This article explores the nightmares of Cambodian refugees in a cultural context, and the role of nightmares in the trauma ontology of this population, including their role in generating post-traumatic stress disorder (PTSD). Among Cambodian refugees attending a psychiatric clinic, we found that having a nightmare was strongly associated with having PTSD (chi(2) = 61.7, P < 0.001, odds ratio = 126); that nightmares caused much distress upon awakening, including panic attacks, fear of bodily dysfunction, flashbacks and difficulty returning to sleep; that nightmare content was frequently related to traumatic events; that nightmares resulted in a decrease in the sense of "concentric ontology security" (i.e., in an increased sense of physical and spiritual vulnerability in a culture that conceives of the self in terms of concentric, protective layers), including fears of being attacked by ghosts; and that nightmares frequently led to the performance of specific practices and rituals aiming to extrude and repel attacking forces and to create "protective layers." Cases are presented to illustrate these findings. The Discussion considers some treatment implications of the study.
This article describes a culturally sensitive assessment tool for traumatized Cambodians, the Cambodian "Somatic Symptom and Syndrome Inventory" (SSI), and reports the outcome of a needs assessment conducted in rural Cambodia using the instrument. Villagers locally identified (N = 139) as still suffering the effects of the Pol Pot genocide were evaluated. All 139 had post-traumatic stress disorder (PTSD) as assessed by the PTSD Checklist (PCL), and they had elevated SSI scores. The severity of the SSI items varied by level of PTSD severity, and several items--for example, dizziness, dizziness on standing, khyâl (a windlike substance) attacks, and "thinking a lot"--were extremely elevated in those participants with higher levels of PTSD. The SSI was more highly correlated to self-perceived health (Short Form Health Survey-3) and past trauma events (Harvard Trauma Questionnaire) than was the PCL. The study shows the SSI items to be a core aspect of the Cambodian trauma ontology.
Why did you kill?From the first day I arrived in Cambodia to conduct ethnographic research, I had wanted to pose this question to a Khmer Rouge who had executed people during the genocidal Democratic Kampuchea regime (April 1975 to January 1979)- When the Khmer Rouge—a radical group of Maoist-inspired Communist rebels—came to power after a bloody civil war in which 600,000 people died, they transformed Cambodian society into what some survivors now call “the prison without walls”(kuk et chonhcheang). The cities were evacuated; economic production and consumption were collectivized; books were confiscated and sometimes burned; Buddhism and other forms of religious worship were banned; freedom of speech, travel, residence, and occupational choice were dramatically curtailed; formal education largely disappeared; money, markets, and courts were abolished; and the family was subordinated to the Party Organization,Ângkar. Over one and a half million of Cambodia's eight million inhabitants perished from disease, over-work, starvation, and outright execution under this genocidal regime (Kiernan 1996).
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