March THE AMERICAN JOURNAL OF PSYCHIATRY 1963

PSYCHIATRY IN INDONESIA

NATHAN S. KLINE, M.D.1

Indonesia is a country of 97,000,000 peo- monthly average income from private prac-
ple with a total of 32 trained3 psychiatrists. tice in Djakarta is approximately 15,000
Since the population of Indonesia is about rupiah ($167 at the official tourist rate), so
half that of the United States a comparable that it is economically mandatory that all
figure for us would be 64 boarded psychi- physicians have a private practice. This
atrists in the entire country. There are an system of working part of the day for the
additional 10 psychiatrists practicing in the government and subsequently working for
mental hospitals who are not regularly one’s self can be designated as “2 p.m. So-
qualified and 8 residents in training at the cialism.” The 7 a.m. to 2 p.m. time spent
University of Indonesia Department of Psy- at the polyclinics is usually shaded slightly
chiatry. at both ends and private practice starts as
All physicians are obligated by law to a rule about 4:30 p.m. and continues until
work for the government from 7 a.m. to 2 8 or 9 at night.
p.m. at the university or polyclinics but Despite the great paucity of psychiatrists
are free the rest of the time to conduct the demand is even less so that most of
private practice. The only persons allowed those who are qualffied as psychiatrists do
full time private practice are those who general medicine in their private practice
have passed the retirement age for govern- and only 3 or 4 physicians specialize pri-
ment service. The average monthly salary4 marily in psychiatry during their free hours.
for psychiatrists is between 2000 and 3500 University of Indonesia.5 At the Universi-
rupiah, which amounts to between $22 and ty Psychiatric Clinic there are 64 beds for
$39 per month at the official tourist rate of inpatients with a staff of 10 psychiatrists, 8
exchange or roughly $7 to $13 per month on residents who serve for a 2-year period, 8
a free market basis. The superintendent of senior clerks, each rotating for 1 to 2 months,
a hospital earns 4000 rupiah a month. The and 12 junior clerks rotating on the same
basis.
1 Rocidand State Hospital, Orangeburg, N. Y. Much of this excellent system was built
2 Appreciation is expressed to Professor Slamet up during the 5-year affiliation (which ex-
Iman Santoso, Dr. Kusuinanto Setyonegoro and pired in 1961) with the California Universi-
especially Dr. Kho Tjok Khing of the University ty Medical Center. The inpatients are all
of Indonesia for their wann hospitality. psychotics, and in this group somatic thera-
Gratitude is also due to Dr. Salekan, Director
py is almost always used, although not
of the Division of Mental Hygiene, Brigadier
Satryo, Minister of Health, Mrs. Dr. Soebandrio exclusively. During the past 7 years the
and Professor Soedjorno D. Toestonegoro, Presi- number of admissions ranged from 443 to
dent of the University, since without their sponsor- 752 and discharges from 391 to 694, de-
ship this report would not have been possible. The
pending to a large extent on how much
invariable courtesy and assistance make me regard
many others, not individually named, as also chiorpromazine and reserpine were avail-
among my friends. able.
3Three years of specialization plus the writing There was a drop in patients admitted
of a thesis qualifies a physician for certification in and discharged in 1960 due to a sharp de-
psychiatry by the Board of Psychiatry, Neurology
crease in the availability of pharmaceuticals
and Neurosurgery.
is a cost-of-living bonus which presently for treatment purposes. Most of the pa-
amounts to approximately 100% of the salary. tients not discharged to the community
A rupiah is worth about one cent at the official either died or were passed on to the mental
tourist rate. Attendants earn $3 to $6 a month. hospital at Grogol.
The illegal “free market” value of the rupiah is
a third of the tourist rate, i.e., the attendant’s salary 5 The buildings which house the major part of
is $1 to $3 a month. the school were originally an opium factory.

