One day in the late 1990s technicians set off a planned explosion at the edge of Phnom Penh. “Some old mines were being detonated by the Cambodian Mine Action Center to get rid of them,” Quinn remembered. “This set off a major panic downtown because people heard the noise and thought it was 1975 again and that the city was
about to be retaken by the Khmer Rouge. Markets closed, schools emptied, and people raced to find their families and get home to safety.”
Devon Hinton, M.D., a psychiatrist and anthropologist at Harvard Medical School, studied this phenomenon for many years, primarily among Cambodian refugees in Lowell, Massachusetts. More than half of the Khmer Rouge survivors there had PTSD. As he saw it, this illness was just the tip of an iceberg sitting atop a distressingly diverse array of pernicious physical and mental illnesses—one complication that led to another and triggered another and then set off another still. Most of them suffered from one of several physical ailments that resulted from protracted trauma, including blurry vision, headaches, heart palpitations, constant buzzing in the ears, shortness of breath, and a painful neck and shoulders—mimicking the pain of carrying heavy buckets of dirt on a pole resting on the shoulder while working for the Khmer Rouge.
More than half of these survivors frequently experienced intense, sometimes violent, angry outbursts against members of their own families. Normal household disputes triggered these incidents, including something as simple as children who they perceived had acted disrespectfully. The victim might scream at his child, throw things, or strike him, while at the same time he experienced heart palpitations, shortness of breath, dizziness, and chest pain characteristic of a panic attack. At the very same time, he might also experience flashbacks of the events that precipitated the mental illness. Typically, the victim would recall working as a slave for the Khmer Rouge while starving, being tortured, or “forced to stand with biting ants crawling over the body,” Hinton wrote in a study published in 2009.
These symptoms played directly into Cambodian spirituality. Across Southeast Asia people believe that spirits inhabit most objects and people. The little templelike shrines you see on stands in the yards near businesses or homes have nothing directly to do with Buddhism. In these shrines people leave food and other offerings for the spirits. Cambodians believe the spirits within them are particularly powerful. Anger sets them off, and they begin to cause mayhem within the
body—boiling blood that rises in the body, eventually reaching the brain. That superstitious fear, by itself, is terrifying. Coupled with debilitating PTSD, it is even worse.
For these people there was no relief even when they went to sleep. Many Cambodians also suffered from sleep paralysis and an associated disorder known as “ghost sitting.” Sixty percent of the men and women Hinton studied who had PTSD suffered from these two afflictions. “Clinical experience suggests that sleep paralysis occurs at a very high rate in the Cambodian population,” he wrote in another published study. During sleep paralysis, “Cambodians frequently hallucinate certain supernatural beings,” including “a ghost sent by a sorcerer to kill the victim by putting objects into the body, a demon that wants to scare the soul from the body—or the ghost of someone who was killed during the Pol Pot period.” Others might hallucinate “near drowning experiences” or “having a plastic bag placed over the head,” both common Khmer Rouge torture or execution techniques. These events seem to occur during a state halfway between sleep and wakefulness. They could last for roughly five to thirty minutes, and through all of it the victim feels paralyzed; he cannot move or speak. Cambodians call this “the ghost pushing you down.”
One victim profiled in Hinton’s study, a forty-one-year-old woman, said she repeatedly saw “the black shape of a man clutching a knife and walking toward her. With one hand he pointed the raised knife at her; with the other he grabbed her shirt front.” Another victim, a forty-eight-year-old woman, “initially became conscious of her inability to move. Next she saw three ghastly demons, creatures with fur and long fangs, approach her. One of the ogres came close to her head.” Another “held down her legs; yet another held her arms.” Then, “ogres tried to scare her to death.” Usually someone would hear her frightened murmuring and shake her fully awake. The woman, identified only as Chea, said she could not sleep the rest of the night. Instead, horrid images from the Khmer Rouge era came flooding back into her mind, including one when she saw soldiers leading three of her friends from her village, blindfolded, behind a stand of trees twenty yards away. “A
minute later, Chea heard the sickening sound of a skull being cracked with a club.”
