Understanding Trauma in Cambodia

CONTENT:

1. Opening remarks by SENG Theary, Executive Director of CSD
2. Acknowledgements
3. Fear stems from lack of information
4. National reconciliation, personal healing
5. PTSD
6. Dissociation, avoidance, numbing
7. Unhealed trauma can be triggered anytime
8. Unconscious tendencies
9. Post-traumatic growth
10. Simple but powerful reminders

1.Opening remarks by SENG Theary, Executive Director of CSD

On November 21, the Center for Social Development launched Understanding Trauma in Cambodia Handbook, beautifully and thoughtfully written by Matthias Witzel, a consultant of the German Development Service to CSD with 15 years of experience as a clinical psychologist and psycho-therapist with traumatized people from all over the world (Germany, Switzerland), especially in countries with civil war (Yugoslavia, Iran, Iraq, Palestine, Liberia, Rwanda) before working in Cambodia for the last 2 ½ years. He is also a second-generation traumatized person from a family displaced by World War II. The following are excerpts of Matthias’ comments (with the full text available at www.csdcambodia.org “ What’s New at CSD”).


2. Acknowledgements
It is only appropriate to begin my presentation with some brief acknowledgements – especially for my Cambodian colleagues during the process of developing this Handbook.
First of all, our special gratitude goes to all the people who have supported us with their experiences and their knowledge, such as the participants at CSD public fora, who shared personal memories of their suffering during the KR years and gave us invaluable insights into the complex processes of Cambodian trauma. Our debt to them is substantial. In fact, this Handbook owes its existence to these Cambodians who suffered and still are suffering from past experiences.
Second, my very special gratitude goes to the CSD staff, particularly four individuals:

Foremost, there is Seng Theary, who came up with the idea to write this Handbook. During our discussions about psycho-social issues I am always deeply impressed by her precise and profound knowledge about psychological phenomena, especially about the coincidences among aspects of general human development, personality pattern and the situation of young Cambodians struggling with the socio-political reality in their lives. Her engagement of young employees is – from my perspective as a psychologist – outstanding and should be recognized as a role model for other leaders in this country.

Yim Sotheary: She mainly translated and edited the text into Khmer, helped to conceptualize and design the Handbook. Without her substantial engagement and deep commitment, not one single page could have been delivered today.

Sam Sarath, the brilliant CSD cartoonist: Even though unfamiliar with psychological topics, he obviously enjoyed transforming my stickman-drawings and creating the nice cartoons. He is one of the most humble and modest persons I met in Cambodia.
Finally, Om Chariya: She worked very closely with us on the translation and editing and is the core of compassion within the CSD Emotional Support Group. During our reconciliation work in Cambodia’s remote areas and the public fora, I was amazed by her skills to anticipate villagers’ expression of grief and sadness and then to intervene with professional awareness and consciousness.
Everyone involved in the process of creating this Handbook made a conscientious (more or less), deep commitment to themselves to process personal life issues, recognizing it as a chance to develop their own personality pattern about how to deal with stress, overwhelming feelings and the tendency to avoid grief and anger. Dealing with trauma issues or with traumatized people implies a risk that can lead to being co-traumatized, or at least, mental and physical exhaustion, respective to burnout.
We write this Handbook for two principal reasons: to combat fear, and to address personal healing and national reconciliation.

3. Fear stems from lack of information
During our outreach activities and research, we quickly realized that fear is one of the most evident symptoms in Cambodia today, blocking a creative, engaged and healthy life of many people.
Fear is a lack of information (or knowledge, understanding).
In response to fear, the first step is to get control and ownership of one’s own life in or after threatening situations, to get knowledge about the structure and content of the destructive circumstances. The second step is to seek new skills, and/or to reactivate earlier developed skills inorder to cope and to reorganize life in a healthy way.
Step one is only a precondition; it does not give enough skills to deal with damaged self esteem, destructive behavior, lack of trust, or lack of ownership according to a self-actualized, creative, robust living.
For example, if family members do not understand that trauma can lead to an outburst of anger, panic or sudden grief (common symptoms) or that traumatized people change their communication pattern, are more suspicious and afraid, and tend to withdraw from society, how can they understand their suffering relatives, how can they appreciate them in their life struggle. Instead, oftentimes, they are labeled as “ch’kuet”, crazy.
Lack of knowledge leads to lack of understanding, and consequently lack of empathy.
Again, how can people regain peace in their hearts if they are treated as abnormal for their grief, anger and depressive moods. With knowledge about common processes, they may seek help and may be more kind to themselves, because they will realize that their feelings are very, very normal and that the very first important approach to recovery is to treat yourself very kindly.

4. National reconciliation, personal healing
Parents, teachers, aid workers, politicians – the whole of society – have to impart not only knowledge and facts about history (which is fundamental), but need to understand that knowledge about human behavior, motivations, constructive and destructive personality pattern, the dark side of our souls, and even certain aspect of human behavior related to extreme aggression (unexplainable by psychological and sociological theories) is as fundamental.
The complicated process of reconciliation requires knowledge for each individual to understand their mental health situation and the internal turmoil in terms of spirituality and the meaning of life.
People with better knowledge, more informed, more sophisticated thinking pattern are more likely to forgive perpetrators, even murderers from the Khmer Rouge time. They are more able to differentiate pieces of information and ponder the circumstances, the conditions, the obstacles, and suffering of perpetrators; they can imagine the motives and purposes, and eventually, the traumata of the perpetrators. They don’t label and stigmatize people as bad, if they behave badly; they can differentiate between a person’s behavior and a person’s personality.
5. PTSD
Post-traumatic stress disorder is a mental health disease with severe reaction of unprocessed trauma. Last year, 62% of Cambodians living in the US suffered from PTSD and 51% suffered from depression. Despite the difference in circumstances for overseas Cambodians, psychiatrists and psychologists perceive similar high prevalence of PTSD in Cambodia.
At present many organizations and many Cambodians are becoming more engaged in the process of national reconciliation and development. Inevitably, one of the results of the increase of outreach work will be that many Cambodians will face their personal and collective history of the KR years. Undoubtedly, a wide range of symptoms, such as grief, anger, and other expressions of trauma will emerge from the depths of people’s sub-consciousness. Many years after the KR atrocities, the trauma in the hearts of many Cambodians is still unresolved. 6. Dissociation, avoidance, numbing

