By Bronwyn Sloan
DPA
PHNOM PENH: Ansoeng Commune chief Duok Navi tries not to remember the Khmer Rouge regime, under which she was married to a stranger by force and lost more family than she cares to recall.
"I am not angry if I don’t think about it, but when I remember, the anger comes back and sticks in my throat," the 48-year-old says.
Her reaction is typical. Many Cambodians have spent three decades burying their feelings and trying to forget a period of history so dark for so many that is not even dwelt on in the school curriculum.
This year ended with a trial of former leaders of the ultra-Maoist movement looking tantalisingly closer in a process that, after years of silence, is finally highlighting perhaps the most enduring legacy of the 1975-1979 regime: trauma and mental illness.
Ka Sunbaunat, one of only a handful of psychiatrists in Cambodia, says post-traumatic stress disorder is rampant in the country but ignorance, stigma and cultural taboos often prevent sufferers from seeking help. In another blow, funding to treat those who do come forward is minuscule compared to the scale of the need, he adds.
He says he hopes the trial will finally bring to light the full extent of the problem, for donors at least, whom he accuses of applying Band-Aid solutions to societal problems such as domestic violence, alcoholism and drug abuse while ignoring their root cause.
"In the Cambodian tradition, people never talk about symptoms (of mental illness) because that represents weakness," he says.
Post-traumatic stress symptoms range from flashbacks, nightmares and sleep problems to a lack of a sense of a future, emotional numbness and an inability to interact with others, including family, as well as violent behaviour and anxiety attacks.
"People have been living with this their whole lives," he says. "Not just now. And not just the older generation. A lot of young people have grown up in a society destabilised by war. Their parents are traumatised, so there is domestic violence in the home. When dad or mum is violent, how can their children feel safe during a vital period of their psychological development?
"We began (a mental health programme) in 1994 with a few thousand patients," he says. "Now, we have 50,000, but financial restraints and shame still mean people don’t usually present until their symptoms are severe." There are no statistics on how many of the patients in treatment at Sunbaunat’s private clinic or the 40 government psychiatric units around the country suffer war-related mental health problems.
What is clear, he says, is that Cambodia’s current tally of 26 psychiatrists and 40 psychiatric nurses (the Khmer Rouge purged intellectuals, including almost everyone with any medical training) cannot cope with demand.
In December, Australia and the European Union donated funds that are partially earmarked for mental health support tied to the trial. The UN, Belgium and Norway have also donated funds over many years.
Reach Sambath – spokesman for the Extraordinary Chambers in the Courts of Cambodia, the tribunal trying the Khmer Rouge leaders – says the immediate need that will arise when victims face those they blame for their suffering in court has been acknowledged. Space has been set aside for a psychiatric clinic and counselling services onsite.
"We aim to provide sufficient mental health assistance for people who are suffering," Sambath says. "It is not easy. It is very sensitive work. Everyone is affected, but especially those who have gone through the Khmer Rouge period."
But like Sunbaunat, Documentation Centre of Cambodia director Youk Chhang says he does not believe the trial would spark a mental health crisis because the mental health problem is already at a crisis point.
"I am not angry if I don’t think about it, but when I remember, the anger comes back and sticks in my throat," the 48-year-old says.
Her reaction is typical. Many Cambodians have spent three decades burying their feelings and trying to forget a period of history so dark for so many that is not even dwelt on in the school curriculum.
This year ended with a trial of former leaders of the ultra-Maoist movement looking tantalisingly closer in a process that, after years of silence, is finally highlighting perhaps the most enduring legacy of the 1975-1979 regime: trauma and mental illness.
Ka Sunbaunat, one of only a handful of psychiatrists in Cambodia, says post-traumatic stress disorder is rampant in the country but ignorance, stigma and cultural taboos often prevent sufferers from seeking help. In another blow, funding to treat those who do come forward is minuscule compared to the scale of the need, he adds.
He says he hopes the trial will finally bring to light the full extent of the problem, for donors at least, whom he accuses of applying Band-Aid solutions to societal problems such as domestic violence, alcoholism and drug abuse while ignoring their root cause.
"In the Cambodian tradition, people never talk about symptoms (of mental illness) because that represents weakness," he says.
Post-traumatic stress symptoms range from flashbacks, nightmares and sleep problems to a lack of a sense of a future, emotional numbness and an inability to interact with others, including family, as well as violent behaviour and anxiety attacks.
"People have been living with this their whole lives," he says. "Not just now. And not just the older generation. A lot of young people have grown up in a society destabilised by war. Their parents are traumatised, so there is domestic violence in the home. When dad or mum is violent, how can their children feel safe during a vital period of their psychological development?
"We began (a mental health programme) in 1994 with a few thousand patients," he says. "Now, we have 50,000, but financial restraints and shame still mean people don’t usually present until their symptoms are severe." There are no statistics on how many of the patients in treatment at Sunbaunat’s private clinic or the 40 government psychiatric units around the country suffer war-related mental health problems.
What is clear, he says, is that Cambodia’s current tally of 26 psychiatrists and 40 psychiatric nurses (the Khmer Rouge purged intellectuals, including almost everyone with any medical training) cannot cope with demand.
In December, Australia and the European Union donated funds that are partially earmarked for mental health support tied to the trial. The UN, Belgium and Norway have also donated funds over many years.
Reach Sambath – spokesman for the Extraordinary Chambers in the Courts of Cambodia, the tribunal trying the Khmer Rouge leaders – says the immediate need that will arise when victims face those they blame for their suffering in court has been acknowledged. Space has been set aside for a psychiatric clinic and counselling services onsite.
"We aim to provide sufficient mental health assistance for people who are suffering," Sambath says. "It is not easy. It is very sensitive work. Everyone is affected, but especially those who have gone through the Khmer Rouge period."
But like Sunbaunat, Documentation Centre of Cambodia director Youk Chhang says he does not believe the trial would spark a mental health crisis because the mental health problem is already at a crisis point.
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