While I was studying and interning at a local newspaper in Ghana in 2008, I met a student of psychiatry who was doing part of her residency there. She told me unsettling stories of what it was like working in mental health. Patients were sent to camps, where priests and pastors tried starving the spirits out of the patients. Even after reading about cases like this in Africa, I was shocked that in the rapidly industrializing country of Indonesia, with a growing and educated middle class, the Health Ministry estimates that there are 18,000 people with mental disorders that are still subjected to pasung (shackling).
Indonesia is a country of 240 million people. There are only 600 trained psychiatrists and an estimated 33 hospitals dedicated to mental health. Although Diah Setia Utami, director of mental health at the Health Ministry, says that the government aims to provide 30 percent of the country’s 9,000 community health clinics and 1,700 general hospitals with mental health care by 2014, many people in the country still believe that mental illness or sakit jiwa (literally translated as “sick soul”), is a result of black magic and that modern medicine cannot cure it.
After speaking to psychiatrist Dr. Nova Riyanti Yusuf, who is the Deputy Chair Woman of the Commission overseeing healthcare, and who heads a committee that is lobbying to pass a bill to reform Indonesian mental health policy, I became less judgmental. I realized these mental health facilities currently do not have the resources and training to treat these mental health patients in accordance with the World Health Organization guidelines. Yusuf said something really poignant: “In a broken system, it is unfair to punish those that are trying to do good. Despite what we may think is correct, the reason that there are foundations that do pasung, is that the [mental health system] is broken.”
My expertise is not in policy-making or best practices in mental health. I know what I have read and seen, but I am in no position to comment on what needs to be done. My goal for my photo project is to show both sides of this mental health conversation. And in partnering with filmmaker Stan Okumura to tell the story as a documentary, it is not our intention to advocate for a cause. Inadvertently a project like this can be perceived as advocacy because of the strong emotional content of the stories. However, this is an opportunity to open the lens and demystify mental illness, not necessarily focusing on the problems associated with it, but rather what is being done about it.
While the practice of shackling is not uncommon in many parts of Indonesia, through the course of this project I have come across a few organizations that are doing work to raise public awareness and successfully deliver treatment to people suffering from mental illness. I’ve also been fortunate enough to meet loving families that have raised and cared for children afflicted with mental illness, while combating the stigma and misconceptions in their communities. It is my hope that this story can not only inform a broader public about the conditions patients must endure in Indonesia, but also highlight those that are providing life-changing support to the mentally ill and their families.
The situation in Indonesia is not an isolated one. Mental illness has varying degrees of stigma among different cultures. I'm aware of similar cases in both West Africa and South or Southeast Asia. I have friends and family in the U.S. that suffer from depression or bipolar disorder and have been on medication for years, but have kept their illnesses secret because they are afraid of how they might be perceived. Others choose not to get treatment at all and are criticized for their decision. Regardless of geography, the feeling of isolation that results from the stigma attached to mental illness makes this project universal.
I think as a society, if we have a better understanding of mental illness, perhaps we might take a more empathetic approach when interacting with those who face mental illness. My photo series and film are only the beginning of a much larger project to cover and understand the issues affecting mental health across the world. At the moment, our focus is on Indonesia. I think it is important that we truly understand the climate here before moving forward.
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This project is part of GOOD's series Push for Good—our guide to crowdsourcing creative progress.