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ABSTRACT:
Cambodia suffers from an alarming treatment gap in the field of mental health. The Cambodian mental health care systems struggles to meet the overwhelming needs of the population. Shortage of trained professionals, the predominantly rural demographic and the over-reliance on pharmacological therapy (along with all the respective consequences) call for treatment options which feature brief therapeutic approaches, techniques easily mastered by non-psychotherapists, and the complete avoidance of a purely bio-medical approach. Additionally, traditional and cultural beliefs as well as Buddhist spirituality should be taken into account when determining the most effective culturally appropriate treatment options.
The desirable characteristics of potential therapies are featured in the alternative and culturally sensitive approaches described in this research, which include testimonial and dialogue approaches, art and group therapies, forum theater and EMDR techniques.
While the broader issues of government and international funding, low levels of awareness regarding mental health, lack of trained staff, facilities and resources are being addressed, the success of mental health treatment in Cambodia depends upon the short and long-term results of an effective and thorough implementation of such alternative strategies.
Although the Kingdom of Cambodia is rich in natural resources (especially metals, gems and timber) and home to UNESCO world heritage sites (i.e. the ruins of the Angkorian era), corruption is so deeply rooted in the nation that Cambodia is still one of the world's poorest countries.
In the picture, Ta Prohm temple.- Angkor, Cambodia
In the picture, Ta Prohm temple.- Angkor, Cambodia
Over 40% of the Cambodians live on less than US$1.25 a day and over 80% of the Cambodian population live in rural areas. With the few mental health care facilities concentrated in the major urban centers, patients cannot normally afford the transportation costs which results in an inconsistent pharmacological treatment, especially problematic with regards to psychotropic drugs.
Furthermore, drug shortages are frequent and when available they are older generations of pharmaceuticals with greater side effects and lower efficacy.
Above, ricefields near Tonle Sap lake - Cambodia.
Furthermore, drug shortages are frequent and when available they are older generations of pharmaceuticals with greater side effects and lower efficacy.
Above, ricefields near Tonle Sap lake - Cambodia.
Cambodia is home to an alarming number of environmental risk factors for poor mental health, namely the country’s traumatic history and current socio-political condition, general poverty, high rates of violence against women and the dreadful human rights situation.
Above, a survivor of the Khmer Rouge regime shares her story - Kampong Cham, Cambodia.
Above, a survivor of the Khmer Rouge regime shares her story - Kampong Cham, Cambodia.
From 1975 to 1979, following decades of civil unrest and US bombings, Cambodia experienced an autogenocide of massive proportions at the hands of the Khmer Rouge's ultra-Marxist regime.
It is estimated that at least 25% of Cambodian civilian population at that time (1.7 million people) perished as the result of mass killings, starvation, forced labor and disease.
In the picture, cell at Tuol Sleng prison (S-21), where as many as 20,000 prisoners were tortured and killed during the regime. - Phnom Penh, Cambodia.It is estimated that at least 25% of Cambodian civilian population at that time (1.7 million people) perished as the result of mass killings, starvation, forced labor and disease.
Forced to live in close proximity with and to be governed by former Khmer Rouge cadres, the survivors of the regime are deprived of any real sense of closure.
The governing CPP (Cambodia People’s Party) and its leader, the Prime Minister Hun Sen, share similar pasts as mid-level Khmer Rouge cadres with some measure of authority.
Even the ECCC (Extraordinary Chambers in the Courts of Cambodia), established to try a handful of leading members of the KR, has been often reported to suffer from corruption and political obstruction.
In the picture, traditional village abode in Kampong Cham province.
The governing CPP (Cambodia People’s Party) and its leader, the Prime Minister Hun Sen, share similar pasts as mid-level Khmer Rouge cadres with some measure of authority.
Even the ECCC (Extraordinary Chambers in the Courts of Cambodia), established to try a handful of leading members of the KR, has been often reported to suffer from corruption and political obstruction.
In the picture, traditional village abode in Kampong Cham province.
Former Khmer Rouge cadres live today in the same villages and in close proximity to the people whose families they have abused and killed. However, most Cambodians do not feel ready to let go of their resentment yet and the reconciliation with their perpetrators appears only to be a formality.
49% of Cambodians would not want their children to marry the offspring of a former KR cadres.
In the image, children living in the same village, play through the fence which divides their homes.49% of Cambodians would not want their children to marry the offspring of a former KR cadres.
Mental health professionals believe that trauma and Post-Traumatic Stress Disorder in Cambodia are transmitted from one generation to the next, on account of the Khmer Rouge period’s impact on the parenting styles.
Above, Cambodian child - Kampong Cham province.
Above, Cambodian child - Kampong Cham province.
The stigma associated with mental illness constitute a significant barrier to care as Cambodians often interpret mental and emotional disorders through the prism of their spiritual beliefs.
Mental health problems are traditionally considered contagious, hereditary, the result of black magic or the result of improper flow of inner "wind" through the body.
As a result, especially in the countryside, people with mental disabilities are often caged, abused or brought to Buddhist monks and traditional healers ('Kru Khmer').
