The Silent Crisis: How Stigma and State Violence Exacerbated Neurodiversity in the Philippines

Few people talk about how the stigmatization of addiction and the bloody Duterte drug war exacerbated the suffering of ten million Filipinos. It would be great if the arrest and detention of former President Rodrigo Duterte magically ended their daily struggles. But their misery continues.

Duterte characterized drug users as violent beasts who ought to be jailed or killed. This demonization was the justification for his barbaric orders, a move he claimed would end illegal drugs. Instead, thousands died while the illicit drug trade thrived.

Drug users are not inherently evil. Most are likely people with ADHD and other neurodivergences who found relief in methamphetamine because it quieted the chaos in their heads and made them feel human. Victims of the drug war were simply self-medicating with the only chemical option available. Executing them was like shooting someone for taking an unprescribed antibiotic or sedative.

Millions of Filipinos navigate daily life under the heavy weight of an invisible burden, struggling with chronic executive dysfunction, emotional dysregulation, and persistent social alienation because of how their brains are wired. Yet, in a society where proper diagnostic infrastructure is a luxury out of reach for most, this operates as a silent crisis.

Unmanaged ADHD manifests as career instability, academic failure, and emotional burnout. Because society routinely misattributes these cognitive differences to laziness (katamaran) or poor discipline (walang disiplina), individuals internalize these judgments as character defects.

This silent hardship took a dangerous turn under the Duterte administration. By framing substance use as a moral evil to be eradicated through state violence, the campaign weaponized the vulnerabilities of undiagnosed neurodivergent individuals. The neurobiology of ADHD involves a baseline chronic deficit in dopamine, a brain chemical essential for executive function, impulse control, and focus. When legal prescription stimulants like methylphenidate are inaccessible due to high medical costs or supply shortages, the brain seeks external balance. In informal labor markets, many low-income Filipinos turned to street stimulants like shabu (methamphetamine) to quiet racing thoughts and survive grueling work shifts.

Having personally tried to get diagnosed, I found the evaluation process prohibitively expensive, often costing up to ₱28,000 across multiple sessions. Like many average-income Filipinos, I could not complete the process. To cope, I rely on herbal supplements and a strict routine. Even so, I still struggle. There are times I simply cannot function, leading to missed deadlines, lost income, and ongoing distress.

This chemical drive to self-medicate is a universal neurobiological reality highlighted during the nationwide ADHD medication shortages in the United States. In a story published by The New York Times, drug policy consultant Edward Krumpotich shared his two-decade struggle with methamphetamine addiction, a cycle driven by untreated ADHD. It took over thirty rehabilitation stays before a clinician finally prescribed him proper stimulant medication, stabilizing his dopamine pathways and resolving his addiction. Public health alerts from the U.S. Centers for Disease Control and Prevention similarly warned that prescription shortages pushed desperate individuals toward illicit alternatives like cocaine, street meth, or toxic counterfeit pills simply to function. When society denies safe medical access, illicit street drugs fill the void.

These realities turned a healthcare void in the Philippines into a lethal hazard. Through Oplan Tokhang, local barangay watchlists were compiled based heavily on neighborhood social bias. Undiagnosed individuals seen as erratic or socially awkward (makulit) were easily flagged as drug suspects. During high-stress police operations, the sensory overload inherent to neurodivergent processing frequently led to freeze or panic responses. Armed law enforcement routinely misread these non-compliant reactions as active resistance (nanlaban), resulting in fatal extrajudicial violence. Meanwhile, those funneled into overcrowded correctional facilities received zero psychiatric screening, trapping them in systems where untreated executive dysfunction guarantees high recidivism.

The intersection of the Duterte drug war and the neurodiversity crisis demonstrates the devastating human cost of addressing public health realities with state violence. True progress requires moving away from criminalizing chemical coping mechanisms and dismantling mental health stigma. Addressing this crisis demands an immediate pivot toward decriminalization, public health subsidies for adult evaluations, streamlined regulations for legal ADHD medications, and widespread institutional accommodations. Until Philippine society stops confusing executive dysfunction with laziness and chemical self-medication with criminality, millions of neurodivergent Filipinos will remain trapped in a cycle of silent suffering.