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The first series on mental health in the developing world (6 films)


A documentary film series that examines the lives of severely mentally ill people living on the Indonesian islands of Bali and Java. Afflictions is based on more than a decade of clinical ethnographic research conducted by documentary filmmaker and anthropologist Dr. Robert Lemelson.

 

Each of the six films—Memory of My Face, The Bird Dancer, Family Victim, Ritual Burdens, Shadows and Illuminations and Kites & Monsters— tells the story of the diagnosis, care and treatment an Indonesian suffering from a mental disorder and looks at the impact of culture, family and community on the course of their illness. Themes emerge with universal impact: how family members treat the mentally ill shapes outcomes, both positive and negative; culture has the power to protect and buffer the mentally ill or exacerbate their condition; to understand the experience of the mentally ill, it is essential to understand their cultural universe and values; and finally, pharmaceutical treatment can be effective or unsuccessful.


Afflictions: Culture and Mental Illness in Indonesia Box Set


Volume 1: Psychotic Disorders

 

A Balinese rice farmer haunted by the spirit world (35 min)

Shadows and Illuminations

Credits

Director
Producer

DP
Consulting Editor
Editor
Music Composer
Music Editor

 

Robert Lemelson
Robert Lemelson & Alessandra Pasquino
Wing Ko
Pietro Scalia
Wing Ko
Malcolm Cross
Richard Henderson

The film follows an older Balinese man, Nyoman Kereta, as he struggles with the intrusion of spirits into his consciousness. Kereta says he has been living in two worlds, the world of his family and community and the world of the spirits, for the past 40 years. His experiences skirt the borders of cultural and spiritual norms, simultaneously manifesting and exceeding Balinese beliefs about the supernatural world and the possibilities for human interaction with it.

Kereta’s reported experiences seem credible or explicable to some, bizarre and extraordinary to others, enigmatic or doubtful to his wife, and the sign of major mental illness to his psychiatrist. The film documents his painful history of trauma, loss and poisoning, and draws on his other family member’s interpretations of how to understand his struggles and distress. Central questions of how to interpret his experiences, and what role a schizophrenia diagnosis entails are explored.

 

An Indonesian perspective on madness in a globalizing world (22 min)

Memory of My Face

Credits

Director
Producer

DP
Assistant Camera
Consulting Editor
Editor

Music Composer

Robert Lemelson
Robert Lemelson
Alessandra Pasquino
Dag Yngvesson
Wing Ko
Pietro Scalia
Sandra Angeline
Chisako Yokoyama
Malcolm Cross

The film focuses on Bambang Rudjito, a university-educated Indonesian man in his late thirties diagnosed with schizoaffective disorder. It explores the “globalized” features of Bambang’s illness and recovery narrative — western psychiatric diagnostics and pharmaceuticals, work opportunities in a rapidly changing urban environment, participation in an interfaith religious community, and his family’s understanding and acceptance of what Bambang describes as a “mental disability.”

But it also considers aspects of Bambang’s more complex, historically and politically shaded narrative, giving language and a deeper substance to his illness experience. Memory of My Face illustrates how the residues of colonialism and the pervasive influence of globalization affect the subjective experience of mental illness.

 

A Balinese woman’s ceremonial obligations trigger her bipolar disorder (25 min)

ritual burdens

Credits

Director
Producer

DP
Assistant Camera
Consulting Editor
Editor

Music Composer

Robert Lemelson
Robert Lemelson
Alessandra Pasquino
Wing Ko
Dag Yngvesson
Pietro Scalia
Herbert Bennett
Mike Mallen
Malcolm Cross

The film focuses on Ni Ketut Kasih who has lived her whole life surrounded by the complex rhythms of the Balinese ritual calendar. Here, participation in ritual events is both a spiritual mandate and social obligation for women who spend countless hours crafting offerings. Ni Ketut’s masterful hand has contributed to her status as a highly respected ceremonial leader. However, the pressures of ritual requirements often overwhelm her, crowding her mind with memories of her difficult childhood during Indonesia’s war for independence.

This may trigger Ketut’s bi-polar disorder episodes, for which she has been hospitalized over 35 times. Ni Ketut’s case reveals the binding associations that may make certain burdens unbearable as cultural obligations, traumatic historical events, and personal experience overlap in unique schemas of stress that trigger cyclical episodes of mental illness. Ritual Burdens questions how communal spiritual obligations may be folded into personal schemas of stress to trigger episodes of mental illness.


Volume 2: Neuropsychiatric Disorders

 

A Balinese woman with Tourette’s Syndrome struggles for acceptance (40 min)

The Bird Dancer

Credits

Director
Producer

DP
Consulting Editor
Editor
Music Composer
Music Editor

Robert Lemelson
Robert Lemelson
Alessandra Pasquino
Dag Yngvesson
Pietro Scalia
Herbert Bennett
Malcolm Cross
Richard Henderson

The film focuses on Gusti Ayu Suartini, a young Balinese woman living with Tourette’s syndrome. Members of Gusti’s small rural community, who do not recognize her illness as a medical disorder, regard her with scorn or pity. Mired in loneliness, Gusti begins to question the meaningfulness of her existence after treatment by western and traditional practitioners fails.

