Awareness of mental illnesses growing in Cambodia

From the Phnom Penh Post in Cambodia:

The life of 53-year-old Sok Mach fell apart when her marriage failed and she lost one of her children to a preventable childhood disease.

When she began suffering incapacitating pains, she assumed she was simply delirious with grief. Unable to get her life back on track, she never suspected that she was suffering from an undiagnosed psychological disorder.

"I got headaches, I couldn't sleep and I would vomit almost every day," she recalled. "I went to see a doctor and they diagnosed me with psychasthenia. Only then did things start to get better."

Psychasthenia, a disorder characterised by phobias, obsessions, compulsions and excessive anxiety, is one of many psychological conditions, recognition of which is now emerging into the Cambodian mainstream. But for a country so accustomed to physical hardship, it is often difficult for individuals and even health institutions to recognise, let alone diagnose, internal pain. It is not only Cambodia's turbulent history that has left a legacy of mental illness; the social and economic problems people encounter today are increasingly taking their toll.

Psychologists in Phnom Penh say they are now dealing not with long-buried psychological trauma but with contemporary psychosocial problems.

"We encounter a whole range of conditions in the younger generations: depression, anxiety and stress, along with psychological problems stemming from sexual abuse, dealing with HIV/Aids or other forms of severe trauma," says Dr Ken Wilcox of the Wilcox & Associates psychology practice in Phnom Penh.

"Psychologists in Cambodia are not dealing [primarily] with postwar trauma anymore," Wilcox said.

Chea Sophal, like Sok Mach, now realises that stress-related social problems were what triggered the onset of his mental illness. The Kandal province native says that he felt he "was a crazy person" for years before he got up the courage to ask for help.

"For many years I didn't want other people around me.... I couldn't control myself," he said.

Wilcox said unwillingness to seek professional help, coupled with a complete lack of knowledge about mental illness, was a common problem.

"Among the local population, we do see many instances of psychological trauma related to family and cultural issues." he says.

"Often people do not know how to cope with the stresses they suffer, and so they internalize it. They have no outlet," Wilcox said.

Yim Sobotra, deputy head of psychiatry at the Cambodian-Russian Friendship Hospital, acknowledged that the predominance of family-related stress means that
women were most afflicted by mental illness.

"Most patients are women, twice as many as men, because women get pressure from both their families and society," he said. His hospital, which deals with up to 200 patients seeking regular consultations and medical prescriptions, receives around 20 new patients a day. But he worries that there are still many people who are unable to recognise the seriousness of their psychological problems.

"Some of them don't know they have a mental illness. They think they have been hurt by black magic or that they have done something to offend their guardian spirit."

Traditional ways of dealing with different kinds of psychological disorders are still common among the older generation of Cambodians, who are more likely to seek help from herbalists or faith healers. But Wilcox is more optimistic for the future.

"While older generations will suppress their problems or look to spiritual means to cope, the younger generations are starting to seek help when they are concerned about their psychological health," he said."We now see many 15- to 25-year-olds who see that there are options available to them."

Kang San, program coordinator of the Trans-Cultural Psychosocial Organisation (TPO), also expressed the importance of a back-to-basics approach to psychological health.

"I think we can reduce the number of instances of mental health problems among Cambodian people in the future if we can address some of the more serious issues in society right now," he said.

For Kang San, poverty alleviation and education will play an integral part. "If we can reduce the poverty of those with psychological problems, provide them with a job and educate them about their illness, I hope we can effectively treat them."