IDII
IIIIIIUII
hID
IUIIDIIIIUI
JQN9-R5F-DORZ
809
810 PSYCHIATRY IN INDONESIA [ March
An average of 40 (1000 per month) pa- not have outpatient facilities. Treatment is
tients are seen per day at the university almost entirely custodial with less than 5%
outpatient clinic during a 6-day working of all patients on active somatic treatment
week. Of these approximately 10 each day or psychotherapy.6
are new patients. I was able to visit five major mental hos-
About three-fourths of the psychotic pa- pitals in Indonesia: 1. Sumber Porong
tients seen at the outpatient clinic are not which is at Lawang and has 2000 patients
admitted either to the University Clinic or (pre-war 4000 patients); 2. Bogor which
to the local mental hospital because both is located outside of Bogor and has a ca-
are already filled to capacity. When electro- pacity of 1200 patients (pre-war 3000 pa-
shock equipment and drugs are available tients); 3. Kranat which is at Magelang
patients are given ECT and psychopharma- with 1100 patients (pre-war 2000 patients);
ceuticals. At times such patients are kept in 4. Grogol at the outskirts of Djakarta with
the hospital from in the morning until 6 a capacity of 400 patients; and 5. Bangli
at night, thus constituting a day hospital which is on Bali with a capacity of 150 pa-
program out of necessity. tients plus an additional 100 beds under
As a rule patients are seen about every construction. The drop in patient population
2 weeks over an average of 1 to 2 years. from pre-war was necessitated in part by
These figures do not include epileptics who the reduction in professional personnel,
are referred to the neurology clinic nor since of the 18 Dutch psychiatrists who
mentally deficient patients who, once diag- were evicted at the time of independence
nosed, are kept at home. The arterioscie- 12 had been working in the mental hospi-
rotics constitute about one-fiftieth of the tals. Another factor is that the mental hos-
admissions and organic psychotics in gen- pitals were greatly overcrowded and since
eral are rare. There are some character dis- their reorganization they have not taken
orders, usually 1 or 2 neurasthenics, 1 or 2 more patients than they could adequately
obsessive compulsives, 1 or 2 anxiety states, handle. The most important factor, how-
and the same number of involutional de- ever, is probably budgetary limitations since
pressions in each 25 admissions. Two or 3 some of the hospitals have empty beds, but
of the 10 new patients each week are schizo- no way of providing food and services for
phrenic. Pre-war about 25% of new patients patients who could be admitted.
were general paretics, but it is now hard to Grogol Hospital. Grogol Hospital, named
find any of the classical type of luetics in for the river that passes in front of it, is
the new admissions. located some 10 Id. from the center of
In the mental hospitals and the clinics Djakarta. Of the 400 beds only 300 are
the number of Chinese, whether foreign or presently in use; 200 for males and 100 for
Indonesian born, is disproportionately females. The hospital occupancy is 25% be-
great; the Chinese are more health con- low capacity because money is not available
scious whereas the Indonesians tend to for food, clothing, drugs, water, electricity,
“protect their family name” and “explain transportation and other upkeep. The ad-
away” illnesses or other disorders. Thus 40% mission rate is 100 patients per year with
of the inpatients at the clinic and 30% of approximately the same discharge rate. The
the outpatients are Chinese in origin al- total yearly hospital budget exclusive of
though the Chinese comprise only about salaries is 1.4 million rupiah ($14,000 at the
10% of the 3,500,000 persons in Djakarta. official tourist rate and roughly $5000 at
Military Hospital. The Military Hospital the free rate). The staff consists of a di-
has an inpatient facility of 60 beds and a rector and 4 physicians, all of whom are
twice-a-week outpatient clinic handling 20 general practitioners. There are 30 nurses
patients each working day. plus 70 other personnel including attend-
Divi$IOn of Mental Hygiene. There are ants. In the past year 7 patients had been
7400 patients in 25 mental hospitals given insulin and 14 patients a combina-
throughout the country staffed by a total of
32 psychiatrists (of whom 22 are qualified). 6The total budget for the management of men-
The Department of Mental Hygiene does tal hospitals is 50 million rupiah a year.
1963 1 NATHAN S. KLINE 811

