The physical confinement and restraint of people with mental health problems has a long and inglorious history, and virtually every society has restrained people with mental problems at some point in their history. Philippe Pinel is credited with having released the mentally ill from their chains at the Bicêtre and the Salpêtrière hospitals in Paris at the end of the 18th century. Yet physical restraint continues in mental hospitals, religious shrines and healing sanctuaries, and other settings in many parts of the world. In Indonesia, such restraint methods (known as pasung) include shackles, rope, wooden stocks, cages, and the locking of people in confined spaces. These methods are applied (also in combination) to men, women and children who show certain attitudes, behaviors and emotional expressions that depart from ‘normality’. In most cases, the decision to restrain is initiated by members of the family, although in some instances it is supported or imposed (and maintained) by community leaders. Previous studies have indicated that the duration of pasung ranged from three months to 30 years. In some instances, restraint may be intermittent – applied only during periods when the person is considered by the family or community to be dangerous to him/herself or others. The location of restraint varies also: a person may be restrained in a room of the family home, under a tree in the yard, in a small shelter nearby, or up to a few kilometres away from the home. Because of their restricted mobility and extremely poor hygiene and diet, people in pasung develop mental and physical disabilities, injuries, and diseases, in addition to difficulties in developing social skills. The inadequacy of the mental health system; unaffordable, ineffective and difficult to access treatments; uncoordinated if not conflicting therapeutic approaches (i.e. traditional/spiritual vs. biomedical interventions); and a general lack of reinforcement and implementation of human rights and health legislations, form the backdrop of the pasung stories, including those highlighted in the film Breaking the Chains.
(Extract from E. Colucci, 2013, Breaking the chains: Human rights violations against people with mental illness in Indonesia. Companion text to the ethnographic documentary “Breaking the chains”).
READ article co-written with a Pasung survivor: Anto SG, Erminia Colucci (2015): Free from pasung: A story of chaining and freedom in Indonesia told through painting, poetry and narration, WCPRR September/December 2015: 149-167
READ BLOG piece written for Mental Health Innovation “Human rights of people with mental health problems: Reflections from field/film-work”
Watch videos where the film-maker and researcher behind Breaking the chains talks about the film and the issue
Some useful resources about pasung and similar violations of the human rights of people with mental health issues can be found below.
Please note that the list is not exhaustive and will be constantly updated. You are invited to please send your suggestions about additional resources (especially those freely available) to Dr. Erminia Colucci or using the blog/comment page, thanks!
Minas, H., & Diatri, H. (2008). Pasung: Physical restraint and confinement of the mentally ill in the community. IJMHS, 2(1) Freely available at www.ijmhs.com/content/2/1/8
Puteh, I., Marthoenis, M., & Minas, H. (2011). Aceh Free Pasung: Releasing the mentally ill from physical restraint. IJMHS, 5(1), 10-14. Freely available at www.ijmhs.com/content/5/1/10
Read, M. U., Adiibokah, E., & Nyame, S. (2009). Local suffering and the global discourse of mental health and human rights: An ethnographic study of responses to mental illness in rural Ghana. Globalization and Health, 5(13). Freely available at www.globalizationandhealth.com/content/5/1/13
Broch H. B. (2001). The Villagers’ Reactions Towards Craziness: An Indonesian Example. Transcultural Psychiatry , 38(3):275. Freely available at tps.sagepub.com/content/38/3/275.full.pdf+html
Silove, D., Ekblad, S., & Mollica, R. (2000). The rights of the severely mentally ill in post-conflict societies. Lancet, 355, 1548-1549.
Arboleda-Flórez J. (2008). Mental illness and human rights. Current Opinion in Psychiatry. 2008 Sep; 21(5):479-84.
WHO resources on Mental health, human rights and legislation
Chain-Free pasung program on Mental Health Innovation Network
Other resources on human rights and related issues:
University of Melbourne podcast “Free and equal: Human rights in the global imagination”