The concept of health in Java can loosely be divided into physical and mental health.. However, just as the Javanese notions of lahir and batin do not precisely parallel the Western dichotomy of mind and body, the notions of physical and mental health in Java are somewhat distinct but distinct1y linked, and the causes of mental and/or physical disease might be attributed to social, attitudinal or emotional causes in addition to physical 'natural' causes or supernatural influence. Contagion is a concern, but is not limited to ideas about the transmission of disease borrowed from Western germ theory. For example, one should never look another person directly in the eye when he or she is suffering from an eye infection, as that could pass it on. Rivers and streams are generally used, even in the urban areas, as places for bathing, laundry, garbage disposal, and toilets; therefore, even city tap or well water is boiled before drinking in every household to avoid common water-borne illnesses.

Food taboos abound. Eating cold fruit before eating something hot and nutritious first thing in the morning will make you sick. Eating pineapple will give you a cough, and drinking or eating ice can give you a runny nose and a cough. If one has a cough, one should always avoid pineapple or fried food. If one needs to take medicine in the form of pills from the pharmacy, one should take it after eating, with plain water; drinking medicine with coffee can be fatal. Food and drink are prepared at home and ordered from food seilers with the express purpose of promoting health. For example, chicken feet are eaten to strengthen the legs. Healthy drinks such as "stmj" - milk, raw egg, honey and ginger-are served hot to fortify the body. But the most common health promoting drink is unquestionably jamu, the ubiquitous Javanese herbal Medicine. This is the cry heard in the Indonesian street each day,the call of the roving tukang jamu, or janiu seller. Some men jamu seilers can be seen on busy city streets, bottles of jamu stashed in baskets on the back of a bicycle, but the traditional jamu seiler is a woman. She carries bottles of jamu, traditional Javanese herbal medicine, on her back in a large basket, along with glasses and water to wash them in, honey to sweeten the palate after a particularly bitter brew, lime to freshen the doying beras kencur, and eggs to add energy for a potent mix. There is jamu to cleanse the blood and intestines, jamu to gain weight or lose weight, jamu to cool the body or warm it up, jamu to increase potency, strength and vigor, Jamu to brighten the skin and eliminate nwrinkles, jamu to get rid of coughs ad excess mueus, jamu for aches and pains, jamu to refresh and to restore energy. While these are all popular for both men and women, there are some gender-specific jamu that treatmale impotency, regulate the menstrual eycle, treat yeast infections, and some that are meant to ensure "marital happiness" by drying and tightening the female genitalia. Typical ingredients of jamu include: riee powder, ginger, assorted medicinal herbs,honey, lime leaves, water, salt, Javanese red sugar, turmeric, galangal, cinnamon, and sweet soy sauce.The jamu of Madura and Central Java are eonsidered the original and most efficacious of herbal medicine. Recipes from this area have been used,virtually unchanged, for hundreds of years, but now, with an exploding population, mobile, urban middle dass, not everyone has the luxury of waiting for their local tukang jamu to make her rounds in the morning-or may even be working far from their home town, on another island, where fresh Javanese jamu is hard to come by. So, creative entrepreneurs have developed jamu-to-go, pre-packaged processed powders, pils and capsules that contain some of the ingredients of the traditional fresh drink. This has caught the consumer fancy, and the last ten years there are hundreds of brands on the market, sold at local jamu shops (often in addition to fresh jamu), in pharmacies, grocery and convenience stores and in stalls at the traditional market, on campuses, even in airports. What was once limited to home industry has b,ecome the basis for some huge financial empires. Javanese entrepreneur Martha Tilaar, for example, built a small jamubusiness into a multi-million dollar corporation that produces cosmetics, beauty products and toiletries in addition to a post-modern panoply of mass marketed hygienically and attractively packaged "traditional" jamu caplets.One of her products artfully combines the tradition of lengthy post-partum care and daily massage and herbal medicine for the new mother offered by traditional' midwives, with the Islamic custom of the observance of forty days after the birth as aperiod of ritual unc1eanliness: large, attractively packaged boxes offer forty days of powders, pills, and 'caplets guaranteed to return the new mother to her pre-birth state of c1eanliness, health and beauty.So whether it is fresh warm jamu from a smiling tukang ju' s basket on a sunny morning street, or hand-rolled pills (looking suspiciously like rabbit pellets) from a Madurese jamu shop encountered on a leisurely afternoon of shopping at the traditional market, or an upscale box of shrink-wrapped tablets from an antiseptic grocery store on the way home from work in the evening, the Javanese can fit a bit of timeless tradition into their busy lives and enjoy the benefits of jamu anytime.

