Family coping strategies caring for patients with mental disorders post-pasung

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Illustration of a person with mental health disorder physically restraint with pasung. (Source: DW)

The physical restraint with pasung to person with mental health disorder (ODGJ) is illegal, a violation to human rights and a discriminating act to the patient. Pasung is often used to patient with a chronic mental disorder that often causing disturbances in their residential area. The families confine, chain the leg or use a block of wood as shackle (pasung) and hide them from neighbors. When the authority release the patient, the family will restrain them again after they are okay to return home.

No one wants to have a mental disorder, none of the families expect one of their family members to have a mental disorder, but the facts often say differently, the results of basic health research in 2018 show 7 out of a thousand Indonesians experiencing severe mental disorders. Families with one family member experiencing mental disorders can cause high conflict, become an objective burden due to financial problems, illness does not heal and become chronic, subjective burden due to shame, blaming each other, involvement of hostility between family members, not to mention stigma from the public. Family coping will be different and will affect the attitudes, ways of caring for and treatment of families to post-pasung ODGJ. The study was conducted to know more how the families’ coping strategies to deal with the person with mental disorders post pasung.

This study uses qualitative methods with a case study approach. It is a research that specifically uses techniques to obtain answers or in-depth information about a person’s opinions, perceptions, and feelings. Data collection was carried out by in-depth interviews, observing field notes, recording devices in the form of video cameras or recorders . If participants are not willing to use video cameras, researchers record interviews using a recorder.

The results of the thematic analysis found 7 themes, 19 sub themes, and 32 categories. The themes, sub themes and categories are based on four specific research objectives; 1) the condition of family coping in treating post-pasung ODGJ, 2) the process of family coping strategies, 3) the source of family coping support, and 4) the meaning felt by the family in caring for post-passive ODGJ.

The description of family coping in caring for post-birth ODGJ in general is in the form of family coping conditions, family coping strategies, the source of family coping support and the meaning felt by the family for what is experienced. The condition of family coping in caring for ODGJ post pasung is described as constructive coping and destructive coping. Constructive coping are conditions in the form of actions taken by families such as finding drugs, monitoring drug consumption, interacting, thinking positively.

Destructive coping includes actions to attend non-medical / alternative, overprotective, negligence of drug control, negative feelings. This study describes the family coping conditions in treating post-birth ODGJ not always in one coping condition, but in general all participants have been in both conditions. This depends on the problem or situation at hand, even though post-pasung ODGJ families are in a constructive condition, they can be in a destructive condition to face new problems or new situations.

The family coping strategy process in caring for post-pasung ODGJ described as stages of strategic process. The strategic process were divided into four stages: the initial stage where a family is not aware of the situation that is happening to family members. The second stage, the family will seek help that is not right, such as spiritual or traditional shaman. The third stage, the family is at zero. The family will run out of assets to seek treatment because of going to alternative medicine (shaman) repeatedly without any progress in improving the condition of ODGJ. In the fourth stage, the family survives. In this stage there are two categories of choices, go through a situation or continue to look for ways to cure post pasung ODGJ.

The source of family coping support in caring for post-pasung ODGJ in this study shows that support for each participant is not always from one direction, but can be from various directions. The source of support is interpreted into two sources of coping, intra-family and public support . Sources of intra-family support are from relatives outside the nuclear family. Public support in the form of support in the form of material or non-material from neighbors or government / social leaders.

There are two types of perceived meaning from taking care of the post-pasung patient with a mental disorder, positive meaning and negative meaning. The positive meaning felt by the family is that it is a trial and test from God leading to better spiritual piety. The positive meaning is interpreted as sincere, patient and surrendering attitude. The negative meaning felt by the family it that it is a destined fate and they connected it to lineage issue. (*)

Author: Ah. Yusuf

Complete article available at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7047469/

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