Village in Kampong Cham province.Mental health problems are traditionally considered contagious, hereditary, the result of black magic or the result of improper flow of inner "wind" through the body.
As a result, especially in the countryside, people with mental disabilities are often caged, abused or brought to Buddhist monks and traditional healers ('Kru Khmer').
More than thirty years following the fall of the Khmer Rouge, many Cambodians still suffer from psychological consequences directly resulting from the trauma they experienced decades earlier.
In the image above, a woman who survived the KR participates in the Testimonial Therapy ceremony held at the Killing Fields Memorial.
In the image above, a woman who survived the KR participates in the Testimonial Therapy ceremony held at the Killing Fields Memorial.
Buddhist concepts and ideas have been found to be deeply effective in improving psychological well-being as they are founded on the belief that the most important aspect of human life is mental cultivation.
According to the Buddhist principles, suffering does not derive from an unintelligible plan to which humans are merely subject, but it derives from a twisted interpretation of reality— problems and solutions are both our creations.
In the picture, woman chants during a religious ritual of blessing.
According to the Buddhist principles, suffering does not derive from an unintelligible plan to which humans are merely subject, but it derives from a twisted interpretation of reality— problems and solutions are both our creations.
In the picture, woman chants during a religious ritual of blessing.
Small temples like this one are often found outside homes and businesses and are dedicated to the spirits who protect the house and the family. These shrines are a clear example of the legacy of the ancient animistic religion and of its blend with Buddhism in Cambodia today.
Under the Khmer Rouge, the Cambodian Buddhist sangha (the community of monks) was almost completely eradicated along with its spiritual guidance. Only 3,000 of Cambodia's 50,000 monks survived the regime.
Above, Buddhist monk prepares to perform the blessing ritual during a Testimonial Therapy ceremony.
Above, Buddhist monk prepares to perform the blessing ritual during a Testimonial Therapy ceremony.
Testimonial therapy is an individual psychotherapy method for survivors of human rights violations. In cooperation with a counselor the clients are enabled to restore their painful memories and convert them into a written document, the testimony, which is later handed out to the client during a cathartic honoring ceremony.
Above, survivor of the regime (center) listens to her testimony being read aloud.
Above, survivor of the regime (center) listens to her testimony being read aloud.
The Buddhist ceremony is a fundamental part of the Testimonial Therapy process. This version of the process was developed to take into account the local cultural and spiritual dimensions, by incorporating country-specific coping-strategies, such as traditional healing rituals and honoring practices.
Such practices have been demonstrated to be extremely effective in catalizing positive therapeutic outcomes.
In the picture, the monk blesses the survivors with water and jasmine blossoms.
Such practices have been demonstrated to be extremely effective in catalizing positive therapeutic outcomes.
In the picture, the monk blesses the survivors with water and jasmine blossoms.
Woman receives support and encouragement from TPO staff member as she hears her story read out loud during the Testimonial Therapy ceremony.
Testimonial Therapy has been implemented in Cambodia since 2010 for civil parties of the ECCC Trials.
Testimonial Therapy has been implemented in Cambodia since 2010 for civil parties of the ECCC Trials.
Group therapy sessions ('self-help groups' as they are called at TPO) are probably the most effectively implemented alternative treatment in Cambodia.
They encourage and develop altruistic collaboration, mutual support and trust while at the same time promoting the de-stigmatization of mental health problems.
Group discussion at TPO Cambodia (Transcultural Psychosocial Organization).They encourage and develop altruistic collaboration, mutual support and trust while at the same time promoting the de-stigmatization of mental health problems.
Forum Theater is a form of Drama Therapy characterized by active interaction between the actors and the so called ‘spect-actors’ (i.e. actively participating spectators). Through a dialectic process, Forum Theater aims at raising awareness and at empowering social change.
TPO staff member Thida Kim invites the villagers to interact with the play - Siem Reap province, Cambodia.
TPO staff member Thida Kim invites the villagers to interact with the play - Siem Reap province, Cambodia.
Currently, TPO's Forum Theater activities are aimed at de-stigmatizing mental health issues in the villages as well as raising awareness regarding Gender Based Violence.
Violence against women and domestic abuse are a major issue in Cambodia. Studies have shown that 74% of women knew someone who had been victim of domestic abuse.
The villagers enjoy the Forum Theater performance - Siem Reap province, Cambodia. Violence against women and domestic abuse are a major issue in Cambodia. Studies have shown that 74% of women knew someone who had been victim of domestic abuse.
While the broader issues of government and international funding, low levels of awareness regarding mental health, lack of trained staff, facilities and resources are being addressed, the success of mental health treatment in Cambodia depends upon the short and long-term results of an effective and thorough implementation of such alternative strategies.
Tuk-Tuk driver near Tonle Sap lake - Cambodia.
Tuk-Tuk driver near Tonle Sap lake - Cambodia.
For more information, please download the full research by clicking the link at the top of the page.
For more information, please download the full research by clicking the link at the top of the page.
For more information, please download the full research by clicking the link at the top of the page.
