A man of silence
A 50–year-old man had sat in the dark. With both of his legs chained, he had barely moved. The chains had been quite old- brown and rusted. These chains had been linked with padlocks to a longer chain, which had been locked to a one and a half meter long, wood of a coconut tree. He had remained in the corner of a poor, wooden house kitchen and he hadn’t talked at all. He had been silent. For more than fifteen years, this had been his state.
Before he was locked up, he had a good trading business, by which he raised his kids and fulfilled his family’s needs. This was before business problems and military conflicts brought him misfortunes. He started acting strange, wandering in the village, suffering from a short-temper, and hitting villagers for no reason. The community labelled him a “crazy man”. The family tried to seek help from traditional or religious healers several times, but were unable to change his eccentric behaviour. Later the family offered a “normal” and commonly accepted “treatment” by restraining him with wood and chains, “pasung”.
This man is not the only one who received such inhuman and cruel treatment. There are about 30.000 similar cases in Indonesia today, who received so little attention from their community and continue to be ignored. The situation has been worsened by poor service in mental health care, low literacy levels in mental illnesses, high stigma and bias, lack of human resources, and, most importantly, inappropriate policies towards mental health in general in the country. These factors cause the mentally ill to suffer very severely physically and/or economically.
According to the man’s family, he was neither given any western medical treatment nor was he diagnosed by health professional. These were only possible after he was released and taken to an asylum two years ago. The man’s life changed and getting better than ever.
Aceh province initiated a programme called Aceh free pasung in 2010. During that year, more than 150 mentally ill patients were released from chains, obtained proper treatment in the mental hospital, and received free medication and consultation once they returned home. However, to this date, this programme exists only in this province, while thousand others remain untreated elsewhere.
This man was just one of hundred cases that we got discharged to the hospital. In the confinement, He was cared for by his family, and although locked in the house, was fed three meals a day. He could carry out activities with his hands and best of all, had a great wife, who looked after him everyday for the past 15 years.
In another care, we had walked many kilometres into the jungle to release the mentally ill. These individuals used to had irregular food supply from the family and were bridled under the tress, unable to move their arms and legs. This showed how the community marginalized and abandoned the mentally ill.
A girl in chains, is there another chance?
From my own experience working with the lay and mentally ill, I know there is a big window of opportunity to treat them properly. There is a need for the international community to show commitment and support. I remember when I met a young girl chained on two of hers leg and able to walk around the village. My initial visit to the village was only to meet my friend who worked as a social worker. I saw the girl walking around while kids poked fun at her; she was the object of ridicule and stigma. Sympathising with the girl’s condition, I tried to gather information about her from the villagers. They said that she has been like that (restrained) for years: suffering with epilepsy and wandering the whole day in the village. I questioned further to find out why she hadn’t been released and taken to a health post. The villagers were unable to give any answer. Then I asked them if I could talk to the girl’s family, some of them told me that it would be useless and would not get any support from the family, but I insisted.
My friend, who had been working there for sometime, was able to takes me to the family. As a stranger I needed to explain my intentions, but I was fortunate to have my friend introduce me to them and help me start the discussion. I asked the mother to tell me everything about the girl’s life, beginning with her childhood. The mother was very candid; she told me everything, narrating, in detail, all the events leading up to the girl’s current situation. After listening to her for about two hours, I came to the decision that the family has no idea about the girl’s sickness and was oblivious to the wrong they had done to her. And I started to explain them about the disease that the girl was suffering. It took me three hours to convince them that their girl’s condition was treatable; at least, to prevent the epilepsy attacks, which she suffered from four to six times every day.
Two days later, I borrowed my friend’s truck and took her and her mother to the hospital. She met a doctor who gave a proper test and provided consultation. In the afternoon, I took them back home with a proper diagnosis and a pack of medicines that she has to take every day. Since then, she had no more epileptic attack, no more restrain and can perform simple household chores with her mother. After one month, I visited them again and the mother told me that she had found her lost daughter again, finally.
Our study reveals that there are many places where families tie up their “crazy” relatives like the jungle case described above or under small shelters behind traditional stage houses or in gardens around houses. The length of their imprisonment varies from a few months to long 20 years. The average time of restraint suffered is approximately 4 years.
The majority of lay people in communities know very little about mental illnesses and what they know about it was mostly wrong. Stigma is very high and mental health is not yet a priority in health care. The international organizations that work with mental health issues are also very rare, despite the fact that mental disorders are more prevalent than other diseases. Most mentally ill also live in low and middle-income countries where low resources hinder proper treatments.
Most people in Aceh believe that mental illnesses are caused by bad spirit, black magic or misconduct. This is the reason why many consult the ‘traditional’ or ‘religious’ healers, believing that these shamans, and not professional doctors, are more capable in finding the cure. This thwarts proper treatment for patients and is a foremost issue to be dealt with. The other issue is that of stigmatization where people with mental illnesses struggle with discrimination and seclusion. According to many people, mentally illnesses bring trouble and are incurable. It is therefore preferred that incurable patients should be kept in solitude, separate from the working of a ‘normal’ life. Those who consult a health professional on mental health are deemed mentally unfit and incapable in working in a job as a consequence.
Last but not the least, poverty is a social detriment that hinders those seeking mental health treatments. There are some who are aware of the treatments available from medicial professionals but not all of them can afford them. These two stories suggest that there is always an opportunity to help the mentally ill especially those among the poor or lay people. The problem is not merely lack of accessibility but most definitely lack of awareness. I believe that by just providing proper information about mental health and care, we can work towards releasing half of the 30.000 who remain restrained.
Mental Health volunteer in Aceh-Indonesia