The film, which follows her slow, painful, and courageous effort to create an independent life for herself outside her village, addresses the profound impact of family and community’s acceptance or rejection on the lifecourse of persons living with a neuropsychiatric disorder. The Bird Dancer focuses on the social stigma of neuropsychiatric disorder and the human suffering it entails.

 

The ‘bad coconut’ of a Javanese family (38 min)

Family Victim

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Credits

Director
Producer

DP
Consulting Editor
Editor
Music Composer
Music Editor

Robert Lemelson
Robert Lemelson
Alessandra Pasquino
Dag Yngvesson
Pietro Scalia
Sandra Angeline
Malcolm Cross
Richard Henderson

Estu Wardhani is a young Javanese man and has struggled for most of his life to achieve a sense of competency and inclusion in his familial and social world. The second youngest of eight children born to an upper-class family living in the rural region of Gunung Kidul in Cental Java, Estu has been ‘different’ ever since he was a young boy. Estu’s actions, and their disorienting power, cannot be understood outside of the cultural and social context within which they have taken shape nor can they be considered apart from the disruptive and painful effects they have on his family.

Estu’s problems are interpreted as ‘psychopathy’ by a psychiatrist, spirit possession by local healers, and as dimangakan or ‘spoiled’ by his family. Estu himself desires to be a ‘big man’, and he feels misunderstood and disrespected by his family. His case involves not only his own troubling symptoms, but the striking and extensive interpretive work his family, healers and community engages in while trying to understand Estu’s personality and behavior. This film explores the multiple ways the family interprets such dilemmas, and his tribulations and finally transformations as he matures into culturally defined adulthood.

 

A Balinese boy’s imaginative journey towards recovery from Tourette’s Syndrome (25 min)

Kites and Monsters

Director
Producer

DP
Consulting Editor
Editor
Music Composer

Robert Lemelson
Robert Lemelson
Alessandra Pasquino
Wing Ko
Pietro Scalia
Chisako Yokoyama
Malcolm Cross

The film focuses on a growing boy, Wayan Yoga, and is not so much about illness as it is an exploration of the protective aspects of culture that may guide developmental neuropsychiatric processes. At six years old, Wayan Yoga is an energetic boy who flies kites and is obsessed with the monsters of Balinese mythology. He also has various tics, which move his parents to seek treatment. At twenty, he is a young man planning his career as a chef and an expressive Balinese dancer.

Ultimately, Wayan Yoga’s tics are insignificant to his evolving sense of self-compared to the saturation of symbols, images, and narratives of his culture. While Wayan must learn to negotiate the kinds of movements, interests, and goals that are culturally appropriate, the protective buffer of his family guides him successfully into normative Balinese adulthood.


Director's Statement

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One hundred-fifty million people suffer from different types of mental illness in the developing world, where psychiatric treatment is often limited or non-existent. With such daunting statistics, one would expect their recovery rate and outcomes to be deficient. But, the World Health Organization, in a landmark, decades-long research project, found that the mentally ill living in non-industrialized nations actually fare better than their industrialized counterparts where biological approaches to mental illness prevail. On a population level, the mentally ill—including schizophrenics–return to their homes and their jobs more quickly, are hospitalized less frequently and experience less severe symptoms, overall.

In 1996, armed with a Fulbright scholarship, I went to Iive in Bali and Java, to research the circumstances behind these startling findings, along with the more general question of the relationship between culture and mental illness. At that time, I interviewed many patients. As an anthropologist, I was not only interested in their diagnosis, illness and treatment, but also in their goals and values, in how their illness impacted their self-perception and self-esteem, and how they were regarded and understood by their family and community.

In subsequent years, I returned to Indonesia many times to film mentally ill men, women and children (forming long-term relationships), to record their struggles and defeats and moments of happiness and transcendence. Afflictions: Culture & Mental Illness in Indonesia, the first film series on the lives of the mentally ill in the developing world, was born out of this footage.

Afflictions” evolved into six short films. With the probing and detailed eye of the video camera, the films look at an equal number of Indonesians who suffer from schizophrenia, Tourette’s syndrome and anti-social personality disorder. The narratives are at turns informative, disturbing and even heartwarming.

As the stories unfold, it becomes clear that it is neither their psychiatric diagnosis nor their illness, per se, that is the most troubling to the mentally ill. Rather, it is the response of their family and community to their condition and the depth of their struggle to forge identities that they believe to be valued and valuable.

The “Afflictions” films shine a light on societal issues impacting the experiences—the suffering and the wellbeing–of the mentally ill, some specific to the Indonesian culture and others with global application. Balinese religious symbology, Dutch colonial occupation and Indonesian historical events play a role in the their stories. At the same time, universal concepts rise to the surface: home placement can be more beneficial than institutional care; urban living impacts disease onset and outcomes; and treatment modalities that integrate psychiatric and outpatient treatment can be the most effective.

In the end, it is my hope that the findings clarified and made accessible in “Afflictions” help shape the care and treatment of the mentally ill in Indonesia, in other developing nations and around the world.