Blinding Horrors : Cambodian Women’s Vision Loss Linked to Sights of Slaughter

Eang Long cried for many days after the Khmer Rouge soldier beat her brother and his three children to death. She vividly recalls how the soldier threw the youngest child, a 3-month-old, against a tree until the baby died.

“My eyesight started to get terrible after I saw the tragedy,” Long said. “Because I was crying so hard and long, my eyes were red and started to swell up. Then I started to have problems with my eyesight.”

Trauma From Genocide

A decade later, Long, 65, who now lives in Long Beach, still has days when shadows--like silent phantoms of the past--obscure her vision. She says her bifocals do not always help and she fears her eyesight will get worse.

Long and dozens of other middle-aged Cambodian women are coping with a condition that some researchers have called “functional blindness”--blindness or visual problems caused by psychological factors.

Two researchers who have studied the condition say it is linked to post-war trauma stemming from the genocide by Communist leader Pol Pot and the Khmer Rouge in the late 1970s.

Gretchen Van Boemel, associate director of clinical electro-physiology at the Doheny Eye Institute in Los Angeles, says it was 1984 when she started to notice a disproportionate number of Cambodian women in the 40-to-60 age group who had the disorder.

“I talked about this with a friend who was involved in Southeast Asian affairs,” Van Boemel said, “and she described all the atrocities and killing fields in Cambodia.”

Armed with this information, Van Boemel contacted her friend and former college classmate Patricia Rozee-Koker, now a psychology professor at Cal State Long Beach. By 1985 the two researchers had located a group of 30 Cambodian women, ages 40 to 69, who volunteered to be in a study. All of the women had lived in Cambodia during the Pol Pot regime and later spent one to six years in a Thai refugee camp before being relocated to the United States.

Van Boemel said the purpose of the survey was to show that “a psychological overlay was causing the women’s eye problems, even if the brain was functioning normally.”

Each woman was interviewed and given an eye exam and a test to determine whether the visual system in the brain is functioning normally. Van Boemel said the test monitors brain waves as subjects look at checked patterns on a video monitor.

In each case, the test revealed normal visual acuity, often at the 20/20 or 20/40 level. These same women, however, when looking at an eye chart could barely see the top line of 20/200--the point of legal blindness. Other women had no light perception and could not detect light or dark shadows.

Pol Pot Years

Rozee-Koker said most of the women’s functional blindness surfaced during the Pol Pot years. Personal interviews brought out repeated stories of forced labor, the murder of family and friends--often in their presence--beating and torture, starvation, a treacherous escape to Thailand and separation from family.

She said the findings indicated that the longer a woman was bound to Khmer Rouge servitude or life in a refugee camp, the more her vision was impaired.

Results of the study were presented at the 1986 American Psychological Assn. annual meeting in Washington. There was only one other paper about Cambodian refugee women and both reports received considerable attention. The paper, “The Psychological Effects of War Trauma and Abuse on Older Cambodian Refugee Women” is scheduled to appear in a coming issue of the journal Women and Therapy.

The researchers found that the Cambodians do not always understand their condition and that many optometrists and ophthalmologists dismiss the vision loss as a case of “faking” or “malingering,” Van Boemel said.

As an example, Rozee-Koker pointed to a 1985 piece in the journal Ophthalmology. It described new immigrants who might be milking the welfare system with complaints of functional blindness. “That article was racist,” Rozee-Koker said. “But people believe it. It was very insensitive.”

Dr. Eric Nelson, a third-year resident at the UCLA School of Medicine, recently completed a preliminary study of Cambodians with functional blindness. “We found some patients who had been considered malingerers,” he said. “But our research proved this to be wrong.”

Unexplainable Problems

His findings were confirmed by Long Beach ophthalmologist Hector Sulit, who in the last five years has noticed a significant number of Cambodian women with unexplainable visual problems.

“I don’t think it has anything to do with their age, but (it is) because they lost family or children,” he said.

As more data about functional blindness in the Cambodian community became available, Rozee-Koker and Van Boemel decided to continue their study.

This fall they completed a 10-week study of 15 Long Beach Cambodian women. Each Saturday the women participated in a therapy or skills group for 90 minutes. The therapy group uncovered deep post-war trauma.

The most dramatic improvement took place in the skills group. As the women mastered such basic skills as taking a bus downtown, using a telephone and shopping, they felt a growing sense of empowerment over their lives.

Or as one Cambodian woman told Rozee-Koker: “When I am happy I see better.”

“It was amazing to see the difference,” Rozee-Koker said. “From having to be guided by our arms into the elevator to the psychology building or holding themselves in a fetal position--to the last week when they were standing up straight. Many could smile and with some, their vision improved.”

For Chhou Chreng, 64, the sessions were an opportunity to learn how to dial 911 and to brush up on writing.

“I lost my vision in an accident in 1979,” she said. “Something fell on my head and then things were not clear.” Under Pol Pot she was forced to work in the rice fields for four years. Her husband, brother and many cousins died of starvation.

“Sometimes I will get a headache if I think about my sister in Cambodia,” she said. “Then I will get pain all over my body and my eyes will hurt.”

Both researchers, who are compiling their data, acknowledge that 10 weeks is not enough time to deal with these bouts of depression. Next year they hope to start a student intern program at Cal State Long Beach that will assist local Cambodian women.

The nonprofit Community Rehabilitation Industries also works with Cambodian women. Konthea Kang, a program coordinator at CRI, estimates that up to 20% to 30% of the dozens of Cambodian women she sees have had visual loss symptoms.

Older women, she said, have a more difficult time assimilating into American life styles. In Cambodia, most young people take care of their elderly relatives and parents. In rural areas, she said, women stay at home and raise families and many urban husbands also frown upon wives who work.

When these women reach the United States, they are strongly encouraged by federal and state agencies to find a job. But in the workplace, they encounter yet another problem.

“When they can’t speak English, they don’t know what to do and get laid off,” Kang said. “After this they feel lost for several months.”

As a counselor at the Asian Pacific Mental Health Center in Long Beach, the Rev. Kong Chhean said he tries to help his patients become more secure. The counselor and Buddhist monk has a caseload of about eight women with visual dysfunction symptoms. They are tormented by frequent nightmares about the Khmer Rouge and are still afraid of attacks, even though they are far from the soldiers who hunted them.

Although light is being shed on functional blindness, experts say that successful treatment is often tied to mental health care and that poses a problem in the Cambodian community.

Kung Chap, a vocational rehabilitation counselor at the Long Beach office of the California Department of Rehabilitation, said the concept of mental health care in Cambodia is negative. A mental health facility in Phnon Penh called Takhmao Hospital “looks like a jail,” he said. “The people there are labeled as crazy people. They would have been beaten and electric shock used on them.”

Cambodians, Chap said, would rather seek help from the family, a temple or a shaman with magic cures. They are slow to accept the American style of counseling and therapy.

Rozee-Koker and Van Boemel have also found Cambodians to be afraid of agencies, hospitals and the university. On one occasion they made an appointment to interview a woman and her family at home. When they got to the house, the entire family had and moved.

“We had evoked memories of the Khmer Rouge,” Rozee-Koker said. “To them it was a voice of authority. To their minds it sounded like Pol Pot.”

The refugees, Rozee-Koker said, will carry the scars of their experiences throughout their lives. “They do not want to see any more violence, any more pain. They have essentially closed their eyes to it.”

Or, as Chhou Chreng put, it, “When I feel happy my eyes are normal. When I think about Cambodia and my family I see flashes of light and dark.”