Scores of Cambodians complain they are blind or suffer blurry vision although their eyes are normal--a malady some experts blame on the horrors they witnessed in the killing fields of their native land.
"These women saw things that their minds just could not accept," said psychology professor Patricia Rozee-Koker of Cal State Long Beach, who studies vision complaints of the Khmer Rouge regime's refugees.
"Seventy percent of the women had their immediate family killed before their eyes," she said. "So their minds simply closed down, and they refused to see anymore--refused to see any more death, any more torture, any more rape, any more starvation."
The majority of the refugees with vision complaints are 40- to 70-year-old women who fled the Khmer Rouge regime, which was toppled a decade ago.
Experts believe that the refugees suffer hysterical, psychosomatic or functional blindness, in which psychological turmoil spurs people with normal eyes to believe that they are blind or see poorly.
Many of the Cambodians also show signs of severe depression and post-traumatic stress disorder, which afflicted many Vietnam War veterans, Rozee-Koker said.
Eye doctors said it is very difficult to distinguish patients with hysterical vision loss from malingerers who fake blindness to obtain disability benefits, attention or sympathy.
Some question whether psychological vision problems were triggered by sights of mass murder in Cambodia, or by trauma endured by Khmer-speaking Cambodian peasants adjusting to U.S. life.
"I think it's a real phenomenon," said Dr. Hector Sulit, a Long Beach eye doctor who examined dozens of Cambodians in recent years. "It could be the trauma. . . . The other possibility is cultural shock. There might be a few looking for sympathy."
Dr. Michael F. Marmor, ophthalmology chairman at Stanford University School of Medicine, said Cambodians examined there "for the most part were not consciously malingering, although it's almost impossible to rule out."
Hundreds of thousands of Cambodians were killed from 1975 to 1978 by Pol Pot's fanatical communist Khmer Rouge, who tried to transform the nation into an agrarian commune until Vietnam invaded in late 1978. Nearly 200,000 Cambodians fled to the United States. Vietnam withdrew its troops in September.
Hysterical blindness has been reported among shellshocked soldiers during World War I, children of divorced parents and people involved in traffic accidents.
Five years ago, an unusual number of female Cambodian refugees with psychosomatic vision problems were noticed by Gretchen Van Boemel, an electrophysiologist at Doheny Eye Institute in Los Angeles.
She contacted Rozee-Koker, an old friend, and since then they identified about 150 Cambodian refugees in Long Beach who claim blindness or blurred vision, although brain wave and eye tests find nothing physically wrong.
"One woman saw her four children and husband killed in front of her, then lost her vision right after," Van Boemel said. "One woman watched her husband and three children taken away in 1975. They never returned. She reported she cried daily for four years, then she stopped crying and couldn't see."
About 15% of the women said they were blind--with no perception of light--and the rest claimed varying degrees of blurry vision, she added.
At Stanford, Marmor and Dr. Michael Drinnan examined a number of people with psychosomatic blindness during the last two years.
"There were more Southeast Asians with functional vision loss than other members of society, and almost all seem to be Cambodians," a majority of them women, Marmor said. "Most had some perception of light, but they ranged widely over what they could see. We speculated this may have to do with war trauma."
Rozee-Koker and Van Boemel initially interviewed 30 Cambodian women through an interpreter, and found that those with the worst vision spent the most time living under the Khmer Rouge or in refugee camps.
"The women's trauma history was extreme," Rozee-Koker said. "They had lost several to all of their relatives. They experienced beatings, starvation, forced labor, humiliations, separation from their families." She also suspects that the women may have been raped.
Dr. Eric Nelson, an ophthalmology fellow at UCLA's Jules Stein Eye Institute, said the women's psychosomatic vision problems "did seem to happen shortly after they saw some horrendous things, but they also went through horrendous changes of life" as refugees.
Marmor speculated that Cambodian refugees may be more prone to complain of vision trouble because they tend to be uneducated peasants who experience difficulty adapting to life in a new country.
"To know whether the Cambodian war was the cause of this would really take some scientific scrutiny, particularly when we have such a different social situation and culture to understand," said Dr. John Keltner, ophthalmology chairman at UC Davis.
Since 1977, Keltner and colleagues examined 137 patients who complained of vision problems but had healthy eyes. They included Laotian refugees but not Cambodians. Most were faking to obtain disability payments or awards in lawsuits, Keltner said.
Nelson studied eight Cambodians to determine if their vision complaints were sincere.
"Some had applied for disability, but some months before their vision loss," he said. "In five cases, the patients were given a diagnosis of major depression," and two more also probably suffered from it.
Van Boemel said most of the women she studied also had psychosomatic headaches, dizziness, general malaise and stomach cramps.
Rozee-Koker said the women "sit isolated in their rooms and live over and over the trauma through horrible nightmares and intrusive thoughts," and their vision problems are worse when they feel depressed.
Two years ago, Van Boemel and Rozee-Koker placed five of the women in group psychotherapy, while five others participated in a group where they learned survival skills: how to call police, shop and ride buses.
After 10 weekly sessions, about three-fifths of the women reported improved vision and reduced depression, Rozee-Koker said.
Sulit said some Cambodians get better without treatment. He refers many to mental health clinics, but "the system is not there to help them" with long-term counseling, he said.