Victims of sleep paralysis, ghost sitting, and related trauma wake up terrified, exhausted, and subject to panic attacks throughout the day. Some grow so anxious that they become dizzy, afraid they might fall down. Not surprisingly, they suffer chronic insomnia. They are afraid to go to sleep, which only exacerbates the problems.
Daryn Reicherter, M.D., a psychiatrist at Stanford University, discovered identical sleep paralysis and ghost-sitting symptoms among a different Cambodian refugee population, in San Jose, California. He also encountered the phenomenon of hysterical blindness. “The Khmer Rouge generally spared blind people,” he noted. “So people used that as a coping strategy. They pretended to be blind.” Now, “many of the Khmer Rouge victims’ coping strategies today are maladaptive,” or inappropriate. Some of his patients seem to go blind “when they are stressed.” He imitated a patient in his office bumping around with his arms stretched out. “You can’t really tell if it is fake or real. For him it might be real. It comes and goes, and it lingers to this day. I have seen some of this in Cambodia, too,” Reicherter added. “It’s at least the same there and probably worse.”
These deeply troubled refugees in Massachusetts and California are largely dysfunctional. Numerous studies have shown that they can’t hold jobs. In one study, in Massachusetts, 90 percent of the PTSD patients were unemployed. Decades after moving to the United States these people still spoke no English. They lived tormented lives on government assistance.
A study published in the
Journal of the American Medical Association
in 1995 looked at Cambodian refugees in Long Beach, California, who came to the United States in the early 1980s, just after the Khmer Rouge years. More than half suffered serious, debilitating depression. Two-thirds had PTSD. More than three-quarters of the adults had no education. Most were unemployed, desperately poor, and prone to irrational violence. More than one-quarter were disabled. They lived in slums and were emotionally incapable of interacting with others. In
San Jose, too, “they are still monolingual, illiterate, unacculturated, drunk,” Reicherter said. “Most of these people cannot work. They are on disability still. They all have major depressive disorders.”
Millions of Cambodians suffered from these and similar symptoms and disabilities resulting from the trauma they experienced decades earlier. The few studies conducted in the country confirmed that fact. Muny Sothara, a psychiatrist in Phnom Penh, described “a household provincial survey in Kampong Cham in 2004 that showed PTSD or symptoms of other psychotic disorders in 47 percent of the population.”
Left untreated, these people passed their illness on to their children. Nigel Field, a professor at the Pacific Graduate School of Psychology in Northern California, is an expert on what he calls second-generation effects. He studied two hundred children in a Phnom Penh high school and found that the more they knew about their parents’ traumatic experiences, the worse off they were. “Children, seeking approval, parrot their parents’ aberrant behavior,” Fields said. “There’s also a tendency for children to become ‘parents’ for their parents, to try to help quell their parents’ anxieties. These children tend to see danger when there is no danger,” just like their parents. When asked to list the events they knew their parents were exposed to—starvation, torture, near death—“some of them get angry when they talk about it, showing the role reversal. They have higher anxiety, depression. These stresses take a toll on their lives.”
Muny Sothara, the Cambodian psychiatrist, suggested that parents unwittingly teach PTSD to their children. They do this by “educating the child, warning about dangers. Saying ‘don’t participate; don’t get involved. Be quiet.’” As Reicherter put it, “What we have learned is that if you have a traumatic childhood, you are more likely to get PTSD. So we have children who are growing up with violent parents who are drunk and beat them. That’s the generation that’s coming.”
That new generation has already arrived. In about 2004 Cambodian officials estimated that one-quarter of the nation’s men frequently beat their wives and children—one of the highest rates in the world. By the
end of the decade, as more of the Khmer Rouge victims’ children married and had children of their own, the rate had actually increased, to about one-third of the nation’s families.
Hinton and Reicherter both reported that therapy helped some Cambodian refugees. But in the 1990s Cambodian psychiatry was not yet even in its infancy. The state had perhaps four or five psychiatrists nationwide. All of them worked for hospitals, dispensing outdated medications. Reicherter said he visited one village where “we saw one man, a schizophrenic apparently, with a dog collar, tied to a tree—how psychiatry was practiced a millennium ago. We gave him a shot. One shot. And they were able to let him go.”
