It started in 1992, Aang Buhori was a 22 year-old-man. Along with his friends, Aang visited a nearby waterfall around their home in Cianjur, West Jawa. On his way home, Aang was sure a dark being with evil intention was following him. When the night came, he burst out from his modest wooden house, tried to fight said being. Instead, there was nobody. The darkness was all in his head. Suyati, Aang’s mother, was worried. Soon, Aang started to wander around. One day he did not come home. Suyati, his husband, and the rest of the family were panicking. They rented a car to look for Aang. They found him. However, Aang kept trying to wander around. After three times of leaving home, Aang’s family decided to hold him in confinement in their kitchen at the back of the house, a practice that is known as pasung. Suyati, now 66 years old, said that she had no other choice, every time Aang was wandering around, they needed to rent a car to look for him. The money that they used to rent the car was equal to groceries for the entire family for a week. They needed to eat. Now, Aang is 49 years old. He has been living in confinement for 24 years.

Why some Indonesian still use pasung, restrain, and confinement to “treat” people with mental illness? The investigation that I conducted in Cianjur, West Jawa 2013, found that for some people in Indonesia, pasung is an act of love. They did not want their son, daughter, brother, or sister to wander around, getting hurt, or getting killed by other people. Thus, they made sure to keep this family member close to them. Furthermore, pasung was usually their last choice after they have exhaust other options that were available to them. These other options were usually spiritual/traditional approaches that often unsuccessful. Some families also pursued the allopathic path. However, these families usually did not understand that psychotic patients need to continue their psychotherapy for the rest of their life. When families who act as caregivers saw their mentally-ill family member was getting better, the caregiver usually stopped giving the medication, making the patients relapse and be put in pasung again.

Up until the end of the second decade of this new millennia, Indonesian are still in a struggle to find the best solution to replace the practice of pasung. In this paper, I suggest a cultural, spiritual approach, along with allopathic treatment, to help undertake the practice of pasung. As Jan Ilhan Kizilhan states is “Religious and Cultural Aspects of Psychotherapy in Muslim Patients from Tradition-oriented Societies,” taking patients’ value system into consideration in a culture-sensitive way, with reference to their notions of magic, healing ceremonies, and religious rituals and especially patterns of relations and experience in the treatment of psychological diseases in medical, psychotherapeutic work, with due regard to scientific psychotherapeutic standards, can be used as an intercultural resources and lead to establishing partnership-like relationships between patients and therapists (Kizilhan 2014). The cultural-sensitive approach is specifically essential for Indonesia due to the inadequacy of mental health practitioners. Indonesian psychiatry  has seen a better day. However it has long gone.

Indonesian psychiatry has been moving backward. In his paper, “The Development of Psychiatry in Indonesia,” Hans Pols states that the period of 1970-1985 is the golden age in Indonesian psychiatry (Pols, 2006: 367). Pols explains at that period, Kusumanto, the Director of the Directorate of Mental Health within the Department of Health, managed to open 22 new public mental hospitals, making 26 mental hospitals available in 31 provinces. Kusumanto then named as the father of Indonesian psychiatry and later the father of ASEAN (Association of Southeast Asian Nation) psychiatry (Pols, 2006: 367).  However, it seems that his successor did not continue Kusumanto’s achievement.

Today, there is no meaningful breakthrough in Indonesian mental health facilities that are akin to opening 22 public mental hospitals. Instead, the number of physicians that interested in pursuing a degree in psychiatry has stagnant. According to Tempo article, “Indonesia Kekurangan Psikiater,” or “Indonesia shortage of Psychiatrist,” only around 773 psychiatrists available for 250 million people, meaning for every psychiatrist there are 323,000 patients. According to the World Health Organization, the ideal ratio is 1:30,000.  Moreover, most of the psychiatrists dwell in Jakarta, the capital city of Indonesia, or other places in Jawa, Indonesia’s main island. One of the understandings behind the scarcity of psychiatry in Indonesia is because it is seen as a “dry” field, meaning there is no financial gain for a doctor that wants to be a psychiatrist. I argue that this is due to insufficient awareness of mental health in society. For instance, when a mother sees her daughter having a manic episode, the majority of Indonesian mothers will assume that santet or black magic is causing their daughter to act that way. Instead of going to a doctor, the families of mentally ill patients prefer to go to a religious, spiritual, or traditional healer. By doing that, these traditional healers practically “stealing” the psychiatrists’ patients.

To help with spreading awareness about mental health in rural Indonesia, mental health practitioners need to change their point of view when talking about cultural, spiritual healers. Instead of seeing them as “stealing” potential patients, mental health practitioners should work with them and take benefit of their influence among most Indonesian people. Across Indonesia, from Yogyakarta to Bali, there is evidence that people with mental illness improve their conditions after they have a religious, spiritual activity.  After running both quantitative and qualitative data collection methods to investigate the relation between subjective-well being and dzikir intensity from members of Sholawat A’dzom Dzikir Congregation, Yogyakarta, Indonesia. Dizkir is a ritual in which Muslims seek enjoyment by keep chanting God’s name over and over (Hamsyah et al. 2017: 80).  Fuad Hamsyah and Subandi in “Dzikir and Happiness: A Mental Health Study on An Indonesian Muslim Sufi Group” find that dzikir intensity highly corresponds to subjective well-being (Hamsyah et al. 2017: 93).