tion of chlorpromazine and reserpine (with which costs the family $1.83 per day extra
drugs supplied by the family). Eighty per- is extremely rare. As will be noted later
cent of the patients are schizophrenic and the only size chlorpromazine tablet availa-
another 10% are epileptic. About 50 patients ble in all of Indonesia is the 25 mg. size. In
are given ECT 3 times a week. Since there view of the cost the family frequently tries
are no electroshock machines, convulsions to bargain with the hospital physician, urg-
are produced by placing electrodes on ing him to use as few tablets as possible.
either side of the head and then plugging The hospital is completely “open” with pa-
into a wall circuit and pulling out again. tients free to come and go as they choose
According to the director the biggest prob- and without locked wards. An average of
lem is the lack of aftercare which results in perhaps one per month leaves the hospital
an extremely high relapse rate. Since the but invariably returns. The departure from
family of the patient must provide his medi- the hospital is usually the result of getting
cations which are quite expensive they are lost rather than an attempt at escape. Of the
almost invariably discontinued when the 1350 patients already in residence or ad-
patient leaves the hospital. Also pre-war mitted during 1960 there were 958 hebe-
there was some system of paying the fam- phrenic schizophrenics, 125 catatonic schizo-
fly to help take care of the patient if he phrenics and 135 paranoid schizophrenics.
was well enough to leave the hospital al- The attitude of the community toward
though not well enough to work, but since mental illness according to the director of
this is no longer done the families are not the hospital is usually quite open, and there
anxious to have patients return home, and is no feeling of either fear or dislike of psy-
they tend to become stockpiled at the hos- chiatric patients. This is in some contrast
pital. Approximately 20% of the families do to Djakarta where there is a certain amount
pay toward the cost of the patient care but of shame regarding disease in general, but
this averages 17% rupiah (20t) per day. interestingly enough primarily centered on
Bogor Hospital. Bogor Hospital, built in leprosy and tuberculosis rather than psychi-
1882, now has a capacity of 1200 with 580 atric disorders. Occasionally a major social
male and 550 female patients in residence. problem is created by a patient (a father,
There are an average of 400 yearly admis- say) being accepted back into the family
sions and discharges. The staff consists of if the daughters are about to be married
5 doctors (of whom 3 are psychiatrists), since the father may become an economic
250 male nurses and 250 female nurses. burden. There is a great tendency to forget
There are different classes of patients in about relatives who are hospitalized and
the hospital and 10% pay something toward particularly in those groups which do re-
their upkeep. Fourth class patients when gard mental disease as a disgrace. Because
they can afford it are supposed to pay 12% of the extended family system a peripheral
rupiah per day and first class patients 37 relative is just as great a source of embar-
rupiah. The actual cost is 10 rupiah per rassment as a father or son.
day for food and 30 rupiah per day for There is invariably a long waiting list for
total maintenance exclusive of the medical admission but in cases of extreme urgency
care. Occupational therapy is the main type the staff can accept a patient immediately.
of treatment. EST is given twice a week to All patients admitted to the hospital re-
37 of the 550 female patients and 3 times quire certification. The family applies for
a week to 30 of the 580 male patients (the admission and the patient is then certified
difference is due to the decision of the by a psychiatrist and placed at the bottom
doctor running the service). Occasionally of the waiting list. The notice of certifica-
Cardiazol is used, but insulin is too ex- tion is sent to the Department of Justice
pensive. Chiorpromazine is used at times for filing in case anyone wishes to contend
when it can be supplied by the family since the action.
the hospital cannot afford to provide it. The Of the patients discharged from Bogor
cost is 2.75 rupiah for a 25 mg. tablet and an average of about 1 per day can be seen
occasionally 10 tablets will be given 6 times at the outpatient polyclinic in town. At the
a day (i.e., 1500 mg.), but such dosage Bogor Mental Hospital which is several
r812
miles outside of town there are
PSYCHIATRY

extensive
IN INDONESIA

TABLE 1
[ March

follow-up facilities available, but they are Diagnostic Distribution of Patients at

Bangli Hospital, Bali
rarely if ever used because of the trans-
portation problem. It would cost 20 or 25 NO. OF NO. OF
rupiah at the very least for the patient to DIAGNOSIS MA LE PATIENTS FEMALE PATiENTS TOTAL