But the most important thing that the Javanese must do to maintain physical good health is to prevent wind from entering the body, creating the common malady called masuk angin. To protect against masuk angin (getting the wind in), some people who are particu1arly susceptible wear thick jackets when going out at night or when riding a motorcycle. People may cover their heads and their necks when riding in a publie conveyance in which air conditioning may be used, or a window may be opened. Babies and others prone to masuk angin will be rubbed with balsam or aromatic oils such as minyak angin, wind oil, after a bath or before bed.. To avoid masuk angin, one never bathes too late at night, washes one' s hair during the menstrual period, or bathes when too hot and/ or sweaty. One should not sit in front of a fan when wet, should not expose oneself to the wind night or day, and many feel that they should not sit in a breeze from an air conditioner. One should not sit directly on a cold floor, or walk on a cold floor barefoot, as the wind can enter through contact with the chilled tiles.

Also Ferzacca calls masuk angin the most common of all maladies, and found it emblematic of "the Javanese concept of the aqueous and pneumatic body...physiologies that emphasize its fluid nature and saturation in winds and flows" (Ferzacca 1996:433, 441). He translates it as penetrating wind, (Ferzacca 1996:441), and gives a list of symptoms and causes and cures (1996:441-446) which he says are organized around a hot-cold humorism. The return to a state of health when one contracts masuk angin requires kerokan or cupping. Kerok or kerik is the practice of scraping the skin to allow the wind trapped in the body a path to escape. The preferred scraping tool is an old coin with edges worn smooth with age, bilt there are tools made specifically for this purpose that have a one-inch smooth metal ring attached to a six-inch handle. The skin of the back, shoulders, chest, and sometimes legs or buttocks is lubricated with one of the many kinds of balsem available in any store, thick pastes that contain varying amounts of aromatic and stimulating substances such as eucalyptus, menthol, cloves, or even chili oil in a stable thick oily base. Kerokan causes dark red or purplish stripes to appear on the body if a person indeed has the wind inside; if not, no welts appear. While the practice is not necessarily painful, these dark red marks can last for days, and it can be uncomfortable when the coin passes over thin skin covering abone, as on a shoulder blade. There are specialists who effect the same type of cure by cupping, or burning a small piece of paper under a glass, small bowl or even an animal horn pressed against the skin, to again raise a welt and pull out the offending wind. But the home remedy is always to kerok those who have masuk angin, and it is effective: if almost always induces the wind to come out in great huge burps and flatulence.


Explanations for illness

A core belief held by the Javanese is that the world we live in consists of more than just what can be seen. There is the physical, lahir level in wich humans interact, and there is another batin level in which other force; such as spirits or people's souls, exist, act, and impact the lahir, the physical, tangible world around uso This idea of two separate but intertwined spheres of existence has carried over into descriptions of Javanese theories of illness, and have in many cases been translated into the complementary categories of natural and unnatural illness. I frequently read. that the Javanese have two kinds of sickness, natural and unnatural, where natural sickness is caused by an imbalance of the elements, deterioration, accident, or other natural causes, and unnatural sickness is caused by an imbalance in power, lack of spiritual attentiveness, and/or attack by supernatural elements. According to the Javanese Primbon, ancient manuals of traditionallore, there are several causes of illness: mysterious words or evil magie, water, wind, exposure to the wildnerness, or breaking a vow (Darnawi 1983: 260), an interesting combination of natural and supernatural forces that can affect the physical body and induce illness, wherein the wilderness becomes the unsafe, unnatural antonym of culture. Clifford Geertz asserts that 11 all Javanese seem to hold that there are two main kinds of disease: one kind with discoverable physical causes, which is amenable to treatment by Western doctors, and a second kind in which there are no medical findings but still the person is ill, the latter type being the kind dukuns' are peculiarly competent to cure" (c. Geertz 1976:97). He found that dirty blood, lack of blood, having an empty or weak soul or lack of spiritual discipline, air or heat or foreign objects entering body were common „ natural" causes of disease (c. Geertz 1976:98-99).

Many authors who address culture in Java or the nearby island of Madura have found that spirits or black magic were common causes of physical illness.Madurese villagers believe that "illness is eaused by either or both of two factors: physical conditions or an evil spirit" (Mansurnoor 1990: 198). The spirits that cause illness could be random denizens of the supernatural realm, or could be the four spiritual siblings who accompany everyone at their birth, symbolized by the blood and the placenta, amniotic fluid, blood, vernix and/or umbilical cord. Failure to take proper care of these siblings, in Javanese the sadulur papat, or kanda empat, could cause them to retaliate by causing illness (Weiss 1977:205). Other spirits could cause disease and any number of problems in the home or in the workplace, but they could be handled with the right ritual apparatus: "Invisible spirits which bring illness and death if ignored or angered can be appeased trough offerings (sesajen) or through the intervention of a dukun" (Magnis-Suseno 1997:18).

