him goodbye on the cheek, it excited him and
increased his attraction to her, thinking that she was also attracted to him because she was being
accommodating and friendly. He started becoming sexually aroused when they would accidentally
touch and especially when he would kiss her. When the time to go to the sports fest in Masbate
City came, he felt excited and nervous because he knew he would have the opportunity to be
alone with Lily, and was a little scared of what can happen. At the last minute, Lucas asked his wife
to come with them but she refused as she had just travelled all the way from Manila to see their
son. Lucas decided to go ahead with his plan to go to the sports fest alone with Lily and 3 other
female athletes, a 14 year-old girl and two other 18 year-old girls. When they arrived at Masbate,
Lucas rented a room in a hotel, thinking that he and the 4 female teenagers can leave their things
there before going to the sports fest, and eventually spend the rest of the day there. Lucas denied
that he had specific plans about what he wanted to happen in that hotel room but admitted that he
booked it because he thought he would enjoy staying there with the girls. After the track and field
event, Lucas went back to the hotel room with Lily first while the other 3 were still finishing up with
their games. When they were alone in the hotel room, Lucas tried to kiss Lily on the cheek but she
turned away from him and refused to let him kiss her. Lucas was surprised, thinking that she would
not refuse him because she used to let him kiss her goodbye for the past month, so he stopped
and tried to joke about it with her, saying that Lily was being masungit. The other 3 girls arrived
soon after and they went home. After the sports fest, the parents of Lily and the other girls filed a
complaint against him with the district minister. The district minister told him that according to Lily,
he tried to rape her while they were alone in the hotel room, and because of this report, he was
again being dismissed from his duties as a minister. He repeated his previous efforts to get himself
reinstated, however, this time around, he was told to seek psychiatric clearance before the church
He reported having depressed mood continuously for a month after he was dismissed but
denied having other depressive symptoms such as loss of appetite, anhedonia, feelings of
hopelessness or excessive guilt and suicidal ideations. However, though his mood lifted after a
month, he reported that he had persistent feelings of sadness over the next 2 years especially
when his family would inquire about when he will go back to being a minister. He would feel
slighted whenever his family would mention how their life had changed immensely since he was let
go from the ministry. He had difficulty sleeping and spent most of his time online, and even joined
an online e-loading business, an occupation that he does not take pride in as he believes he is not
doing the work that he was ordained to do. He complained of having low energy and of gaining
weight. He finally sought consult at PGH Out-patient Department with the intent of getting
Review of Systems:
(+) dizziness (-) weight loss (-) fever (-) nausea/vomiting (-) dyspnea (-) orthopnea (-) chest pain
Past Medical History: (+) asthma (+) hepatitis (+) Hypertension (-) PTB (-) DM (-)testing for STI
- heart disease
- deceased
- hypertension
- bronchial asthma
Family profile:
Romulo Lucas father was a hardworking, simple man who worked as a farmer to provide for his
family. He was strict and employed corporal punishment towards his children whenever they do
anything wrong. Though he had financial hardship all his life, he taught his children never to steal
from anyone and instead earn an honest days work through their own efforts. He converted to
their Christian denomination religion after Lucas was converted and was a devout member of the
Edna Lucas mother is also a devout church member who also converted after he converted. In
her younger days, she worked several jobs to provide for their family but due to poverty she and
her husband left their children under the care of her mother when Lucas was 11 years old. She and
her husband went home to Masbate to farm but unfortunately they were not successful and instead
went home to their children and tried to make ends meet. She was able to have a more
comfortable life after Lucas became a minister and is now concerned about when Lucas will go
Lorna She became his wife when he was about to become a minister. Lucas chose him over his
other girlfriends because he believed she was the most suitable to become the wife of a minister
since she was 2 years older than him and was more mature than his other girlfriends.
Tony Lucas oldest brother has an undiagnosed behavioral problem since he was 12 years old
after he had a head injury. He has not been heard of since he left home at the age of 17.
