Cambodia: helping genocide survivors with talk therapy and drugs

Now Prozac Battles Dark Dreams That Khmer Rouge Left – by SETH MYDANS

PHNOM PENH, Cambodia — Mao Irang is an evangelist for the new magic in Cambodia, a treatment that can cure everything from headaches to blackouts to nightmares to bursts of violence.

"I ask my friends, 'What is your problem?' " she said. " 'Does your food get stuck in your throat? Do you have pain here, and here, and here? Do you have problems with your sleep?' I say, 'O.K., try this doctor.' "

Her doctor is Ka Sunbunaut, one of only 26 psychiatrists in this nation of 12 million traumatized people, the survivors and the children of survivors of one of the past century's most horrifying episodes of mass killing.

After therapy with him, said Ms. Mao Irang, 35, a social worker tormented by her memories, "I felt like I was another person; I was not a prisoner anymore."

She was liberated through a combination of talk therapy and psychiatric drugs — treatments that are largely alien to Cambodians, who often turn to faith healers and herbalists. But the word is spreading now among a relatively small circle of educated people: your ailments have a cause, and there are treatments that can help you.

It is a quarter century since the Khmer Rouge was driven from power after causing the deaths of 1.7 million people from 1975 to 1979 through execution, starvation or overwork.

"Until today, most people don't realize they have psychological problems," Dr. Ka Sunbunaut said in an interview. "They don't understand about trauma. Mostly, they believe it is all related to karma."

Now, though, people here are increasingly turning to drugs like Prozac and Valium, which are expensive but available without a prescription. Dr. Ka Sunbunaut said most of the medicines he prescribed were generic drugs manufactured in Asia.

"He gave me holy medicine," said Preap Phal Theary, 52, a wholesale rice dealer and former French teacher. "It is a holy medicine. It has changed my life. I've become a normal person instead of a sick person."

She said that before being treated, she had blackouts and intestinal problems. She had convulsions, and passed out whenever she went to the bathroom, she said.

"For 15 years I tried all kinds of medication, modern and ancient, with herbs and Chinese cures and spiritual cures and monks' blessings and praying at my home altar," she said. "For 15 years I had two jobs. One was to feed my children and the other was to be ready to fall into a coma at any moment, so I always needed an escort."

Psychiatrists now are considering the possible effects on traumatized people like Ms. Preap Phal Theary of plans to hold a trial for surviving leaders of the Khmer Rouge. Preliminary work is being done to set up a tribunal, although it will be many months before any defendants are put in the dock.

Convictions of the former Khmer Rouge leaders could bring some clarity and relief to people who still do not understand the causes of their suffering, doctors say. But for many the trial could revive traumas that have been suppressed over the years.

"At the moment I'm not sure whether a tribunal can bring peace or problems in our society," said Dr. Sotheara Chhim, a psychiatrist who is managing director of the Transcultural Psychosocial Organization, which is preparing for the trial.

He said his concerns were "retraumatization" of survivors who will come face to face with the past; new trauma on young people who did not experience the Khmer Rouge era; and renewed anger and hostility among victims.

"I believe everybody has suffered," he said in an interview. "Everybody has inside some memory, some past trauma. But their abilities to cope are different."

The Khmer Rouge era itself could be seen as an episode of madness. In a utopian frenzy these radical Communists sought to erase the modern world and systematically killed off most of the country's educated and skilled people. Few doctors survived.

Cambodia has no in-patient clinics for mental patients, the doctor said, and only 40 psychiatric nurses (and another 40 in training). He is only now organizing a committee for mental health , with its own budget, in the Ministry of Health.

No reliable data exist on the traumatic effects of the past, partly because people are not generally aware of the lasting impact of their experiences, said Dr. Sotheara Chhim. "People think their past problems have been buried and don't realize that the present is connected to the past," he said.

A study of Cambodian refugees in the United States, published last August in The Journal of the American Medical Association, found that 62 percent had suffered from posttraumatic stress disorder in the previous year, compared with a rate of 3.6 percent in the general United States population. It found that 51 percent had suffered from major depression , compared with 9.5 percent of the general population.

According to the study, 99 percent of the survivors of the Khmer Rouge years reported almost starving to death, 96 percent said they had been forced into slave labor, 90 percent said that a family member or friend had been killed and 54 percent said they had been tortured.

Even if they learn to cope, their memories remain to torment them, the doctors said.

Ms. Preap Phal Theary, the rice seller, closed her eyes for a moment. "I see a man running, and I see a man shooting," she said. "I hear gunfire. You don't just have a picture of people running in a field, you have sound, too. I can hear the people saying, 'Oh, they killed him.' It is like a snapshot in my mind."

Until she was treated, she said, loud noises, gunshots and the sight of people arguing caused her to pass out.

For Ms. Mao Irang, who was orphaned in the Khmer Rouge years, the most vivid memory almost seems to have been a nightmare.

"When I heard my parents were killed I fainted," she said. "I did not wake up for a week. In the hospital they thought I was dead. They put me in a pile of bodies.

"When I woke up I thought, 'What is that smell?' And I crawl, crawl, crawl to the door. And then I realize I am in the dead people's room."

She was 7 or 8 years old at the time.

She pressed the palms of her hands against her eyes. "Today, I feel much better," she said.