Black magic or sorcery was also cited as a common explanation for illness. Geertz describes several diseases attributed to foreign substanees in the body-nails, hair, broken glass or iron placed in a person's stomach by an unscrupulous dukun-or the vomiting of blood, general stomac:h sickness and fever, caused by a moek selametan held by a dukun (C. Geertz 1976: 98,107).Most of the other authors who wrote on black magie, as outlined in my chapter on dukun, also describe the black magician as a causative factor in sending disease to, victims chosen by his clients for motives of revenge, envy, jealousy, or anger. Ferzacca also found that sickness can result from natural causes or supernatural interventions by soreerers or spirits, but in addition he found two other common explanations for disease: karma, or one' s own 'inauspicious or incautious actions; and exeess. In order to maintain health, his informants told him,'one has to avoid exhaustion, and follow a middle path of moderation (Ferzacca 1996:449-451). In his work on Bast Javanese theories of illness, Weiss also focuses on the idea of balance: within the individual body, the microcosm needing to be balanced with the macrocosm; or the need for the person to be "in balance 'with its ambient environment" in a kind of homeostasis (Weiss 1977:149-155), avoiding what Ferzaeca calls "disequilibriums and imperfect fits" (Ferzacca 1996:431). In the explanations provided by their Javanese informants, excess .of any of the four elements causes disease, and can be a result of consuming to much of a particular type of food, and can cause mental or physical illness (Weiss 1977:205, 228-234;  Ferzacca 1996:85) particularly if the individual is physically or temperamentally weak (Weiss 1977:228; 554-555).

Browne and Ferzacca also found that stress was offered as an explanation for the development of mental and physical illness.. In their work in Central Java in the late 1990s, the discourse on stress had not replaced other explanatory models, but seemed to be becoming popular, especially as explanations for "Western lifestyle diseases" like diabetes and heart disease, and for depression. Ferzacca translates several articles from the popular media on stress as an outcome of modern life, and as a primary cause of disease (1996:458-459 and 481-486). While these ideas about stress are presented as becoming more prevalent in the explanatory models of the Javanese anthropological works, as late as the mid-1980s Koentjaraningrat maintained that the notions of sorcery and of karma as a cause for illness, of disease as a punishment visited on the sinner, or a result of ill will- and dark ritual by an evil dukun, were still prevalent theories of physical disease in Java. (Koentjaraningrat 1985:416). Also today (2007), it is still generly assumed that if someone were sick that it was with a simple physical illness with evident natural causes; people wouldn't start to make a distinction between natural and unnatural illness unless they were already convinced the illness stemmed from a supernatural cause, or unless repeated consultations with or treatments by a medical doctor couldn't eure them. Circumstances could indicate what would appear to be a simple physical illness as obviously having a supernatural cause. For example, if soon after coming home from a graveyard or another place that is angker or wingit (creepy, spooky, scary:  forest, an empty house, a place with big trees, a cave) one developed a fever, vomiting, or other alarming symptoms that would not go away after applying the standard home remedies, one would go to a doctor. If the doctor could not cure, this would be a clear indication of a supernatural origin of the symptoms, and would indicate the need for a visit to a dukun or kyai. It seemed that fatigue, food (bad food or bad fit, eating too little or too late) and lack of fitness were the most common reasons for falling siek, and the conditions of wind or weakness, imbalance or excess would make anyone prone to physical illness.

It is said that a person can be possessed by a spirit if his mind is blank or empty. Hence the spirit uses him as a medium. Then what happens? According to Javanese beliefs, he becomes crazy, and runs around naked. Mental illness is mainly caused by pressure on the brain, for example, worrying about material things... Themes of stress and disappointment, of goals not met, of emotions and behavior out of control, are repeated endlessly when discussing mental illness with the Javanese. A blank or taxed mind as well as disappointment, social withdrawal and daydreaming are widely viewed in Javanese culture as making one vulnerable to a range of gangguan jiwa (mental/ spiritual illness), inc1uding stress and kesurupan (spirit possession)" (Browne 1999:8).. Most Javanese conflate mental illness and spirit possession; even some psychiatrists in Indonesia treat them as literally or practically synonymous. Since Javanese culture however can be different than other pIaces in larger Indonesia in context of this we are not using data or conclusions from areas outside of Java although there might indeed be regional communalities, yes even Asia wide paralells, at times. Also the island of Madura is close off the northeast coast of Java, just abrief twenty-minute sIow ferry ride away. Millions of ethic Madurese live in East Java, and despite Iinguistic differences, cultural similarities are striking. This is why Jordaan's work with the Madurese seems indeed pertinent. So Weiss' work on the folk psychology in that area is also worth noting as it is remarkably consistent with what we found in Java during this early part of the 21th century. At this point it is also worth noting that definitions of mental illness vary; expressions range from extremes of total withdrawal to public exhibitionism; and there are scores of presumed causes. Things that are not defined in the West as mental illnesses are included within that category in Indonesia. We will come back to these later, but for the purposes of a brief illustration here a list of the six types of mental illness from a press release from the Psychiatrist Dr. Benny Ardjil, head  of the West Kalimantan governemental agency in charge of mental health services (BPKJM) on World Health Day, 2001:"schizophrenia, Alzheimer's/senility, depression, narcotic addiction, epilepsy and mental retardation." Disorders like the startle syndrome latah (which causes the sufferer to repeat senseless motions and profane language when startled) are considered merely entertaining eccentricity. And trance states and spirit possession may induce behavior that mimics madness, but temporary transportation into these states can be a powerful curing tool used by mediums, paranormal practitioners and religious healers – professionals with the power to submit to these states and return to normalcy with their faculties intact. The dangers of spirit possession and trance, however, are considered immediate and serious for all but the adept.

