Voices of Experience: Cambodian Trauma in America
Broadcast starting week of July 21, 2004

More than 20 years after fleeing the brutal Khmer Rouge regime, many Cambodian refugees are still trapped in the psychological grip of their past. This one-hour documentary special examines the mental health of Cambodian refugees living in America, and the impact of trauma on the hundreds of thousands of other refugees pouring into the United States. Journalist Karen Brown spent a year researching and reporting the story, and worked with The Infinite Mind's executive producer, June Peoples, to produce and write the special report. The documentary also features Dr. Richard Mollica, a psychiatrist and co-director of the Harvard Program in Refugee Trauma, John Salzburg of the Center for Victims of Torture, the extraordinary accounts of people who were terrorized by the Khmer Rouge two decades ago and still live with the trauma, and a follow-up discussion with Dr. Patricia Shannon of the Center for Victims of Torture in Minneapolis, which has helped refugees from more than 60 countries rebuild their lives.

Karen Brown is a reporter for public radio station WFCR in Amherst, Massachusetts, a small college town that’s home to a surprising number of Cambodian refugees. Fascinated by the Cambodian culture, Karen became concerned about the lingering effects of trauma on these peaceful Buddhist people.

The documentary begins with a recap of history, recalling how in 1975, the brutal Khmer Route regime seized power in the sleepy agrarian nation, slaughtering monks, intellectuals and professionals in a bid for power. The regime of dictator Pol Pot held control for four years, during which more than two million Cambodians died through starvation, sickness, abuse or outright execution. For the most part, the genocide passed unnoticed by the rest of the world.

To date, the United States has granted refugee status to more than 150,000 Cambodians. Several communities have sprung up as a result, the largest in Long Beach, California, near Los Angeles, and in Lowell, Massachusetts, outside Boston. But many of the refugees remain haunted by ghosts from the past: loved ones, lost in the genocide; family members left behind in Cambodia; soldiers and torturers from the Khmer Rouge. Dr. Richard Mollica, a psychiatrist and co-director of the Harvard Program in Refugee Trauma, says Cambodian refugees have, on the average, experienced 14 or 15 major "trauma events" in their lives, ranging from beatings to starvation to witnesses the execution or rape of a family member.

The documentary details the history of the Khmer Rouge take-over and the experiences of several Cambodians. Theanvy Kuoch, who now lives in Hartford, Connecticut, tells how soldiers forced her to march from her home with thousands of other people. Their hands were tied together with a thin thread, and if they broke the thread, they were killed. The slogan of the Khmer Rouge, Theanvy says, was "To keep you is no gain; to lose you is no loss." During the march, her sister's baby sickened and died, and was thrown to the side of the road as they were forced to march on. Other Cambodians describe starvation, relatives who disappeared, and conscription into youth camps far from their families.

Like many others, Theanvy eventually escaped over the mountains to a crowded, dangerous refugee camp on the border with Thailand. There, Cambodians trying to win refugee status had to convince skeptical UN and U.S. immigration official that her life was in danger if she returned home. The very process of applying for refuge, says John Salzburg of the Center for Victims of Torture, was traumatizing for refugees who had suffered such abuse at the hands of their own government officials. Cambodians lived in the refugee camps for as long as 10 years before they were resettled; Theanvy waited three years for a sponsor.

Once in America, Cambodians were faced with a wholly new culture and language, and the need to keep themselves and what was left of their families clothed, fed and housed. Many were also sick or suffering the physical effects of torture and starvation. And it wasn't long before evidence of psychological damage started to emerge. Refugees reported horrible nightmares, dizziness, headaches, depression, anxiety and a heightened state of alertness, all signs of Post Traumatic Stress Disorder stemming from their experiences under the Khmer Rouge. Mollica said his research among Cambodian refugees in the Boston area found rates of depression 10 to 20 percent higher than the general population. The problems are profoundly disabling, Mollica said, affecting people at home and at work. And the phenomena has gone on to affect a new generation; teenagers who try to talk to their parents about the normal problems of adolescence may find themselves facing the spectre of the Khmer Rouge . "They can’t understand what I’m going through … they can never see my problems that big," says 15-year-old Saraum An.

