Disorder: Indonesia's Mental Health Facilities by Andrea Star Reese

3 minute read

Pasung is the Indonesian term for restraints or restrained. It is used to refer to shackles, but can also refer to being locked in a room or confined in a shed or animal pen.

From January 2011 through the end of 2012, I spent time photographing people in Indonesia being held in homes, shelters, schools and hospitals. Many had not been seen by a psychiatrist or diagnosed with mental illness, stress or a physical condition that might explain symptoms or behaviors they exhibited.

Pasung, banned in 1977, is the widespread traditional response to mental disturbances like these. People resort to pasung when they cannot afford care, fear medications, want to avoid the stigma attached to a diagnosis of mental illness, or most commonly, feel it is necessary to protect family, community and the disturbed individual.

Effective regional programs continue to be rare and underfunded. Common obstacles for Indonesians include access to care, cost of treatment, and the lack of widespread dissemination of basic information. Indonesia’s local and regional officials recognize the important role existing private and licensed shelters can play, despite their current inadequacies.

Differing figures reported by the government indicate that Indonesia has about 600 to 800 psychiatrists—half based in Java, and half of that 50% practice in Jakarta. Some still use only one diagnosis and one prescription. Needed prescriptions can be unavailable for months due to shortages. Patient compliance and lack of family support can also lead to treatment failure. To further complicate efforts for reform, the Department of Health oversees mental hospitals while shelters for the mentally ill are the responsibility of a separate department.

And furthermore, Shamans and traditional healers continue to remain the popular choice of mental health care throughout the country. For Indonesians, it is better and cheaper to attribute confusing or abnormal behavior to spiritual weakness, spells, or possession. There is no stigma attached to being under a spell or possessed.

Mental illness is a disease that can be treated successfully; as my project demonstrates, inadequate access to the medications and treatments commonly available though out much of the world has devastating consequences. The largest may be that many people don’t even know that they can get better.


Andrea Star Reese is a documentary photographer based in New York. A selection from her series Disorder will be exhibited at the 2013 Visa Pour L’Image Photojournalism Festival held in Perpignan, France from August 31st to September 15th.

In addition to publication, photographs from Disorder will be used for education, training and as part of community outreach programs in Indonesia.