Of course, with the privileging of order and self-control that define the Javanese ideal of culture (see next part for details) and individual maturity, the demand for social integration and conformity, the careful training in appropriate language choke that the Javanese receive, the observably mad would have to be seen as violating all the standard norms of Javanese culture. To be mentally ill in Java is to embody disorder, to engender shock, to abrogate the rules of tata krama and sopan santun (polite, prescribed behavior) to overtly threaten rukun – the essential state of social harmony. In the same press release from 2001 in which he discusses the six types of and stigma surrounding mental illness, Dr. Ardjil lists these common "harmful" myths about mental illne Mental illness cannot be healed. (He explains that doctors can help cure everyone.) Mental illness is due to the weakness of a person and the result of black magic. (He explains that it is caused by the interaction of biological ,psychological and socio-cultural factors.) 'Mental illness only happens to adult he explains that every age is susceptible.)

The mentally ill should be locked up in stocks (dipasung) and shunned. (He explains that that every mentally ill person can return to normal function and that putting them in pasung or ignbring them or throwing them out" disregards their human rights.")

The mentally ill are often described in Java as lost, or as having forgotten the appropriate emotion of shame. In her research about popular conceptions of mental illness in the East

Javanese urban area of Surabaya city, Javanese anthropologist Pinky Saptandari found that her informants described mental illness as " a disturbance that causes people to not be able to think dearly, or healthily; a disturbance that causes people to act abnormal1y, for example to run naked on the highway; a disturbance that happens to peop1e that always hallucinate" (2001:5). They found the tenn mental illness to be interchangeable with nervous dis order, and espoused the conventional wisdom of 'once crazy always crazy'; reporting the belief that even though they claim to be cured, the mentally ill will always relapse (Saptandari 2001:5).

We observed instances of public nudity, individuals evidently deranged, studiously ignored and avoided, objects of fear and loathing for their obvious loss of control of their physica1 and mental se1ves. Some cases of psychic disorder in Java are considered demonstrations of one' s holiness, and the use of refined language around mental illness in the language indicated to Jordaan "the awe that these illnesses inspire" (1985:196); but we never saw the least indication of this attitude in Java the past few years. The mad were objects of fear and loathing, a shameful seeret to be hidden within the family, who occasionally provided public amusement and even more rarely elicited feelings and gestures of compassion.

Arguably the most famous representation of madness in Indonesian film is in the movie Perempuan Dalam Pasungan, "Woman in Stocks" released in 1980. And where the West, is concerned with the (Christian?) opposition of good vs. evil, Indonesia emphasizes order'vs. disorder. In the just mentioned  film released in 1980 all of these themes are elaborated. A woman believes she accidentally killed her best friend when driven mad by jealousy she attempts to poison her husband whom she erroneously suspects of having an affair. Being overcome with animal passions, losing control and driven mad with grief, her orderly existence descends into disorder (as 'does her physical appearance-for example, her hair becomes gradually looser and wilder as she gradually loses control of her emotions and becomes literally undone by grief) and her disorderly behavior requires her family to lock her up in stocks, a punishment long reserved only for the uncontrollably insane. The usual sign of a woman' s insanity is her long loose hair. Indonesian women in general take great pains with their coiffeurs.Placing her in stocks -the wooden frame for public punismnent or private confinement-becomes a sign of social order restored. Thus even today, editors love to run articles about the mad in their magazines as they guarantee to sansfy an audience fascinated with the strange and the taboo.

Despite regular articles on some poor demented soul who was found after years of being locked up in stocks in the family cornpound and finally taken to a nearby state mental hospital for free treatment (and the aceompanying admonishments to "bring out your mad" and to submit them for humane treatment), newspapers and television generally show the same lack of sensitivity as found in popular magazines, and the same kind of delight in reporting episodes of deranged or maniaeal behavior, whether they involve a mob or a particular individual. The public seems to have an endless fascination with stories and photographs of violations of society' s taboos and norms, and as in many. other cultures the madman is considered to be the epitome of the violent and dangerous; violent crime is often considered analogous with mental illness. Murder (especially of a child, family member or members, or multiple homicides), suicide, human and animal sacrifice, mob lynching and rape are all rejected as the possible product of a mentally sound, rational mind. Criminal behavior of this violent type is so far outside the boundaries of acceptable Javanese behavior, so out of control, it is almost unimaginable, so the pictures and stories provoke a kind of nearly disbelieving yet titillated enthrallment that captivates the Javanese. In the crime scene footage or re-enactments of violent crime that the cooperative criminal is required to perform for police-and that are frequently shown on television - or the newspaper articles and photographs that show the victims' corpses in full and gory detail, all violent criminaIs are dehumanized and demonized as they are dismissed as insane...and thus this in turn reinforces fear of the insane as potentially, probably, violent and dangerous.