get to the hospital, and in most cases it

Schizophrenic 47 34 81
would be closer to several hundred rupiah
Manic 9 9 18
which is completely prohibitive. Manic-depressive 6 3 9
Bangli Hospital on Bali. The Bangli Hos- Psychopath 3 1 4
pital, formerly a military barrack, was built Hysteric 0 4 4
in 1920 and became a 150-bed mental hos- Melancholic 0 1 1
pital in 1930. Two new 50-bed wards for Dementia paralytia 1 0 1
males are to be added in 1962. On the Epileptic 9 2 11
island of Bali there are also three 40-bed Idiot 0 1 1
general hospitals. Luetic psychosis 5 2 7
Paranoia 3 1 4
There are 18 polyclinics on the island
with a limited number of physicians who
are in attendance on different days. The parently do extremely well under super-
visit to the mental hospital is routinely made vision. The government pays 2 rupiah per
on Monday and probably does not occupy day toward the patient’s upkeep if the
more than an hour of the time of the general family cannot afford this. The colonia is
practitioner. There are no resident physi- largely self-supporting since it sells the
cians at the hospital and there are no psy- agricultural produce it grows.
chiatrists on the island of Bali. The number Porong Hospital in Lawang. Built in 1902
of patients at the hospital (circa 1961) is the full name of this hospital is Rumah
the same as when the Dutch were there. A Sakit Djiwa Sumber Porong. Formerly there
definite shortage of supplies exists, includ- were 4000 beds, but now the theoretical ca-
ing penicillin and even materials for work pacity is 2000 patients with three unused
therapy, so that there are looms and other wards, because the buildings have been
equipment which stand idle. In 1961 there condemned. The actual capacity is there-
were 90 male patients, 60 female patients fore 1800 and the actual occupancy is 1774
and a waiting list of 131 men and 20 patients plus 110 patients on parole. The
women. Thus the waiting list was larger hospital is extremely clean throughout, al-
than the number of hospitalized patients. though there is open ditch sewerage as in
Patients are given a month’s clinical trial most of Southeast Asia. There is an acute
at home before they are formally dis- shortage of journals and current psychiatric
charged from the hospital. The hospital books. A colonia for 1100 patients was
averages about 15 male and 10 female ad- totally destroyed during the war for inde-
missions per year. pendence and the patients sent home.
The diagnoses of the patients of the hospi- Treatment consists primarily of ECT with
tal in 1960 are shown in Table 1. patients given a course of 12 treatments.
The facilities for laboratory examinations Drugs are used only when the family can
are also extremely limited, and during the afford to buy them and in the course of the
entire year 1960 there were only 13 blood past 4 years there have been less than 100
tests for syphilis (4 were positive), no spu- such patients. Chlorpromazine is usually
tum tests, no vaginal smears, 122 urine and given in
top doses of 150 mg. a day or
fecal examinations (diarrhea and particular- reserpine is used, 12 tablets of the 0.25 mg.
ly amebic dysentery are common). size (i.e., 3 mg. per day). Another form of
In conjunction with the mental hospital at treatment is occupational therapy, but only
Bangli, but several miles away at Klung- 6 of the 50 looms have sufficient thread for
Kung, there is a colonia( 1) of 59 patients patients to be working on them.
managed by 8 employees. This is a type Magelang Hospital. This hospital, built in
of rural farm residence for long term pa- 1920, formerly was overcrowded with 2000
tients who cannot adjust in society but ap- beds in contrast to the 1100 now in use. Ad-
 - \e T!-1