In a different cultural and religious setting, Lesmana et al. find that the cultural psychiatry approach also useful among Hindus in Bali. In the article “Spiritual-Hypnosis Assisted Therapy: A New Culturally-Sensitive Approach to the Treatment and Prevention of Mental Disorders,” Lesmana et al. examine the therapeutic approach of Spiritual-Hypnosis Assisted Therapy (SHAT). Lesmana et al. argue that SHAT has been extensively and successfully used in clinical practice in Bali for over a decade now for a variety of mental disorders, emotional distress, sexual, relational, and sexual orientation problems, and post-traumatic stress disorder. Lesmana et al. conclude that SHAT is economical, easy to master, and highly effective (Lesmana et al. 2010: 206). Furthermore, people with mental illness would be highly benefited from such activities because they will be able to socialize rather than feeling alone and isolated.

However, even though the cultural, spiritual strategy has been successfully helpful for people with mental health in Indonesia, we should not ignore that the allopathic approach is inevitable to reach maximum remission. In the article “Remission in Schizophrenia: A Community-based 6-year Follow-up Study in Bali”, Kurihara et al. investigate the rate and predictors of remission at medium-term follow up of individuals with schizophrenia in a community setting in Bali. Kurihara et al. use the analysis of the naturalistic study and qualitative method. They screened 8546 general residents, finding 37 individuals with schizophrenia, including 19 never-treated cases. The results demonstrated that 27% of subjects achieved complete remission, and those with less severe negative symptoms at baseline and those who had received psychiatric treatment for more than half of the follow-up period were more likely to achieve complete remission at medium-term follow up (Kurihara et al. 2011: 480). Kurihara et al. conclude that the majority of community-screened individuals with schizophrenia failed to achieve complete remission at the 6-year follow up (Kurihara et al. 2011: 480). Kurihara finding reveals that regulations and promotional efforts are crucial to increasing the amount of remission among schizophrenia patients.

Nonetheless, mental health promotions and regulations are not enough to change the behavior of Indonesians who live in rural and still practicing pasung toward their families. In the article “Aceh Free Pasung: Releasing the Mentally Ill from Physical Restraint,” Puteh et al. states that Free Pasung program is an essential mental health and human right initiative that can serve to inform similar efforts in other parts of Indonesia and other low and middle-income countries where restraint and confinement of the mentally ill is receiving insufficient attention (Puteh et al. 2011). However, on the same topic, Irmansyah et al. in “Human Rights of Persons with Mental Illness in Indonesia: More than Legislation is Needed,” concludes that more than legislation is needed to protect the human rights of persons with mental illness. I argue that “more” here is the involvement of the local community to help spread awareness about mental health. Due to the scarcity of mental health practitioners, it is clear that Indonesian can not rely solely on psychiatrists to spread awareness about mental health, instead Indonesians need to work with all the resources they have. Spiritual healers, cultural leaders are all great communicators that can lend their voice to promote the importance of mental health.

To conclude this article, I would suggest future researchers study more about the effectiveness of cultural, traditional healers in their collaboration with mental health practitioners. Hamsyah et al. and Lesmana et al. have been giving us evidence of the spiritual, traditional practices that are beneficial for positive well-being. However, we need more studies to back these claims so the practice can be more easily be adapted to other places, and later hopefully will be able to replace pasung. Furthermore, this paper aims to be beneficial for cultural psychiatry study. Outside academia, this paper should be seen as information to understanding the motive of people who practice of pasung and the search for a better alternative that should replace these traditional practices soon in the future.   

Works Cited Entries

Hamsyah, Fuad, and Subandi. “Dzikir and Happiness: A Mental Health Study on An Indonesian Muslim Sufi Group.” Journal of Spirituality in Mental Health, vol. 19, no. 1, Jan. 2017, pp. 8094. EBSCOhost, doi:10.1080/19349637.2016.1193404.

Irmansyah, et al.. “Human Rights of Persons with Mental Illness in Indonesia: More than Legislation is Needed”. International Journal of Mental Health Systems, 19 June 2009, 3:14.

Kizilhan, Jan Ilhan. “Religious and Cultural Aspects of Psychotherapy in Muslim Patients from Tradition-Oriented Societies.” International Review of Psychiatry, vol. 26, no. 3, June 2014, pp. 335–343. EBSCOhost, doi:10.3109/09540261.2014.899203.

“Indonesia Kekurangan Psikiater”. Koran Tempo. 6 October 2016. www.koran.tempo.co.

Kurihara, Toshiyuki, et al.. “Remission in Schizophrenia: A Community-Based 6-Year Follow-up Study in Bali.” Psychiatry & Clinical Neurosciences, vol. 65, no. 5, Aug. 2011, pp. 476–482. EBSCOhost, doi:10.1111/j.1440-1819.2011.02246.x.

Lesmana, Cokorda Bagus Jaya, et al.. “Spiritual-Hypnosis Assisted Therapy: A New Culturally-Sensitive Approach to the Treatment and Prevention of Mental Disorders.” Journal of Spirituality in Mental Health, vol. 12, no. 3, July 2010, pp. 195–208. EBSCOhost, doi:10.1080/19349637.2010.498696.

Pols, H. “The Development of Psychiatry in Indonesia: From Colonial to Modern Times.” International Review of Psychiatry, vol. 18, no. 4, Aug. 2006, pp. 363–370. EBSCOhost, doi:10.1080/09540260600775421.

Puteh, et al.. “Aceh Free Pasung: Releasing the Mentally Ill from Physical Restraint”. International Journal of Mental Health System. 2011, 5:10.