While sorne might argue that the news stories that feature this kind of dehumanization are only for adults and thus might not influence a younger more impressionable audience, the popular children' s television show Si Unyil features in its cast of neighborhood characters a madwoman puppet that is the object of delight and fear, and teaches children around the archipelago the same attitude of fascination, derision and dread of the insane. The puppet sports a dirty, disheveled demeanor ragged clothing and wild hair growing into "kimbal" dreadlocks. She sings a song about "di mana anakku?" - "where is my child?" -a catchy tune that you can hear Javanese kids singing in the streets. On the show, the children puppets tease her and flee in an ecstasy of terror and glee when she is angered, and cackling Wildly, chases them about. Others today, like the famous Javanese musician and social critic Iwan Fals in 1993 named one of his most popular album after one of his wildly popular songs: "Drang Gila" "Madman". This song and his song "Sudrun" offerred a seldom unreserved compassion for the mentally ill.

As well as a piethora of terms available to describe degrees and kinds of madness, the Javanese have developed a robust set of explanations for the onset of mental illness. Their explanations are richly woven with the themes of order and disorder, the importance of self-control and appropriate, vigilant self-awareness, the need for harmony and balance, and the power of the supernatural. These concepts, so important in Javanese culture in general, have particular import when considering the forces and mistakes and weaknesses that can precipitate madness.Even the power of language, presented as a prominent theme in the culture of Java, emerges once again as an abiding motif when considering mental illness. Dark arts and disharmony: black magic or curses. The events which bring on the leveling of a curse or black magic usually involve some unresolved intense inter personal conflict, some kind of betrayal or abrogatiori of a relationship, a drawing of anger or resentment, or jealousy. A powerful parent may curse a thankless child; a kyai religious teacher may curse a faithless pupil.

Whether through a curse or black magie, mental illness is often considered. to be a direct result of intentional action and ill will of another. Weiss (1977:413) and Jordaan (1985:265-267) both found the malidous acts of others to be a primary ascribed cause of mental illness, and they both seemed to include "love magic" within this category; neither of them mentioned the kind of magic that confuses the understanding of a victim or witness to obscure the commission of a crime, usually petty theft. But pelet or love magie and gendam, the magical scienee of trickery, are quite different, for while they exert their influence on the mind (and perhaps the heart) of the innocent other, the effects are not permanent and are really not intended to harm. The individual who performs black magic or engages someone to perform black magic on his or her behalf, does so with the intent to kill or to ruin the objeet of their hatred, relegating them to the living death that is the .oblivion and ostracization of mental illness.

As for so called spirit possession, Saptandari' s informants defined mental illness as, among other things, "a disturbance that happens to people when they sit with a blank stare (and you can identify the mentally disturbed by their 'empty eyes') (2001:5). Weiss also reported concern about absentmindedness: "People who have no ngelmu, are mentally retarded or mentally ill are said to be 'empty', and are considered to be easy marks for sorcery, spirit possession, and mental and physical illness" (Weiss 1977:311).A person who is distracted (nglamun) is highly susceptible to attack from spirits and to the machinations of black magic;..To let one' s mind drift about in whatever mood, is ill advised. It may cause people to laugh by themselves, or get angry by thernselves, both signs of incipient madness" (Keeler 1987: 219-222).

In his 1999 book Mencegah, Mengobati Stres dan Gangguan (' A voiding and treating stress and mental illness"), Masruri  gives  three reasons why for example,the seeking of mystical knowledge or ngelmu can cause a person to become mentally ill: a "dose" of ilmu (knowledge) that is too large, a weak spirit, or too strong a bond with the material world (1999:9). He describes "overdoses" of tirakat and other forms of the search for mystical knowledge, and uses the term fingelmu insanity" to deseribe the process of the search for knowledge or power gone wrong (1999:13), in the form of „mistakes“ made in their study of mystical knowledge (1999:79).The term supranatural is one that  Javanese adepts use to describe powers that have been developed through ascetic practice or handed down from an elder, and is used as adescriptor for individuals who have deveIoped enhanced abilities primarily through human achievement of feats of fasting, meditation and/ or prayer. The prefix supra- indicates powers that transcend the natural abilities most humans exhibit, and distinguishes these kinds of powers from those obtained from an occult, or supernatural, practice.Interestingly enough, moral weakness or the inability to behave in an acceptably moral fashion was never listed as a possible cause of or indicator of mental illness by anyone that we spoke to, although it was a common concept and clearly distinct from spiritual weakness, which centered around religious observance. And although the governmental mental health institutions consider narcotics addiction to be a particular type of mental illness, it was never discussed as an example of spiritual, moral or mental weakness.

