B. Discussion
4. Discussion
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that people with mental disorders are attached to their lives with criminal behavior;
Third, the assumption that people with mental disorders must be ostracized and exiled in social life; Fourth, the assumption that mental disorders cannot be cured;
Fifth, the assumption that people with mental disorders must be due to poor parental care.
On that basis, the alternative to seeking mental health treatment services is inseparable from the beliefs of ODGJ families. As Kleinman (1985: 65) states that the belief in deciding to choose health services can be influenced by various factors, including: 1) etiology and condition, 2) the time and type of symptoms that attack, 3) the treatment process, 4) the severity disease, and 5) appropriate treatment for the condition.
These factors are an important element of a decision in the selection of the health care sectors to be used. Said to be important because it is a concept or cognitive maps that are always referenced and used by individuals (community members or medical practitioners) to explain the causality of illness, diagnosis, and treatment.
On this basis also individuals in the community classify the types of diseases that can or should be treated by doctors or hospitals and the types of diseases that must be brought to the dukun (traditional healers) who know and are able to treat it. The explanation given is partly on consciousness and partly outside consciousness. The characteristics of the model explain the point of view of these individuals
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Stigma that occurs can not be separated from the background of myths circulating in the community about mental disorders. First, there is an assumption that people with mental disorders only occur in people who are weak soul; Second, the assumption that people with mental disorders are attached to their lives with criminal behavior; Third, the assumption that people with mental disorders must be ostracized and exiled in social life; Fourth, the assumption that mental disorders cannot be cured; Fifth, the assumption that people with mental disorders must be due to poor parental care. Based on the description of knowledge related to the etiology of mental disorders mentioned above, the practice of care behavior in ODGJ families in Blahbatuh village is seen in the decision process of treatment and treatment choices undertaken which are divided into traditional care behaviors (household care choices and shaman care options) and professional or modern care behaviors (puskesmas, public hospitals, psychiatrists, mental hospitals). Behavior of home care (home remedies) lived by ODGJ families is the first action taken to overcome the disease which is seen as self-medication. The reason for ODGJ families is as a trial and error business. Behavioral care behavior is chosen by ODGJ families with the assessment that the illness suffered is "not an ordinary illness" or personalistic (noetic), which cannot be overcome or cured by themselves. On the other hand, the behavior of modern / professional care was chosen based on several reasons, among others, failure / lack of progress in treatment carried out balian, ODGJ's own conditions that are troubling family members and themselves ODGJ, just understand that the RSJ will be handled by experts, believe that "sick balinya" has disappeared and the reason to cure medical pain alone.
Shamans as traditional healers are known as balian, tread or jero dosaran. The ability to treat this is obtained in various ways. Unlike in the world of modern medicine or paramedics gain knowledge and ability to treat the sick from school, traditional healers get their expertise based on tradition, ancestry, taksu, pica or it can also be a result of learning in people who have become balian and various other ways. There are some things that do not want to be called a ballot or Jero Target, they only claim to be people who help or treat.
Most balian perform their medical duties without expecting sasantun, they are willing to treat anyone who needs help without seeing a day or the number of sasantun put in their offerings. All treatments take place sincerely without sincerity.
Because all balian really balian in Bali, know the results of trials will sasantun and other material. Supernatural powers or in terms of treating the sick will decrease and fade. If they know they will not be able to treat their patients, they will frankly say and suggest looking for a gift that is smarter than him. If you know the prognosis is bad (dead) they will not want to treat.
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In the treatment carried out by balian, also known as malukat is a process to purify oneself. Malukat is a word that is very familiar to the Balinese manners to be carried out in ritual life. The purpose and hope of this ceremony is to be able to improve the quality of life better. Certain goals to be achieved are to cure medical and non- medical diseases. Malukat is performed at the spring , shower water, river, at sea even using holy water from Sang Sulinggih. Kumbara (2017) states that Balinese generally will ask for help from a shaman or balian to obtain an explanation of the causes of illness as well as ways to overcome them. In addition to asking for help from a dukuh or balian, the family will invite the person concerned to perform the ritual of painting which has a symbolic function and meaning that leads to efforts to cleanse the souls of ODGJ in order to achieve or restore the disturbed soul balance.