Queenie Lucas oldest sister became his primary caregiver during his early childhood because
both of their parents were hard at work. Lucas thought that she was pretty and attractive, and that
she had many suitors. Lucas had a close relationship with her while they were growing up, but
when she had a family of her own they eventually drifted apart.
Romy Lucas parents treated his other older brother as someone who could not do heavy work
due to his congenital cyst on his left eye, though he was able to finish high school and have a
family of his own. Romy also converted, same as the rest of their family.
Anamnesis:
Patient was born full term via normal spontaneous delivery, with an unremarkable perinatal
course, no noted maternal illness and no fetomaternal complications. He is the youngest of four
children. He had no noted developmental delays during infancy and early childhood. His primary
caregiver was his mother until 4 years of age. Lucas does not have any memories of his early life
and does not know any stories from his mother about how he was as an infant and toddler. At age
4, his father took him and his siblings with him to Masbate where he found work as a plumber while
his mother stayed behind in Pasig to continue working as a factory sewer. His older siblings
became his caregivers as his father was working, and even when their mother followed them, his
oldest sister still took care of him as his mother also continued to work. He was a shy and quiet
child who interacted mostly with his siblings and a few playmates.
He and his siblings relocated several times, first when he was 6 years old to Ticao Island
which he considers as the happiest time in his childhood because they were all together as a
family and even if they lived simply, their life was peaceful and he was able to go to school
regularly. When Lucas was 8 years old, his oldest brother Tony had a head injury and fractured his
skull, after which he was noted to have episodes of aggression and disorganized speech, which
would spontaneously resolve and recur intermittently. He was not brought to a doctor and their
family learned to get used to his behavioral changes. At age 9, Lucas stopped going to school
because his parents did not have enough money to send all of them. At age 10, he was able to go
back to school and started selling vegetables grown in their backyard so he could earn for himself.
At age 11, his parents brought him and his siblings to their maternal grandmother in Cavite, telling
them that they were only going to be gone for a month so they can earn money by farming.
However, his parents did not come back and was not able to give them financial support for 6
months. Tony, who was 17 at the time, left home and started working in a piggery and was not
heard from again. Lucas again stopped going to school along with Romy. Queenie continued to go
to school in order to graduate from high school while Lucas delivered pan de sal and newspaper so
that they would have money for food. He felt sad and often pitied himself and his family because of
their situation in life. He also felt unsafe in their neighborhood because there were gangs and gang
wars, though he denied ever involving himself with them and denied ever stealing and getting into
other criminal activities. When his parents finally came back to live with them after 6 months, his
paternal grandmother visited them and took him to Quezon to stay with her for almost a year. Upon
going back to Cavite, he found that his family had relocated to Laguna.