Weiss concluded that" (i)f a person is spiritually strong he will not contract mental illness.. even if he has a hereditary susceptibility to it" (Weiss 1977:313). Saptandari's informants listed a weakness of confidence in self or in the tenets of some re1igious faith as a common cause of mental illness. In Java, the strength of conviction can protect you from "a disturbance that happens to people who like to ta1k to themselves, who do not believe in. themselves and have low self esteem.. . weakness of religious belief, and/or laziness in religious practice" (Saptandari 2001:4-6). Insufficient religious faith or inability to accept God' s will may lead to an excess of emotion or frustration that can lead to mentalmillness, or the development of the particular form of mental illness that is 'stres'. Here, the term ' stres' - obviously a derivative of the English word 'stress'- has become a common synonym for mental illness. The concept of stress as a precipitator for mental illness is thus as important and as prevalent as it is in delineating the reasons for physical illness in Java. The kind of stress that the East Javanese consider to be dangerous is defined by the overwhelming nature of having too many burdens - burdens such as the extended pressure of. a difficult, thankless or low-paying job, debt or a sudden substantial economic loss, an unhappy spouse, troubled children, or children pursuing an unsuitable match. The combination of too much stress and the lack of ability to withstand that stress is mentally toxic.  Browne analyzes the modern psychological discourse in popular magazines and newspapers (1999:106-108) and in particular the discourse on stress (1999:110-115). He breaks down the reasons for attributed causes of mental illness from nineteen informants in Central Java (reported in 1999:150-151). In general he found that men and women both suffer insanity that is a perceived product of stress, but men "suffered stress after not achieving goals, working too hard; many women suffered more due to relationship and family problems" (1999:156-157).

Defilement or desecration: breaking a taboo: The classic example of this perceived cause of mental illness or other misfortune is sinning - stealing, drinking a1cohol, gambling, having sex or violating other taboos-in a graveyard, a holy place or a keramat place- a place full of supernatural power, possibly inhabited by a supernatural being or spirit. Saptandari' s informants called it aeting "contrary to religious and social norms", and also listed "(b )othering a. place that is keramat, or breaking a taboo" as a cause, and considered mental illness to be "seen as a right and righteous, just result of these violation of norms, a kind of 'social sanction'"(Saptandari 2001:4-6).Jordaan teimed it a "deliberate infringement of sacrosanct and moral rules, e.g. the violation of asolemn oath" Jordaan 1985:266), and Weiss also stressed failure to keep a vow (Weiss 1977:413) as a possible cause of mental illness.

While the notion of vows and the terrible consequences of breaking a vow was not a common cause of disease or accident discussedin Java, the notion of kuwalat, or a kind of supernatural set of negative consequences of bad or taboo actions was very common. One could guarantee that at least one explanation for any negative experience in a -car accident or other accident, disease, of something precious, a natural disaster – would involve searching backward for an active origin, something someone could pinpoint, some negative or unkind, ungenerous thought or action that would require the divine retribution that came back on the originator in the inevitable karmic logic of kuwalat.

Degeneration: nerve or brain disorder:In his research, Weiss concluded that for the Javanese of Ponorogo "(d)amage to or displacement of the brain or the liver jheart or the nerves that connect them (w)as the single most important cause of mental illness" (Weiss 1977:241). I (ound sakit syaraf or "nerve sickness" a common diagnosis in the private mental hospital, a gentle explanation of why a patient might be taking a sort of rest care there for "a case of nerves." Saptandari' s informants listed "nerve disorders" as a common cause for. mental illness (2001:5), and"gangguan' syaraf' or disttirbance of the nerves was a not uncommon explanation for the same from our surveys for the more educated, middle dass middle-aged respondents. Senility or retardation might be considered types of mental disease by the mental illness experts but not by the general public. A person who is developmentally delayed is described as not as "full" as normal, slower than normal; the senile or pikun are considered to have once again returned to a childlike state, forgetting all the lessons of culture and proper sodal intercourse that they had learned so well long ago. Strange behavior due to brain damage may or may not be interpreted as fully mad, depending on the type and severity of symptoms.They may instead be said to be "shaken", "tiIted", "not full" or simply "not right" in the head.

Demonic disturbance: Spirit possession or harassment by a spirit Kesurupan or spirit possession in Java is a powerful precursor to madness. We saw a number of people who were described as experiencing the deleterious effects of spirits. Hauntings or possessions caused cases of fever, seizure, prolonged unconsciousness, incoherence, and all manner of bizarre behavior. Spirit possession would be indicated by a temporary loss of consciousness, feats of superhuman strength, inability to recognize anyone, growling or speaking in tongues, and violent behavior. Ward Keeler describes the process of possession, and the importance of language as an element of possession and cure: (The spirit) is pressured by the wong tuwa (lit. the old person, the dukun) to express some request, usually for some kind of offering. The satisfaction of this request should suffice to rid the person of the spirits. A mute spirit is considered particularly dangerous and hard to deal with, since then it is more difficu1t to ascertain its identity and make it articulate a particu1ar wish. However, a particularly potent wong tuwa may not even need to enter into dialogue with a spirit The strength of bis presence may be such that the spirit flees at bis mere approach.When Javanese speculate on what impels spirits to take possession of people, they often attribute to them the characteristics of naughty children or dissatisfied and rather ill-mannered adults. For example, a spirit may feel hungry or thirsty, so it takes possession of someone in order to force people into giving it offerings, which are its food and drink. It may simply be feeling lonely, or perhaps impish, or insulted by some human' 5 thoughtlessness takirig possession of people, they acquire voices with which to speak, and so to mystify, taunt, or order people around. Eventually, they are foreed to express some very specific, and modest, desire, and the little escapade is over (Keeler: 1987:118-119).