1963 1 NATHAN S. KLINE 813

missions and discharges total about 300 a this is especially helpful in the treatment
year. The director is a German physician of ambulatory patients. If, for instance, they
who has been there for 6 years. In addition are asked to feed a withdrawn or depressed
on the staff are 3 or 4 local physicians not patient they will continue offering him food
trained in psychiatry. Approximately 50 pa- perhaps 100 times whereas the average
tients pay up to 50 rupiah and another 50 European or American family would give
patients pay less than 50 rupiah whereas up in disgust after 3 or 4 attempts.
the other 1000 pay nothing. Treatment con- Differences in Types of Mental Disorders.
sists of scopolamine, morphine, and ECT The hospitalized patients are usually schizo-
for sedation. Psychophannaceuticals are not phrenic with an even higher proportion than
available. in the United States. There do exist some
EC’F, used only in cases of excitement, subtle differences which may well be re-
is given 3 times a week for up to 10 weeks. lated to culture. One of the most interest-
For the past year patients have been kept ing of these is that the paranoid patients
outdoors most of the day, and there is very do not have nearly so systematized de-
little disturbed behavior. The remaining lusions as do paranoids in the Western
closed wards in the hospital are having the world and even when they have hallucina-
bars removed since all of the patients are tions, rather than trying to find out how
outdoors at least in the afternoon. they are produced, who is causing them,
Occupational therapy consists largely of and why, the patients simply accept them.
mat weaving with a substantial amount of Abusive voices, visions of people far distant
Batik work which seems most relaxing for or long dead and the other common hal-
schizophrenic patients with a proclivity to lucinations and delusions are not particular-
stereotypy or automatisms. ly disturbing to the Indonesian patient. In
Attitudes Towards Mental illness. As a part this may be because such phenomena
rule there is less fear of psychiatric patients are not regarded as so unnatural as in our
in Indonesia than in many other cultures, culture, and in part there is a general ac-
and certainly leprosy and tuberculosis are ceptance of things without the need to in-
regarded as having a greater stigma attached quire into causes (which is so typical of
to them than mental disorders. One possible Western civilization).
explanation is that in accord with Javanese In none of the hospitals which I visited
religious practices there is appeasement of was there any record of a native Indonesian
the “black gods and spirits” as well as ever having committed suicide, and even
worship of the good ones so that people are among Indonesians of Chinese origin sui-
not afraid of becoming contaminated by the cidal attempts are extremely rare. As far as
evil spirits in the mentally ill since these could be gathered from the statistics the
spirits have been propitiated. occurrence of manic states was more fre-
As is obvious, only a small proportion of quent than depressions.
the mentally ill are admitted to the hospi- Among the more unusual forms of psy-
tals and the majority are given “native chiatric disorder is lztah. This appears to
treatment,” particularly in east and in cen- occur in a hysterical type personality and
tral Java. Such practices are more frequent may be a type of conditioned reflex. It is
in the villages than in the cities and general- usually an elderly Indonesian servant who
ly consist of “washing a patient’s soul in becomes latah with attacks being precipi-
the river” which is not without its hazards tated by sudden or unexpected events,
as sometimes the patients drown. There is sounds or occurrences. The most strildng
also treatment with incense, holy water symptom is repetition, but it is quite distinct
and amulets. A large number of the patients from echolalia. The person becoming latah
who cannot be admitted to the mental hos- usually shouts such phrases as “horse penis,”
pitals because of the space limitations be- “cow vagina” or other phrases with similar
come tramps and wanderers. Senile patients sexual content. An attack can be deliberate-
and mental defectives, on the other hand, ly provoked by shouting, for instance, “don’t
are kept at home. do that !“ with the victim then repeating
Javanese families are very patient, and “don’t do that” or, if a dirty word is
814 PSYCHIATRY IN INDONESIA [March

shouted, the patient will repeat it or add the incidence is as high in individuals of
one or two of her own. This can be trans- Chinese origin as among the Indonesians.
ferred into the sphere of action, e.g., a Another practice which falls into this
servant enters carrying a bowl and if some- general group is diguna-guna which is
one shouts “drop it” the servant will drop it probably a type of anxiety pseudo-psychosis.
and then repeat whatever is said. The at- By way of background: 1) a man is in
tacks last only as long as the person is love with a woman who dislikes him and he
being teased. Subjects are almost always then seeks some device to make her love
conscious of what they are doing and do him; 2) a man feels he has been insulted
set limits to their action: for instance, if and wishes an evil spell cast to make his
a female is told to pull up her sarong she enemy ill. Both of these can be theoretically
will not do so. Someone could shout “kiss achieved by taking some belonging of the
him” and the person in latah might do this person on whom the spell is to be cast
but later become angry about what she (such as nail parings or hair) and bringing
had ben tricked into doing. If the teasing this to the dukun who (in addition to be-
continues long enough the subject may ing the local medicine man) is a medium
make an effort to discontinue the odd be- and capable of inducing (or removing)
havior and terminate the attack. trances. The person on whom the spell is
In summary, latah appears to be a type cast cannot resist: the woman falls in love
of hyper-suggestabiity induced by shock, with the man; the enemy becomes psy-
command, noise or physical trauma such chotic in which case “black magic,” di-
as stumbling or being pinched. Almost hi kin, has been invoked. The victim is
all the patients are females. not always directly informed that he or
Another much discussed condition is she is being “bewitched,” and it is a ques-
amok which is probably an indiscriminate tion as to whether he learns of this from
acting out of acute aggressiveness without secondary clues or in some other way. It is
specific motive or selectivity as to the per- possible to influence the patient out of this
son or thing being attacked. If nothing else pseudo-psychotic state. There does not ap-
is available such patients will sometimes pear to be an easy explanation for some
attack their own body. It is unusual to be of these cases. There are some intriguing
able to examine such patients since the similarities to Haitian beliefs(2).
attack almost always ends in the death of Mandi-Minjak-Mendidi (which means
the patient who is shot by the police or “bathing in boiling oil”) and djalan diatas
military to prevent further mayhem or api bara (“walking on blazing charcoal”)
homicide. The disorder usually occurs in are both Chinese religious ceremonies
young or middle aged males who are quite which occur yearly (if the government per-
responsible individuals up to the time of mits) when a particular statue is taken out
running amok. It is possible that these and carried through the streets. The de-
attacks are induced by shame with an in- votees transform themselves into the “God
ner need for revenge. The person appears of Fire” with the help of Chinese priests
to accept an insult or a shameful situation and in this trance state they demonstrate
quite calmly without saying anything and the might of the god since they can per-
quite possibly without conscious awareness form feats that would not otherwise be
of his deep emotional reaction only later to possible.
become amok. The few patients examined Koro is the Chinese belief that under
-have all had complete amnesia for the epi- certain circumstances the penis may recede
sodes and are definitely not schizoid types into the abdomen and occasional cases are
of individuals but appear to be the more found where a stick has been bound tightly
emotionally hyper-reactive. It may be that to the organ to prevent this disaster.
they experience an hallucinatory state with Kesuruban is like a seance in the United
a feeling of being pursued by devils which States or Western Europe. One who be-
it is necessary for them to slay. Incidentally, lieves intensely goes into a trance and is
there is no record of a patient who became then possessed (usually by a good spirit).
latah later running amok. Unlike latah, One occasion for kesuruban is if a physi-
 T!-y;_-,_--_._#{149}