When Lucas was 12 years old, he went back to school and started feeling attracted to a girl
in his class and started experiencing sexual urges but did not know what to do about them, as his
parents did not talk to him about sex and he had no one else to talk to about it. During this time,
Queenie who was then 18 years old started working as a hostess in a club so she would have
money for college. His sister brought him after school to the club where she worked so that she
had someone to go home with. Before operating hours, he would sweep and clean the club to earn
a little money. While he was there, he saw women kissing and sitting on their customers laps,
which excited and aroused him but also made him uneasy because he never saw his parents do
those acts in front of him. He did not fully see and understand what was happening inside the club
but learned that it was something that was not done outside and knew intuitively that there was
something wrong because he was not allowed to enter the club during operating hours from 6pm-
12 midnight. He overheard the conversations of the adults around him and learned that women
who worked there contracted diseases when they go out of the club with their customers, and
because of that, he believed that these women were dirty and dangerous. He was scared of them
but believed that Queenie was different because he had never seen her do what the other women
did. However, he also started feeling scared and protective of her, always tagging along when men
approached her. At one point, Queenie left the club with a middle-aged Chinese man and brought
Lucas with her when they checked into a hotel room. Lucas remembered feeling excited to be
spending the night in a hotel room for the first time, but was also nervous because he did not know
what they were going to do there. He eventually felt at ease when he saw that the man that
brought him and Queenie there looked clean and had nice clothes, and was gentle when he put his
arm around him to guide him into the room. Until the present, Lucas maintains that his memory of
that night was vague because he was so sleepy so he could not remember if he slept on the couch
while the two were on the bed, or if he slept on the bed while the two lay on the carpet. He only
remembered falling asleep as the man was teaching his sister Mandarin and waking up hours later
in the early morning not being able to breathe, scared, wheezing and calling for his sister. He
denied remembering what he saw when he woke up and only remembered that the man wanted to
bring him to the hospital but his sister refused and only waited for his asthma attack to pass. When
he felt better, Lucas and his sister went home. Because of what happened, his impression was that
the Chinese man was nice and caring, different from the other men he saw in the club. He did not
see the man again until 2 months after when Queenie found out the man had gotten her pregnant,
and when she told him, the man went to their parents and told them that he would provide for his
sister and their child. Queenie stopped studying and working at the club, which made Lucas feel
relieved and made him admire the Chinese man for being good to his sister. After Queenie gave
birth, Lucas helped in taking care of his nephew for a while until they moved out and Queenie
started living with another man and spent less time with their family.
With Queenie gone, Lucas continued school and graduated from elementary and continued
into high school as he and his family moved back to Cavite where his father opened a tailoring
shop.
At age 14, he met several gay hairdressers in a parlor next to his fathers tailoring shop. He
enjoyed their company and the attention they gave him because they often joked around him and
even gave him food. They would tell him how handsome he was, and cut his hair for free and even
shape his eyebrows. He denied that they did anything else to him other than that. When Romulo
found out about this, he got angry and forbade him to see them because he it seemed to him that
Lucas was becoming effeminate and told him, Baka mahawa ka sa kanila, baka maging bakla ka
din. His father stopped renting out the parlor space to them, which made Lucas feel sad because
He continued with his high school studies and excelled academically. He had his first
girlfriend at age 16, a 15 year-old classmate whom he shared his first kiss with. He stopped going
to school for a year in his 2nd year in high school after his Filipino teacher scolded him for
allegedly correcting him in class, and enrolled again the next year. However, he transferred to
another school for 3rd year, and there, he became involved in a fraternity and even established his
own fraternity with his friends. He became involved in fraternity violence, though he still excelled
academically. When his adviser told him that he would not get any honors since he was a
transferee, he refused to take his exams but still got 3rd honors, which he did not claim at the end
of the year. He also became active in the barangay youth activities and was sent to dances in
several barangays and had numerous girlfriends in each barangay. At age 20, he first had sexual
intercourse with a girlfriend whom he knew had already had sexual experience. Though he had
many girlfriends, he reported that he only ever had 4 sexual partners. He also learned to smoke
He was unable enroll for his 4th year in high school because his father went into hiding to
escape their town mayor who had his father beaten up because he allied himself with the mayors
enemies. Their family travelled to a remote town where they farmed to sustain themselves. He was
enjoined by the local New Peoples Army to train with them and assassinate the mayor. While he
was awaiting the order to carry out his mission, he went gold panning and met several members of
a Christian denomination religion and had a girlfriend among them. His girlfriend encouraged him
to be evangelized and after listening to a minister, decided to convert. He remembered feeling his
hatred for the mayor and his attraction to his girlfriend go away after he was converted, so he then
left the NPA and also broke up with all his girlfriends. He also stopped smoking and drinking
alcohol but continued his activities in his fraternity until his minister forbade him to do so.
