From 1975 to 1979, two million Cambodians were murdered by the Khmer Rouge in the killing fields. Thirty years later, a major medical study in the U.S. finds that two thirds of the 150,000 Cambodian refugees here still suffer from the disabling flashbacks, nightmares and depression of post-traumatic stress disorder. Now, in California’s Bay Area, dozens of Cambodians face a new challenge. The Social Security Administration is investigating them, for fraud.
Souphan is 55. Though she left Cambodia 26 years ago, she still has nightmares of the killing fields. Sitting in her small kitchen in Oakland, she says that after her parents and three siblings died in Khmer Rouge prison camps, she fled to the Thailand border.
Souphan: "I ran with my child. Run, run. And then I accidentally dropped my child’s hands. And they shot my child. And my child died."
Another daughter starved to death in the refugee camp. Psychologist Mona Afary first heard Souphan’s story two years ago.
Dr. Afary: "She basically could not carry a conversation without crying. It was just the look of someone who is in grief, deep grief. So, definitely this woman needed treatment, and she had needed it for many, many years."
Dr. Afary directs a non-profit clinic in Oakland for refugees. She specializes in post-traumatic stress disorder. Known for afflicting Vietnam war veterans, PTSD can strike anyone after life-threatening events. Without therapy, the psychic damage can last for years. Afary says that’s the case for her Cambodian patients.
Dr. Afary: "None of the Cambodians had received medical treatment before, and it was like they had a scream inside them that had never come out. It seemed as if they were frozen in their traumatized state."
Souphan came to see her after she’d lost many jobs. She said she was seeing images of her dead daughters and would weep uncontrollably at work.
Souphan: "I don’t know what kind of work to do. I don’t have enough money to pay the bills."
Afary sent a psychological evaluation to Social Security. She said Souphan couldn’t work because of depression and PTSD, and would need disability benefits while in therapy.
In the past two years, Afary sent similar assessments for dozens of Cambodians. Jonathan Lasher is a legal advisor with the investigative branch of Social Security. He agreed to be interviewed only off tape. Lasher says so many similar diagnoses from the same psychologist typically lead to an investigation.
Souphan: "They rang my doorbell. One woman and one man. They asked to see my medicines."
Social Security opened investigations on at least twenty Cambodians, who say investigators trailed them in the streets, to supermarkets, to doctors appointments. Souphan says in Cambodia, such actions were followed by imprisonment, and death. Souphan is actually not her name – she asked it be changed because she now fears the U.S. government.
Souphan: "I was scared. I didn’t know what they had come for."
Investigators gave Souphan a standard test of mental function. They asked how apples and oranges are similar. She said she didn’t know. The investigator wrote in his report, “…incorrect responses to such basic questions are often associated with malingering.” In other words, she was faking it.
Social security denied Souphan’s disability benefits. Dr. Afary says she understands that social security needed to check out the Cambodians’ claims. But, she says, for the Cambodians, Social Security’s style of investigation is psychological torture.
Dr. Afary: "Since these investigations started, all the symptoms came back. Nightmares, flashbacks, panic attacks. Their homes don’t feel safe anymore."
Lawyers have met twice with Social Security to ask that they stop the investigations or require investigators to change their techniques. Stephen Weiss represents fifteen Cambodians under investigation.
Stephen Weiss: "The investigations are being done despite the fact that there is substantial documentation of their condition, despite their community and personal history."
But David Butler, a supervisor in the investigative branch in Los Angeles, says they don’t change the style of their investigations to accommodate the mental health needs of refugees.
David Butler: "We’re not psychiatrists and we’re not medical doctors. We’re federal investigators. So, when you get a fraud investigation, you look at everything and you go where it takes you."
Social Security’s western public affairs officer Leslie Walker would only comment off tape. She said they constantly work with their staff to be culturally sensitive. But they have to forward suspicious cases to the independent investigative branch. Said Walker, “We can’t influence what they do.” The Cambodian’s lawyers say the investigations led to a denial of benefits in all twenty cases.
Seven have been overturned by appeals judges, who granted benefits. Thirteen appeals, including Souphan’s are pending. And, social security continues to open new investigations of Cambodians, with no change in methods. Dr. Afary says Souphan, after making progress in therapy, is again overwhelmed by fear.