Jakarta. In Indonesia, where mental health education is almost nonexistent, one of the biggest problems faced by people suffering from mental illness, including schizophrenia, is stigma.
Many people here still think that schizophrenia is caused by demonic possession or black magic.
Family members who often don't know what to do are pressured to take the patient to a dukun, or shaman, to be exorcised, which almost always results in disasters for all concerned.
This is only one example of the consequences of mental illness stigma that often leads to sufferers of schizophrenia being mistreated, shunned off by society and sunk deeper into a private misery.
According to the American National Alliance on Mental Illness (NAMI), schizophrenia is a severe brain disorder that interferes "with a person’s ability to think clearly, manage emotions, make decisions and relate to others."
Symptoms include delusions and hallucinations. As a result, people who suffer from it may display inappropriate or erratic behaviors that can turn aggressive.
The condition is incurable but manageable if the patient gets the right medication and extensive psychotherapy.
According to political activist Yeni Rosa Damayanti, now also a disability rights advocate and the head of the Indonesian Mental Health Association, strong support from family and friends are also crucial if people with schizophrenia are to get well.
Stigma Prevents Treatment
Mental illness stigma affects almost everything in a patient's life, from personal relationships to performance at school or at work.
It also prevents people with mental health problems from seeking help and treatment.
A recent report in 2003 by WHO said stigma is one of the greatest obstacles for people suffering from mental illness to get properly treated.
Schizophrenic patients, since they can show disruptive behaviors, are often easy targets for stigma and discrimination.
Because of this, people who have schizophrenia often also suffer from low self-esteem, shame, a strong sense of alienation and social withdrawal.
"It is difficult for some [schizophrenic patients] to find a community where they feel comfortable and accepted. Their fears eventually lead them to stop seeking treatment because they are afraid to be judged," said Bagus Utomo, the head of KPSI, Komunitas Peduli Skizofrenia Indonesia (Indonesian Community Care for Schizophrenia).
Entrepreneur Dina Trihapsari, 35, said she was diagnosed with schizoaffective disorder – a hybrid condition that includes schizophrenia, bipolar disorder and depression – 10 years ago, just after her father had passed away.
Dina was aware she suffered an emotional breakdown but didn’t know it was the symptom of an early stage of mental illness.
"I would stay awake for days and was very hyperactive. When I was happy I felt very happy but when I was down I just wanted to disappear from this world," Dina said.
Despited her desperate condition, Dina initially refused to go to the psychiatrist.
"I told my mom I didn’t want people, especially my friends, to think that I am crazy. I begged her to stop taking me to the doctor to get treatment," she said.
Stigma affects not only the individuals with mental illness, but also their families.
Bagus said some families withdraw from social life because they suffer discrimination from being associated with a person with mental illness.
Dinar Rizki Kusumajati was diagnosed with schizophrenia four years ago after he was involved in a traumatic motorcycle accident.
Dinar said he started suffering from hallucinations that made it a struggle for him to go outside.
"I had visions of a woman dragging a cow with a thorn leash. I became an outcast. My neighbors kept telling my parents to commit me to a mental hospital," he said.
"Fighting stigmas remains a tough challenge for me. Something must be done – to break this vicious cycle. I wasn't the only one who was affected, my parents were also shunned," Dinar said.Negative Portrayal in Media
Unfortunately, the media often contributes to the negative portrayal of people with mental illness, reinforcing the stigma against them.
Local news reports often blame random acts of violence on "crazy people." In February, according to a report on BBC Indonesia, East Java police, soldiers and local Social Services Agncey rounded up homeless people "with mental illness" off the street because they were suspected of attacking Muslim clerics.
Many films and TV series also have "mad characters" who commit violent crimes.
Night Shaymalan’s "Split," for example, sensationalizes and misrepresents multiple personality disorder, imbuing its main character with monstrous supernatural traits.
Apart from having 23 different personalities, the film's antihero Kevin can transform into a beast that crawls on walls.
Even the treatment for mental illness gets the same sensationalistic treatment. Images and videos of confinement, electric shocks and psychosurgery can horrify mental illness patients and stop them from seeking medical treatment.
Clint Eastwood's "Changeling," for example, shows mental hospitals as institutions of torture.
Yenny said negative portrayals of mental illness in the media often hinder a patient's recovery from a schizophrenic episode and make it even harder for them to reintegrate into society.
"Sensationalized focus on impaired functions and behaviors endorses negative views of psychiatric treatment, preventing patients to disclose their condition or to seek professional help," she said.
Education Is Key
In Indonesia, recognition and understanding of mental illness remain appallingly low.
Bagus said negative stigma of mental illness is the direct consequence of that lack of knowledge.
"Education can't get rid of mental illness but it can give people the tools they need to seek an early diagnosis and appropriate treatment, which are crucial for patients to stand a chance of total recovery," he said.
"People need to know that schizophrenia is not caused by black magic. The condition needs medical treatment. It's very important that people understand this," Bagus said.
Bagus founded KPSI in 2009 to provide accurate information about schizophrenia for patients, their families, communities and the government.
The community has since become a safe space for people with schizophrenia – and those suffering from other types of mental illness – and their caregivers to share stories about their life.
Bagus said he has seen for himself that immediate changes in the way we deal with mental illness can be achieved through communicating openly about mental health issues.
"No one should deal with stigmas alone. Starting conversations is an important first step to break down barriers and to share this very heavy burden," he said.
Sharing Is Caring
According to Health Ministry (Kemkes) data, Jakarta saw 142 cases of suicide in 2011 and 167 cases in 2012. According to the ministry, the most frequent causes cited were mental illness, including depression, and financial problems.
In 2011, Kemkes launched a suicide prevention hotline called Halo Kemkes, providing people suffering from depression with professional help and counseling.
The suicide prevention hotline has trained counselors ready to pick up calls 24 hours a day. The counselor can refer callers to the nearest mental hospital if necessary.
The Halo Kemkes hotline is 1500-567 or through text message on +6281281562620.
Nonprofit organization Yayasan Pulih also offers counseling for victims of abuse and natural disasters, and people suffering from mental illness, including depression. The Yayasan Pulih hotline is (021) 982 86398 or 0888 1816860. The foundation also offers online counseling by email at email@example.com or by phone on (021) 788 42580.
People who need help can also visit the Yayasan Pulih office at Jl. Teluk Peleng No 63A, Kompleks AL, Pasar Minggu, South Jakarta.
KPSI and Bagus Utomo can be contacted at its head office on Jalan Raya Jatinegara Timur No.99 Kel, RT.9/RW.2, Bali Mester, Kec. Jatinegara, East Jakarta. The phone number is (021) 8579618