from the series: Disorder
The following project was photographed between Jan. 2011 and Nov. 2012. Galuh Foundation, located on the outskirts of Jakarta, is licensed by Indonesia’s government. No one is turned away if they cannot pay. Galuh receives enough rice, noodles and cooking oil for two months from the local government, the totality of all current government support. Medications are not available.Andrea Star Reese
from the series Chasing Stigma
Evi has been living at Bina Lestari Foundation for more than two years. She was fifteen when she began to first experience hallucinations. Her family pays for her platform bed and for the Islamic based spiritual approach to healing.Andrea Star Reese
from the series: Chasing Stigma. Catching Burnout. Semangot_Neve
Agus, Liana and Jarmoko live in cages at Jasono Alternative Treatment Center. Jasono, the owner, learned his method of treatment from a Pesantren in Jakarta; he sprays water on the men and women and gives them an herbal drink.Andrea Star Reese
from the series: Chasing Stigma. Catching Burnout. Semangot. Nev
Pesantren METAL offers a refuge for mentally ill women, as well as emotionally traumatized pregnant and unwed mothers, some of them girls as young as ten. At METAL, when the unwed mothers depart, the children stay. Much of the responsibility to care for the youngest is undertaken by boys and girls only slightly older. The sexes are separated.Andrea Star Reese
from the series: Chasing Stigma. Catching Burnout. Semangot. Nev
Pasung (shackling) at Bina Ahlaq, used after a run-away attempt. Once a Silat (martial arts) college, Bina Ahlaq now houses about 200 students suffering mental distress. Martial arts instructions and herbal remedies are central to treatment.Andrea Star Reese
Four years ago when Elis was 24, her family brought her to Salafiyah Al-Bajgur, an Islamic boarding school in Madura, East Java. Isolated, and locked away in a small crumbling room she has no furnishings or platforms only a few bits of cloth and clothing. Last year her parents died leaving only K.H Masturrahman the school owner, to look after her._Pondok Pesantren Salafiyah Al – Bajigur, Madura, East Java, Indonesia
Four years ago, when Elis was 24, her family brought her to Salafiyah Al-Bajgur, an Islamic boarding school in Madura, East Java. Isolated and locked away in a small crumbling room, she has no furnishings and only a few bits of clothing. Last year, her parents died, leaving only the school owner to look after her.Andrea Star Reese
from the series: Chasing Stigma. Catching Burnout. Semangot. Nev
Ibu Maliah cooks lunch for 280 mentally ill men and women at Galuh, a family-run shelter. She is assisted by former patients Siti, a ten-year resident, and Datir, 40, a transgender who has been at the shelter for thirteen years.Andrea Star Reese
from the series: Abnormal Behaviors, Mental Illness:Indonesia
At Galuh, there is no actual housing although small rooms have been built for management and staff. Many of the men and woman stay in the large cage enclosed pavilion under a leaking roof without access to the outdoor toilets.Andrea Star Reese
Meta was brought to Galuh suffering from mental issues complicated by drug use. For eight years she has lived without privacy in a large outdoor cage separated from the men by a wire wall. Sarja, one of 40 member staff also lives at Galuh._Galuh Foundation_Bekasi, Java, Indonesia
Meta was brought to Galuh, suffering from mental issues complicated by drug use. For eight years she has lived without privacy in a large outdoor cage separated from the men by a wire wall.Andrea Star Reese
from the series: Disorder
Maftukhah is suffering from depression. After her husband left her to marry another woman, her family brought her to Yayasin Bina Lestari, a small foundation under the Brebes Department of Religion.Andrea Star Reese
from the series: Chasing Stigma. Catching Burnout. Semangot. Nev
It is not unusual to find a sole child among adults being treated in hospitals and shelters.Andrea Star Reese
from the series: Chasing Stigma. Catching Burnout. Semangot_Neve
Agus sings in his cage, his hands moving in an intricate dance. Agus is housed in a cell to ensure he can not run away. He is being held at Jasono Alternative Treatment, a small private shelter in Cilicap, Central Java.Andrea Star Reese
from the series: Chasing Stigma. Catching Burnout. Semangot_Neve
At Bina Ahlaq boarding school, the large Silat (martial arts)-trained staff is available night and day to respond to emergencies.Andrea Star Reese
10.10.12_Evi the young woman in the pink dress is still at Yayasin Bina Lestari. Medications are still not available._Yayasan Bina Lestari, Brebes, Central Java, Indonesia
Evi, the young woman in the pink dress, is still at Yayasin Bina Lestari. Medications are still not available.Andrea Star Reese
10.24.12A large challenge to reform is the stigma surrounding the label mentally ill. There is no stigma attached to being possessed or under a spell. Keris Nangtang Foundation is an experimental shelter run by activists for homeless mentally ill and drug addicted men and women. Herbal treatments are used No one is chained.._Yayasan Keris Nangtung, Tasikmalaya, Java, Indonesia
A large challenge to reform is the stigma surrounding the label mentally ill. There is no stigma attached to being possessed or under a spell. Keris Nangtang Foundation is an experimental shelter run by activists for homeless mentally ill and drug addicted men and women. Herbal treatments are used and no one is chained.Andrea Star Reese
from the series: Chasing Stigma. Catching Burnout. Semangot. Nev
Anne’s father believes she does not need much to eat. Her family is distressed by the lack of improvement in her condition.Andrea Star Reese
from the series: Chasing Stigma. Catching Burnout. Semangot_Neve
Nurhammed, successfully treated for bi-polar disorder, tells Saepudin that he can get better. For nine years, Saepudin lived shackled in a back room in his family home. The two men met through a controversial program recently suspended for allowing volunteers to obtain diagnostic information and deliver medications. Now people in West Java’s remote villages must be brought to a hospital for treatment.Andrea Star Reese
from the series: Chasing Stigma. Catching Burnout. Semangot. Nev
Pondok Pesantren Bina Ahlaq is considered a boarding school and requires a tuition fee.Andrea Star Reese
from the series:Chasing Stigma. Catching Burnout. Semangot/ Neve
Gede, living chained to a post in a shed behind his mother’s home in a remote area of Bali, was reported to the Suriani Foundation. Dr. Suriani founded one of the rare, perhaps the only, outreach programs in Indonesia involving home visits by a psychiatrist.Andrea Star Reese
from the series: Chasing Stigma. Catching Burnout. Semangot_Neve
Mustofa, the sole assistant and primary caregiver at Kyai Syamsul's family-run shelter, gives a shower to Akrom, 25 years old. Andrea Star Reese
from the series: Chasing Stigma. Catching Burnout. Semangot_Neve
Didin, 25 years old, receives treatment from Abah Sanuk, a traditional healer using Silat, a martial arts method. Shamans and traditional healers are the most popular and more affordable mental health care providers throughout Indonesia.Andrea Star Reese
from the series: Chasing Stigma. Catching Burnout. Semangot_Neve
Muhammad Ikromudin, 25, was trained by to have special powers. He assists the men and women attending a mass healing that will last throughout the day and night. Participants pray, drink herbal drinks, vomit, and eventually enter a hypnotic trance. Afterwards, cleansed of their sins, they are showered with fragrant herbal water.Andrea Star Reese
10.10.12_Namiratus, the nine year old daughter of a traditional healer likes to help with the care of the men and women that live in a locked section of her home. Fathoni, has been living there as long as she can remember. He was bullied in high school and is described by her father, Shaman Usted Agus as “a near idiot.” _Usted Agus Suroso family home/shelter, Tegal, Indonesia, Central Java
Namiratus, the nine-year-old daughter of a traditional healer, likes to help with the care of the men and women that live in a locked section of her home.Andrea Star Reese

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