Caged people: the tragedy of Bali's mentally ill
From The Australian, Feb 14 2015
Full article here: http://www.theaustralian.com.au/new...l/news-story/17982a897b5f09c7e0a4a6f6cf02663f
IT’S a typical Bali setting. The TV burbles in the background. Sticks of incense smoulder in the morning sun and chatter fills the courtyard, competing with the incessant yapping of a caged dog as the family anticipates a Hindu cleansing ceremony.
Only the forlorn figure of Kadek, chained to his bed, his feet in stocks, in a room just metres from the courtyard hub, shatters the illusion. The 47-year-old’s sporadic guffaws punctuate the household’s routine. He sits facing a paneless window with a permanent view of half a tree and the dog.
His body is misshapen, gnome-like, and his skinny legs are bare, his only clothing a filthy, torn shirt. Empty banana leaves, which serve as a plate, lie on the bed beside a jar filled with coconut water. A bucket under the bed is his toilet and a crude hole has been cut in the *bamboo bed, dispensing with the need to move him. His family has disposed of his *faeces but the stench of caked filth and urine is overpowering.
Looking in, the viewer sees a grey, withered shadow of a man. His left eye is permanently closed and he has lost the ability to walk. Sometimes he makes eye contact; mostly he is lost in a desolate world. This morning, his 90-year-old mother has entered the fetid room, Kadek’s home for the past six years. Arm outstretched, he silently seeks a reassuring touch but she stays out of reach and ignores his entreaties. *Standing, locked in his gaze, she is inscrutable. Is it shame, remorse, guilt, anger, or simply love for a long-lost son that she feels? In a split second, Kadek segues from hope to despair. He withdraws his arm as if stung. His face shuts down. His mother retires to her adjoining room. No words have passed between them.
Kadek has schizophrenia and a tendency to aggression. His cousin-in-law, Anggraeni, 28, says Kadek’s propensity to attack people and steal would be unmanageable were he free. She is one of 10 family members, including three children, Kadek’s brother and elderly mother, sharing the compound in south-east Bali’s Klungkung regency. “This is horrible and sad, the chains, but Kadek is with mental illness,” Anggraeni says, adding the stocks are backup security should he break the chains. “If he was free he would make *trouble for the neighbours. Before [he was restrained] the family was scared of him. He was always disturbed. If people didn’t give him money or food he attacked them.”
Apart from a brief taste of freedom during a 2012 hospital stay for tuberculosis, Kadek has remained shackled. Does he complain of discomfort or pain? “He never says he is in pain,” Anggraeni replies. “Normally, people with *mental illness have strong antibodies. He never has colds or flu. When mosquitoes bite, he doesn’t complain; when the weather is cold, he doesn’t ask for a blanket.” Neither does Kadek wish for freedom. “No,” he replies emphatically when I inquire. It’s one of the few words he utters. There is nothing to suggest any semblance of a life amid the deprivation. And Kadek’s case is not uncommon — about 60,000 Indonesians live like this.
The practice of restraining the mentally ill is called pasung. Even though it has been outlawed since 1977, it is widespread among poor *Indonesian families who resort to iron shackles, wooden stocks, ropes, cages and locked rooms. The custom extends to many Asian and African countries but it has aroused little human rights concern and is neglected by researchers.
There has been some progress in Indonesia: since an anti-pasung program was launched in 2011, more than 5000 restrained people have been freed. The Health Ministry’s director of mental health, Eka Viora, says the rest should be released immediately. Viora is optimistic that a pasung-free program for 2015-19 will end shackling, although it’s unclear how violators would be penalised. There remain many obstacles to wiping out the practice, not least the severe shortage of mental health facilities. Mental health was allocated only about two per cent of the national budget last year, in a country where seven of the 34 provinces are without a dedicated hospital or programs and only 700 psychiatrists serve the sprawling archipelago of 240 million people. In Bali there is only one state psychiatric institution, the Bangli Mental Hospital. Last year, 45 previously shackled people were admitted there, on top of 32 in 2013, sparking hopes that more *families are seeking help (although two-thirds were returning patients.)
“The government knows there are many more out there not being treated,” says psychiatrist and head of services at Bangli, Dewa Gede Basudewa. “There is a lot of stigma with pasung patients. Most are schizophrenic with hallucinations. Families isolate them because they are ashamed and embarrassed. The patients have many long-term problems. Some cannot walk or have atrophy. Some have been in chains for 20 years. They have infections, tuberculosis, malnutrition. We want to find pasung people, prevent them from being rechained and stop them being chained in the first place. Families know it’s not good to chain them but they do because they are very poor.”