Mental Disorders in Indonesia By: Monica Hausler November 17, 2005

Malaysia Culture definitely has an influence over the mental health of those who live in Malaysia. –Depression –Anxiety –Hypochondria –Epidemic Hysteria –Obsessive-compulsive Disorder Patients would rather talk in terms of physical problems than mental problems –Explain their problems in terms of “loss of soul substance”

Culture-bound Syndromes “Koro” –Genital retraction syndrome –Man fears that his penis is shrinking and being absorbed by his body Situation: a man goes to urinate and notices that his penis is becoming smaller…after hearing about all of the koro attacks in his community and that koro is considered to be deadly, he develops anxiety He quickly grabs a hold of his penis and calls for help, if no one is around he may use cords, chopsticks, clamps or small weights to keep it from retracting. –Woman fears that her nipples are retracting Case report: “Cannabis-induced koro in Americans” –Disorder has appeared as part of a panic response to cannabis, but only in citizens of India

Culture-bound Syndromes “Latah” –A jolt of surprise that turns into a 30-minute orgy of screaming, dancing, and hysterical laughter, punctuated by shouted obscenities –Usually takes place with middle-aged woman –Not so much fun for the latah herself, but her family and friends find her outbursts entertaining and often provoke them to see a “show”. –Sometimes she will mimic those around her “aping relatives or imitating things they see on TV” –This causes a bit of a problem when going into public. –Anything can cause these episodes, some sufferers claim the source of a traumatic experience (i.e. the death of a child)

Culture-bound Syndromes “Amuk” (or mata galap) –Created the phrase “running amok” –Victim is known as a pengamok, who suddenly withdraws from their friends and family, and bursts into a murderous rage, attacking people around him with whatever weapon is available. He doesn’t stop until his is overpowered or killed! –Sometimes he may fall into a sleep or stupor and awaken with no knowledge of his violent acts –Victims are almost always men between the ages of 20 and 45 Only one recorded case of a female pengamok –Psychiatrists attribute it to extreme restrictive ness for adolescents Causing the young male to suppress their feelings of hostility, blame others for their difficulties, and lash out their emotions of rage –Social psychologists believe that it could be a result of a loss of social status or another major life change

December 26, 2004 “the greatest natural disaster of our times” Out of the 11 Indian Ocean nations that were hit, Indonesia was the worst affected by the tsunami. Up to 100,000 people may need psychiatric care Many of the survivors suffer from: –Economic loss –Loss of loved ones –Depression/Need for livelihood –Stress –Emotional issues related to their loss –Anxiety ~ especially at night –Demoralization –Psychosomatic complaints “In the wake of the tsunami disaster, Indonesia is launching its biggest ever mental health drive for traumatized survivors—many of whom have never heard of a psychological counselor before”

Jakarta 650, 000 refugees are in a very unstable emotional condition Estimated 20-50% could have a serious mental problem Post-traumatic stress syndrome, which has symptoms that range from sleeplessness, depression, rage and despair People are too terrified to return to their seaside homes for fear of future tsunamis, which causes severe stress and grief.

Aceh The acehnese people usually go to their family, traditional healers or religious leaders to seek help with their problems. Almost half a million people may suffer from depression, anxiety and sleep disorders. The children and elderly that have lost most of their families will be most vulnerable to these symptoms. Suicide attempts and domestic violence may increase

Sri Lanka A survey found that 40% of people who are victims of post-traumatic stress disorder are children. Mental health workers had to deal with grief reactions, depression with suicide attempts, and other conditions. Surveys categorized mental health conditions into 3 categories: 1.Mild psychological distress that resolved within days or weeks 2.Moderate/severe psychological distress that resolved with time or mild chronic distress 3.People with mental disorders, divided into those with mild and moderate disorders and those with severe disorders.

In general, survivors may experience mental trauma from witnessing someone dying or being injured, dismembered body parts, being trapped under debris, or being separated from their families. 2010, ratio of mental health disorders in the national population is predicted to be at 140:1,000 people (older than 15 years of age). 1.5% of patients currently receiving treatment in the hospitals are mental health patients. Currently, the National Health Department is focused on the physical needs of the people. Government has made no clear moves to respond to the mental health needs, even though so many people are suffering.

So what happens next… Many of the tsunami survivors have been placed in temporary camps with other people from different ethnic, culture, and religious backgrounds. These people are being forced to temporarily live under these difficult conditions. The psychological damage will need a long-term social recovery Psychological groups cannot do their work without the proper funding! Leaders of these affected countries are suggesting that “donor nations” send teams of international counselors over to help deal with the trauma reactions of the survivors.

