Crying Out for Help

The Jakarta Post ,  Jakarta   |  Fri, 05/23/2008 7:52 PM  |  Center Piece

Shame and stigma continue to cloud the issue of mental illness. Annastashya Emmanuelle reports.

What was playing on the mind of Indi Afif when he jumped off the roof of a mental hospital in West Jakarta is anyone’s guess.

The 22-year-old was admitted to the government-run facility just two days before the incident and no thorough diagnosis of his mental condition had been made.

Indi’s family described him as often angry and disconnected from the people around him before they finally decided to seek medical help.

“Perhaps he wanted to escape from the hospital so he climbed up on the roof and fell,” said Rizal, a nurse at the mental hospital who was among those who found Indi’s lifeless body.

The fact that an in-patient could elude the supervision of staff who were supposed to be caring for him is a grim illustration of the lack of attention paid to mental illness in Indonesia, as well as the decrepit condition of facilities that treat those with psychological problems.

People lacking the finances to be treated at privately run mental hospitals have no option but to seek whatever help they can get at understaffed, poorly funded public hospitals.

Often, those finally brought to such facilities are already severely ill because Indonesians are traditionally reluctant to seek treatment for mental disorders. Psychologists say a combination of social stigma, lack of financial resources and ignorance about the subject are the reasons.

In a society where maintaining appearances and conforming are essential, having a mentally ill family member is a source of great shame, something better hushed up or kept from prying neighbors. The attitude is that people should snap out of it and get on with their lives, or at least smile through whatever is troubling them.

“In Indonesia, social status and appearance are highly regarded …. Often mental illness cases are hidden by the family and only brought to medical care when it’s already at its late stages,” said Dr. Ashwin Kandow, a psychiatrist at the Dharmawangsa Sanatorium in South Jakarta.

Driven by embarrassment or lack of knowledge, families often first take their “strange” family members to consult religious leaders under the assumption they have been possessed by evil spirits or fallen victim to witchcraft. When that fails, soothsayers are also popular alternatives for seeking answers.

Seeking psychiatric help is often the last resort because it is seen as stamping the label “crazy” on not just the patient but also the entire family.

“What most people don’t understand is there is a wide range of mental disorders that vary from minor mental illnesses, such as depression and anxiety, to severe schizophrenia,” said Dr. Kandow.

Mrs. Rianti was initially reluctant to visit a psychiatrist at Cipto Mangunkusumo’s Child and Teenage Mental Health Department after her son was diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). She feared what people would think.

The consultations are usually scheduled after class or extracurricular activities at school, where mothers often gather while waiting for their kids. Rianti often feels at a loss for excuses when invited to go on after-school outings.

“I’m embarrassed to say that we need to go see a psychiatrist because the follow-on question will be, ‘why do you need to go to the psychiatrist?’” she says. “People usually think negatively when words such as psychiatrist are mentioned and will conclude that we have a serious mental health case.”

It is then that the harrowing image of bedraggled individuals sometimes seen talking to themselves or roaming alone on Jakarta’s streets comes to mind. Just like the members of the public who choose to look the other way, they may have been conveniently forgotten by their families who did not file a missing person’s report when they wandered from their homes.

Most never receive any treatment until they are picked up by city public order officials and taken to a province-funded mental rehabilitation center. Despite the rudimentary medical treatment at the centers, at least they are provided accommodation and food. Or it was the case at Bina Laras mental health center before the Jakarta provincial administration decided to cut the daily meal allowance from Rp 15,000 per person per day to Rp 11,000 as of March.

Medicine for the patients is heavily dependent on donations from pharmaceutical companies in Jakarta. According to the center’s chief administrator, Sahabuddin Siregar, an additional 82 people were admitted between January and March this year to join 202 other patients.

In the past three years, the hospital has also returned 80 patients to their families after they were able to remember their home address. Families are sent a photo and a letter requesting they take the patient home.

But some letters go unanswered. Siregar chooses to think positively about the reason. “Perhaps the patient did not remember the correct address,” he says.

While having a psychologist on speed-dial is common among the affluent in the West and getting therapy is no longer shameful, people in Indonesia are still reluctant to confront mental illness. Although there have been several high-profile cases of women murdering their children, either due to post-partum depression or schizophrenia, there is little focus on the issue once the blaze of headlines has died down.

Along with Indonesia’s gradual economic growth has come intense social pressure to keep up with social changes. The demand to stay ahead combined with increasing economic pressures contribute to growing cases of mental illness in urban areas.

Psychiatrists list anxiety, mood and eating disorders, obsessive-compulsive behavior and depression as the most common conditions in metropolitan areas such as Jakarta.

Privately run Dharmawangsa Sanatorium recorded 5,120 patients in 2002. By 2007 the number had increased to 5,682, with about 8 percent of patients diagnosed with severe disorders. Those who cannot keep up with the rat race slip into isolation.

In October 2007 the World Health Organization reported the average suicide number in Indonesia from 2005-2007 was 24 people per 100,000 of the population, most often due to depression caused by poverty and homelessness.

Dr. Kandow said psychiatric drugs are expensive in Indonesia and most of the time are unaffordable to lower-income patients.

The deeper problem, he adds, is the lack of understanding of the importance of the mind.

“We often gesticulate by holding our hands to our heart when we’re saying we’re sad. Actually we should gesticulate to our head to indicate sadness because all forms of feeling originate from the brain.”

+Illustration by Staven Andersen

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