By Ainur Rohmah
JAKARTA
Residents of an East Javan town have become accustomed to seeing Najad dancing in an old green military uniform. As he moves in the street to a silent beat, he waves a gold knife around him.
The villagers are scared. They watch the 55-year-old -- one of many Indonesians with mental illness left to fend for themselves -- from a distance fearing attack.
"No one dares rebuke him, although this is the main road to the market," a chicken seller named Surti -- many Indonesians use only one name -- tells The Anadolu Agency as she glances nervously around.
One day, a bearded Sufi preacher believed to have supernatural powers passed by; the man -- Muhammad Sholeh -- sidling up to Najad, and, as his patterned sarong gently billowed in the breeze, whispering something in Najad's ear that the townsfolk say they never ever got to hear.
And then Najad followed as if in trance as the preacher walked on.
Sholeh -- his bright white 'topi' cap sat tight on his head -- told the AA that there is an evil spirit inside Najad, and that this is the only man Najad obeys.
"I whispered to him [the evil spirit] to go home and not interfere with anyone else. And the spirit dutifully obliged."
Kholis, 27, is from the same village. He is plagued by a condition similar to that of Najad, with locals believing that he too became mentally ill after failing to master his spirits.
The man, however, confines himself to his home, his mother, Mutamimah, grieving to see her son in such as state.
"I am sad to see him like this, while friends his age already have families," she told the AA while holding back tears.
"I was lucky that I did not to have to lock him up in a cage or shackle him."
According to data from a 2013 Ministry of Health report, around 57,000 people with serious mental illness have been placed in "pasung" -- both physical restraint and confinement -- by their families.
Many are chained or shackled in their homes because families cannot afford treatment, or are ashamed of their illness.
Mutamimah -- whose family lives on the $2 per day her husband makes selling tempeh (a traditional Indonesian food made of soybean) -- told the AA that there is nothing she wants more than to see her son "live a normal life, married and working," but "there are no hospitals around here."
In a country of over 237 million people, there are just 45 mental health hospitals -- the majority located in the cities.
Mutamimah says that her and her son would have to travel for five hours to the city to visit a mental health institution.
"I just can't afford that," she says.
Cokorda Bagus Jaya Lesmana, a psychiatrist at the nonprofit Suryani Institute for Mental Health on the Indonesian tourist haven of Bali, told the AA that access to treatment is difficult for many families with relatives suffering from mental illness. Many of them are not informed about medical treatment, do not trust it, or just cannot afford it, he says.
He said that many people believe such illnesses are caused by "black magic, evil spirits, karma or curses," families bringing their relatives to traditional healers rather than doctors.
And when that fails, families -- typically uneducated and from lower socioeconomic strata -- choose "pasung" as a last resort, some chaining or caging their relatives, while others have their legs tied to wood.
"Most of them are not cared for properly, while pets like cows, chickens, cats and dogs -- though bound -- are still cleaned," he said.
He added that while others may judge such families as "barbarians" or "inhumane" for such treatment, that is certainly not the case.
“Pasung is an act of desperation. The biggest problem I face is restoring the family’s hopes of finding a cure."
Dr. Lesmana recounted to the AA that he had once visited a patient who had been in "pasung" for 12 years.
"She looked very thin, and was covered in her own filth and litter. When I arrived, she looked at me and uttered just three words - ‘I am dead’," he said.
"But what’s most pitiful is the fate of people who experience mental disorders" in Indonesia, he adds. "Death may well be better for that woman."
Dr. Lesmana said that after gaining permission from families, his team treats patients without charge at home so those around can learn to deal with mental disorders, such as schizophrenia, and recognize its signs and symptoms.
The team also teaches meditation and relaxation to families and community leaders to remove the stigma associated with such disorders, and to foster the patients' acceptance into the community.
Moves are now afoot to ban "pasung," and also to find treatment for the mentally ill, the Indonesian parliament planning legislation that would make it more comprehensive -- ranging from prevention to rehabilitation.
But Dr. Lesmana says he is not very optimistic about the bill, as -- "although effective for psychiatric problems -- it does not cater for those in pasung."
He says the bill is too fixated on treatment at mental hospitals, and does not consider community-based treatment, where health workers visit patients at home with the participation of families and communities.
"It will not address the constraints families face due to the lack of psychiatric facilities and professional human resources," he told the AA.
Dr. Lesmana expressed hope, however, that the government will start to treat patients through a door-to-door policy -- so they can also help and work with the families -- rather than adhering to the old policy of accommodating them in institutions.
"They need relief not only from drugs, but also from themselves," he underlined. "They should be encouraged to rise up and fight back against anger and sadness. These cause mental disorders that require longer treatment than that used to fight physical pain."
Back in East Java, Mutammimah's neighbor told the AA that she had once had a brother -- now deceased -- who was in pasung.
She said her father had no choice but to pasung him, fearing he'd escape from home and attack others.
"He'd been married, and his wife's family didn't want to take care of him, probably because of the shame," she added.
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