What does the word “psychologist” (psikolog) mean in Indonesia? How does it compare to the US or Germany?

The word “psychologist” conveys different professional meaning in different countries. To many, the word “psychologist” triggers a picture of a person talking to clients to help them with their problems. However, this is not always correct and that mind picture mostly relates to a more specific form: “clinical psychologist”. So, is “psychologist” equals to “clinical psychologist”? It all depends on the regulation and system of the particularly country. I will first try to briefly describe the system in United States and Germany, so that I can contrast it with the Indonesian system.

Now from what I have read in various sources, in the US, the exact word “psychologist” just means anyone with a degree in psychology. However, to deliver psychotherapy and give clinical diagnosis, a special degree and license is required. This is usually achieved by completing a doctoral degree in clinical psychology (PhD.Clin. or Psy.D.) and then, a person can apply for a license to practice. This profession is called clinical psychologist.

In a somewhat similar situation, “psychologist” in Germany is an open profession and is not a protected professional word (unlike medical doctor). Sometimes one does not even need to have a degree in psychology! Still similar with the US system, delivering psychotherapy and giving clinical diagnosis require a special degree and license. Now, unlike the US system, this profession is called psychotherapeut (psychotherapist), not clinical psychologist. To enter this profession, one has to finish a master degree in psychology and then, finish an Ausbildung (training program) for specific psychotherapy format. There are generally two main options: Tiefenpsychotherapeut (literally translated, deep psychotherapy – psychoanalysis) and Verhaltenspsychotherapeut (behavioural psychotherapy – behavioural therapy and cognitive behavioural therapy). The training program can take from three to five years, but some finish it in seven years (for Verhaltenspsychotherapeut). After the training, one still has to apply for license to practice at a certain geographical area (the number of insurance covered practice is limited according to the needs of a geographical area).

Now the Indonesian system is unlike the US and Germany. First, the word “psychologist” is a protected profession in Indonesia. Not everyone can call themselves psychologist without having the proper credential. To become a psychologist there are two requirements: a professional master degree (M.Psi.) and a license from the professional organisation (Himpunan Psikologi Indonesia – HIMPSI – Indonesian Psychology Organisation). Both can usually be obtained in 2 years, but now I hear 2.5 years is the norm for adult clinical psychologist. There are 4 types of professional master degree program: adult clinical psychologist (for clients aged 15 years and above), child clinical psychologist (for clients aged 15 years and below), educational psychologist, and industrial/organizational psychologist.

Is LGBT a mental disorder in Indonesia?

During these past couple of weeks I have observed that the topic of LGBT is being hotly discussed in Indonesia. Some of the discussions hinge upon questions such as is LGBT a disorder? Is it a ‘normal’ condition? Does it have to be ‘fixed’ (changed into heterosexuality)? Of course, these are questions that are very relevant to the profession of psychologists or psychiatrists.

It can then be expected that the Indonesian public demands answer from the professional organization of psychologists or psychiatrists. The formal organization representing Indonesian psychiatrists is the PDSKJI, and their formal statements about LGBT can be seen here http://pdskji.org/img_galeri/33648SuratPernyantaanPDSKJI.jpg and http://pdskji.org/img_galeri/478992SuratPernyantaanPDSKJI_0001.jpg . The formal organization representing Indonesian psychologists is called the HIMPSI, and there is an interest group under that organization called the IPK HIMPSI to represent clinical psychologists. The IPK HIMPSI also releases a formal statement, but I cannot find a good documentation of it on the internet. For example, there is a documented press release here, http://www.republika.co.id/berita/nasional/umum/16/02/06/o23v6y330-himpunan-psikolog-menentang-kelompok-yang-halangi-pemulihan-penyandang-lgbt?fb_comment_id=1064450723604982_1064467986936589#f33aa9bcdf27c5c , and there, http://manjanik.net/news/nasional/ipk-himpsi-kaum-komunitas-lgbt-bertentangan-dengan-bangsa-merusak-tatanan-masyarakat/ . There is also a discussion about the topic from the formal website of IPK HIMPSI, https://ipekajatim.files.wordpress.com/2016/02/breakthrough-lgbt.pdf . However, none of these is a direct document of a formal statement of IPK HIMPSI on the topic.

