Andrea Star Reese

DISORDER_2011-­‐2016 and ongoing

Disorder is documentary photo reportage about abuse against people with psychosocial disabilities in Indonesia:

Pasung is the Indonesian term for chains, stocks, or shackles, but can also refer to being locked in a room, pen or cage.

Banned in 1977, it is the widespread traditional response to mental disorders throughout Indonesia and an act of desperation. Caregivers resort to pasung when they cannot afford care, fear medications and addiction, 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. Indonesia is estimated to have over 19 million people with psychosocial disabilities.

Even with the passage of the 2014 Mental Health Law, effective regional programs continue to be rare and underfunded. Common obstacles for Indonesians include access to care, cost of seeking treatment, and the lack of widespread dissemination of basic information.

Indonesia has about 48 mental health institutions and roughly 700 psychiatrists. More then half of the psychiatric hospitals are in four of the country’s 34 provinces, while eight provinces have no psychiatric hospitals at all. Of Indonesia’s psychiatrists, half are based in Java, and half of them practice in Jakarta. Needed prescriptions can be unavailable for months due to shortages. Patient compliance and lack of family support can also lead to treatment failure. A new development that is being talked about by families, is the suspicion that a multi-billion dollar deficit risk is affecting Government Health Insurance. Doctors have begun to charge patients additional costs that families are unable to pay. Without needed medications, people who have survived pasung are worsen, are locked away and chained. To further complicate efforts for reform the Ministry of Health oversees mental hospitals while shelters for the mentally ill are the responsibility of the Ministry of Social Affairs

And furthermore, Shamans and traditional healers continue to remain the popular choice of mental health care throughout the country. For Indonesian’s, 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.

In 2013 Human Rights Watch contacted me after seeing my photographs which led to an investigation . On March 21, 2016 Human Rights Watch released their Report: LIVING IN HELL. In mid April, “Indonesia’s Minister of Health, Nila Moeloek, committed to providing mental health medications in all 9,500 community health centers (puskesmas) across the country. Achieving this could turn the tide against shackling” wrote Kriti Sharma, an HRW investigator. However, despite the subsequent International response to 2016 HRW Report, actions by Indonesia’s Ministry of Health, and the relentless efforts of Indonesia’s Mental Health professionals and activists, “little has changed” according to Andreas Harsono, Indonesia’s researcher for Human Rights Watch September 9, 2016. Most recently, “The health ministry has taken steps to train staff on mental health and is providing mental health medication in 2,000 puskesmas (community healthcare clinics). They hope to reach all 9,500 by 2019.” Kriti Sharma, Human Rights Watch Investigator.

Inadequate access to the medications and treatments commonly available throughout much of the world has devastating consequences. Many people don’t even know they can get better.

Walking through the door is easy. It is leaving that is hard. This reportage of men and women who are invisible to mainstream society is in response to what has been discovered concerning the complex realities that challenge the men and women in these photographs.

Consultants and fixers essential to my work are: Iin Purwanti Cox, Outpost, initial and ongoing consultant; Dr. Pandu Setiawan,  Psikososial Indonesia, primary consultant; Yeni Rosa Damayanti, Indonesian Mental Health Association, primary consultant; Dr. Hervita Diatri, Cipto Hospital; Dr. Yunier Sunarko, Lewang Mental Hospital; Bagus Utomo, Komunitas Peduli Skizofrenia Indonesia; Goen Guy Gunawan, primary fixer; Bustanul Arifin Bokir, local contact, dialect translator; Nurhammed, local contact; among others.

72,107