Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-848d4c4894-xm8r8 Total loading time: 0 Render date: 2024-06-25T22:49:35.793Z Has data issue: false hasContentIssue false

9 - Key Idioms of Distress and PTSD among Rural Cambodians

The Results of a Needs Assessment Survey

Published online by Cambridge University Press:  05 November 2014

By
Devon E. Hinton ,
Alexander L. Hinton  and
Kok-Thay Eng
Edited by
Devon E. Hinton  and
Alexander L. Hinton
Devon E. Hinton
Affiliation:
Harvard University
Alexander L. Hinton
Affiliation:
Rutgers University
Kok-Thay Eng
Affiliation:
Documentation Center of Cambodia
Devon E. Hinton
Affiliation:
Harvard University, Massachusetts
Alexander L. Hinton
Affiliation:
Rutgers University, New Jersey
Get access

Summary

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).

Type
Chapter
Information
Genocide and Mass Violence
Memory, Symptom, and Recovery
 , pp. 212 - 241
Publisher: Cambridge University Press
Print publication year: 2014

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (2000, 2013). Diagnostic and statistical manual of mental disorders, 4th ed., text revision and 5th ed. Washington, DC: American Psychiatric Association.Google Scholar
Barrera, T. L., Wilson, K. P., & Norton, P. J. (2010). The experience of panic symptoms across racial groups in a student sample. Journal of Anxiety Disorders, 24, 873–8.CrossRefGoogle Scholar
Barsky, A. J. (1992). Amplification, somatization, and the somatoform disorders. Psychosomatics, 33, 28–34.CrossRefGoogle ScholarPubMed
Becker, E. (1998). When the war was over: Cambodia and the Khmer Rouge revolution. New York: Public Affairs.Google Scholar
Carr, J. E., & Vitaliano, P. P. (1985). The theoretical implications of converging research on depression and the culture-bound syndromes. In Kleinman, A. & Good, B. J. (Eds.), Culture and depression: Studies in anthropology and cross-cultural psychiatry of affect and disorder (pp. 244–67). Berkeley: University of California Press.Google Scholar
Caspi, Y., Poole, C., Mollica, R. F., & Frankel, M. (1998). Relationship of child loss to psychiatric and functional impairment in resettled Cambodian refugees. Journal of Nervous and Mental Disease, 186, 484–91.CrossRefGoogle ScholarPubMed
Chandler, D. P. (1999). Voices from S-21: Terror and history in Pol Pot’s secret prison. Berkeley: University of California Press.Google Scholar
de Jong, J., & Reis, R. (2010). Kiyang-yang, a West-African postwar idiom of distress. Culture, Medicine, and Psychiatry, 34, 301–21.CrossRefGoogle ScholarPubMed
de Jong, J., (2013). Collective trauma resolution: Dissociation as a way of processing post-war traumatic stress in Guinea Bissau. Transcultural Psychiatry, 50, 644–61.CrossRefGoogle Scholar
Fassin, D., & Rechtman, R. (2009). The empire of trauma: An inquiry into the condition of victimhood. Princeton, NJ: Princeton University Press.Google Scholar
Good, B. J. (1977). The heart of what’s the matter: The semantics of illness in Iran. Culture, Medicine, and Psychiatry, 1, 25–58.CrossRefGoogle ScholarPubMed
Hinton, A. L. (2005). Why did they kill? Cambodia in the shadow of genocide. Berkeley: University of California Press.Google Scholar
Hinton, A. L. (Ed.). (2010). Transitional justice: Global mechanisms and local realities after genocide and mass violence. New Brunswick, NJ:Rutgers University Press.Google Scholar
Hinton, A. L., & O’Neill, K. L. (Eds.) (2009). Genocide truth, memory, and representation. Durham, NC: Duke University Press.CrossRefGoogle Scholar
Hinton, D. E., & Good, B. J. (2009a). A medical anthropology of panic sensations: Ten analytic perspectives. In Hinton, D. E. & Good, B. J. (Eds.), Culture and panic disorder (pp. 57–81). Stanford, CA: Stanford University Press.Google Scholar
Hinton, D. E., (Eds.) (2009b). Culture and panic disorder. Palo Alto, CA: Stanford University Press.Google Scholar
Hinton, D. E. & Hinton, A. L. (2015). An anthropology of the effects of genocide and mass violence: Memory, symptom, and recovery. In Hinton, D. E. & Hinton, A. L. (Eds.), Genocide and mass violence: Memory, symptom, and recovery. Cambridge: Cambridge University Press.Google Scholar
