What are the wounds of mass violence on various experiential levels and how might recovery occur? Despite the emergence of an international human rights movement in the period after the Holocaust and World War II, mass violence has not ended. The late twentieth-century genocides in Bosnia and Rwanda were followed by early twenty-first-century genocides in Sudan and the Democratic Republic of Congo. Civil war remains a central part of many of these conflicts, as illustrated by the atrocities perpetrated in Aceh, Colombia, East Timor, Guatemala, Liberia, Kosovo, Nepal, Peru, Sierra Leone, Somalia, Syria, and Uganda. The United States has recently entered zones of mass violence in a post-9/11 world, and with its allies has waged war in Afghanistan and Iraq while confronting terrorism at home. There is the postconflict legacy of such violence: economies and infrastructures destroyed, families and communities fractured, interpersonal mistrust, grieving, trauma, symptoms, unwanted memories, and many other forms of social suffering.

This volume explores lingering aftermaths of mass violence and the reaction to it. What are the legacies of mass violence for individuals and the social worlds in which they live and how do they seek to recover? Former zones of violence often become sites of humanitarian aid, peace-building efforts, and transitional justice, but scholars and practitioners have paid too little attention to the ways in which individuals and cultural groups react to mass violence through microdynamics of memory, social practice, ritual, coping, understanding, symptoms, and healing. Psychological anthropology should have much to say about these issues given its emphasis on taking into account various levels of human ontology such as social experience, collective representations, and sociopolitical process; brain function and psychology; the phenomenology of lived experience; and the nexus of self, memory, and emotion. But psychological anthropology has only just begun to grapple with the legacies of mass violence (see, e.g., Fassin & Pandolfi, 2010; Kirmayer, Lemelson, & Barad, 2007; Kleinman, Das, & Lock, 1997; Robben & Suárez-Orozco, 2000).

Introduction

This chapter describes key idioms of distress among Cambodian refugees and their manner of generation, and it reports on the results of a needs assessment survey of rural Cambodians that was undertaken by the Documentation Center of Cambodia (DC-CAM) as part of their Victims of Torture (VoT) project. The VoT project was conceived by the director of DC-Cam (Youk Chang) and implemented by a VoT project team leader (Kok-Thay Eng). The purpose of this project was to document experiences under the Khmer Rouge, to identify rural villagers who had significant distress, and to provide services to those suffering from PTSD. Members of DC-CAM went to rural villages in Kampot, Takeo, and Kandal Provinces and asked local officials (e.g., the commune or village chief) and villagers to identify individuals who had psychological problems owing to the Pol Pot period. After being interviewed, all participants were given basic mental health information, including instruction about the use of relaxation and breathing techniques to reduce stress, and those individuals who were found to have significant mental health concerns were provided with psychological services, including referral and modest funds to visit the closest mental health clinic and to pay for any prescribed medications.

To date, what little formal knowledge we have about mental health in Cambodia has been derived from a handful of instruments, such as the Harvard Trauma Questionnaire and the Hopkins Checklist. During a pilot version of the Victims of Torture project, DC-Cam team members noted that the instruments were not culturally sensitive in that they did not assess many symptoms of concern among those surveyed such as dizziness. After discussing these issues, the DC-CAM staff asked to include the Cambodian Symptom and Syndrome Inventory (C-SSI), an instrument devised by the first author based on work with Cambodian Americans in a Massachusetts clinic, as an addendum to the existing assessment survey in order to seek a more culturally sensitive means of assessing psychological distress in Cambodia. The C-SSI is an addendum of symptoms and syndromes (see Table 9.1) that are a key aspect of the presentation of trauma-type distress among Cambodian refugees but are not among the seventeen symptoms listed in the PTSD criteria of the Diagnostic and Statistical Manual of Mental Disorders-IV-TR (DSM-IV-TR; American Psychiatric Association, 2000) or among the updated list of twenty symptoms in the PTSD criteria of the DSM-5 (American Psychiatric Association, 2013).