A spiritual-hypnosis assisted treatment of children with PTSD after the 2002 Bali terrorist attack.

The aim of this study was to assess the effectiveness of a spiritual-hypnosis assisted therapy (SHAT) for treatment of posttraumatic stress disorder (PTSD) in children. All children, age 6-12 years (N=226; 52.7% females), who experienced the terrorist bomb blasts in Bali in 2002, and subsequently were diagnosed with PTSD were studied, through a longitudinal, quasi-experimental (pre-post test), single-blind, randomized control design. Of them, 48 received group SHAT (treatment group), and 178 did not receive any therapy (control group). Statistically significant results showed that SHAT produced a 77.1% improvement rate, at a two-year follow up, compared to 24% in the control group, while at the same time, the mean PTSD symptom score differences were significantly lower in the former group. We conclude that the method of spiritual-hypnosis is highly effective, economic, and easily implemented, and has a potential for therapy of PTSD in other cultures or other catastrophic life-threatening events.

Suicide in paradise: aftermath of the Bali bombings.

BACKGROUND: The relationship between the Bali (Indonesia) bombings of October 2002 and suicide has not previously been investigated, despite anecdotal evidence of the economic and psychological consequences of these attacks. METHOD: Suicide rates were calculated over the period 1994-2006 in three Bali regencies to determine whether suicide increased in the period following the first Bali bombings. Poisson regression and time-series models were used to assess the change in suicide rates by sex, age and area in the periods before and after October 2002. RESULTS: Suicide rates (age-adjusted) increased in males from an average of 2.84 (per 100 000) in the period pre-2002 to 8.10 in the period post-2002, and for females from 1.51 to 3.68. The greatest increases in suicide in the post-2002 period were in the age groups 20-29 and 60 years, for both males and females. Tourist arrivals fell significantly after the bombings, and addition of tourism to models reduced relative risk estimates of suicide, suggesting that some of the increase may be attributable to the socio-economic effects of declines in tourism. CONCLUSIONS: There was an almost fourfold increase in male suicide risk and a threefold increase in female suicide risk in the period following the 2002 bombings in Bali. Trends in tourism did not account for most of the observed increases. Other factors such as indirect socio-economic effects and Balinese notions of collective guilt and anxieties relating to ritual neglect are important in understanding the rise in suicide in the post-2002 period.

Shamanism, psychosis and autonomous imagination.

This paper focuses on traditional healers (balian) in Bali, Indonesia, to raise new arguments concerning the nature of the initiatory sufferings reportedly experienced by shamans in many cultures. Our evidence suggests that a) contrary to our expectations, an initiatory madness or illness is experienced by a minority rather than the majority of balian, and b) whether or not a balian undergoes initiatory sufferings seems to be linked to gender and to the methods of healing employed - thus women healers who employ trance possession are those most likely to report an initiatory madness or illness. This leads to the central argument of the paper: c) the nature of the initiatory sufferings, where they do occur, can be clearly distinguished on several grounds from the onset of mental illness among Balinese, both emically in terms of cultural understandings, and ethically in terms of objective criteria. Finally we discuss the concept of "autonomous imagination," suggesting that the key to becoming a balian is not overcoming an initiatory madness but gaining control over this special mode of imagery thought. We further suggest that Western ideas concerning the self and self healing, the superficial resemblance of the initiatory sufferings to schizophrenia, and the dramatic nature of the initiatory sufferings when they occur, have combined to give a misleading prominence to the role of an initiatory madness in shamanism.

Psychiatrist, traditional healer and culture integrated in clinical practice in Bali.

This paper considers the psychiatrist-traditional healer relationship in clinical management of mental disorders in Bali. It also concerns the role of sociocultural factors in the etiology and management of mental disorder. The basic concepts and therapeutic strategies of Western psychiatry co-exist with the beliefs and methods of traditional healers. Often psychiatrists and traditional healers are involved with the same patients. A clinical case study of an episode of mass dissociative disorder (trance state) in which psychiatrists acted as consultants illustrates the integration of concepts of Western psychiatry and Balinese culture in the diagnostic evaluation and therapeutic strategies.

Palm wine drinking in a Balinese village: environmental influences.

The present study reports observations of drinking patterns and life-style of Bali-Hindu men in a Balinese village, Pemuteran, who have a relatively high prevalence (about 40%) of excessive consumption of locally produced palm wine. Patterns of drinking were defined. They are rooted in the customs of the inhabitants prior to mass displacement to a "new" land area following a volcanic catastrophe in their old village location in 1963. Excessive drinking appeared to be causally related to identified sociocultural factors and to a physically impoverished environment that greatly reduced work opportunities during much of this year. A similar village in the area which underwent important social and drinking pattern changes consequent to government provision of irrigation water and greater work opportunities suggests that alcohol drinking in Pemuteran may decline under similar social-environmental changes.

Multi-cultural study of minor psychiatric disorders in Asia: symptom manifestations.

Patients with minor psychiatric disorders, including neuroses, situational adjustment reaction or acute emotional reaction, were investigated using symptom questionnaires at five research sites in Asia including: Chiang-Mai, Thailand; Bali, Indonesia; Kao-Hsiung, Taiwan, China; Shanghai, China; and Tokyo, Japan. The results revealed that the symptom profiles differ significantly among groups of different settings indicating that sociocultural background does contribute to the manifestation of neurotic symptomatology. It was also found that numerous and various subtypes of somatic scales were identified through factor analysis of symptoms for these Asian populations. It demonstrates that the spectrum of neurotic symptoms has a different focus for subjects in different sociocultural settings.

Culture and mental disorder: the case of bebainan in Bali.

This is an investigation of bebainan, a disorder which Balinese believe to be caused by sorcery. Most attacks are brief, lasting 1/4-1 hour. The most common symptoms are sudden feelings of confusion, crying, screaming and shouting, followed by inability of the sufferer to control his or her actions. Most sufferers are aware of their behavior during an attack, and remember the occurrence afterwards. The investigator interviewed all the members (296 persons) in the compound of the descendants of the former royal family of Klungkung, among whom 27 people had suffered bebainan attacks. The victims, mostly females, offspring of endogamous marriges, experienced their first attack between the ages of 16 and 30. Analysis of the psychological and social pressures acting on these women suggests that bebainan attacks provide sufferers with an opportunity to release feelings of frustration and anger without risk of widespread disapprobation or stigmatization. However, bebainan is not instrumental in altering access to resources within the restricted environment of the royal compound, nor does it empower the victim within this environment in any but the most transitory ways. Bebainan cannot be regarded as a form of psychosis, even of the reactive or atypical type, it is neither an organic mental disorder, nor a form of neurosis. Instead bebainan can be considered a form of dissociation which is only understandable in the local context of Balinese culture.