Hinton, D. E. & Hinton, A. L., Eng, K. T. (2015). Key idioms of distress and PTSD among rural Cambodians: The results of a needs assessment survey. In Hinton, D. E. & Hinton, A. L. (Eds.), Genocide and mass violence: Memory, symptom, and recovery. Cambridge: Cambridge University Press.Google Scholar
Hinton, D. E., Hinton, S. D., Loeum, J. R., & Pollack, M. H. (2008). The “multiplex model” of somatic symptoms: Application to tinnitus among traumatized Cambodian refugees. Transcultural Psychiatry, 45, 287–317.CrossRefGoogle Scholar
Hinton, D. E., Hinton, S., Um, K., Chea, A., & Sak, S. (2002). The Khmer “weak heart” syndrome: Fear of death from palpitations. Transcultural Psychiatry, 39, 323–44.CrossRefGoogle Scholar
Hinton, D. E., Hofmann, S. G., Orr, S. P., Pitman, R. K., Pollack, M. H., & Pole, N. (2010). A psychobiocultural model of orthostatic panic among Cambodian refugees: Flashbacks, catastrophic cognitions, and reduced orthostatic blood-pressure response. Psychological Trauma: Theory, Research, Practice, and Policy, 2, 63–70.CrossRefGoogle Scholar
Hinton, D. E., Hsia, C., Park, L., Rasmussen, A., & Pollack, M. H. (2009). Cultural anthropology and anxiety diagnoses. In McKay, D., Abramowitz, J. S., Taylor, S., & Asmundson, G. J. (Eds.), Current perspectives on the anxiety disorders: Implications for DSM-V and beyond (pp. 245–74). New York: Springer Press.Google Scholar
Hinton, D. E., Kredlow, M. A., Bui, E., Pollack, M. H., & Hofmann, S. G. (2012). Treatment change of somatic symptoms and cultural syndromes among Cambodian refugees with PTSD. Depression and Anxiety, 29, 148–55.CrossRefGoogle ScholarPubMed
Hinton, D. E., Kredlow, M. A., Pich, V., Bui, E., & Hofmann, S. G. (2013). The relationship of PTSD to key somatic complaints and cultural syndromes among Cambodian refugees attending a psychiatric clinic: The Cambodian Somatic Symptom and Syndrome Inventory (SSI). Transcultural Psychiatry, 50, 347–70.CrossRefGoogle Scholar
Hinton, D. E., & Lewis-Fernández, R. (2010). Idioms of distress among trauma survivors: Subtypes and clinical utility. Culture, Medicine, and Psychiatry, 34, 209–18.CrossRefGoogle ScholarPubMed
Hinton, D. E., (2011). The cross-cultural validity of posttraumatic stress disorder: Implications for DSM-5. Depression and Anxiety, 28, 783–801.CrossRefGoogle ScholarPubMed
Hinton, D. E., Nickerson, A., & Bryant, R. A. (2011). Worry, worry attacks, and PTSD among Cambodian refugees: A path analysis investigation. Social Science and Medicine, 72, 1817–25.CrossRefGoogle ScholarPubMed
Hinton, D. E., Peou, S., Joshi, S., Nickerson, A., & Simon, N. (2013). Normal grief and complicated bereavement among traumatized Cambodian refugees: Cultural context and the central role of dreams of the deceased. Culture, Medicine, and Psychiatry, 37, 427–64.CrossRefGoogle Scholar
Hinton, D. E., Pich, V., Chhean, D., & Pollack, M. H. (2005). “The ghost pushes you down”: Sleep paralysis-type panic attacks in a Khmer refugee population. Transcultural Psychiatry, 42, 46–78.CrossRefGoogle Scholar
Hinton, D. E., Pich, V., Marques, L., Nickerson, A., & Pollack, M. H. (2010). Khyâl attacks: A key idiom of distress among traumatized Cambodia refugees. Culture, Medicine, and Psychiatry, 34, 244–78.CrossRefGoogle ScholarPubMed
Hinton, D. E., Rasmussen, A., Nou, L., Pollack, M. H., & Good, M. J. (2009). Anger, PTSD, and the nuclear family: A study of Cambodian refugees. Social Science and Medicine, 69, 1387–94.CrossRefGoogle ScholarPubMed
Hinton, D. E., Rivera, E., Hofmann, S. G., Barlow, D. H., & Otto, M. W. (2012). Adapting CBT for traumatized refugees and ethnic minority patients: Examples from culturally adapted CBT (CA-CBT). Transcultural Psychiatry, 49, 340–65.CrossRefGoogle Scholar
Hinton, D. E., Sinclair, J., Chung, R. C., & Pollack, M. H. (2007). The SF-36 among Cambodian and Vietnamese refugees: An examination of psychometric properties. Journal of Psychopathology and Behavioral Assessment, 29, 38–45.CrossRefGoogle Scholar
Hinton, D. E., Um, K., & Ba, P. (2001a). Kyol goeu (“wind overload”). Part I. A cultural syndrome of orthostatic panic among Khmer refugees. Transcultural Psychiatry, 38, 403–32.CrossRefGoogle Scholar
Hinton, D. E., Um, K., (2001b). A unique panic-disorder presentation among Khmer refugees: The sore-neck syndrome. Culture, Medicine, and Psychiatry, 25, 297–316.CrossRefGoogle ScholarPubMed
