Notes from Seminar on “Building Mental Health Capacity in Culturally Diverse Indonesia”

Jogja (16/7)

Who doesn’t want to go to Harvard? Simple question that probably result with close to anonymously uniform answer: No one!

However, due to many reason only small fraction of numbers of people can go there for study. But that’s not why we are here today.

Yes, Harvard is a precious school to go to but it doesn’t mean that non-Harvardian cannot be benefitted from the development of knowledge generated from what used to be a clergy school established by John Harvard in the 17th century.

In this borderless world driven by the advancement of technology, the economics concept of ‘externalities’ (uncompensated impact of one person or firm’s actions on the well-being of a bystander) aid to magnify the extension of knowledge development. One way this oldest higher education institution in the U.S. doing it is through online course and Harvard even joint venture with its neighbor, the MIT, the engineering school prodigy (http://www.nytimes.com/2012/05/03/education/harvard-and-mit-team-up-to-offer-free-online-courses.html?_r=1).

In case you are not online student material, attending lectures by Harvard professors is the other viable option and the purpose of this writing is to share what have been discussed by Professor Byron J. Good of Harvard Medical School.

Themed “Building Mental Health Capacity in Culturally Diverse Indonesia: Anthropology, Indonesian Subjectivities, and Post-Colonial Disorders” Professor Good or, as he addressed in the class, Professor Byron share his story about mental health care projects he had in Indonesia. The seminar was strongly sponsored and organized by UGM, July 16, 2012.

First set foot in Indonesia in February 1996, Professor Byron and his wife, also professor at Harvard, Mary-Jo fell in love and maintain their love towards Indonesia. Being a multidiciplinarian as he is, Professor Byron was a mathematician by undergraduate and medical school student with strong approach on anthropology. This is not the case for professor in Indonesia. As can be drawn from the them of the seminar, he talked about various subjects ranging from medical, psychology, and anthropology, even political aspect of culture psychology.

One logically acceptable rationale behind this is that it is simply painstakingly impossible to understand mental illness (sakit jiwa) without first understand the psyche (jiwa) and the ocean of culture surrounding it.

Introduction presumably suffice, let’s go to the main course. One fact that echoed during the seminar was the fact that Indonesian psychiatrists to population ratio is the lowest in Southeast Asia. Compare to advance Singapore with between 2 up to 3 psychiatrists for every 100,000 people, Indonesia is lagging way behind with only 0.21. It means that theres only one psychiatrist for every half-a-million Indonesians!

“We need 8,000 psychiatrists while only 600 available currently,” said dr. Carla, the psychiatrist.

Now you wonder why there’s many severe mental illness patients wandering in the streets of our city.

He continue in providing elaborate explanation on the data accumulated from the research on the effect of unfortunate events on one’s mental health. It is widely known that mental illness rooted from other sorts of pshychological issues in lesser degree such as anxiety, post-traumatic stress disorder, depression, and their families. As Prof. Byron stated during discussion,“Stress is not the sole source of mental illness” as widely perceived.

For the purpose of entertaining those with less medical background like myself, he share an illustration of a patient of mental illness he frequently visit from 1999-2005 annually. Say subject A was a regular person. A villager in Kulon Progo Regency of Yogyakarta. Subject A was in his/ her teenage years when the tipping point of mental illness occured.

As probably common for many ethnics or tribes in Indonesia, the reason for the psychological problem was, according to the subject, metaphysical interaction with the unseen. Subject A confirmed to be ‘attack’ by many type of spirits. He or she even met with the Queen of the South (Java) Sea, Nyo Roro Kidul.[1]

Like many other Indonesians who might ashame when their relatives shown mental illness syndrome, subject A family failed to treat him/ her with due medical treatment. In the case of people I know, they will go to paranormals for reference as the second opinion to licensed medical practitioner. Some even, to some extent, perceive it as the first reference.

This, according to my social sciences analytical assumption, might have something to do with deep culture in the Indonesian society. People strongly affiliated with their culture associated with traditional values unconsciously have this approach in treating an illness. This might be exception for those with access to higher education and financial coverage.

However, over period of time and medical approach to the mental illness, subject A recovered just within one month since started taking the medication. And, unlike several other subjects who faced recurring illness, subject A recovered completely from what once delcared acute mental illness.

The lesson learned here is that we have to treat the syndrome of mental illness at earliest stage and by treating it means consult with psychiatrist about the patients. As added by a psychiatrist from the panelist who happened to assisted the research with subject A  years ago, mental illness is stigmatized, in both ends. First, from the patients’ family, they would be embarrased having a ‘troubled’ or to a larger extent ‘crazy’ family member so that public institution facilities are just out of the question. Second, the professional career as psychiatrist is undermined in the society leading to small number of professionals thriving in the field. No wonder the ratio was so small in Indonesia.

On the other note, without neglecting the rich socio and cultural background of Indonesian society, Prof. Byron also suggested that mental health care in Indonesia treated wisely by incorporating local values in the treatment.

When he was studying Comparative Religions in University of Chicago, Prof. Byron taught by Professor Clifford Geertz, a famous Indonesianist and anthropologist who came with the book “The Religion of Java”. Perhaps through interaction with Geertz, the interest towards Indonesia started to dwell in him.

On the social sciences perspective, Prof. Byron and his wife, Prof. Mary Jo, did research on post-colonial trauma in Aceh. The case that might applied to Indonesia in general.

One particular trait, negative in it’s matter, amok or amuk (mengamuk) in Bahasa Indonesia, used by colonial sociologist in describing the violent nature of society. The word ‘amok’ who seem to derive from Indonesian ‘amuk’ even absorbed into English dictionary.

The case mentioned for the proclivity of amuk society is that during the Reformasi movement in 1998 culminated with Soeharto’s fall the Indonesian society, especially political activists, were so violent as highlighted by media worldwide. The seed to violence even spread later on in several ethnic based conflict in Mollocas (Maluku), Poso, Sampit, Solo and other similar cases.

Prior to the 1998 movement, the term ‘amok’ was used by the reign of New Order as an excuse for Indonesia to accept more democratic standard of governance.

In some daily cases, we can even recite the scene of mob violence where someone, usually alleged or red handed thief, was attacked by angry mass. Many of this cases lead to death for the thief or the like without any legal prosecution proceeding the events. It clearly is a prove that legal base ‘assumption of innocence’ is not enforced here.

But what does it have to do with mental illness? As the case of individual mental illness, a violent society which easily triggered to wreak havoc this is a strong indicator that, collectively, our society is a sick society. Just like individual is treated when they are subjected to mental illness, our society must also be treated to recover from this serious issue. (HPY)


[1] A mythological being who rule(s) south of Yogyakarta’s sea

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