Many Cambodians are resistant to mental health care, afraid that they will be written off as "crazy people," says Samkhann Khoeun, who now works in Lowell, Massachusetts as an advocate for Cambodians seeking social services. In their home country, emotional troubled people were taken to a monk or village elders. Furthermore, when they do seek care, they are confronted with practitioners who may or may not understand their belief system. Concepts like spirit possession and hearing the voices of dead ancestors could be easily dismissed as schizophrenia, says Sovann Dung, who works as a cultural liaison between Cambodians and the western mental health system.

Some western practitioners modified their treatment for their Cambodian clients. Psychiatric nurse Marguerita Reczycki scheduled "headache clinics" and "dizziness clinics" since Cambodians were more likely to seek treatment for physical ailments. She relates how her patients would come hours early for their appointments, and how she opened the door into an adjoining room and suddenly had a therapy group. She also found a plot of land for a community garden, and there, she says, the women's trauma stories began to emerge:

"So now they’re out there digging with a pitchfork with a vengeance, and laughing and smiling, so I said to my partner, "What is she talking about?" and she said, "Oh she’s talking about how many of her children were killed in front of her." I said "Oh, okay." So then another woman is really digging and laughing, and I said "What’s going on with her?" And she said, "Oh she’s just talking about what she’d like to do to the Khmer Rouge if she ran into them today."

Mollica, the psychiatrist, says he works Cambodian cultural imagery into his work with the refugees. The Buddhist religion teaches the practice of "mindfulness," stilling the mind by focusing on the breath and remaining in the "now." Mollica finds a link in that practice to the western system of Cognitive Behavioral Therapy, through which people are also encouraged to "let the past be the past" (as Maha Gosananda, the leader of all Cambodian Buddhism, says in an interview at the Cambodian temple in Lowell).

Augmenting psychotherapy and medication is a rejuvenation of the Cambodian culture in the U.S. In Massachusetts, for example, Samkhann Khoeun has organized an annual water festival on the Merrimac River, similar to the festival held each year on the Mekong River in Cambodia.

Cambodian refugees say they hope their experiences will be a cautionary tale to public policymakers in the U.S. about the need for mental health services for arriving refugees from other nations. Says Theanvy Kuoch:

"There are lessons from the past that can help new refugees. If they don't learn to understand why Cambodians came here, why they are sick, how could you provide the treatment? If the United States government (is) kind enough to provide the appropriate treatment and service to them, I can assure you that Cambodian will be a good citizen of the United States."

In the interview that follows, The Infinite Mind's host Dr. Fred Goodwin speaks with Dr. Patricia Shannon, a clinical psychologist with the Center for Victims of Torture in Minneapolis, Minnesota. The center, a leader in advocacy, research, treatment, and training on refugee issues, has helped refugees from more than 60 countries rebuild their lives.

Dr. Shannon says that the trauma and subsequent effects described by Cambodian refugees bear marked similarity to the experiences of other refugees to the U.S., whether they come from Bosnia, Liberia, West Africa or the Middle East. Research, she says, shows that refugees are best able to work through their trauma when they are resettled into an "enriched environment" that pays lots of attention to emotional as well as physical needs. She urges federal and state governments to provide more money for outreach to traumatized refugees, and for subsequent treatment.

You can get more information about refugee resettlement and mental health through the following links:

U.S. Committee for Refugees

Office of Refugee Resettlement (A branch of the U.S. Department of Health and Human Services/The Administration of Children and Families)

Center for Victims of Torture

Substance Abuse and Mental Health Services Administration (Oversees Refugee Mental Health for the U.S. Dept of Health and Human Services)

Refugee Mental Health program at the Center for Multicultural Human Services

South East Asian Resource Action Center

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