Members of the government didn’t seem to care, even though many senior officials had the same symptoms. “Mental health is the last priority here,” said Michael O’Leary, head of the World Health Organization office in Phnom Penh. “The ability to provide support is really quite limited.”
Khieu Kanharith, the information minister, said he suffered a recurring nightmare, a hallmark of PTSD: “I go back to my home and most of my family is on the ground, on their knees,” as they would be just before execution by the Khmer Rouge. Since 1979, “I actually have been back home only once, and it’s in a village just up the road. I wrote on the wall of my house: I am alive! But it’s too stressful to be there. I haven’t been back. PTSD, everyone has it.” The continuing war with the Khmer Rouge only amplified the people’s pain.
At the same time, even months after the “coup” in 1997, the CPP and Funcinpec fought sporadic battles across the country—utterly heedless of anything but advancing their own positions. The people they were supposed to serve suffered the tortures of the damned. Terrified, tens of thousands of them fled to Thailand once again, just as they had in 1979.
Nothing could have seemed more discordant to the mood of the state, but Cambodia was supposed to hold national elections in July 1998, just a year after the battles between Ranariddh and Hun Sen.
Ranariddh was in exile, and Hun Sen promised to put him on trial for something close to treason if he ever dared to return. Ung Huot, an ineffectual Funcinpec placeholder, had been installed in Ranariddh’s office to carry the party forward until the elections. But how could you have an election with only one major party running for office? Funcinpec had won the last election. But it was the “royalist” party, and without Prince Ranariddh, it stood not a chance.
Sure, in Iraq, Egypt, Yemen, and countless other authoritarian states the leaders staged one-party elections. But Cambodia was different. It was just four years out from the UN occupation and the national elections. The aid groups had settled into a routine of giving the government about $500 million a year, more than half of the government’s budget. Hun Sen couldn’t risk losing all of that largesse and what little was left of the world’s goodwill.
In Washington, already, denunciations were flying fast and thick. Brad Adams, the UN official, told a receptive congressional committee, “Funcinpec, a royalist party, now has no members of the royal family in its leadership, rendering the party politically meaningless. Hun Sen has staked out a clear strategy: create the appearance of a constitutional, multi-party government and political system, such as by placing a malleable figure such as Ung Huot in the position of first prime minister, hold elections next year without any semblance of a real opposition, exercise control over all levers of government, dominate the electronic media and wait for the international community to hold its nose and declare the elections minimally free and fair.”
In the end, the Japanese brokered a deal. Japan was eager for influence in Southeast Asia to counter China’s growing clout and stepped in to help break this impasse. Ranariddh had asked his father, King Sihanouk, to pardon him. But Sihanouk refused—unless Ranariddh apologized. Sihanouk, at least, knew who had started the violence. And now father and son were not getting along too well.
Ranariddh refused to apologize, saying he was not willing to admit guilt—even though he knew he was, in fact, guilty. (In truth, though, both sides had been brewing for a fight. If Ranariddh hadn’t
started it, sooner or later Hun Sen probably would have.) That led to even more complex maneuvering.
Under the Japanese plan Hun Sen’s courts put on a show trial and convicted Ranariddh of smuggling arms and conspiring with Khmer Rouge guerrillas to launch a coup. The court sentenced Ranariddh in absentia to thirty-five years in prison and fined him $54 million for damages to businesses that resulted from the fighting—and from the looting afterward, even though it was actually done by Hun Sen’s troops. Once the verdict was in, Sihanouk pardoned his son, and Ranariddh came back in 1998. He commenced running for office again, as if nothing had ever occurred.
Tidy as this plan was, Ranariddh’s image among Cambodians was now something less than pure and clean. This time around he also had a serious competitor in Sam Rainsy. The parliament had finally enacted a political-party law, and in a bold display of his own view of himself, Rainsy was now head of the Sam Rainsy Party.