Caged and shackled, forced to eat, sleep, and defecate in the same place. Definitely not an image that comes to mind for mental health treatment. Fortunately, mental health awareness and treatments have improved much since the times of widespread exorcisms and institutional abuses. However, that is not the case for many people living with mental illnesses in Indonesia and throughout the world today. A lack of resources, superstitions, and stigmas surrounding mental illnesses have forced thousands of Indonesians to suffer at the hands of a practice called pasung and to be subjected to inadequate treatment at mental health institutions.
Though it has been banned since 1977, pasung remains one of the main methods families choose to treat people with psychosocial disabilities in Indonesia. It consists of shackling or confining an individual for lengths of time that can extend to years. The prisons vary in features, but are usually small and filthy; some are even void of sunlight, with boarded up windows to prevent their prisoner from escaping.
There are an estimated 18,000 people currently subjugated to this practice; a recent report by the Human Rights Watch found that a staggering number of 57,000 people have been shackled up or confined to small places at least once in their lives. People of all ages and genders can be put through pasung, some enduring it from an early age. Lack of understanding mental illness, prevalent in rural areas, perpetuates the age old perceptions that demonic spirits are responsible for the individual’s behaviour. Thus families of those with perceived or actual psychosocial disabilities turn to the advice of spiritual healers, who then advise the families to confine their relative to the cruel chains that often lead to acute muscular atrophy.
The main reason this practice persists is due to poverty, with 90% of people wanting treatment but being unable to afford it. Even when one is freed from pasung because of temporary treatment, when the family can no longer continue to pay for medication, the individual’s condition quickly relapses and thus is returned to captivity. A lack of resources is also to blame; in a country with a population of 250 million, there are only around 48 mental hospitals. To make matters worse, they are mostly in four out of 34 of Indonesia’s provinces, with eight having absolutely no mental health institutions; since most families are unable to pay for treatment, transportation is an obvious additional burden many cannot bear. With only 800 psychiatrists, Indonesia has a ratio of around 1 psychiatrist for every 300,000 patients, an obviously insufficient number.
However, those who do manage to find themselves in an institution are not necessarily better off, being subjected to shock therapy and rituals akin to exorcism. While pasung is described as “living in hell”, sanitation at these institutions is staggeringly similar, having led to outbreaks of lice and scabies amongst the patients. The living conditions mirror the horrific abuses felt by institution patients across the developing countries, including cases of physical and sexual violence, the use of electroconvulsive therapy without anesthesia, restraint and forced contraception.
Even with the Indonesian Government putting much effort into improving conditions for the mentally disabled -like enforcing a Mental Health Act in 2014- poverty and stigma prevalent in rural areas persist. The Health and Social Affairs ministries are also actively trying to eliminate the practice through anti-shackling campaigns, however the decentralized nature of the Indonesian Government make progress slow and insufficient. It is obvious a stronger approach must be taken, and the rest of the world must also take action. People with disabilities are entitled to the same rights as those without, no matter their nationality or income level. We are all part of the global community called humankind; it is our responsibility to work towards a world free from treatments like pasung. Though progress has been made, it must not stop, it must not be slowed down, until practices like pasung exist only in nightmares.
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