‘Killing Fields’ Haunt Newcomers : Cambodians Struggle to Leave Nightmare Behind

The weathered faces of those gathered in the semicircle looked like individual moments of agony frozen in time.

Drooping low in her chair, a gray-haired Cambodian woman sat in silence, methodically crumpling a napkin between white-knuckled fists. A few seats away a young man stared blankly into space. And near the end of the line, another woman fidgeted and sighed continuously as if in great physical pain.

As each spoke in turn, the others listened with no visible reaction. Some recited their experiences as if they had happened to someone else. Others became animated as they talked, suddenly transformed into angry, tearful beings of passion and force.

“They took my brother away,” said Rao Im, 53, speaking in a choked voice through an interpreter. “They tied him to a chair and beat him with a brick. Then they cut him open and took out his liver.”

Said a poker-faced Saroeun Sous, 41: “My 2-year-old son got sick. The soldiers said he was useless, so they threw him against a bamboo bed and broke his back. Two days later he died.”

The tragedies occurred nearly a decade ago under the harsh regime of Pol Pot, the Communist ruler of Cambodia from 1975 to 1979. History has moved on since then, recording newer casualties and conflicts. But to the people who witnessed it, the Cambodian holocaust--by most accounts one of the most brutal in history--is far from over.

“They are still suffering,” said Florentius Chan, a Chinese-born psychologist and director of the county-operated Asian Pacific Mental Health Center in Long Beach where the handful of survivors had gathered to talk.

In fact, Chan says, their symptoms are epidemic.

He has seen Cambodian women with no physical impairments literally go blind because they could not bear the memory of loved ones who had been tortured to death before their eyes.

Four months ago, a refugee Chan knew shot his wife and himself to death in front of the couple’s four horrified children. Patients have come to the clinic carrying guns they refused to relinquish, afraid of security guards because of their uniforms. And it is not uncommon, the psychologist said, for Cambodian refugees to suffer severe headaches, dizziness, disorientation, poor memory, depression, insomnia, body aches, irritability and hallucinations. Some, he says, hear the voices of dead relatives calling to them.

Prolonged Disorder

“(Theirs) is an episodic, prolonged disorder,” said Dr. J. David Kinzie, a psychiatrist whose mental health center in Portland, Ore.--which also has a sizable refugee community--has treated more than 100 Cambodians in the last eight years. Considered an expert in the field, Kinzie likens the refugees’ condition to that of Jewish concentration camp survivors of a generation ago. “It’s much more severe for these people than for the American Vietnam veterans,” he says.

And, the experts say, the problem seems to be getting worse as time goes by.

From 1975 to 1979, nearly 3 million of Cambodia’s 7 million people died under the Pol Pot regime. Many of those who were not killed outright died of starvation, disease or torture. And many of the survivors underwent years of forced labor during which they were beaten, deprived of food and tormented psychologically as well as physically.

Since 1975, an estimated 136,000 Cambodian refugees have fled to the United States. More than 30,000 of them now live in Long Beach, making that city home to the largest concentration of Cambodians in the country and giving rise to Chan’s clinic, which opened a year ago.

Largest Such Group

Although the center also serves Laotians, Vietnamese, Thais and some other Southeast Asian groups, more than half of its 250 clients are Cambodians. Chan says it represents the largest group of Cambodian mental health patients in the country.

A survey of 125 of them--virtually all his adult patients--revealed some alarming statistics, which the psychologist presented recently to a national meeting of the Western Psychological Assn. in a paper entitled “Survivors of the Killing Fields.”

Seventy-three percent, the paper reported, had lost siblings or parents under the Pol Pot regime. More than half (57%) had suffered from extreme hunger and about half had been tortured. Finally, about a third (35%) had lost spouses and nearly a quarter (24%) had lost children.

As a result, Chan reported, 80% complained of chronic headaches, 62% of dizziness, 49% of sleep disturbance, 30% of body pain and 30% of poor memory.

Widespread Brutality

Of the Cambodian refugee population at large, Chan estimates, as many as 90% experienced some form of brutality under Pol Pot and perhaps 20% now require therapy to help alleviate the results.

Dr. Kinzie is less conservative in his estimates. A recent survey of 46 supposedly healthy Cambodian high school students who had been children under the Pol Pot regime, he said, revealed that about half suffer from post-traumatic stress syndrome to a degree that the psychiatrist believes warrants therapeutic intervention.

