[Editor’s note: Mental trauma remains one of the main issues for Cambodia, a legacy of the Khmer Rouge and the country’s conflicts. Ka Sunbaunat, a psychiatry professor and dean of the faculty of medicine at the University of Health Sciences, in Phnom Penh, spoke to VOA Khmer recently. He says the lingering problem should be a top priority in a developing country like Cambodia.]
Cambodians suffered severely during the Khmer Rouge, so how does this affect the people and society today?
Cambodia was at war from 1970 to 1975, and under the Pol Pot regime from 1975 to 1979. The western part of the country continued to suffer by war, and it was not until 1998 that the country was totally at peace. This produces psychological effects, such as anxiety disorder, depression, and post-traumatic stress disorder, in Cambodians who directly suffered during those periods.
Due to the delay of its treatment for years, or even decades, PTSD has become another kind of disease. The symptoms are stomachache, headache, body-ache, depression and high blood pressure. For those who experience depression, they drink alcohol to release their depressed feeling, and this will affect society.
For those who directly suffered from these problems, they will be short tempered. This might cause domestic violence. Domestic violence has effects on the next generation, who has never suffered, witnessed, or even known war or the Pol Pol regime. Therefore, war and the Pol Pot regime have both direct and indirect effects on those who directly lived in the regimes and the next generation. They also affect the Cambodian Diaspora.
Are there any other symptoms that we can notice in people who have mental disorders?
These kinds of disease make the patients unable to effectively perform work, unable to memorize, unable to make decisions and so on. Sometimes, it makes patients lose interest in earning a living; they just want to earn just enough for day-to-day survival, because they are afraid of facing challenges that might remind them of past suffering. Some symptoms of a very severe depression are: less appetite, less self-care, which causes the whole body to weaken, leading to other diseases such as a cold, fever, diarrhea and others. A mental disorder can be less severe, severe and more severe, and many Cambodian people are currently having such kind of disease.
According to your research or others, how severe do you think mental health issues in Cambodia are?
Up to now, there has been no research focusing on measures of mental disorders, examining what percentage of this mental illness is less severe, how much is severe, and how much is more severe. I’ve noticed that most Cambodian people I have met have short memory, as they are easily frustrated, worried and lose confidence. This clearly shows that it not only affects people’s mental health, but also the effectiveness of their work performance and the effectiveness of their dealings with challenges they face.
What kinds of symptoms could we notice that tell us that the subsequent generations are affected by mental health issues?
I’ll raise some examples about that. In one family, both husband and wife are depressed or have mental disorders. A mental disorder makes the patient get angry easily, so both husband and wife frequently insult or quarrel with one another. And as always, their children need happiness and care from their parents, even though the family is very poor. However, due to the frequent quarrelling of their parents, they suffer and are depressed. This is one of the indirect effects of violence during the Khmer Rouge regime and war.
Do you think Cambodian people believe that they have mental disorders?
Usually, they do not think that they have mental disorders because the understanding of psychology and mental health issues in Cambodia is vague. It is always perceived that if one has mental illness, he or she has to be crazy and hard to communicate with, or has to walk on the street shouting at others in public, or has to laugh or cry alone, and so on.
In other countries, their people are mostly educated; at least they have finished their high school educations. In addition, the understanding and awareness of mental disorders is strong, because there is mental health awareness information promoted on TV, the radio, in books, and so on.
In Cambodia, mental health services had been developed up to 1975 and then were destroyed. Since 1994, services have only slowly started to redevelop, so people’s understanding about psychological issues and mental disorders is still low. According to 1999 research, about 40 percent of Cambodian people had not finished third grade. This is the reason they do not understand mental health, particularly psychological issues. However, they in turn believe in superstition, so when they have symptoms of mental disorder, they go to traditional healer or a monk for help. Therefore, only a few people seek mental health treatment in present-day Cambodia, though [the number] is higher than the number of people seeking mental health treatment in 1994.
More and more people are turning to mental health treatment in the hospital instead of seeking traditional healing, but compared to other countries, Cambodian people seeking mental health treatment in the hospital is still low.
How can Cambodians deal with mental disorders on their own?
Besides mental health services provided in public health care centers, Cambodians have their own way of dealing with mental illness. Influenced by Buddhism, they always avoid the problem. Buddhist education makes us more patient, calm and peaceful. Cambodian people believe in a next life, so they don’t care too much about this life; they just care about the next life. If they have problems in this life, they think those problems are the consequences of the previous life, so they accept them, which makes them feel calm to some extent. However, if they accept those consequences too much, it is not that good, as they will suffer a lot, and this might make them unable to tolerate them anymore.
Moreover, monks and Buddhist disciples, who are knowledgeable in Buddhism, can share Buddhist education to those who are suffering, so they can feel calm and relaxed. In addition, during Buddhist holy days, elderly always go to pagoda to pray to Buddha, and after praying, they usually sit and have lunch together, and have chitchats about their suffering and the problems they are facing. This is a good opportunity for them to share their experiences regarding their suffering and their coping with that suffering, so they can learn from each other, which makes them feel released and relaxed.
Based on your own experiences in helping treat Cambodian mental disorder patients, how do you help them?
Usually, neither the families of mental patients nor society notice that the patients have a mental illness, or even if they could notice the disease, they still do not understand well the situation or symptoms of the disease. Usually, patients have a feeling of hallucination, with which they themselves often see or hear something unpleasant that their family members or the others don’t see or hear. So family members don’t understand what is going on with the patients.
When the patients come to us, because we understand their disease, we counsel and act properly, telling them, “No one is threatening you; you have so many people surrounding you to help you; what you have seen is not real.” So they are very happy and trust us, and tell us every detail about their problems or suffering. This will make their symptoms subside without taking any medication.
In case the patients’ symptoms become so severe that they cannot control themselves, or they cannot be communicated with, we need to use medication to cure them. Once they feel well enough that we feel we can communicate with them, in addition to medication, we need to use counseling, psychotherapy, psychological education, family therapy, and problem-solving to treat them accordingly.
Mental disorder is very complicated, as there are many contextual factors involved, such as the involvement of other family members. So we need to find the key sources of the problem by inviting all those involved in the problem to come together and talk to each other, digging out the problem and finding the solution.
Are there other recommendations for dealing with mental disorders in Cambodia?
Currently, the main misery of [many] people, who have just recovered from war and violence, is poverty. So the development of the country is the most important thing to help those people heal their mental disorders and have hope and long life. Once they have a good standard of living, they can think of going to see a mental health specialist or a doctor. Therefore, the whole world should see the suffering and difficulties that Cambodian people are currently facing due to war, and, even recently, natural disasters.
The world should see the endeavors of the Cambodian government in developing the country, and then help the poor and those suffering from mental disorders. In a nutshell, the development of Cambodia, with the help from all the stakeholders, is the main means of dealing with all the difficulties and suffering that Cambodian people face, and that make them become mental disorder patients.