He decided to go to ministerial college, but knew that he would need a high school diploma
to qualify, so he went back to school and enrolled in his 4th year, working for his Spanish teacher
as a houseboy to pay for his tuition. When he took the National College Entrance Examination and
believed that he passed, he stopped going to school thinking that it was enough to graduate, and
instead went to work with his father drilling wells in different barangays to save up for his ministerial
studies. At the end of the school year, knowing he passed the NCEE earlier in the year, he
believed that he deserved to graduate but found that he was not on the list of graduates. He
believed that all his classmates became sad at this news, so they rallied in front of the school
administration and threatened that they will not attend the graduation if Lucas did not graduate with
them, and entreated the help of his Spanish teacher who vouched for him and paid his final tuition
He dreamt of becoming a minister and worked his way to finish his studies. As he was
studying, he was sent to different provinces to do ministerial work. He had numerous girlfriends in
almost every locale he was assigned to even though as students, they were not allowed to have
such relationships, claiming that there were many girls who found him attractive and he believed
that, Maraming mga kababaihang nagpaparamdam sa akin and that he could not help but
respond to them. His first girlfriend as a ministerial student was Lorna, the daughter of the
caretaker of a church he was assigned to. He found her attractive because she was young looking
even though she was 2 years older than him, with her short stature, cute face, and mild manner.
He met her when he was 23 years old and maintained a long distance relationship with her for 3
years while having relationships with girls in other locales he was assigned to. Some of these girls
were not church members so he would often break off their relationship after a few months. When
he was finally ordained as a minister, he decided to get married to Lorna in order to distance
He was an effective minister as he would be able to increase the size of their membership
wherever he would be assigned. However, he was also reprimanded on several occasions for
being overly friendly and familiar with young teenage girls, and was told by his supervisors to
refrain from fraternizing with them. He also had numerous conflicts with men that he worked with;
several times engaging in physical altercations with them that would get him transferred to a
different locale.
Unremarkable
Patient was seen as a middle-aged, slightly stocky man with average height, dressed in
pressed short-sleeved button-down shirt, slacks and leather shoes. His trimmed hair had some
areas of grey and was neatly parted on the side. He wore a large gold ring on his left ring finger
that he often fiddled with. He had spontaneous, normoproductive speech with normal rate and
rhythm. He had fair eye contact. He was euthymic and had appropriate affect. He denied having
any perceptual disturbances, delusions and suicidal ideations. He was preoccupied with reinstating
his position as a minister and believed that Gods mission for him is to continue this work. He had
no looseness of association or tangentiality, but was evasive and circumstantial in his answers to
questions regarding his relations with underage girls. He was oriented to 3 spheres, with good
concentration and calculation, intact memory, good fund of knowledge, good abstract thinking,
good judgment and poor insight as he believed that he did not need treatment because he does
not have an illness and only needed to be evaluated and cleared by a psychiatrist to go back to his
ministerial work.
Psychoeducation.
Discuss roles of treater and evaluator. Offer both services and assign to resident-in-charge for
Course of Care:
Evaluation
Patient initially did not consent for treatment and only consented for evaluation. Follow-up
was given for resident-in-charge evaluator. Patient was seen by resident-in-charge evaluator for 2
sessions and referred for baseline psychological assessment as part of forensic evaluation. After
which, patient was informed that no clearance will be given at the time he was seen and that the
recommendation is for him to undergo treatment. Patient was informed that reassessment would
be done after treatment.
Patient was referred for treatment to resident-in-charge treater, to which patient finally
consented to go.
Primary Working Impression
Other specified paraphilic disorder (pedophilic disorder of less than 6 months duration)
Treatment
Upon seeing the patient again after being referred by evaluator, readiness for change was
assessed and noted to still be low, so initial sessions were targeted at establishing rapport and
engagement. It was only after patient was given homework to detail an account of the roles and
responsibilities of a minister an account of what he actually did while he was a minister that he was
able to see and accept that he had a problem. Planning of cognitive behavioral treatment was
done.
20mg/cap 1 cap OD for depressive symptoms and for impulsivity and aggression. Baseline