Al Ghazali's Concept of Diseases of the Spiritual Heart and its Significance to the DSM-5-TR Diagnosis.

The intertwined relationship between religion and mental health has been accounted for since the earliest recorded history. This study aimed to explore the relationship between the concept of diseases of the spiritual heart (DOTSH) from the Islamic-Sufi perspective and the medical-psychiatric concept of mental disorder. We examined two essential documents as our primary data sources: (1) Al Ghazali's Ihya Ulumuddin (Revivals of Religion Sciences) Volume III entitled the Quarter of the Destructive and (2) The Diagnostic and Statistical Manual, Fifth Version, Text Revision (DSM-5-TR). We employed a document analysis of the qualitative method by applying six steps of data analysis. We reviewed the English version of Al Ghazali's book to identified DOTSH. In this stage, we found six DOTSH categories which comprised of 40 DOTSH. Then, we searched the correspondence of DOTSH's categories to the DSM-5-TR criteria for mental disorders. We found that all DOTSH categories correspond to DSM-5-TR diagnostics criteria, diagnostic features or diagnostic associated features. We concluded that spiritual heart diseases not only present as symptoms but also can be regarded as mental disorder preconditions that require preventive intervention.

The principles of recovery-oriented mental health services: A review of the guidelines from five different countries for developing a protocol to be implemented in Yogyakarta, Indonesia.

BACKGROUND: Recovery-oriented mental health service has become the focus of global change in mental health services. Most of North industrialized countries have adopted and implemented this paradigm in the last two decades. Only recently that some developing countries are trying to follow this step. In Indonesia's case, there has been little attention to developing a recovery orientation by mental health authorities. The aim of this article is to synthesize and analyze the recovery-oriented guidelines from five industrialized countries that we can use as a primary model for developing a protocol to be implemented in community health centre in Kulonprogo District, Yogyakarta, Indonesia. METHOD: We used a narrative literature review by searching for guidelines from many different sources. We found 57 guidelines, but only 13 from five countries met the criteria, including five guidelines from Australia, one from Ireland, three from Canada, two from the UK, and two from the US. To analyze the data, we used an inductive thematic analysis to explore the themes of each principle as described by the guideline. RESULT: The results of the thematic analysis revealed seven recovery principles, including (1) cultivating positive hope, (2) establishing partnerships and collaboration, (3) ensuring organizational commitment and evaluation, (4) recognizing the consumer's rights, (5) focusing on person-centeredness and empowerment, (6) recognizing an individual's uniqueness and social context, and (7) facilitating social support,. These seven principles are not independent, rather they are interrelated and overlap each other. CONCLUSION: The principle of person-centeredness and empowerment is central to the recovery-oriented mental health system, while the principle of hope is also essential to embracing all the other principles. We will adjust and implement the result of the review in our project focusing on developing recovery-oriented mental health service in the community health center in Yogyakarta, Indonesia. We hope that this framework will be adopted by the central government in Indonesia and other developing countries.

Psychotheraputic Dimensions of an Islamic-Sufi-Based Rehabilitation Center: A Case Study.

Due to limited professional mental health facilities in Indonesia, traditional and faith-based mental health care is essential to provide an alternative treatment. This study explored the therapeutic aspects of treatment at Pesantren Tetirah Dhikr (PTD), an Islamic-Sufi-based rehabilitation center for people with mental illness and drug addiction in Yogyakarta, Indonesia. We employed a case-study method to understand the process of therapy and the theoretical ideas behind the practice. We conducted interviews with the Kyai (head of PTD), his assistants, and sixteen patients (called santri). The results of a thematic analysis revealed that the practice of dhikr was the essential therapeutic component for improving the participants' mental health. From an Islamic psychological perspective, the process of therapy at PTD was comparable with the process of purification of the soul in Sufism. This process comprised three stages: takhalli (purifying the soul from reprehensible attributes), tahalli (adorning the soul with noble and praiseworthy attributes), and tajalli (attaining of a pure soul). From a transpersonal psychology perspective, the effect of dhikr was comparable with the therapeutic benefits of meditation practice and other psychotherapy.

Cultural explanations of psychotic illness and care-seeking of family caregivers in Java, Indonesia.

The cultural understanding of illness among caregivers of first-episode psychotic persons is a crucial issue. Not only does it influence caregivers' care-seeking behavior and length of time until receiving medical treatment (known as the 'duration of untreated psychosis' or DUP), but it also predicts the outcome of the illness. This article aims to explore cultural understanding and care-seeking behavior among caregivers of psychotic patients in Java, Indonesia. Data for this article have been taken from two studies conducted by our research group in Yogyakarta, Indonesia. Methods of data collection include surveys, case studies, ethnographic fieldwork, and in-depth interviews. Results of analyses, within and across studies, indicate that caregivers have employed diverse cultural explanatory models in order to understand psychotic illness. Local cultural beliefs, including possession and forms of black magic, were among the most common initial concepts held by family members in relation to psychosis. This echoes broader cultural beliefs in Java. However, it was not uncommon for caregivers to also understand illness in psychological terms (such as frustration, disappointment, and stress) and attached medical explanations. Caregivers' understanding of illness also changed over time following the changing course of the illness. Both models of illness and the rapidity of care-seeking are also related to the acuteness of onset. This article concludes that it is important for mental health providers, as well as those designing systems of care, to understand the diversity and changing nature of caregivers' cultural understanding of psychotic illness.