The concept of illness according to the beliefs of Balinese who are Hindus occurs due to an imbalance of 3 elements of Buana Alit, Buana Agung and Sang Hyang Widhi Wasa so that the scale factor or noetic factor can cause disturbance in humans. Then this belief is what causes the sufferer or his family to visit a traditional healer, shaman (balian) to get treatment. In traditional healers in Bali, the treatment process is usually accompanied by prayer ceremonies and offerings at Pura (Merajan), holy places, the sea and so on in accordance with the views or beliefs of these traditional healers. Seen from traditional medical materials such as loloh, simbuh, boreh, metirta, painting.
The patient's family comes to the Bali Provincial Mental Hospital on the grounds of the family's request after receiving Balian's instructions / consideration. Besides, it is also on the advice of health workers and the advice of religious leaders. It was also found that most visits to traditional healers (balian) were more than once with very varied results. Some feel healed for a long time, only healed briefly, always recurring or recurring, there was no change at all, and getting worse. When viewed from those who suggested that they seek medical treatment, they included family, neighbors, courtesy, friends, and also because of their own beliefs. Also found the reason for the concept of family seeking cleaning after going to the hospital due to feeling fatigued / dirty, mala / disabled, so that the patient's spirit not floating.
After being discharged from the Hospital, the treatment sought was traditional healer, medical, and a combination / overlap (between medical and traditional).
The patient's family will overlap the two treatments (Foster and Anderson, 1986). If they relapse, most of them come to the balian. The patient's concept and his family are said to be sick because they are sick of Bali because they feel fatigued / dirty so they feel the need to clean or malukat. Balian is able to influence the patient and his family and most believe in what is stated by balian. After the cleansing ceremony, the feeling of the patient is calmer, more energetic, feels clean. ODGJ patients during medical treatment at the mental hospital related to the explanation by families of
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medical staff about illness, the medical care system, the patient's condition, medication adherence, were felt to be very poor for the patient's family.
For the patient's family that the patient's recurrence aside from the trusted noetic factor, it also occurs due to feeling guilty, feeling depressed, feeling shunned / not cared for, impatience of the family attitude, being trusted and always being suspected. This guilty feeling can be in the form of belief that the cause of the disorder is due weakness in the trials / tests of life, punishment from God, or past mistakes (Putro, 2016). Regarding the form of communication and interaction patterns in traditional healers take place openly and without secret. The family can accompany and express opinions or comments about problems faced by patients openly to traditional healers and sufferers.
Relating to the quality of relationships in traditional healers in general are non- formal, open, relaxed, friendly and do not require strict procedures. Just emotional contact. Even if there is something that is formal, it is limited when it is in a trance state, after that it is normal, not formal. Regarding attitude, for people in Bali who still have strong traditional culture, there is no ambivalent attitude towards their traditional healers (Glynn, 2016). Regarding the nature of the sacred and not sacred in Bali, the nature of the sacred is very prominent compared with other regions, and the nature of this sacred also varies in each of the traditional healers, for example, the nature of the sacred is more prominent in traditional healers who use a trance in their medical practice. In connection with the view of disease in Bali for a balian, complaints and disorders expressed by most patients treated as a disease (disease).
Relationship with clinical reality is one aspect of social reality related to health, especially attitudes and norms about disease, the etiology of the disease, the process and mechanism of decision making, clinical relationships and healing activities. This is very much determined by the local social and cultural conditions.
In general, the treatment process experienced by ODGJ is back and forth which has the implication of causing ODGJ to return to make him not in charge of himself. the weakest and helpless in living the routine day of the occupants of the Mental Hospital. As a result, burn-out and ODGJ family despair occur. This happens because the energy drained to deal with the stress experienced continuously in the course of treatment of ODGJ patients. Lack of knowledge and family support in treating patients at home causes relapses or relapses (the return of an illness after it seems to subside), which in turn leads patients to return to treatment and care at the Mental Hospital which causes the patient's family despair. The families of ODGJ patients also do not allow themselves to continue to feel disappointment, anger, sadness, pressure, loss, anger, regret and confusion, but they also do not allow these feelings to last long in themselves. Coping is part of resilience. Resilience is the ability or capacity of the human family of patients to deal with, prevent, minimize
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and even eliminate the adverse effects of unpleasant conditions and even change the miserable conditions into conditions to accept reality to be overcome.