Jenkins, J. H., & Valiente, M. (1994). Bodily transactions of the passions: El calor (the heat) among Salvadoran women. In Csordas, T. (Ed.), The body as existential ground: Studies in culture, self, and experience (pp. 163–82). Cambridge: Cambridge University Press.Google Scholar
Kidron, C. A. (2015). Embodying the distant past: Holocaust descendant narratives of the lived presence of the genocidal past. In Hinton, D. E. & Hinton, A. L. (Eds.), Genocide and mass violence: Memory, symptom, and recovery. Cambridge: Cambridge University Press.Google Scholar
Kirmayer, L. J. (1996). Confusion of the senses: Implications of ethnocultural variations in somatoform and dissociative disorders for PTSD. In Marsella, A. J., Friedman, M. J., Gerrity, E. T., & Scurfield, R. M. (Eds.), Ethnocultural aspects of posttraumatic stress disorder: Issues, research, and clinical applications (pp. 131–64). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
Kirmayer, L. J., & Sartorius, N. (2007). Cultural models and somatic syndromes. Psychosomatic Medicine, 69, 832–40.CrossRefGoogle ScholarPubMed
Kleinman, A., & Becker, A. E. (1998). “Sociosomatics”: The contributions of anthropology to psychosomatic medicine. Psychosomatic Medicine, 60, 389–93.CrossRefGoogle ScholarPubMed
Kleinman, A. & Kleinman, J. (1994). How bodies remember: Social memory and bodily experience of criticism, resistance, and delegitimation following China’s Cultural Revolution. New Literary History, 25, 707–23.CrossRefGoogle Scholar
Langer, L. L. (1991). Holocaust testimonies: The ruins of memory. New Haven, CT: Yale University Press.Google Scholar
Lock, M. M. (1993). Encounters with aging mythologies of menopause in Japan and North America. Retrieved from
McDonald, S. D., & Calhoun, P. S. (2010). The diagnostic accuracy of the PTSD Checklist: A critical review. Clinical Psychology Review, 30, 976–87.CrossRefGoogle ScholarPubMed
McNally, R. J., & Frueh, B. C. (2013). Why are Iraq and Afghanistan War veterans seeking PTSD disability compensation at unprecedented rates?Journal of Anxiety Disorders, 27, 520–6.CrossRefGoogle ScholarPubMed
Mollica, R. F., Caspi-Yavin, Y., Bollini, P., Truong, T., Tor, S., & Lavelle, J. (1992). The Harvard Trauma Questionnaire: Validating a cross-cultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Indochinese refugees. Journal of Nervous and Mental Disease, 180, 111–16.CrossRefGoogle ScholarPubMed
Mollica, R. F., Mcinness, K., Poole, C., & Tor, S. (1998). Dose-effect relationships of trauma to symptoms of depression and post-traumatic stress disorder among Cambodian survivors of mass violence. British Journal of Psychiatry, 173, 482–8.CrossRefGoogle ScholarPubMed
Mollica, R. F., Wyshak, G., Marneffe, D., Khuon, F., & Lavelle, J. (1987). Indochinese version of the Hopkins Symptom Checklist-25: A screening instrument for the psychiatric care of refugees. American Journal of Psychiatry 144, 497–500.Google Scholar
Reis, R. (2013). Children enacting idioms of witchcraft and spirit possession in response to trauma: Therapeutically beneficial, and for whom?Culture, Medicine, and Psychiatry, 50, 622–43.Google ScholarPubMed
Rubel, A. J., O’Nell, C. W., & Collado-Ardón, R. (1984). Susto: A folk illness. Berkeley: University of California Press.Google Scholar
Shawcross, W. (1984). The quality of mercy: Cambodia, Holocaust, and modern conscience. London: Andre Deutsch.Google Scholar
Shorter, E. (1992). From paralysis to fatigue: A history of psychosomatic illness in the modern era. Toronto: Maxwell Macmillan Canada.Google Scholar
Sonis, J., Gibson, J. L., de Jong, J. T., Field, N. P., Hean, S., & Komproe, I. (2009). Probable posttraumatic stress disorder and disability in Cambodia: Associations with perceived justice, desire for revenge, and attitudes toward the Khmer Rouge trials. JAMA, 302, 527–36.CrossRefGoogle ScholarPubMed
Terry, F. (2002). Condemned to repeat? The paradox of humanitarian action. Ithaca, NY and London: Cornell University Press.Google Scholar
Weller, S. C., Baer, R. D., Garcia de Alba Garcia, J., & Salcedo Rocha, A. L. (2008). Susto and nervios: Expressions for stress and depression. Culture, Medicine, and Psychiatry, 32, 406–20.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×