Development and Evaluation of a Mental Health Training Program for Community Health Workers in Indonesia.

The treatment gap in mental health care in Indonesia is a critical issue due in large measure to the dearth of professional mental health staff. In response to this need, our team designed a mental health training program for existing community health workers. The training program was offered to 65 participants at 2 (two) community primary care center (Puskesmas); we evaluated the training program with quantitative and qualitative methods. We assessed the gains in knowledge using a 20-question knowledge assessment test. In addition, in Puskesmas 1, the test was repeated as a follow-up test 4 months after the training. Statistical analysis showed that the differences between pre-test and post-test scores were significant in both Puskesmas 1 (p = 0.004) and Puskesmas 2 (p < 0.001). This study concluded that the model of integrative training appears effective for preparing Indonesian CHWs to recognize and respond to needs for mental health care.

Early psychosis in Indonesia: reflections on illness and treatment.

This paper provides an overview of more than 22 years of research conducted in the central Javanese province of Yogyakarta, Indonesia, by teams of researchers associated with Gadjah Mada University and Harvard University, led by the authors of this essay. This work is placed in the context of the very limited literature on early psychosis and mental health services in Indonesia. It provides an overview of mental health services in Indonesia and of this team's research trajectory, then addresses four key domains: the cultural phenomenology of early experiences of psychotic illness; patterns of onset, with a particular focus on extremely rapid onset psychoses; patterns of care-seeking for first episode illness; and mental health services and patterns of utilization. It then discusses the importance of rapid onset psychosis for research on early psychosis, and the question of whether collinearity of rapidity of onset and rapidity of care-seeking raises questions about the long-standing finding that a short duration of untreated psychosis leads to better outcomes. It concludes by discussing difficulties of prioritizing early intervention models in settings with very low mental health resources.

Shame as a cultural index of illness and recovery from psychotic illness in Java.

OBJECTIVE: Most studies of shame have focused on stigma as a form of social response and a socio-psychological consequence of mental illness. This study aims at exploring more complex Javanese meanings of shame in relation to psychotic illness. METHOD: Six psychotic patients and their family members participated in this research. Ethnographic fieldwork was conducted in Yogyakarta, Indonesia. RESULT: Thematic analysis of the data showed that participants used shame in three different ways. First, as a cultural index of illness and recovery. Family members identified their member as being ill when they had lost their sense of shame. If a patient exhibited behavior that indicated the reemergence of shame, the family saw this as an indication of recovery. Second, as an indication of relapse. Third, as a barrier toward recovery. CONCLUSIONS: Shame is used as a cultural index of illness and recovery because it associated with the moral-behavioral control. Shame may also be regarded as a form of consciousness associated with the emergence of insight. Further study with a larger group of sample is needed to explore shame as a 'socio-cultural marker' for psychotic illness in Java.

Bangkit: The Processes of Recovery from First Episode Psychosis in Java.

There is a growing literature on recovery from schizophrenia. Most studies, however, focused on outcome, with insufficient attention paid to the process of recovery. The aim of this study was to explore the process of recovery from first episode psychotic illness in a Javanese cultural setting. An ethnographic method was applied where researcher conducted a field work and followed seven participants in their natural setting. This study identified three phases of recovery process in the context of Javanese culture: Bangkit, gaining insight; Usaha, struggling to achieve recovery; and Rukun, harmonious integration with family and community integration. Recovery entails regaining insight, followed by simultaneous inward and outward efforts that reconstitute one's inner and outer world, respectively. Participants also expressed their recovery in terms of a movement through physical space, from confinement in their own home to the wider spaces shared with family and community. Movements in physical space parallel movements in social space, where participants accomplish a social recovery. The Javanese phase of recovery found in this study is comparable to the phase of recovery identified by previous literatures in the Western context.

Family expressed emotion in a Javanese cultural context.

This study aims at understanding the emotional milieu of families of psychotic patients, focusing on the concept of expressed emotion (EE). A combination of ethnographic and clinical methodology was employed. During the fieldwork in Yogyakarta, Indonesia, nine participants diagnosed as having first episode psychosis and their families were followed closely over the course of 1 year in their natural home setting. Through ongoing engagement with families, the researcher was able to gather data on the diversity of family responses to illness. Despite the fact that most families in this research could be considered to have low EE, ethnographic observation provided a more complex and nuanced picture of family relationships. This article discusses four issues concerning EE in relation to Javanese culture: the role of interpretation, the coexistence of criticism and warmth, the interpretation of boundary transgression, and the cultural concept of warmth and positive remark.