The further you move away from urban centers, the less adequate the infrastructure for caring for mentally ill people. This sentence could perhaps also apply to Germany. Elsewhere, it applies in a similar way or even more so. In Indonesia, for example, where Prof. Dr. Thomas Stodulka and his doctoral student Florin Cristea from the Institute of Social Anthropology are researching the course of illnesses, particularly on the islands of Java and Bali. The scientists have only just returned to Münster from their respective research visits. Thomas Stodulka, Professor of Social Anthropology in Münster since October 2023, carried out long-term field research in Indonesia. Doctoral student Florin Cristea is also involved in his DFG-funded research project “Afflicted Minds - ‘Madness’, morality, and emotions in rural Bali”.
With around 377 million inhabitants, Indonesia is one of the most populous nations in the world. Social inequality as well as cultural and religious diversity characterize the experience of illness and psychiatric care. It is often families and relatives who bear the costs of treating people with a mental illness. Most psychiatric facilities are located in the urban centers of Java, and the care profile is similar in Bali. The way in which traditional and conventional medical treatments intertwine seems to be changing.
“For around ten years, there have also been efforts in the countries of the Global South to increasingly treat mental illnesses with conventional medicine and ensure appropriate care,” explains Thomas Stodulka. However, traditional medicine, especially in the treatment of schizophrenia or depression, is still based on herbs or ritual medicine. “For example, clergymen or experts perform the Hindu ritual 'Melukat', in which water plays a major role.” Recently, the different approaches have become increasingly intertwined. “Sufferers and their families are campaigning to utilize the respective advantages of the two medical systems.”
Taking schizophrenia as an example: “As long as there are no blatant incidents, hearing voices is not always viewed negatively, but sometimes as a gift. Only when it disturbs the social community do people consider turning to health centers. From this first point of contact, people are referred to clinics or healers, in Bali to Hindu priests, in Java to Muslim mediators, so-called 'Kyai'.”
Traditional therapies often focused on morality. “If someone became ill, someone in the family must have misbehaved in rituals or not followed social rules.” A psychiatric diagnosis, on the other hand, provides a neutral framework for what happens to those affected. “It's not the family, the village or I who have behaved incorrectly, it's an illness.” This often helps to relieve the burden on those affected and speed up their recovery. Assigning them small tasks in their familiar environment, i.e. their district or neighborhood, has also proven to be promising.
“In Bali and Java, psychiatric treatment is different to here in Germany, for example when it comes to dealing with emotions,” emphasizes Thomas Stodulka. His ethnographic research project investigates how local and global knowledge influence each other. He and Florin Cristea are working together with professional networks and local and international institutions, for example with self-help groups, therapists and healers. Florin Cristea has also conducted over 80 interviews with patients, healers, psychologists and psychiatrists. She followed some cases for years. “The experience gained from this is feeding back into the Global Mental Health movement, which has set itself the goal of closing the treatment gap for people with mental disorders worldwide using conventional medicine,” reports the social anthropologist. One example is the treatment of mental illnesses with medication. Ritual work such as the “Melukat” in Bali or “Ruqiah” in Java should be continued during conventional medical treatment if possible.
Author: Brigitte Heeke
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This article comes from the university newspaper wissen|leben No. 7, November 6, 2024.