“It’s a very fundamental problem,” said Chon Suh, a clinical psychologist who oversees the county-run Indochinese Counseling and Treatment Unit in Los Angeles, which has about 50 Cambodian patients. “People recognize the food and shelter need, but mental health is fundamental because these refugees are not able to adapt, not able to make new lives for themselves in America.”

‘Swallowed Their Tears’

The symptoms are increasing, Chan believes, for two reasons: Until recently many of the refugees were in camps where their daily struggle for survival overshadowed personal traumas; and, like other groups that have suffered similarly, the Cambodians have tended to suppress the deep feelings of grief, anger and resentment that for some are only now beginning to surface.

“They have swallowed their tears,” the psychologist explained. The underlying purpose of therapy, he said, is to help them retrieve, and ultimately move beyond, those tears.

At Chan’s center--which turns away some would-be clients each week because of limited space and personnel--this is done in a number of ways. The vast majority of clients, he said, are put on some form of medication. In addition, they attend a variety of therapy groups designed to help them express emotions that have been pent up for years.

With lower-functioning people, such as those who have limited verbal skills even in their own language, this is accomplished primarily through art. For patients with more self-awareness, Chan said, therapy consists of anything from simple verbal sharing to nonverbal visualization and relaxation exercises.

Few Speak English

Because few of the refugees speak English, most of the groups are conducted with the help of trained Cambodian community workers who act as interpreters. One of the major hurdles he faced in setting up the program, Chan said, was the rarity of credentialed Cambodian mental health professionals.

Another problem, he said, was the natural distrust of people from a society in which emotions are generally not shared and there is no tradition of mental health service.

“These people had never heard of psychiatry,” Chan said.

To help solve that problem, the center hired a Cambodian Buddhist monk--a figure traditionally afforded great respect and authority by Cambodians--to act as its behavioral consultant. In addition to running groups of his own, the Rev. Chhean Kong advises non-Cambodian staffers on how to relate to their Cambodian clients.

“He bridges the gap between East and West,” Chan said of Kong, who holds a doctorate in religion and is a candidate for a master’s degree in family counseling at Pepperdine University.

Meditation Encouraged

Among other things, Kong encourages patients to meditate and practice mind-control techniques as well as to generally follow their doctors’ orders. “I tell them, ‘If you love yourself, take your medicine,’ ” the monk says.

Occasionally the meditation exercises cause unforeseen reactions, according to community worker Sovicheth El. One woman, he said, ran shrieking from a room after hearing the voice of her dead husband during a particularly vivid meditation. Another, he said, refuses to close her eyes for fear of confronting the visions ushered into her head.

But the monk’s calming effect on most of his charges was evident during a recent gathering at which they greeted his entrance quickly, with respectful bows. Where conversation earlier had been strained, now suddenly it seemed to flow. “They see him and they feel relieved,” Chan explained.

During an earlier session, though, some of the refugees had poured out their hearts.

Brutal Beatings

Thouk Thoeung, 45, told of being forced to dig long trenches and haul huge buckets of dirt up steep hills. When she couldn’t continue, she said, she was given brutal beatings that left physical scars on her face and mental ones in her psyche. “Before I came here, I couldn’t tell anyone,” she said.

Horn Heng, 50, lost her husband and 15-year-old son to the communists. Later she was forced to bundle rice for 11 hours a day without food or rest on pain of death. “When I come to the group, I can share my story,” she said. “When I stay home, I mainly sleep and do nothing.”

Both said they have suffered years of headaches, backaches, hallucinations and depression.

Chan believes the therapy is helping, though he is quick to add that it is too early to tell yet whether the benefits will be permanent. At least, he says, the refugees are beginning to talk more freely about what they have long suppressed.

Problems Return

Kinzie, whose clinic has been treating Cambodian refugees considerably longer than Chan’s, is somewhat less optimistic about the long-term prognosis. A recent follow-up of 13 patients, he said, revealed that half were doing better a year after beginning therapy. But a year after that, he said, the ones who had improved were once again regressing.

“We’ve seen people who’ve been well for years,” he said, “then a new stress comes along and the whole thing returns.”

As a result, Kinzie said, he has learned to lower his expectations.

“I don’t know how you can cure people who’ve seen their brothers and fathers shot in front of them,” he said. “Those scars are deep in the brain and permanently affect the way one lives.”

So how does the psychiatrist measure his success?

“If we can get them through a night without screaming,” he says, “then I think we’ve done a good thing.”