Time does not heal all grief and pain: trauma can be re-experienced many times throughout one’s life.
The brain employs different strategies to protect us from psychological and physical pain. Survival mechanisms such as dissociation, avoidance, numbing can initially help us to cope with an unbearable moment. But if we do not integrate our pain within some weeks or months after it occurred, it can lead to unhealthy long-term effect.

Many Cambodians who lived through the KR years did not have the chance to integrate their trauma. They repeatedly had to face traumatic events, and then experience the continuous intrusion of new traumatic events till today. Without a safe place to integrate their feelings of fear/pain and support from people who were not traumatized, these Cambodians did not have an opportunity to heal. Hence, many Cambodians remain in a state of dissociation. They avoided feeling the full depth of the overwhelming pain. The coping strategy of dissociation allows people to struggle with unfathomable, unbearable circumstances, but with detachment and suppression of feelings. Consequently, from time to time, the tremendous suppressed grief, sadness, and anger erupt in problematic ways, e.g., high prevalence of domestic violence.
7. Unhealed trauma can be triggered anytime

A trigger is an event, an object, a person, or a sensation that sets a series of thoughts in motion or reminds a person of some aspect of their traumatic past. A person may be unaware of what is triggering the memory (e.g., loud noises, a particular color, piece of music, odor). But becoming aware of these triggers and learning not to overreact to them are important therapeutic steps in the treatment of people who suffer from anxiety, detachment, nightmares, increased aggressiveness, alcoholism, or even severe mental diseases such as PTSD.
In Cambodian society, daily life remains full of triggers. Every frightening personal or social situation may wake the "sleeping dogs" of trauma. This could be the unstable political situation, the insensitive statements of Cambodian leaders, or personal experiences related to corruption, land grabbing, landmines, rape, domestic violence, unprofessional and unjust courts and many more societal problems. As long as life in Cambodia continues to lack real security and reliability, every single moment can trigger memories of old traumatic experiences and feelings.
To handle the challenges of Cambodian life, people have had to develop specific psychological and behavioral coping strategies, seen pervasively throughout the country. These coping strategies could be constructive or destructive, depending on personal and environmental conditions. The goal is to avoid the emergence of too much grief and anger related to past traumatic events.

8. Unconscious tendencies

There is not yet any systematic research about the existence of typical Cambodian coping strategies. Nevertheless, there are unconscious tendencies that seem to be common in Cambodia, similar to other countries attempting to reconcile their specific history after civil war:
·Avoidance of talking about recent Cambodian history (personal or collective).
·Emotional detachment characterized by a lack of compassion for the suffering of weak, disabled or displaced people. The fact that Cambodians take extremely good care of their relatives and friends reveals that compassion is often fragmented. Being in touch with one's own feelings is only possible within the shelter of one's own family. To avoid triggers, people with background trauma often "choose" to avoid the grief and despair of strangers. Unfortunately, the coping strategies they use to deal with trauma often malfunction, due to the large amount of triggers in daily life. Many people channel the triggered energy of grief and anger through domestic violence, alcohol, drug abuse, and other destructive coping mechanism.
·Former victims unconsciously treating other people as they were treated in the time of the atrocities.

9. Post-traumatic growth

The variety of positive changes that individuals may experience in their struggles with trauma are described in psychological models of post-traumatic growth. These changes include improved relationships, new life options, a greater appreciation for life, a greater sense of personal strength, and a deepened sense of spiritual development. This reflects a basic paradox or irony: trauma survivors sometimes find that their losses have produced valuable gains.
In addition to psycho-therapy and counseling, healing requires an active creating of peaceful, trustful, compassionate secure atmospheres in the public domain, which is the necessary prerequisite in the national-wide healing process.
Without a secure social environment, without trust in good leadership - and therefore a different leadership approach then experienced for decades – the traumatized souls will remain suspicious, avoiding healthy and creative life approaches and transmit their distrust and self-distrust to their children. And if a healthy developmental process of individuals is blocked because of the impact fear and anger, everything in a country especially the process o reconciliation is blocked.


10. Simple but powerful reminders

I always repeat the following sentences in my interaction with villagers:
·Everyone should have access to appropriate support and healing approaches.
·Nobody should be ashamed; symptoms of trauma are never a sign of weakness of character or a reason to be depreciated.
·Each phenomenon and symptom of trauma has two sides, even if the constructive side is more hidden.
·Healing and reconciliation requires personal, individual engagement.
We believe that a greater consciousness and knowledge about the socio-political and individual aspects of trauma is one of the first steps towards individual and national reconciliation. There will be no path to comprehensive reconciliation in this country until there is more inner peace in the hearts of individuals, more conscious and relaxed communication between couples as well as among people in families, villages, and towns. Without consciously facing the phenomena, the traumatic legacy, the aggression and feeling of being lost will be unconsciously passed onto the next generations of Cambodians.
______________________________
Phnom Penh, den 1.12.07 - Matthias WITZEL