American Anthropologist

Afflictions: Culture and Mental Illness in Indonesia [The Bird Dancer, 40 min.; Family Victim, 38 min.; Shadows and Illuminations, 35 min.] by Robert Lemelson


Afflictions: Culture and Mental Illness in Indonesia [The Bird Dancer, 40 min.; Family Victim, 38 min.; Shadows and Illuminations, 35 min.] Robert Lemelson , dir . Watertown , MA : Documentary Educational Resources , 2010 .

Given that mental illnesses and other psychosocial disorders are a universal part of the human experience, it is remarkable that there have been so few ethnographic films about neuropsychiatric conditions in non-Western contexts. Other than the films under review, I know of only two other ethnographic films about mental illness made by anthropologists: Ronald Simons's Latah: A Culture-Specific Elaboration of the Startle-Reflex (1983) and my own film Bethel: Community and Schizophrenia in Northern Japan (2007).

There are many possible reasons why ethnographic filmmakers have avoided the topic of mental illness. Professional ethics and the strictures of Institutional Review Boards can limit work on vulnerable populations. Many families are ashamed of their mentally ill relatives and secrete them away. And for ethnographic filmmakers, representing mental illness visually is very challenging. Individuals with various mental illnesses may appear normal, as much of what is going on is in the interior of their minds. As a result, it can be difficult to show through film what it personally means to live with a mental illness—or what it means to live with a family or community member who has a psychiatric disorder.

Add to that the complexity of cross-cultural psychiatry wherein the nature of illnesses is mediated through culture, and one can begin to see why there is so little work in this area. Stepping into this void, psychological anthropologist and filmmaker Robert Lemelson has recently directed and produced a series of groundbreaking ethnographic films about mental illness in Indonesia under the label Afflictions: Culture and Mental Illness in Indonesia. The first three films were released in 2010 by Documentary Educational Resources with another three to follow shortly. This review covers the first three in this series: The Bird Dancer, Family Victim, and Shadows and Illuminations.

The first film in the series, The Bird Dancer, came about when Lemelson was doing research in Indonesia in the 1990s on neuropsychiatric disorders. In Bali, he meets Gusti Ayu Suartini, an attractive young woman who has uncontrollable nervous tics: her body jerks and kicks, she feels ants crawling under her skin, she spits, and she occasionally utters noises and profanities. Her neighbors call her “the bird dancer” because of these strange movements.

Gusti's behavior has caused her and her family much distress. In elementary school, she was teased by her classmates and was eventually expelled because her teacher thought she did not have “a serious attitude towards her studies.” Without an education, a job, or any friends, Gusti helps around the house as best she can. Balyan or traditional healers try various treatments—incense, massage, pungents, and potions—to no avail. Gusti sees a series of psychiatrists who prescribe various pharmaceutical interventions, but they make her too sleepy or nauseous. Despondent, alone, and ashamed, Gusti laments that she just wants to die. Lemelson stages an intervention by having Gusti meet another woman with similar nervous symptoms.

Two years pass before we meet Gusti again and the situation is much different. Inspired by the other woman, Gusti has moved from her family's village and is working as a housemaid in the city. She is financially and emotionally independent with her own friends and support networks. Freed from the tyranny of small-village life, she is considerably happier even though medically her symptoms haven't changed much. Lemelson muses in a voiceover that when he first met Gusti, he was initially concerned about her neuropsychiatric disorder and its symptoms, but he now recognizes that her family and her social ostracism were the true causes of her distress.

The second film in the series, Family Victim, is situated in Java. While he is doing his survey work on culture and mental illness for the World Health Organization (WHO), Lemelson is surprised to learn that one of the case studies is actually the younger brother of one of his collaborators on the project. As in The Bird Dancer, Lemelson never tells us what is wrong with Estu Wardhani; rather, he shows us the effect that this individual and his condition have on his family and community.

