New Book Explores Cambodia’s ‘Hidden Scars’

Friday, 23 September 2011
Phy Sopheada, VOA Khmer | Washington, DC

"Many people who are affected by trauma would never think to go to a psychiatrist or a psychologist, but in fact they would go to a “kru” or go to a monk."

[Editor’s note: “Cambodia’s Hidden Scars” delves into the trauma caused to the Cambodian population by the Khmer Rouge, even today. One of the authors, Daryn Reicherter, is a professor of psychiatry at Stanford University’s School of Medicine. He has researched mental health and human rights issues in Cambodia, Haiti, Indonesia and other countries. He spoke to VOA Khmer about the reasons such study in Cambodia deserves closer attention.]

What is the book mainly about?

The book is about the idea that human rights violations, armed conflict and war cause psychological and psychiatric outcomes. Many Cambodian survivors were affected by the war and the trauma in terms of their psychological outcome. The book is really meant to be more an advocacy piece, not just to highlight statistics about how trauma has affected Cambodians but to start a dialogue on how psychology affects the [UN-backed Khmer Rouge tribunal] process and affects the victims as they go through the court’s process. The last part of the book looks at what measures have been done, and what measures can be done, to provide more resources for people who were affected psychologically by the war.

Why was this study important to undertake?

I actually work in California with refugees, survivors of human rights violations, from all over the world. Specifically, I work with the Cambodian population in the [San Francisco, Calif.] Bay area. And that population really has increased incidents in mental health disorders as compared with some of the other refugee population overseas. Their symptoms are profound, even though the trauma was years and years ago.

How are individual Cambodians affected by this trauma and how has Cambodian society been affected over all?

The first part of the book is really devoted to answering that question. On the individual basis, every person is different, and everybody’s experience is different, but there tends to be characteristic outcomes for everybody that has been exposed to terrible violence. What we see in Cambodia are very high statistics of people with distress after Pol Pot.

The other chapter of the book looks at the multi-generational affect. Cambodia has a very high percentage of people exposed to extreme violence, and people who have negative psychological outcomes because of that. We could imagine that those psychological outcomes cause areas of dysfunction, like problems with their family, problems with employment, problems with their personal lives, and you can imagine the ripple effect by having so many people exposed. It’s not just the individual who is having a hard time functioning, it’s more a community of people who are having a hard time functioning together.

When you have been exposed to trauma, and now you have some mental health issues, the parenting style may be different for people who are survivors as compared with people who are not. One of the chapters examines the concept of how the generations that have come after Pol Pot have been affected by their parents and are having different behaviors. In other words, they have different parenting strategies because of their experience and that translates into the next generation.

What are the treatments for post-traumatic stress disorder?

The book is a little bit unspecific on that point. When we are treating PTSD in mental health in the West, there are some evidence-based practices that we understand, and we use medication and psychotherapy. The specific concept that is used in mental health in the United States may not always be 100 percent applicable in Cambodia.

In Cambodia, it is not necessarily just a mental health issue; it’s beyond mental health. Many people who are affected by trauma would never think to go to a psychiatrist or a psychologist, but in fact they would go to a “kru” or go to a monk. There really needs to be a hybridized approach to address this problem in Cambodia, because if you just put money into the mental health system and just expect people to show up at the office of a psychiatrist, we are not necessarily going to see that. But there really needs to be some dialogue between disciplines.

Is it that people don’t understand PTSD, or that they better trust traditional means of treatment?

I think both are true. First of all, there is a large stigma around mental health in Cambodia—and also other places. They don’t know that they have a disease that would be something that could be treated by a psychiatrist or psychologist, but in fact, very often they are going to religion or to folk medicine or even the primary care doctors.

The other issue is access. If somebody who lives in the countryside in Cambodia did recognize their symptoms as a mental health disorder, and they wanted to get treatment in mental health, really there is no access to it. The people would not understand that mental health disorder, because there is not a very good public advocacy campaign to explain what mental health is.

What is the role of the tribunal in helping address this problem?

One of the things that the prosecutors did in the opening day of the trial was to talk about the potential reparations that may come out of the court, and one of the reparations that was suggested was the improvement in the resources for mental health. And as far as I know, this has not been suggested as a reparation in other courts like this one. I don’t think the court is going to create a mental health clinic, but the court could be an advocacy piece.

If the court finds at the end that reparations are important and that mental health should be considered, reparation could be directed at the government to make changes or improve the status of mental health delivery, or to the international community, to say, Cambodia has been struggling with this issue and the court has recognized this and recommends that international donors consider more funding toward this issue of trauma mental health, which is really behind many social problems that are happening in contemporary Cambodia.

Where will the book be distributed?

The book will be distributed in Cambodia. There are specific targets where we are trying to make the book available for free, but for other people, they’ll have to buy it through the Documentation Center of Cambodia. In order to have powerful advocacy, you have to make your information available. Some specific parts of the book are being translated into Khmer. Some of the concepts and recommendations that we made will definitely be translated into Khmer.