Providing Psychological Aid When planning to enter into these disaster zones, mental health professionals need to familiarize themselves with the contextual challenges of applying psychological techniques across cultures. –There’s great political and religious diversity –International workers need to learn as much as they help –Context-relevant training Lacking familiarity in these areas could cause a serious risk of culture error and arrogance in providing assistance Newcomers should consult local psychiatrists, other mental health workers and any other community organizations that have had a long history with working in these settings Developing community health care can help extend treatments as well as gain geographical coverage

Helpers need to realize that it is going to take time, sensitivity and effort in order to build a sense of trust with the local communities. –The feelings of being protected and cared for has a powerful influence over reducing acute traumatic symptoms Psychosocial recovery takes a long time –Helpers rushing in and out with a “quick-fix” approach can do more harm than good for the survivors because it can leave a residue of resentment and unfulfilled promises. –Maintain a medium-term to long-term horizon aimed for recovery Giving the patients a voice in the development of treatment programs will help form a partnership between the helpers and survivors, which is very critical –Social reconstruction may be the most beneficial therapy –There’s evidence that communities have started to rebuild their houses and villages

Any Positive Outcomes? More emphasis will be given to building a comprehensive network of community- based mental health services across the nation.

Mental Health Care Closely related to religious traditions Bio-medical in orientation 1882, the colonial government formed the Mental Health Act, which then followed the establishment of the first mental hospital in Bogo, West Java. Towards the end of the 19 th century and into the first half of the 20 th century, there were 21 mental hospitals set up by the colonial administration in the archipelago. –Patients were admitted to the hospital through court orders After claiming its independence, Indonesia’s government created a more modern mental health approach –Non-legal procedure of admissions were then possible 1966, Mental Health Law was established and made mental health care more closely directed to community

“Tri Upaya Bing Jiwa” Meaning the three pillars of mental health services: –Prevention –Promotion –Treatment

There are currently 34 state and 16 private mental health hospitals in Indonesia –Capacity of approximately 10,000 beds 350 psychiatrists & 100 clinical psychologists Resources for mental health care is limited for almost 200 million people that are in Indonesia Newly developed mental health care allows hospitals to extend outpatient services, therefore mental health care can reach those who live in remote areas. –Causes the care provider to incorporate a more community oriented approach, rather than the traditional biological medical approach

Alternative Approaches An Islamic institution, that uses a system of religious mental health care, is known as a “Pesantren” –Leader, teacher (and most often the owner) is called “Kyai” –A “santri” is a student who studies Islamic religious teaching Most Pesantrens are located in small towns or villages that have a very pleasant surrounding, only a few are found in urban areas –The Pesantren consists of a large mosque in the center, surrounded by the house of the Kyai and dormitories for the Santri It is a dynamic institution that is consistently in dialogue with its surrounding, both locally and nationally Have existed in Java since the early Islamic era –During the Dutch colonial period, Pesantren were considered to be centers of rebellion Transformation of the Hindu-Buddhist monastery

There are currently 3 thousand Pesantrens in Java (both large and small) –Pesantren “Suryalaya”, Pesantren “Roud hotul Muttaqien”, Pesantren “Tebuireng” –Each Pesantren has different characteristics that are influenced by the aspect of Islamic teaching that is focused on through the expertise of the Kyai. Shari’ah: The Islamic Law Tafsir: interpretation and commentary of the Holy Qur’an and the Hadith— the tradition of the Prophet Mohammed Producing Hafidz: one who memorizes the whole Qur’an verbatim Tasawwuf/Tarekat: Islamic mysticism Not all of the Kyai have the ability to treat mental illnesses, most act as counselors for the people within the society –Religious problems, social, family, marriage, & even emotional problems Parents from big cities (Jakarta), send their teenagers to be educated in Pesantren so they can avoid the negative environment of juvenile delinquency

Conflict With Traditions Two main traditions of healing: medical & religious They are both in conflict with each other –Each claim that their own system is more important and helpful than the other one and in turn ignore the other treatment In order to resolve conflicts, more professionals (psychiatrists & psychologists) are respecting religious traditions and incorporating them into healing mental illness through including prayer therapy as a part of the treatment

Work Cited Azhar, M.Z., Varma, S.L. (2000). Mental illness and its treatments in Malaysia. Al- Junun: Mental illness in the islamic world. Madison, CT, U.S.: International Universities Press, Inc, Earlywine, M. (2001). Cannabis-induced koro in Americans. Addiction, 96(11), Kua, E.H. (1991). Amok in nineteenth-century British malaysia history. History of Psychiatry, 2(8), Quinn, A. “Indonesia tackles tsunami mental health crisis”. Retrieved from: Silove, D., Zwi, A.B. (2005). Translating compassion into psychological aid after the tsunami. Lancet, 365(9456), _health_care_east_&_west_context.htm m.english.general_D87RITT00_news_ap_org.anpa.xml&provider=Associated+Press