Mbok Ka' s rice water rituals and regular offerings of flowers, food, drink and cigarettes at particularly vulnerable times for us (as when moving in to a new household) were meant to appease the local spirits and prevent possession or harassment. And when the so called possessed, we encountered spoke, the spirits inside them did seem to have some desire or need, which, when fulfilled or dismissed by the curer, gave some relief. In Java, the influence of spirits isn' t always a negative influence: alleged spirits can also be helpful. Mediums and eurers use possession as a tool to predict or to prescribe, to diagnose or to cure. Many paranormal practitioners believe they have spirits that he1p them in some way with their practiee, either acting through them or speaking to them while in trance or providing insight in dreams or in some special method of diagnosis the practitioner has developed. And the key to the ability to withstand harassment by spirits seems to be, again, the ability to maintain self-control, awareness, complete and harmonious wholeness of the intellect. In 1985' Javanese anthropologist Koentjaraningrat wrote that "kesurupan is considered to be a result of feeble-mindedness or a tendency to daydream" (1985:343). To this day anyone in Bast Java who is holding a sharp, dangerous object like shears or a knife (or areal weapon) and begins to act in an other than calm and rational manner will inevitably be warned "Hati hati! Nanti setan adu-adu" meaning "Be carefull Evil spirits will pit you against someone." A smiling mock threat of "Ooh, I could kill you!" or simulated anger or violence expressed while wielding a potentially dangerous item is no laughing matter. It is presumed that the simple loss of composure that joking or silliness inspire could cause a fatal temptation when a spirit goads the unwary.

Descent/ heredity:The Javanese have a saying about the things you look for in a mate for your son or a daughter: "bobot, bibit, bebet", which translates as family wealth; ancestry or inheritance (bibit is literally the word for seed, and includes the existence of mental illness or other inheritable diseases in the family); and social rank. It is strongly believed that mental retardation and a susceptibility to mental illness are inherited. Sometimes they are described as a kind of recessive gene or a sublimated tendency, sometimes "active" and sometimes not" active" within children who carry the possibility inherent in a particular bloodline. Saptandari' s informants listed "having a tendency (bakat) towards mental illness" and "inheritance" as two of the causes of mental illness. Jordaan talks about "heredity - organic" causes (Jordaan 1985:265) and it seems Weiss found that when people in Ponorogo talked about insanity as product of descent, most often it was not as a result of a literal bloodline, but instead the consequence of the sins of the parents being visited upon the children-mental problems as the result of "inherited sin" (Weiss 1977:168).When considering the idea of heredity, once again we can see the connections between the conditions of sakti and insanity: we can see that just as children are considered to carry the possibility of inherited disease they also carry possibility of being sakti. One can inherit powerful.weaknesses and one can also inherit powerful tendencies-and as we know in Java all power is dangerous. Strength and weakness, powers and vUlnerabilities- all of these can start to be surmised from the answer to a common greeting when meeting . . children in Java: "Kamu anale sapa?" - "Whose child are you?"

Despair and disappointment:An ability to remain calm, untroubled, and unmoved is deemed essential to the maintenance of physical and mental hea1th. Extremes of happiness or sadness imply a lack of self-control, which incites vulnerability to spirit possession and madness (Kee1er1987: 219-222). Saptandari's informants considered mental illness to be "a disturbence that happens to people that cannot control their emotions" (2001:6) and Jordaan' s considered it to be a result of "severe emotional strain" (1985:265). Disappointment and frustration seem thus to be two of the key emotional states that can influence mental health. Common causes for disappointment and frustration are "indulgence in unrealistic and overambitious fantasies" (Jordaan 1985:266) and "failing to live up to one's position or exceeding the limits of the position assigned to them"(Jordaan 1985:267). Keeler also foundthat "(p)eople susceptible to spirits are those who have experienced frustration, anger, loss, and other strong negative emotions that lay them open to attack...the key term. is frustration" (1987:116-118). Indeed, the term frustrasi has entered colloquial use in Bast Java as a common descriptor for someone who begins to act oddly, whether the odd behavior is attributed to mental illness or spirit possession or stress. It is clear in Java that not only is it dangerous to entertain negative emotions, the danger is compounded by holding on to that negative emotion too long, or falling into an excess of emotion. This is a common fate of women who have lost children, men or women who have experienced a broken heart, and women who have become pregnant out of wedlock and have been abandoned. Experts are called in to calm the grieving; women, girls and small male children are not allowed to go to the graveyard when someone is buried to protect them from an excess of grief. Dwelling within a negative emotional state can encourage despair, and leave one exceedingly vulnerable.

