Mental Disorders in Indonesia

1
Mental Disorders in Indonesia

• By Monica Hausler
• November 17, 2005

2
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

3
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 smallerafter 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

4
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)

5
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 doesnt 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

6
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 survivorsmany of whom have never
  heard of a psychological counselor before

7
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.

8
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

9
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
• Mild psychological distress that resolved within
  days or weeks
• Moderate/severe psychological distress that
  resolved with time or mild chronic distress
• People with mental disorders, divided into those
  with mild and moderate disorders and those with
  severe disorders.

10

• 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
  1401,000 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.

11
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.

12
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.
• Theres 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

13

• 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
• Theres evidence that communities have started to
  rebuild their houses and villages

14
Any Positive Outcomes?

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

15
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 19th century and into the
  first half of the 20th 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, Indonesias
  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

16
Tri Upaya Bing Jiwa

• Meaning the three pillars of mental health
  services
• Prevention
• Promotion
• Treatment

17

• 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

18
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

19

• 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.
• Shariah The Islamic Law
• Tafsir interpretation and commentary of the Holy
  Quran and the Hadiththe tradition of the
  Prophet Mohammed
• Producing Hafidz one who memorizes the whole
  Quran 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

20
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

21
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, 163-186.
• Earlywine, M. (2001). Cannabis-induced koro in
  Americans. Addiction, 96(11), 1663-1667.
• Kua, E.H. (1991). Amok in nineteenth-century
  British malaysia history. History of Psychiatry,
  2(8), 429-436.
• Quinn, A. Indonesia tackles tsunami mental
  health crisis. Retrieved from
  http//www.medicinenet.com/script/main/art.asp?Art
  iclekey41422
• Silove, D., Zwi, A.B. (2005). Translating
  compassion into psychological aid after the
  tsunami. Lancet, 365(9456), 269-271.
• http//www.crescentlife.com/articles/islamic/20ps
  ych/religious__medical_mental_health_care_east__
  west_context.htm
• http//www.psychport.com/show/Article.cfm?xmlFile
  ap_2005_01_25_ap.worldstream.english.general_D87RI
  TT00_news_ap_org.anpa.xmlproviderAssociatedPres
  s
• http//www.reliefweb.int/rw/RWB.NSF/db900SID/RMOI-
  6DF67E?opendocument
• http//www.thejakartapost.com/yesterdaydetail.asp?
  fileid20050907.P01