Estu is a troubled individual, the “bad coconut” and ne’er-do-well of a wealthy and well-educated family. Because he does not wish to pursue either higher education or a career, his family does not know what to do with him. They buy him a small store so that he and his wife can earn a living selling mobile phones, but he instead scrawls graffiti all over it stating that he is a “family victim” and that his is a “life without hope.” Estu steals from his family and friends, lies to his wife, and gambles. He threatens to kill his siblings’ children if he doesn't get his way. In contrast to Gusti in The Bird Dancer, it is difficult to feel any sympathy toward Estu, who comes off as self-centered, uncaring, and cruel.

This film complicates the question of when should something be considered an illness to be understood—and when should it be read as simply inappropriate, antisocial, or criminal behavior that should be condemned. Estu's brother-in-law, a psychiatrist, is quicker than most to label him as a psychopath, while Estu's sister (also a psychiatrist) is much more understanding. As with the earlier film, Lemelson gives us no answers in this provocative film but provides us with a range of philosophical issues to think about.

The third film, Shadows and Illuminations, is the story of Nyoman Kereta, who suffers from the visitations of spirits. They visit him in the fields and enter his body and soul, wracking his mind. Kereta and his family are unsure of the cause of these apparitions. They wonder whether it was the eels poisoned by pesticides that he ate in 1972, the tragic death of his young child in 1983, or the residual psychological effects of the anticommunist purge in 1965, when Kereta's father and many of his friends were murdered by militia members right in front of him.

As with the protagonists of the first two films, Kereta also sees both traditional healers and psychiatrists. His wife, in particular, has mixed feelings about the traditional healers, as they seem to hurt him more than they help. Both Kereta and his wife agree that the psychiatrist—who has diagnosed Kereta as having paranoid schizophrenia—holds the pharmaceutical key to making his condition better. But in contrast, Lemeleson ends the film noting that it is not the presence of a psychological diagnosis but, rather, the lack of the label of “madness” with all of its negative connotations that has allowed Kereta to live in coexistence with his spirits and still have a full social life with his wife, children, and other villagers.

As a whole, the production quality of all three films is tremendously high, and the visuals, by cameraman Dag Yngvesson, are breathtakingly gorgeous. The films are also an aural splendor, with gamelan and violin music serving as backdrop. Because the films are a compilation of research footage as well as contemporary material, some of the editing is a bit choppy with temporal continuity sacrificed for the narrative arcs. Lemelson appears in the film both visibly and through voiceovers that are more reflexive than didactic.

With all three films in this series, the viewer is left with an array of questions. Some of this is the filmmaker's intent: for example, he does not give the diagnosis for Gusti in the first film to force us to ponder her plight. But in some other cases, I wish Lemelson had told us a bit more about the situation. For example, he explains some of the religious context for the spiritual world of Pak Kereta in the third film but provides very little context in the other two. Unfortunately, there is no teacher's guide in the DVD packaging or on Lemelson's website to help direct further conversation. The DER website does have a reference list of research articles by Lemelson, but the medical journals cited are largely inaccessible to people without university library accounts, such as public-school teachers or community-college faculty.

Nonetheless, these films are well suited for classroom use. Each of these films is less than 40 minutes in length, and they can be viewed (and purchased) separately or together as a single unit. Even jaded students are sure to be captivated by the intensity of the images and the skillful storytelling. One quick thing to note is that although there are subtitles for the Indonesian languages spoken in the film, there are neither subtitles nor closed captions for the expository voiceovers by Lemelson. This is a significant oversight for films that will be used in a multitude of educational settings (such as courses in disability studies), in which there may be students who are deaf or hearing impaired or who have processing or learning disabilities.

These minor issues aside, these three films by Robert Lemelson represent a significant contribution to ethnographic film as a whole and to the cross-cultural visual representation of mental illness in particular. As the culmination of over a decade of close and continuing interaction with his informants, the films show cultural and visual anthropology at their best.