Pasung: Physical restraint and confinement of the mentally ill in the community

Abstract

Background: Physical restraint and confinement (pasung) by families of people with mental illness is known to occur in many parts of the world but has attracted limited investigation. This preliminary observational study was carried out on Samosir Island in Sumatra, Indonesia, to investigate the nature of such restraint and confinement, the clinical characteristics of people restrained, and the reasons given by families and communities for applying such restraint.

Methods: The research method was cross-sectional observational research in a natural setting, carried out during a six-month period of working as the only psychiatrist in a remote district.

Results: Fifteen cases of pasung, approximately even numbers of males and females and almost all with a diagnosis of schizophrenia were identified. Duration of restraint ranged from two to 21 years.

Discussion and conclusion: The provision of basic community mental health services, where there were none before, enabled the majority of the people who had been restrained to receive psychiatric treatment and to be released from pasung.

Figure 1

Iron shackles are fixed to the wooden floor of a hut in which the person is confined.

Figure 2

This man has his ankles in wooden stocks.

Figure 3

The man shown in Figure 2 being released from pasung.