The formal statements released by Indonesian psychiatrists organization, PDSKJI, drew criticism from British Psychological Society (BPS), http://www.bps.org.uk/news/bps-denouces-indonesian-classification-lgbt-mental-illness , and American Psychiatric Association (APA), http://psychiatry.org/File%20Library/Newsroom/APA-denounces-IPA-LGBT-classification.pdf , which I believe to be not well founded. Both BPS and APA stated that the PDSKJI classified LGB as a mental disorder, which is not true. In my opinion this misunderstanding stems from the term ‘orang dengan masalah kesehatan mental (ODMK)’ (literally translated, people with mental problems) that is alien in the English language.

The PDSKJI classified LGB as ODMK. ODMK is a term that is used in a newly passed law about mental health (UU no. 18 tentang Kesehatan Jiwa tahun 2014, http://regulasi.kemenperin.go.id/site/download_peraturan/1830 ). The Indonesian legal system concerning mental health categorizes people into three categories in regard to their mental health: healthy, ODMK (orang dengan masalah kesehatan jiwa, literally translated people with mental problems), or ODGJ (orang dengan gangguan jiwa, literally translated people with mental disorders). The definition of ODMK is “orang yang mempunyai masalah fisik, mental, sosial, pertumbuhan dan perkembangan, dan/atau kualitas hidup sehingga memiliki risiko mengalami gangguan jiwa.” (translated, people with physical, mental, social, development, and/or quality of life problems, thus are at risk of developing mental disorder). PDSKJI classified LGB people into this category. However, one has to understand that many groups of people can be classified into ODMK, including victims of natural disaster or students preparing for exams (see, http://www.bbc.com/indonesia/berita_indonesia/2016/03/160316_indonesia_lgbt_psikiatri_indonesia ). On the other hand, ODGJ is defined according to the law as “orang yang mengalami gangguan dalam pikiran, perilaku, dan perasaan yang termanifestasi dalam bentuk sekumpulan gejala dan/ atau perubahan perilaku yang bermakna, serta dapat menimbulkan penderitaan dan hambatan dalam menjalankan fungsi orang sebagai manusia”(translated, people with disorders in the mind, behaviour, and emotion that manifest in the form of syndromes and/or meaningful behavioural change, and may cause suffering and hindrance in the course of human living.) The diagnoses in ODGJ follow the diagnosis handbook of PPDGJ that is used by mental health professionals in Indonesia. The diagnosis handbook of PPDGJ is very similar to ICD-10. If the ICD-11 is published, the PPDGJ will be updated to follow ICD-11. To reiterate, the PDSKJI, Indonesian psychiatrists’ organization, does not classify LGB as a mental illness, and does not classify LGB as a condition that should be changed (‘cured’).

Now, the Indonesian psychologists organization view on LGB is less clear. There are statements around the internet that may more or less state that the Indonesian psychologists (IPK-HIMPSI) classified LGB as a mental disorder (for example, here http://manjanik.net/news/nasional/ipk-himpsi-perilaku-lgbt-itu-penyakit-bukan-alternatif-gaya-hidup-bagi-manusia/ ). The title of the news report can be translated as ‘IPK-HIMPSI: LGBT behaviour is a disorder, not an alternative lifestyle for human’. However, these are not formal press release statement of the organization. In addition, as a clinical psychologist and member of HIMPSI, I would like to state that it is NOT possible to classify LGBT as a mental disorder, and therefore, there is nothing to be targeted in therapy. Mental disorder classification can only be made if the classification exists in a diagnosis handbook, such as the PPDGJ in Indonesia, ICD-10 in Europe, or DSM5 in the United States. LGB as a diagnosis does not exist in all of those. Furthermore, the Indonesian psychologists association (HIMPSI) has an ethical guideline (Kode Etik 2010) that forbids the discrimination of people based on culture, age, gender, gender identity, race, ethnic group, nationality, sexual orientation, disability, language, and socio-economic status. Therefore, stating that LGB is a mental disorder needing treatment is not in line with the ethical guideline of Indonesian psychologist association (HIMPSI) and Indonesian handbook for mental disorder (PPDGJ).

The case for transsexual is complicated. Because Indonesian mental health system uses the PPDGJ that follows the ICD-10, transexualism is still considered a mental disorder. Once ICD-10 is updated into ICD-11, then transexualism will not be classified as a mental disorder anymore, hopefully.

So.. To put it plainly, LGBT is not a mental disorder in Indonesia and perhaps, in all other places in the world.