1963 1 NATHAN S. KLINE 815

cian tells a patient that there is nothing feet for three to five hours to very monot-
more that he, the physician, can do to onous music with the “master” snapping
help. The patient with some fellow believ- a horse whip. At the end of this time they
ers may go to a local temple. This is true appear completely entranced and will eat
of both the Chinese who pray to the God raw rice including the stems, leaves and
of Medicine and the Javanese who, despite husk and also will chew up electric light
the fact that they are nominally Islamic, bulbs (spitting them out) without apparent
will never pray directly to Mohammed to injury to the mucosa of the mouth. -

ask a favor but always request such help DLcussion on the Future of Psijchiatry in
from the Hindu Gods who are also mem- Indonesia. It is palpably impossible to fur-
bers of the Javanese pantheon. When the nish an adequate number of psychiatrists or
medium goes into trance he speaks with a hospital beds for Indonesia in the immedi-
different articulation and intonation and ately foreseeable future. The responsibility
sometimes uses a foreign dialect. If the god for patient care therefore devolves directly
predicts the patient will get well he or his upon the general practitioner, and a plan
friends later return for a second ceremony is being developed both to provide such
to determine the medication, the dosage, training and to evaluate its effectiveness.
and the method of treatment including in- Some of the general factors that must be
cantations, etc. Frequently the second visit considered have been discussed elsewhere
is unnecessary because the medication itself (3-6).
appears in a trance or a dream and the be-
liever then proceeds to a Chinese or other BIBLIOGRAPHY
dispensary to have the medication prepared
1. Kline, N. S.: Ann. N. Y. Acad. Sci., 84:
according to the recommendations. Some- 149, 1960.
times this consists merely of writing certain 2. Leyburn, J. C.: The Haitian People. Yale
formulae on paper and after burning and University Press, 1941.
mixing, the ashes are swallowed. In kesii- 3. Kline, N. S. (Ed.): Psychiatry in the
ruban a skilled medium can also go into Underdeveloped Countries. Report of Round-
a trance under his own power without a table Meeting, Atlantic City, New Jersey.
seance and transform himself into an “ideal” Washington, D. C.: APA, 1960.
personage. Under these circumstances there 4. Kline, N. S.: Public Health Service Poli-
is frequently identification with the char- cies Regarding Mental Disease in the Light
of Psychopharmacology. In press.
acters of the Indonesian shadow plays
5. Kline, N. S.: Bringing Clinical Services
(wajang).
to Underdeveloped Countries and Contribu-
Another peculiar phenomena is kuda- tions to Basic Knowledge that can be Ex-
kepang (kuda=horse and kepang=mat- pected from such Enterprises. In press.
ting or bamboo). The resultant perform- 6. Kline, N. S.: Applications and Misap-
ance, usually done for payment, consists plications of Pharmaceuticals in the Treatment
of a boy and a girl who spin about on their of West Africa Psychiatric Disorders. In press.