The Javanese do not suppress negative feelings or emotions; it is just that to control these feelings is to be human, to allow culture to suppress the dangerous chaos of nature. When a human loses emotional control in Java (including elsewhere in S.E.Asia), they lose their essential humanity. When the madwoman or madman is placed in stocks they are not just sent to live with the anima1s in the back yard of the traditional compound, they tragically somehow become an animal by Javanese standards of culture. The average Javanese is extremely afraid of someone who is drunk or amok, out of control with anger, as these states-like the state of madness - are so out of control, too unpredictable, as to be threatening.An excess of emotion, uncontrolled emotion, emotion unexpressed, or overwhelming negative emotion .unrelieved - these are certain causes of madness in Java.

Discomposure/ shock: When attempting to preserve mental or physical health in Java, shock should always be assiduously avoided. Unexpected bad news or a sudden, tragic event disturbs the hard-won personal construct of composure and sense. Of order which are so important to the Javanese. Shock is always and unequivocally very bad. Magnis-Suseno (1997:45 and 249) claims there is no Javanese word for surprise-only shock. Geertz discusses two words regularly associated with shock - gela which means disappointed and kaget which means startled, and found that both should be assiduously avoided since "one depresses and the other disorganizes" (c. Geertz 1976:312). In fact, both Geertzes described in several instances the Javanese philosophy of life as a series of shocks from whieh children should be carefully protected (e.g. H. Geertz 1963:92). Jordaan found shock to be a very common explanation for the onset of mental illness (1985:265). But a horrible shock such as news of a death of a loved one (especially a child), a rape, or news of some other tragedy usually only precipitates fainting followed by temporary insanity, and unless the victim of the shock slides into a continued excess of ernotion the concomitant spirit possession or lack of conscious, rational awareness will not be extended beyond abrief interlude of madness.For example letting sorneone who is away know that someone in their family has died and that they need to return horne for the funeral is a very tricky process. Usually the family will call the absent member, and concoct sorne gentle Iie that. includes an obvious imperative for them to come home. Once home, the traveler is given time to drink, to rest and eat and generally shake off the stress of travel to better to prepare thern for the shock of the bad news.It is assumed that one would need some time to regain their equilibrium after the demands of travel in order to better defend one' s self against the onslaught of the shock of the death of a loved one.Mbah Mari tells us that many little performances like this one are often put on by people. Even more, if they know that someone is returning home from working afar and there is a good possibility that they will get hysterical from hearing that someone in their family has died, long before the date of that return they will contact Mbah Mari (Masruri and Dakas 1997a:95-96). Protecting someone from the danger of shock in Java is aIways the duty of a good friend or a family member, even when it requires conceaIing the truth.. .and the lie is" always forgiven.

Disequilibrium/ instability or lack of self-control: The Javanese believe that thoughts, emotions, social hierarchy,social relations, the lahir and the batin - everything in the self, the home, society and the world should ideally remain stable, and much effort is put into maintaining the status quo that demonstrates asolid equilibrium. A disturbance that happens to people who are physically healthy, but their thinking is disturbed; A disturbance that happens to people who are not able to acclimate themselves to their enviromnent, who are easily swayed, and have an unstable personality; Possessing an unstable personality and or unable to control their emotions; Inability to acclimate themselves to their environment; Coming from a broken home, divorce or breakup of the home for other reasons" (Saptandari 2001:5-8).Thus again, disturbance of the individual mind occurs when the order, harmony and stability of the environment or their selves is disturbed.Thus many of the Javanese terms for mental illness have to do with this notion of disequilibrium or disturbance of equilibrium including diganggu (disturbed indicating spirit possession or harassment by spirits); gangguan jiwa (mental disturbance); koplak (shook); miring (tilted); nggak beres (not right); nggak genah (disorderly); and owah (no longer whole or complete). . Even the phrase jatuh sakit «to) fall sick) reflects this notion of disequilibrium as a primary and characteristic cause of madness in Java.

Although they participate in the local culture and share popular conceptions of the nature of health and illness, curers must develop their own theories about the nature of illness that inc1ude detail on the process of treatment and cure. Through their regular contact With patients, some curers become quite adept at explaining the nature of illness and cure. And staying healthy in Java demands keeping ones awareness at a high level so as never to be startled, maining control of the emotions and repressing inappropriate desire. Following a general overview of cultural habits and customs, we will then focus on the practice of these practitioners.


Psychiatry and Beliefs in Indonesia P.2

Psychiatry and Beliefs in Indonesia P.3:

Psychiatry and Beliefs in Indonesia P.4:


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